HomeMy WebLinkAboutAgenda - 08-17-1993 - VIII-F 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
Action Agenda
Item No.Y it -F.
ACTION AGENDA ITEM ABSTRACT
Meeting Date: August 17, 1993
SUBJECT: On-The-Job Training Contract
DEPARTMENT: Social Services PUBLIC HEARING YES: NO: X
ATTACHMENT(S) : INFORMATION CONTACT:
Marti Pryor-Cook, ext. 2802
Contract between Economic
Development Commission (EDC)
and Orange County DSS TELEPHONE NUMBER-
Hillsborough - 732-8181
Chapel Hill - 968-4501
Mebane - 227-2031
Durham - 688-7331
PURPOSE:
To consider a Contract with EDC for On-the-Job Training services for
participants in the DSS Job Opportunities and Basic Skills program.
BACKGROUND:
On-the-Job Training (OJT) is a subsidized employment opportunity in
which a Job Opportunities and Basic Skills (JOBS) program participant
is hired and provided skill training by an employer. OJT provides
work experience to bring job skills to a competitive level in the
marketplace. OJT also improves employability through more substantial
supervision and directions than normally available in an unsubsidized
work situation.
Employers who participate in the program must provide training
essential to work performance and compensate employees at a rate
comparable to other employees performing a similar job. Employers
will be reimbursed 1/2 of the wages paid to the employee, based on
the number of work hours and up to a maximum of 12 months. Upon
successful completion of OJT, the employer is expected to hire and
retain the JOBS participant as a regular employee.
EDC will be responsible for the overall development of the OJT
program which includes recruiting employers, conducting job
assessments, facilitating job placements, and monitoring placements,
subcontracts and participant progress at the work site.
The OJT program is funded by a grant from the State Division of
Social Services. The grant is in the amount of $32,500.
RECOMMENDATION(S) :
The manager recommends approval of the On-the-Job Training Contract
with EDC and authorization for the Chair to sign.
2
• .,;�'` V� 011■JCE COU if
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An
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42' SOCIAL. C 11`/1CJ.,,
• Y Pi..r v4V
North Carolina Department of Human Resources
Division of Social Services
325 North Salisbury Street • Raleigh, North Carolina 27603
Courier # 56-20-25
James B. Hunt,Jr., Governor July 30, 1993 Mary K. Deyampert, Director
C. Robin Britt, Sr., Secretary (919) 733-3055
Ms. Martha N. Pryor-Cook, Director
Orange County Department of Social Services
300 West Tryon Street
Hillsborough, North Carolina 27278
Dear Ms. Pryor-Cook:
Thank you for your response to the Request for Proposals for Component
Development Projects. This letter serves to confirm the approval
telephoned to you and your staff. It is apparent that a significant amount
of effort was invested in the development of this project.' Your proposal
demonstrates exemplary coordination with community agencies and reflects a
sincere interest in providing innovative activities to JOBS participants in
Orange County. You are authorized to proceed with this project with a
budget of $ 32,500.00, effective July 1993.
We remind you that Component Development funds are not exempted from
the usual Division and JOBS budgetary policies. Based on your proposal we
caution you on the following specific issues:
1) Time devoted to the project by both the Economic Development
Commission's Director and Administrative Assistant must be
i
charged to the project as indirect costs and cannot be charged as
direct staff time. A revised budget page has been attached to
reflect these changes.
2) As the Economic Development Assistant is providing direct service
to project participants, the portion of that individual's time
devoted to the project can be direct charged. However, because
the position for which you are contracting is less than full time,
that individual is required to complete time sheets documenting
time charged against the Component Development Project.
3) The length of an OJT contract is dependent upon the complexity of
the specific job and the knowledge, and skills an individual must
acquire in order to perform the specific job. As you are aware
the Component Development Project funding period ends May 31,
1994. Component Development funds cannot be carried from one year
to another. OJT sub-contracts written under the CDP must have a
start date which will enable the participant to complete the
required training by May 31, 1994, unless the county chooses to
An Equal Opportunity / Affirmative Action Employer
3
Ms. Martha N. Pryor-Cook, Director
July 30, 1993
Page 2
support the OJT with regular JOBS OJT funds at the termination of
the Project funding. Counties cannot expect continuation of their
Component Development Project based solely on OJT sub-contract
obligations.
4) If your project was developed to meet a Component Development
objective related to a specific population (e.g. unemployed
parents or teenage custodial parents) , please note that CDP funds
can only be used to provide services to this specific population.
Should you deem it appropriate to provide project
activities/services to participants not identified as your CDP
objective, the costs for those individuals must be charged to your
regular JOBS program funds.
We request your cooperation in two fiscal management areas. Please
inform us as soon as possible if you recognize that the approved budget
includes expenses that are not within the parameters of budgetary policy,
or that the approved budget is greater than you Can reasonably expect to
spend. Also, please monitor project expenditures on a monthly basis and
submit requests for reimbursement in a timely manner.
