CSBG - New Mexico Human Services Department

Policy and Procedures Manual
For the
Community Services Block Grant (CSBG)
Program
State of New Mexico
Human Services Department
Income Support Division
Work and Family Support Bureau
Effective 07-01-2008
Table of Contents

1.0 Introduction Page 3
1.1 Mission Statement Page 3
1.2 Fundable Activities Page 3
1.3 Definitions Page 4
2.0 Grant Formula and Forms of Payment to CONTRACTORs Page 7
2.1 Base Grant Formula Page 7
2.2 Rollover of Funds Page 8
2.3 Forms of Payment to CONTRACTORs Page 9
Quarterly Advance Letters Page 9
3.0 CONTRACTOR Eligibility to Receive CSBG Page 10
3.1 Eligible Entities Page 10
3.2 Board Composition Requirements Page 11
4.0 CONTRACTOR Dispute Resolution Page 13
4.1 Dispute Process for CONTRACTORs Page 13
5.0 Application for Funds Page 14
5.1 CONTRACTOR Requirements for the Application Page 14
5.2 HSD Responsibilities for the CSBG Application Page 16
6.0 Community Action Plan Page 17
7.0 Reporting Requirements Page 20
7.1 CONTRACTOR Insurance Reporting Requirements Page 20
7.2 ROMA and 12 National Performance Indicator Reporting Page 21
7.3 Monthly Client-Track Reports Page 22
7.4 Monthly Expenditure Reports Page 22
7.5 Budget Adjustment Requests (BARs) Page 22
7.6 Board Meeting Minutes Page 22
7.7 On-site Performance Reviews Page 23
7.8 Closeout Reports Page 24
7.9 Annual NASCSP Survey/Report Page 25
7.10 Audit Reports Page 25
8.0 Other CONTRACTOR Requirements Page 25
9.0 CONTRACTOR Fiscal Management Page 26
9.1 Procurement Page 28
10.0 Board Powers and Responsibilities Page 28
10.1 Board By-laws Page 28
10.2 Board Meetings Page 29
10.3 Board Powers and Responsibilities Page 29
10.4 Board Responsibility for the CONTRACTOR’s Community Action Plan Page 29
11.0 Audit Requirements Page 30
12.0 Subcontracting Page 31
13.0 Client Eligibility and Appeal Rights Page 32
14.0 Personnel Page 33
15.0 Advertising Page 33
16.0 Record Retention Page 34
17.0 Reduction in Funding or Termination of the Agreement Page 34
17.1 Decertification Page 36
17.2 Interim Services Page 36
18.0 Forms and Attachments Page 37
1.0 - Introduction
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The State of New Mexico’s Human Services Department (HSD) is the cognizant recipient funding
agency for Community Services Block Grant (CSBG) funds from the federal Department of Health
and Human Services (DHHS). HSD is the responsible State Agency designated to administer the
CSBG program per New Mexico State Statute.
The Secretary of HSD has designated the Work and Family Support Bureau (WFSB) in the
Income Support Division (ISD) to administer the CSBG program.
The federal Omnibus Budget Reconciliation Act of 1981 established the CSBG program. The
most recent reauthorization for the program was included in the federal “Community
Opportunities, Accountability, and Training and Educational Services Act of 1998”, also known
as the “Coats Human Services Reauthorization Act of 1998”. The State of New Mexico’s
Legislature passed Senate Bill 220 (also known as the Community Action Act) in 1983 to
designate Community Action Agencies for certain purposes and to supplement the Federal Act.
Community Action Agencies (CAAs) located throughout the state receive CSBG funds to carry
out the purposes of both the federal and the state Acts.
In order to clarify the requirements of the federal and state Acts and to encourage the efficient
use and management of these funds, WFSB is issuing policies and procedures which are
applicable to all CSBG recipient agencies and their subcontractors, if any. These policies and
procedures may be amended and updated as necessary by agreement between WFSB and the
CSBG recipient agencies.