Reporting instructions are attached. . Please refer questions
concerning fiscal reporting to Nancy Brown, Assistant Chief, County
Administration Accounting Section.
The State JOBS Plan must reflect the addition of new program
activities as they become available to JOBS participants. Your county's
Method of Provision chart has been updated to indicate that new On-the-Job
Training activities will be provided through this Component Development
Project.
The intended nature of the agency/organization partnership was one of
substantive participation in the development, provision, and evaluation of
the component activity. As such, we would encourage the active and
continuous involvement of your partner(s) in each phase of your county's
project, to include the project evaluation. Final evaluations of your
Component Development Project must be submitted no later than June 30,
1994.
One purpose of the Component Development Projects is to develop
working program models suitable for replication across the state.
Employment Programs Section staff may schedule a site visit during the
project period to observe activities and discuss implementation issues and
recommendations identified by county staff. Your assistance will be
extremely valuable in our consultation with other counties regarding
program development.
4
Ms. Martha N. Pryor-Cook, Director
July 30, 1993
Page 3
Thank you for your interest in the Component Development Project and
congratulations on your selection. We wish you success in your project.
Please let us know if we can be of assistance.
Sincerely,
/Or
Lucy W. Burgess, Chief
Employment Progr-ms Section
/ , ///
, t
Alck Chappell/
Chief Fiscal w ficer
LWB/JC/pr
Attachments
cc: Melinda Hamrick
Jan Elliott
Jane Smith
Jean McCoy
5
JOBS COMPONENT DEVELOPMENT PROJECT BUDGET
COUNTY: Orange COMPONENT: OJT
TOTAL AMOUNT CONTACT PERSON: Gwendolyn Price
REQUESTED: $32,500.00
TELEPHONE #: (919) 732-8181
FOR THE PROJECT BEGINNING July 1993 AND ENDING May 31, 1994
DSS Contracted
Project Project
Budget Item Expenses Expenses
I. Direct Services
A. Itemized Component Expenses $25,000.00
Please Specify
(e.g. , tuition, books, fees, etc. )
B. Direct Staff:
(Salary and Fringes) $ 3,100.00
C. Direct Staff Support
Staff Travel: ,
Other: (Please Specify)
SUBTOTAL (I)
$28,100.00
II. Supportive Services
(Please itemize below)
Participant Transportation: 1
Other: (Please Specify)
SUBTOTAL (II)
1% EDC Dir's time $ 1,400.00
10% EDC Admin $ 3,000.00
III. Indirect Costs * Assist's time
$ 4,400.00
TOTAL PROJECT COSTS
(Add Subtotals I and II,
and item III. ) $32,500.00
* Applicable only if "Direct Staff" expenses have been requested at
Item I.B.
6 1
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Page 1 of 5
STATE OF NORTH CAROLINA
•
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACT
ID # M68178
This Contract is entered into between theiDepartment and the Provider
identified on Attachment A. This contract shall consist of form DSS-2497,
Attachment A (DSS-1292) and Budget (DSS-6844) .
The Department will purchase specific services from the Provider as set
forth in the Contract in order to make optimal use of the facilities, staff
and programs of the Provider. This Contract is subject to the provisions of
all applicable Federal regulations and State policies.
Subject to its other provisions, the terms of this contract shall be in
effect to and from the dates specified on Attachment A.
SECTION I : RESPONSIBILITIES
•
A. The Department will:
1. Determine client eligibility for service(s) in accordance with
Federal and State regulations; and
2. Inform the Provider on Form DSS-1360 concerning the eligibility
of each individual for the service, the period of time for
which services are authorized, and any changes in the individual's
eligibility status; and
3. Reimburse the Provider for service(s) purchased as described
in Attachment A of this Contract for eligible clients; and
4. Keep the Provider informed of any alterations in and/or to the
regulations governing the service program; and
5. Accept fiscal responsibility for deviations from the terms of
this Contract as a result of acts of the Department or any of
its officers, employees, agents or representatives.
B. The Provider will:
1. Provide service(s) as specified in Attachment A of this Contract
in accordance with applicable standards for the service(s); and
2. Furnish information to the Department as required to support the
full cost of service(s) provided pursuant to this Contract; and
DSS-2497 (Rev. 4-87)
Family Services
7
Page 2 of 5
3. Comply with all State licensing standards, all applicable
accrediting standards and any other standards or criteria
established by the Division of Social Services to assure quality of
services; and
4. Restrict the use or disclosure of information obtained in connection
with the administration of North Carolina's programs for the
provision of services concerning applicants for and recipients of
those services to purposes directly connected with the
administration of the service program; and
5. Comply with the terms of Section 504 of the Rehabilitation Act of
1973 and all requirements imposed by or pursuant to the regulations
of the Department of Health and Human Services issued pursuant to
that Section, which prohibit discrimination against handicapped
persons in employment and in the operation of programs and
activities receiving Federal funds; and
6. Comply with Title VI and VII of the Civil Rights Act of 1964 and all
requirements imposed by or pursuant to the regulations of the
Department of Health and Human Services issued pursuant to that
Title; and
•
•
7. Accept fiscal responsibility for deviations from the terms of this
Contract as a result of acts of the Provider or any of its officers,
employees, agents or representatives.
SECTION II: RESPONSIBILITY FOR LIABILITIES
Each party hereto agrees to be responsible for its own liabilities and that of
its officers, employees, agents, or representatives arising out of this
Contract.
SECTION III: TREATMENT OF ASSETS N/A No property or equipment will be purchased
Treatment of assets acquired under this Contract shall be subject to the
following:
A. Ownership of property purchased by the Provider under the terms of this
Contract for which reimbursement by the Department is based upon the
actual purchase cost of the property shall immediately vest with the
Department of Human Resources upon such reimbursement.
B. The North Carolina Department of Human Resources shall have no claim to
property purchased by the Provider under the terms of this Contract for
which reimbursement by the Department is based upon an approved'
depreciation schedule or use allowance.
C. The Provider shall maintain and administer in accordance with sound
business practice a program for the maintenance, repair, protection and
preservation of property purchased under the terms of this Contract to
assure its continued availability.
D. Property purchased under the terms of this Contract shall be used anly
for the performance of this Contract.
8
Page 3 of 5
SECTION IV: RECORDS AND REPORTS
A. The Provider agrees to maintain client records which date and document,
in accordance with established policy, the service delivered for the
individual, a valid authorization for service, program records, documents
and other evidence which reflect program operations.
B. The Provider agrees to furnish information to the Department, as
requested, to support provision of service(s) pursuant to this contract
and the ,full cost of the service; and submit changes, as needed or
required, in this contract, Attachment A or approved supporting
information for review and approval by the Department.
C. The Provider agrees to maintain books, records, documents and other
evidence and accounting procedures which reflect all direct and indirect
costs expended under this Contract. A current, complete inventory of all
equipment purchased under the terms of this Contract must be kept.
D. The Provider agrees to retain all books, records and other documents
relevant to this Contract for three years after final payment or until
all audits continued beyond this period are completed. Federal auditors
and any persons authorized by the Division of Social Services or the
Department shall have the right to examine any of these materials. In
the event the Provider dissolves or otherwise goes out of existence,
records produced under this Contract will be turned over to the
Department.
SECTION V: SUBCONTRACTING
The Provider shall not subcontract any of the work contemplated under this
Contract without obtaining prior written approval from the Department. Any
approved subcontract shall be subject to all conditions of this Contract. The
Provider shall be responsible for the performance of any subcontractor.
SECTION VI: MAINTENANCE OF EFFORT
The Provider certifies that the funds to be used under this Contract do not
replace or supplant, in any way, Federal, State or local funds for already
existing services.
SECTION VII: MONITORING AND EVALUATION •
A. The Provider agrees to participate in program, fiscal and administrative
monitoring or audits, making records and staff time available to federal,
State, and county staff.
B. The Provider agrees to take necessary steps for corrective action, as
negotiated within a corrective action plan, for any items found to be out
of compliance with Federal and State laws , regulations, standards and/or
terms of. this contract.
9
Page 4 of 5
SECTION VIII: AMENDING THE CONTRACT
•
This contract in whole or in any part may be 'amended at any time:
A. By the Department in the event that such amendment is necessary to comply
with applicable laws, regulations, .policies and standards; or by wutual
consent of both parties.
B. Each party to this contract will notify the other immediately in writing
if an amendment becomes necessary due to alterations in the activities
described in Attachment A or for any other reason.
SECTION IX: TERMINATION
•
A. This Contract, in whole or in any part, may be cancelled at any time:
1. By any party, with cause, upon at least 30 days notice, in writing,
and delivered by 'registered mail with return receipt requested or in
person, or
2. By the Department in the event reimbursement to the Department is
not available and/or continued at an aggregate level sufficient to
allow for the purchase of the indicated quantity of services. The
obligations of each party shall be terminated to the extent
specified in the notice of termination, immediately upon receipt of
the notice of termination from the Department, or
3. By the Department in the event that the Division of Social
Services/Department determines that the Provider is in violation of
any or all of the terms of this Contract. The obligations of each
party shall be terminated to the extent specified in the notice of
termination immediately upon receipt of the notice from the
Department, or
4. By mutual consent of all parties.
B. In the event of termination in part, all parties shall continue the
performance of this Contract to the extent not terminated.
C. If this Contract is terminated, in whole or ,in part, the Provider may be
required to deliver and transfer Title or assignment of interest to the
Division of Social Services or dispose of any property specifically
produced or acquired for the performance of such part of this Contract as
has been terminated, and the Provider shall, upon the direction of the
Division of Social Services, protect and preserve property in the
possession of the Provider in which the Division of Social Services has
an interest.
D. After receipt of a notice of termination, and except as otherwise
directed by the Department, the Provider shall cease work under the
Contract on the date, and to the extent specified, in the notice of
termination. The Department shall pay the Provider the agreed upon
amount for the delivery of services under the terms of this Contract up
to the effective date of termination. Reimbursement shall not be
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•
Page 5 of 5
•
IL
made for equipment or supplies purchased after the notice of termination
is received except as approved by the Department.