1.1 - Mission Statement
The mission of the State of New Mexico’s Community Services Block Grant Program shall be to
work for the reduction of poverty, the revitalization of low-income communities, and the
empowerment of low-income families and individuals in rural and urban areas to become fully
self-sufficient (particularly those persons attempting to transition off of public assistance), and to
open to everyone the opportunity to live in decency and dignity. This will be done by carrying
out the policy of the State of New Mexico to reduce or eliminate poverty by assuring that, to the
maximum feasible extent, the citizens of the State have access to a range of services and
activities having a measurable and potentially major impact on the causes of poverty in the
community or those areas of the community where poverty is a particularly acute problem.
1.2 - Fundable Activities
Programs, activities and services supported with funding through the Community Services Block
Grant Program shall be intended for the benefit of persons living at 125% or below of the official
poverty line defined by the federal Office of Management and Budget (OMB) and amended on
an annual basis. New poverty guidelines will be implemented each July at the beginning of the
State Fiscal year based on the most current OMB information.
The State of New Mexico’s Community Services Block Grant Program will provide activities
designed to assist low-income participants, including the elderly poor, with the following:
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(1) to secure and retain meaningful employment;
(2) to attain an adequate education;
(3) to make better use of available income;
(4) to obtain and maintain adequate housing and a suitable living environment;
(5) to obtain emergency assistance through loans and/or grants to meet immediate and
urgent individual and family needs, including the need for health services, nutritious
food, housing and employment-related assistance;
(6) to remove obstacles and solve problems which block self-sufficiency;
(7) to achieve greater participation in the affairs of the community;
(8) to make more effective use of other programs related to the purposes of this subtitle;
(9) to provide, on an emergency basis, for the provision of such supplies and services,
nutritious food and related services as may be necessary to counteract conditions
of hunger among the poor;
(10) to coordinate and establish linkages between governmental and other social services
programs to assure the effective delivery of such services to low-income individuals;
and,
(11) to encourage the use of entities in the private sector of the community in efforts to
alleviate poverty in the community.
1.3 – Definitions
The following definitions shall be used in the administration of the CSBG program in the
state of New Mexico.
A. “Administrative Expenditures” shall refer to expenditures required to operate an
organization that provides direct services to clients. These include rent, utilities, salaries
and benefits for personnel, insurance, equipment rental, etc.
B. “ASD” shall refer to the Administrative Services Division within HSD
C. “ASD/CMB” shall refer to the Administrative Services Division, Contracts Management
Bureau within HSD.
D. “Contractor” shall refer to an eligible entity whose CSBG application has been
approved and with whom a contract has been established.
E. “Contractor’s Board” shall refer to the fifteen (15) member governing board of
directors of a community action agency or other eligible nonprofit organization that
administers the CSBG program in a particular service area. The Community Action Act,
passed and signed in 1983, determines the Community Action Board composition in the
state as follows:
(1) one-third of the members of the board shall be elected public officials currently
holding office in the geographical area to be served by the community action agency
or their representatives, except that if the number of elected officials reasonably
available and willing to serve is less than one-third of the membership of the board,
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membership on the board of appointive officials may be counted in meeting the onethird
requirement;
(2) at least one-third of the members shall be persons chosen in accordance with
democratic selection procedures adequate to assure that they are representative of the
poor in the area served; and
(3) the other members shall be officials or members of business, industry, labor,
religious, welfare, education or other major groups and interests in the community.
F. “Bureau Chief” shall refer to the Bureau Chief of the HSD/ISD Work and Family
Support Bureau (WFSB).
G. “Care and Support Expenditures” shall refer to expenditures that provide a direct
benefit to the client or to someone on the client’s behalf. These include but are not
limited to rent payments to landlords on the client’s behalf, payments to clients for
housing, food, medicine, etc. Direct services are usually limited to money or goods with
an assigned monetary value.
H. “WFSB” shall refer to the Work and Family Support Bureau within HSD/ISD.
I. “Certification of an Eligible Entity” refers to the process by which an agency becomes
eligible to receive CSBG funds in the State of New Mexico.
J. “COATS Act” shall refer to the Community Opportunities and Training Act of 1998, the
federal regulation governing the CSBG Program.
K. “Cognizant funding source” shall refer to an agency's federally recognized primary
funding source or the funding source which furnishes the most funds to that agency.
L. “Community Action Agency” (CAA) shall refer to a non-profit agency that has been
designated as an agency eligible to receive CSBG funds in New Mexico.
M. “Work and Family Support Bureau (WFSB)” shall refer to the bureau that has
oversight responsibility for the CSBG program.