E. Waiver of any default shall not be deemed to be a waiver of any
subsequent default. Waiver or breach of any provision of the Contract
shall not be deemed to be a waiver of any other subsequent breach and
shall not be construed to be a modification of the terms of this Contract
unless stated to be such in writing, signed by an authorzied
representative of the Department and attached to the Contract.
•
SECTION X: CONCLUSION
It is expressly understood and agreed that the services provided to eligible
clients pursuant to this Contract shall consist exclusively of those services
specified in the attached program description incorporated into this Contract
as Attachment A.
•
It is further understood and agreed that the provision of services pursuant to
this Contract shall be subject to the limitations and conditions contained in
the laws, regulations , guidelines and plans cited in this Contract, and that
this Contract is subject to renegotiation or revision to meet any new or
revised rules, regulations, or policies that may be issued by the Department
of Health and Human Services, or the North Carolina Social Services
Commission, or the Department of Human Resources and that are communicated to
the Provider.
PROVIDER ' DEPARTMENT
BY:
Title: EDC Director Title: DSS Director
Date: 7/26/93 Date: 7/26/93
This Agreement has been preaudited in the manner required by the Local
Government Budget and Fiscal Control Act.
ATTEST:
County: Orange
Title: Finance Director
Signature:
Date:
11
DIVISION OF SOCIAL SERVICES 1 of 7
' PURCHASE CONTRACT BUDGET
SUMMARY Effective
Provider Fronmic_Development Conmissioh ID# M68178 Period 7/1/93 through 5/31/94
Part I - Estimated Expenditures
Total Non-Matchable I Total Matcnaol(
Program Costs Costs Costs
Object of Expenditure (1 ) I (2) (3)
A. Salaries $ 2,901 $ 2,901
B. Fringe Benefits $ 739 I $ 739
C. Staff Development-Services
D. Travel
E. Equipment Purchases-Tangible Property
F. Transportation-Recipient
G. Medical Supplies and Expense
H. Cost of Space-Non-Residential
I. Room & Board-Residential Treatment
• J. Service Payments $24,404 $24,404
K. Other $ 4,456
$ 4,456
L. Indirect Costs
M. Totals
$3 ,500 I $32,500
Part II - Computation of Unit Cost or Individual Fixed Rate
A. 1 . Total Matchable Costs $ 32.500
2. Less: Earned Income for Unit Cost Method $ -0-
3. Net Matchable Costs $ 32,500
B. 1 . Total Service Unit Capacity, or
2. Total Anticipated Utilization Capacity
C. Method of Computation or Source of Data
D. Estimated Unit Cost or individual Fixed Rate: S per
SS-0844 (2/83)
amily Services
12
2of7
Part III - Distribution of Estimated Revenue for Total Cost Reimbursement Method
(a)
A. Estimated Eligible and Matchable Costs Numb (b)
er Ratio
1 . Estimated Eligible Clients 13 100
2. Estimated Ineligible Clients
3. Total Clients 13 100
B. Eligible Costs
(1 ) Matchable (2) Less (3) Net
(4) - (51 Costs Eligible i
Costs Earned Matchable Estimated for Financial
[Part I, Line M, Income Costs of Eligibles Participation
col . (3)1 [B. (1 ) Less (2)] [A. 1 . (b)] [B. (3) x (4)1
32,500 $ -0- S 32,500 100% : S32,500 .I
..