N. “CSBG” shall refer to the Community Services Block Grant.
O. “DHHS” shall refer to the federal Department of Health and Human Services.
P. “Decertification” shall refer to the process by which the WFSB requests that the
Governor of the State of NM declares that an agency that was eligible to receive CSBG
funds in NM is no longer eligible to receive such funds or to be designated as such an
agency.
Q. “Director” shall refer to the Director or Deputy Director of the Income Support Division
of the Human Services Department (HSD/ISD).
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R. “Disallowed Costs” shall refer to any cost determined to be ineligible for payment or
reimbursement according to OMB Circular A-110 and A-122.
S. “Disputes” shall refer to disagreements between the WFSB and the Contractor over
interpretations in the COATS Act, the NM Community Action Act, the NM HSD
Professional Services Contract for CSBG and/or the NM CSBG Policy and Procedures
Manual.
T. “Eligible Entity” shall refer to any organization eligible to obtain funds through the
Community Services Block Grant Program as specified in the COATS Act, or the NM
Community Action Act that serves as the statutory basis for the implementation of the
Community Services Block Grant program in the State of New Mexico.
U. "Governor" shall refer to the governor of the State of New Mexico.
V. “GSB” shall refer to the General Services Bureau within HSD/ASD.
W. “HSD” shall refer to the New Mexico Human Services Department.
X. “ISD” shall refer to the Income Support Division within HSD.
Y. "Office of Community Services (OCS)" shall refer to the Division within DHHS-ACF
that funds and oversees the CSBG program.
Z. “Program Manager” shall refer to the assigned contact person for specific Programs
(LIHEAP, CSBG, TANF, etc.) under the auspices of the WFSB.
AA.
BB.
CC.
DD.
EE.
“Program Support Expenditures” shall refer to expenditures that are made to benefit a
client but are not either an administrative expenditure nor a direct service expenditure.
These could include but are not limited to the costs for seasonal personnel such as
income tax preparers, the cost of a telephone which would be available to clients for job
search, the cost of lunches for grantee volunteers, the cost of kitchen equipment and
wages for the congregate feeding program, etc.
“Reduction in Funding” shall refer to the process by which an eligible agency’s CSBG
funding will be reduced.
“ROMA” shall refer to the Results Oriented Management and Accountability tool
developed by the Office of Community Services to comply with the requirements
mandated by the Government Performance and Results Act (GPRA) of 1993.
“Secretary” shall refer to the Cabinet Secretary or Deputy Secretary of the New Mexico
Human Services Department (HSD).
“Termination of the Agreement” refers to the process by which an eligible entity’s
CSBG Agreement with HSD will be terminated.
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FF.
“12 National Indicators” shall refer to the National Indicators of Community Action
Performance reporting developed by the Office of Community Services.
2.0 - Grant Formula and Forms of payment to CONTRACTORS
2.1 - Base Grant Formula
The State of New Mexico HSD-ISD/WFSB will review the CSBG cost allocation formula
every 5 years prior to contract renewal or as soon as US Census Bureau data is available after
a full census, to ensure that it reflects the most current trends in poverty demographics for all
counties. CSBG funding received by the State of New Mexico HSD-ISD/WFSB is allocated
as follows:
90% for Eligible Entities + 5% Discretionary + 5% State Admin. = 100% of Grant
5% Discretionary - The State of New Mexico sets aside up to 5% of CSBG funds in
accordance with Sec. 675.C(b)(1)(A through H) of the COATS Act to:
“(A) providing training and technical assistance to those entities in need of such training
and assistance;
“(B) coordinating State-operated programs and services, and at the option of the State,
locally-operated programs and services targeted to low-income children and families,
with services provided by eligible entities and other organizations funded under this
subtitle, including detailing appropriate employees of State or local agencies to entities
funded under this subtitle, to ensure increased access to services provided by such
State or local agencies;
“C) supporting statewide coordination and communication among eligible entities;
“(D) analyzing the distribution of funds made available under this subtitle within the
State to determine if such funds have been targeted to the areas of greatest need.
“(E) supporting asset-building programs for low-income individuals, such as programs
supporting individual development accounts;
“(F) supporting innovative programs and activities conducted by community action
agencies or other neighborhood-based organizations to eliminate poverty, promote selfsufficiency,
and promote community revitalization;
“(G) supporting State charity tax credits as described in subsection (c); and
“(H) supporting other activities, consistent with the purposes of this subtitle.