Part IV - Additional Revenue and Fees •
A. Program Costs Amount Source of Funds
1 . Federal/State Funds $ 32.500 JOBS
2. Local Matching Share
3. Other Budgeted Funds $ -n-
4. TOTAL REVENUE
•
5-- 32,500
B. Fees (If Applicable)
1 . Administrative Fee $ -0-
2. Certification Fee
1
3. TOTAL FEES $ 0-
i
Part V - Reimbursement Projections (For Title XX Providers Only)
July-September October-June
Annual Projection Projection ,
1
A. S
Signed: ,/" dr ��/111W- 0 _3 Date:Prov1Cer/Autho iz-./lfficial
0(A(2-#(1.A._,J 7 0 -' Date: r2 A3
County rect3r/or 3esignee
OSS-6244 (2/E3)
Family Services
13
. uppurc ny tivagec �cneau �es
A. Salary Schedule
(2) (3) (4) (5) (6) (7)
Number Pay % of No. of Months Annual ' Total
of Persons Position or Title , Grade Time Employed Salary Cost
1 Development Specialist 66 10% 12 $29,014 $2,900
•
1
Total - Salaries ($2,901
'B. Fringe Benefit;
() ) (2) (3)
Total
Type Method of Computation Cost
FICA 7.65% of $2,901 $222
Retirement 4.93% of $2,901 ( $143
Health Annual Expense $3,740.64 X 10% $374
Total - Fringe Benefits $739
DSS-6844 (2/83)
14 )
4of7
ytarT ueve ,opment - service t=unas Scneaule
(1 ) (2)
Total
Item Cost
•
•
Total Staff Development - Service Funds
D. Travel Schedule
(1 ) (2) (3) - (4} (5) Daily Subsistence (8)
No. of No. of Rate per No. of (6) 1 (7) Total
I Persons Position or Title Miles/Days Mile Days. Rate I Days Cost
1
Total - Travel
E. Equipment - Tangible Property Schedule
i (1 ) (2) (3) (4)
No. of Total
Units Item Cost oar Unit Cost
•
Total Equipment - Tanniu;e Property
•
3SS-6844 (2/83)
Family Services
15
5 of 7
F. Recipient Transportation Schedule
(1 ) (2) (3)
Total
Item _ Method of Computation Cost
la. Salaries j
# of Pay % of # of Months' Annual
Persons • Position or Title Grade Time Employed Salary
lb. Fringe Benefits
Type 1 Method of Computation
•
` I
'Total Recipient Transportation
DSS-6844 (2/83)
Family Services
16
meoical supplies anu expense 6 of 7
(1 ) l (2)
Total
Item Cost
f
Total - Medical Supplies and Expense
H. Cost of Space - Non-Residential Schedule
(1 ) (2)
Total
Item 1 Cost
i
f
Total Cost of Space - Non-Residential
I. Room and Board Costs - Residential Treatment
(1 )
(2) (3)
Total
Item 1 Method of Computation Cost
1
_ I
Total Roo,;, aro 'car Costs - Resid en' , _I r°_atment_
MS-6844 (2/83)
Family Services
7 of 7 17 )
' J. Service Payment Schedule
(l) (2) (3) (4)
No. of
Units Item Cost per Unit Total
15 OJT Contracts $1,636.93 ( $24,404
Total - Service Payment !$24,404
K. Other Expense Schedule
ll ) (2)
Total
Item Cost
Total - Other Expenses
L. Indirect Cost Schedule
(1 ) (2) (3) ! (4)
Rate Rate Applied to: Amount Rate Applied to: Total
1 Director Salary a $61,043 ;$1,221
1 Adninstrative Assistance 10% $23,582 $2,358
Fringe Benefits
Director: FICA 7.65% of $1,221 93
i t 4.93% of $1,221 j 60
Health Annual $2,789.04 X 2'/ 56
Administrative Assist: FICA 7.65 % of $2,358 180
Retirersnt 4.93% of $2,358 116
Health Annual $3,715.44 X 1O% 371
Total - Indirect Cost : $4,456
DSS-6844 (2/83)
Family Services
4,4ri-/7-13
DATE F` i 7/9-5
ITEM -
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
COUNTY BOARD APPROVAL
This is to certify that on August 17, , 19 93 , the
ORANGE County Board of County Commissioners, in
official session, approved the purchase of certain services from
ECONOMIC DEVELOPMENT COMMISSION to be purchased under the terms of
(provider agency)
the Purchase Contract bearing the ID # M68178
August 17, 1993 , Ai `Atdigg 1
Date Chairman or Secretary
20
ATTACHMENT A
State of North Carolina
Division of Social Services
Contract Application Page 1 of 8
I . Contract Summary
A. This agreement is between the Orange County Department
of Social Services (heretofore and hereinafter referred to as the
"Department") and the _ Economic yeaQnment (ommissinn (Epp
(heretofore and hereinafter referred to as the "Provider") .
B. This agreement shall be in effect from 7/1/93 to 5/31/94
C. Services to be Provided:
(1) (2) (3) (4) (5)
• Number of Number of Definition
Service Persons Units of of Unit
Service Code Served Service of Service
Job
Assessment 521 13 13 1 Participant
OJT 544 13 1 13 1 Participant
Any additional services should be listed in III. -Service Program Description
D. Area to be Served: The participant must be employed at a minimum of 30 hours
per week and a maximum of 40 hours per week. The length of the training
period must be determined by utilizing the Dept. of Labor (DOL) Specific
Vocational Preparation Manual.
DSS-1292 (4/87)
Family Services
• 21
State of North Carolina
Division of Social Services
Contract Application Page 2 of fl
E. Contract Identification: •
1 . Provider
a. Name of Contract Administrator Ted Abernathy
Tel. i/: (919) 732-8181 Ext 2326
b. Name of Program Contact Person: Ted Abernathy
Tel if:
c. Program Name, Location and Mailing Address:
110 E. King St.
P.O. Box 1177, Hillsborough, NC 27278
d. Additional Service Delivery Sites: none
e. Status: Qcl Public ( ) Private, non-profit
( ) Private, for profit ( ) Individual
f. Provider Contract ID 1/: M 68178
2. County Department of Social Services
a. Name of Contract Administrator: Martha Pryor-Cook
Tel. x/:(819) 732-8181 Ext 2802
b. Name of Services Program Contact Person: Gwendolyn Price
Tel. #: (919) 732-8181 Ext 2847
c. Address of County Department of Social Services:
P. 0. Box 8181
Hillsborough, NC 27278
DSS-1292 (4/87)
Family Services
22
State of North Carolina _
Division of Social Services
Contract Application Page 3 of 8
II. Fiscal Provisions
A. Amount of Reimbursement: •
Reimbursement under the terms of this agreement will be limited to a
maximum of:
$ TOTAL = $ SSBG + $ IV-B +
$ x,1,617.13 State + $ RAP +
$ County + $20,882.87 Other (identify) : Federal
(Optional: County funds consist of $ for
(funding source)
and $ for . )
(funding source)
B. Method of Reimbursement:
1. For Purchase Contract (DSS-2497) Total and Unit Cost:
(.)0 a. Reimbursement will be made in accordance with the current budget
approved by the Department and on file with both parties. The
amount of reimbursement will be based on allowable expenditures
made in behalf of eligible clients, determined in accordance with
acceptable cost allocation methods . The Provider will report all
expenditures made under the terms of the contract.
( ) b. Reimbursement will be made at a unit cost rate of $ per
unit of reimbursement delivered to eligible clients for an
estimated number of units . The Provider will document
total expenditures made under the terms of the contract to the
Department within thirty days after the termination of this
contract, or as instructed by the Department. Reimbursement
which exceeds actual allowable cost will be adjusted to actual
allowable cost.
2. For Vendor Agreements (DSS-2252). Fixed Rate
Reimbursement will be based on:
( ) a. a standard fixed rate or
( ) b. an individual fixed rate.
c. Reimbursement will be made at a fixed rate of $ per
unit of
(define) for
an estimated number of units . Reimbursement will be
based on the actual number of units delivered whether over
or under the estimated number. If multiple components are
being purchased, additional rates and units can be identified
as follows:
DSS-1292 (4/87)
Family Services
• 23 '
State of North Carolina
Division :;f Social Services
Contract Application Page 4 of p
C. Reimbursement Reporting:
1. Expenditures
The Provider will report expenditures monthly in accordance with
policy set forth by the Controller's Office, Division of Social
Services , issued via the Fiscal Manual. Expenditures are to be
reported on the DSS Administrative Costs Report (Form DSS-1571,
Part III) . Reports are to be submitted to the Department by the fifth
working day of the month following the month in which services were
delivered. The Department will reimburse the Provider monthly,
•
usually by check, upon receipt of a completed and correctly filed
report.
2. Reporting for the Statewide Services Information System (SIS)
In addition to the Administrative Cost Report (DSS-1571, Part III) ,
the Provider will submit to the Department the Monthly Report of
Service Delivery (DSS Form 1571, Part IV) . This should be submitted
along with the Administrative Cost Report by the fifth working day of
the month following the month in which services were delivered. The
units reported in Column 12 of the 1571 Part IV are the units of
service defined in Column 5 of I . C. of this Attachment. Service
definition and reporting instructions are found in Family Services
Manual, Volume VI, Chapter IV.
D. Audit Requirements
The Provider shall be responsible for compliance with the audit
requirements of Department of Health and Human Services federal
regulation 45 CFR Part 74, Administration of Grants, or State
Administrative Procedures Manual for Federal Block Grant Funds , whichever
is applicable. These regulations stipulate that an annual audit be
performed for the fiscal year in which contract funds were received.
( ) 1. NA
Private, non-profit if amount of reimbursement received is under
$1,000; private, for profit or individual
( ) 2. (Applicable to Private, Non-Profit Providers if reimb. $1,000
or over)
An annual audit is to be performed in accordance with OMB
Circular A-110 by an "independent auditor." "Independent
auditor" means either: (a) a state government auditor from
the Department of Human Resources or the Department of
Administration, Office of the State Auditor; or (b) a certified
public accountant. Upon completion of the audit, a copy of the
audit report must be forwarded to the county department of
social services .
DSS-1292 (4/87)
Family Services
•
24
State of North Carolina
Division of Social Services
Contract Application Page 5 of 8
•
( ) 3. (Applicable to Public Hospitals, Colleges, and Universities)
The annual audit must be performed in accordance with OMB
Circular A-110. It is not necessary for the institution to
program audits performed separately from an all-inclusive
single audit which entails all revenues and expenditures of the
public agency. However, it is the responsibility of the contractor
to insure that the contract program is included in the
institution's single annual audit.
A 'copy of the audit report must be provided to the County
department of social services upon completion of the annual audit.
(X) 4. (Applicable to State or Local. Government Agencies)
An annual audit is to be performed in accordance with 0MB Circular
A-128 by an independent auditor. Upon completion of the audit, a
copy of the audit report must be forwarded to the county
department of social services.
E. Client Fees for Service
(X) 1. No fees will be charged to individuals determined to be eligible
for services by the department of social services.
( ) 2. The service(s) under contract with the Provider are services for
which a client fee may be assessed. Policy regarding the
assessment and collection of fees is contained in Family Services
Manual, Volume VI, Chapter III. If a client is to be charged a
fee, the department will inform the. Provider of the amount of the
fee to be charged and of any subsequent changes by way of the
Purchase of Service Referral and Authorization (DSS Form 1360) .