In some cases emergency funding (due to natural or man-made disaster) may be
requested by the Contractor. Such a request shall be evaluated by the WFSB Bureau
Chief who shall make a recommendation for approval or denial and the ISD Director will
make the final decision. In no instance shall such a request exceed $10,000 per
occurrence. The grantee would be required to submit a proposal and budget for the
approval of HSD. First priority for spending will be for direct client-related costs for
persons who meet the CSBG income guidelines.
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5% Administration - The COATS Act Section 675.C(b)(2) states, “Administrative Cap.
No State may spend more than the greater of $55,000, or 5 percent, of the grant received
under section 675A or State allotment received under section 675B for administrative
expenses, including monitoring activities.” Accordingly, not more than 5% of the
Community Services Block Grant is used for HSD’s administrative costs.
90% Eligible Entity -The COATS Act Section 675C(a)(1) states, “In general-- Not less
than 90 percent of the funds made available to a State under section 675A or 675B shall
be used by the State to make grants for the purposes described in section 672 to eligible
entities. Accordingly, at least 90% is allocated to eligible entities. The funds allocated to
eligible entities are contingent upon sufficient appropriations or authorizations being
made by the DHHS. Traditionally and in accordance with our State Plan, funding has
been allocated as follows:
(1) A base grant of fifty thousand dollars ($50,000) is made to all eligible entities.
(2) HSD allocates seventy-nine thousand, five hundred dollars ($79,500) to one of the
eligible entities to provide statewide services to seasonal and migrant farm workers.
This amount may be adjusted based on current migrant population data.
(3) The balance of the ninety percent (90%) of the award is allocated by county based
upon poverty population statistics. HSD has used poverty population data based on
the 2000 Census to allocate CSBG funds to each Contractor. Other sources for such
data, which may be considered, are US Census data, University of New Mexico Data
Bank information, and the New Mexico Department of Labor’s report on Annual
Social and Economic Indicators.
(4) It has been mutually agreed upon by the State and the eligible entities that no eligible
entity will be funded at less than $50,000.
2.2 - Rollover of Funds
According to the (US Department of Health and Human Services, ACF,
Office of Community Services—Division of State Assistance) Information
Memorandum, Transmittal No. 00-2004 it states, “ The Purpose of the
Information Memorandum is to transmit FY 2005 appropriation language
which mandates the manner in which States must handle carryover funds.
P.L. 108-447 mandates, that to the extent Community Services Block grant
funds are distributed as grant funds by a State to an eligible entity as
provided under the (CSBG) Act, and have not been expended by
such entity, they shall remain with such entity for carryover into the
next fiscal year for expenditures by such entity consistent with
program purposes.”
HSD shall required all eligible entities with carryover funding to
submit a Scope of Work and a line item expenditure budget. The Scope
of Work will detail a description of program service(s), program
objective(s), measurements from Results Oriented Management
Accountability (ROMA) and the National Performance Indicators, and
expected outcomes.
(Revised effective 10/01/2005)
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2.3 - Forms of Payment to CONTRACTORS
A. Advance funding:
CSBG Contracts will begin July 1, 2008 and expire June 30, 2012. The Contracts will be
financially aligned with the state fiscal year however the CONTRACTORs’ expenditures
will be aligned with federal fiscal year. CONTRACTORs in good standing will be eligible
to receive quarterly fund advances equaling three twelfths (3/12) of the contract amount
according to the following schedule: July 1 st , October 1 st , January 1 st , and April 1 st .
Quarterly Advance Letters: A letter of request for quarterly advance funds should be
submitted according to the following schedule: (The letter should be an original, with an
original signature on the CONTRACTORs letterhead):
1st quarter (Jul. Aug. Sept.)
2nd quarter (Oct. Nov. Dec.)
3rd quarter (Jan. Feb. Mar.)