The Provider will establish a plan with the client for collecting
the fee on at least a monthly basis; and when fees are not paid
within ten days of the due date, will bill the client in writing
and send a copy of the bill to the Department. NO OTHER FEES FOR
SERVICES MAX BE CHARGED TO THE CLIENT. Client fees are to be
reported on the Monthly Report of Service Delivery (DSS Form
1571, Part IV) .
F. Management of the Funding/Matching Share Requirement
( ) 1. A cash transfer of the matching share will be made to the county
department of social services in accordance with the terms
specifed in the Donation Agreement (DSS-1319) .
DSS-1292 (4/87)
Family Services
, 25
State of North Carolina
Division of Social Services
Contract Application Page 6 of 8
•
( ) 2. The provider certifies through the contract budget attached to
this contract that the matching share is available. Further,
it is agreed that the provider will report all program costs
incurred each month relating to this contract on the DSS-1571.
However, reimbursement will be limited to the federal/state
financial participation rate.
( x) 3. The county department of social services is providing the match.
G. Provider Fees .(For Purchase Contracts Only)
( ) 1. The Provider agrees to pay the Department/Division up to $
Administrative Fee as payment- in full for the administration of the
contract. The amount of the fee is five percent of the matching
share contributed by the Provider.
•
( ) 2. The Provider agrees to pay the Department up to $ Certifica-
tion Fee as payment in full for the determination and certification
of client eligibility. The amount of the fee is five percent
of the matching share contributed by the Provider.
Monitoring and Certification Fees, when applicable, will be deducted
from the amount to be reimbursed.
•
•
P
DSS-1292 (4/87)
Family Services
26
State of North Carolina Page 7 of 8
Division of Social Services
Contract Application
•
III . Service Program Description
On-the-Job Training (OJT) is a subsidized employment opportunity
in which a Job Opportunities and Basic Skills (JOBS) Program partici-
pant is hired and provided skill training by an employer. OJT will
provide work experience to bring skills to a level that will be
competitive in the marketplace and improve employability potential
through more substantial supervision and directions than normally
available in an unsubsidized work situation.
OJT will be purchased by the Orange County Department of Social
Services from Economic Development Commission (EDC) . The EDC will be
responsible for the development of job sites, the placement of
participants, monitoring participants activities and contract
compliance. The provider, EDC, will enter into sub-contracts with
employers for OJT. The length of the participant training period must
depend on the Specific Vocational Preparation (SVP) level described by
the Department of Labor (DOL) . Employers must provide training essential
to the adequate performance of the job and compensate employees at a
rate comparable to other employees performing the same or similar job.
Upon successful completion of the training, the employer is expected
to hire and retain the participant as a regular employee. The purchaser
will pay 1/2 of the wages paid to the participant, based on the number
of actual hours worked, by the employer upon billing by EDC. This
reimbursement is to be used solely to compensate employers for
training cost.
The Development Specialist and Administrative Assistant report to
the Director. The Director will be responsible for the overall
development of the OJT program and the direct supervision of the
Development Specialist and Administration Assistance. The Director and
Development Specialist will inform the public of the OJT program and aid
in developing employer interest. The JTPA director will monitor the
subcontracts, review participant progress and request for reimbursement
from the employer. The subcontractor will submit budget invoices and
documentation of cost; including a detailed breakdown of OJT cost to EDC.
The Administration Assistant will complete the DSS 1571 Part III and Part
IV for reimbursement of expenses.
JOBS participants will be assessed by JOBS staff and referred to
OJT via a DSS-1360 (Attachment 1 ) , if determined a good candidate for
OJT. The Development Specialist will assess the JOBS client for OJT
27
•
Page 8 of 8
•
participation and provide written feedback of participant status .
If the participant is placed in an OJT slot, the provider must
forward a copy of the sub-contract. The JOBS staff will maintain,
at a minimum, monthly contacts with EDC to keep abreast of par-
ticipant progress . The JOBS Program requires monthly reporting of
hours of participation. The JOBS Time Card is due on the 5th day
of the month following the month of participation. The Development
Specialist will be responsible for obtaining the time card and
forwarding to JOBS staff. The Development Specialist will develop
job opportunities ,by con-tracting area employers, schedule participant
appointments and conduct counseling sessions.
At a minimum, the record maintained by EDC will contain:
1 ) the initial JOBS Referral Form and response;
2 ) documentation of OJT agent' s contacts with the participant
and/or sub-contacts with the employer on behalf of the recip-
ient and documentation of service provision;
3 ) invoices or bills documenting wages paid to the client by the
employer.
DSS-1292
ATTACHMENT I 28
PURCHASE OF SERVICES: REFERRAL AND AUTHORIZATION
a .
I. REFERRAL TO COUNTY DEPARTMENT OF SOCIAL SERVICES
Please determine the need and eligibility of the following individual for •
service 151
Irom provider.
Referred by Date Agency
II. CLIENT INFORMATION
A, Individual to Receive Service(s)
Address
Telephone
Bi rt'hdate
Responsible Adult (it other than above)
It). AUTHORIZATION
A. The provider (is) (is not) authorized to claim reimbursement for services provided to the individual named above.
B. Service is authorized from , 19 through , 19
C. Purchase Program I De
D. Authorization Terminated Effective , 19
IV. SERVICE INFORMATION
A. The provider is authorized to claim reimbursement in accordance with the Purchase of Service Contract for the following
services provided to the individual named above:
Service Code _ fee $ per unit: effective:
Service Code fee $ per unit:, effective:
Service Code fee $ per unit: effective:
Service Code fee s per unit: effective:
B (To be completed if Child Day Core Services ore authorized in Section IVA). As port of the Child Day Core Services outhorized in
Section IVA, supplemental needs services (ore)(are not) authorized for reimbursement at the supplemental needs payment rote.
•
V. ELIGIBILITY INFORMATION
A. Individual category of eligibility code
B. Recipient IDN
DEPARTMENT OF SOCIAL SERVICES.
SERVICE WORKER TELEPHONE:.
Signature of Authorized County Representative Date County Identifier
IN REPLY, REFER TO:, County Case Number
DSS•1360(Rev. 7/85)
Family Services
29
•JRPOSE OF FORM: This form is to be used to reter o client to the D55 for out horizaton to provide services, and for
county DS5's to transmit to providers the authorization and the data necessary to claim r•imbvrsem.M.
SECTION I: (To be completed by the referring ogency if the form is initiated by someone other than the DSS.)Specify the
requested service(s)and the ogency to be providing the service(s). Indicate the person making the referral and the agency
he represents. The agency moking the referral may be the provider agency.
SECTION II: (To be completed by the initiator of the form, whether it is the referring ogency or the county D55.) If it is
completed by the ref erring agency, the D55 should compare the information with their records for accuracy of Home,
address, and birthdote. ,
SECTION III: (To be completed by the DSS only.)Line A. Indicate whether the provider is or is not authorized,to provide
services under Title XX by circling(is)or(is not). (IF THE PROVIDER IS NOT AUTHORIZED, DO NOT COMPLETE Ill B, IV,OR V.)
Line B: Specify the time period for which service(s) is authorized. Line C: Enter the Purchase Program ID R. If the form is
initiated by the provider agency, they may enter this number to facilitate processing. Line D: Enter the date of termination
of authorizoton if client situation changes before the end of on existing period of authorization.
SECTION IV: (To be completed by the DSS only.)Item A: Enter the code for the authorized service(s)or component of the
discrete service in occordonce with the service codes reflected on the client's service plan (DSS•2515/2516). If fees ore
applicable specify the fee to be imposed for the service, the unit of service to which the fee applies, e.g., per task, per
client, per hour, etc. Enter the dote the provider is to begin imposing the fee if the form is being used to inform the provider
of o change in the amount of o fee during on established period of authorization.The effective dote line con be left blank
if the efiecr, a dote cf the fee is the some as the beainr.■ng dote of the period of authorization, Item E If Child Doy Cc•e
-- Services ore authorized in Item A of this Section, indicate whether supplemental needs services are or ore not authorized
for reimbursement of the supplemental needs payment rate by circling (ore)or (ore not)
SECTION V: (To be completed by the DSS only.) Designate the recipient category reflected on the client's service plop
(DSS•2515/2516).
•Code 001—Current Recipient of SSI—Aged
'Code 002—Current Recipient of 551—Blind
•Code 003—Current Recipient of 551—Disabled
'Code 005—Current Recipient of AFDC
•Code 007—Medicoid Only—Recipients
'Code 013—WIN Eligible
"Code 009—Income Eligible with Less than 60% of Established Income
"Code 010—Income Eligible with 60%-79% of Established Income
• "Code 011—Income Eligible with B0%-100%Of Established Income
••'Code 012—Without Regard to Income
•••Code 014—Child Welfare Services
•"Code 019—Without Regard to Income—Adjustment Services for the Blind and Visually Impaired, Adoption
Services, Foster Care Services for Adults, Foster Care Services l'eir Children
For purposes of the 50 Percent Rule:
•indicates individuals who ore in income maintenance and related status , _ •
"indicates individuals who ore in family income status
•'•ts not considered in calculating compliance
Line B: Enter the ID K of the recipient for whom this service is authorized. •
Enter the name of the DSS, the name of the service worker'completing the form and the telephone number of the service
worker.
The form is to be signed by on authorized representative of the county.DSS. Enter the dame on which the form was signed.
The County Identifier and County Cos.x lines ore optionol and may be used by the county to facilitate distribution or filing
within the ogency. if th•county opts to use the County Case N,the provider must use the number when corresponding with
the county about this particular diem.
DISTPJBUTION: Complete in duplicate. One copy for service record and one copy for provider agency.
DSS•1360(Rev. 7/85)
Family Services