4th quarter (Apr. May Jun.)
no later than first Friday of June
no later than first Friday of September
no later than first Friday of December
no later than first Friday of March
Upon receipt of a Quarterly Advance letter of request a WFSB program manger will review
the letter to ensure that it is for the correct quarter and for the correct amount. The request is
then forwarded to the ISD Financial Specialist for processing. The Financial Specialist
will update the recoupment tracking spreadsheet and prepare a payment voucher and send it
to HSD-ASD within ten (10) days of receipt, according to the above schedule. WFSB
shall maintain spreadsheets to track monthly expenditures subtracting them from the
advanced amount.
B. Cost Reimbursement:
If WFSB determines that a CONTRACTOR is no longer eligible to receive quarterly
advance funds, a letter from the WFSB Bureau Chief to the Executive Director and Board
Chair will inform the CONTRACTOR in writing of the specific reasons for such action. If
the CONTRACTOR resolves the problems which caused the revocation of the quarterly
advance status, a letter to Reconsider Advance Status must be addressed to the WFSB
Bureau Chief by the Board Chair. The WFSB Bureau Chief will respond to this request
within 10 days of receipt and either restore advance funding to the CONTRACTOR or
explain why the request to do so has been denied and what action is required by the
CONTRACTOR to restore such funding.
WFSB reserves the right to suspend, withhold or terminate the advance agreement if:
1. Documentation of allowable expenditures in the format prescribed by HSD has not been
provided as scheduled; and/or
2. The CONTRACTOR has not provided its annual single agency audit report to HSD;
and/or
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3. The single agency audit report or HSD Monitoring Review reveals findings, material
weaknesses or audit exceptions; and/or
4. The CONTRACTOR is not complying with contract provisions, the CSBG Policy and
Procedures manual, or federal and/or state regulations and statutes; and/or
5. HSD considers the CONTRACTOR to be at risk of imminent closure, forfeiture of funds,
bankruptcy or other conditions that may make the CONTRACTOR unable to properly
expend the monies provided; and/or
6. The CONTRACTOR expenditure report consistently shows expenditures of less than
one-twelfth of the total annual allocation.
C. Cost Reimbursement Payment:
A CONTRACTOR who has been denied advance funds will be placed on a cost
reimbursement payment plan. The Monthly Expenditure Report will be processed
accordingly. The CONTRACTOR is required to file a monthly expenditure report no later
than the 15 th day of the month following the month for which reimbursement is requested
(Attachment 18.7). The final expenditure report for the contract year must be received by the
WFSB by the 10 th day after the termination of the fiscal year in which services were
delivered.
D. Disallowed costs:
If WFSB determines that any funds have been spent for disallowed costs, WFSB reserves the
right to request reimbursement or withhold funds in the amount of the disallowed costs from
future reimbursements according to state and/or federal regulations. Disallowed costs are
defined by OMB Circular A-110 and A-122.
3.0 - CONTRACTOR Eligibility to Receive CSBG funds
3.1 - Eligible Entities
A. Establishing an Eligible Entity:
The New Mexico State Legislature passed Senate Bill 220 in 1983 as the state’s
Community Action Act. The Act stipulates that the Governor is empowered to declare a
non-profit as a Community Action Agency. Currently existing Community Action
Agencies (CAAs) are designated as “Eligible Entities” under the provisions of the
Community Services Block Grant Act.
If a new eligible entity is needed to provide CSBG-related services to a service area of
the state that is unserved or under-served due to the termination or expiration of an
agreement with HSD, the following procedure will be followed:
1) ASD/CMB and/or WFSB will post a notice of Request for Proposal (RFP) for
such a non-profit to apply for CSBG eligible entity status in the major
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newspaper of the affected service area and in the Albuquerque Journal and the
Albuquerque Tribune for a period of two consecutive calendar days.
2) The RFP will describe specific requirements needed to become an eligible
entity, using both the federal CSBG regulations and the state statute.
3) Upon receipt, evaluation and rating of all such proposals by WFSB (all
procedures of which will be detailed in the RFP), WFSB will determine the
successful offeror and will give that determination to the HSD Secretary or
Deputy Secretary.
4) The HSD Secretary or Deputy Secretary will assign the service area to an
already existing CAA or will make a recommendation to the Governor of the
state that he designate the successful offeror as a new CAA, an entity eligible
to receive CSBG funds in the state of New Mexico to provide CSBG related
services to residents of the unserved or under-served area.
When the governor makes such a designation, that designation will continue until the
eligible entity is decertified by the governor according to the NM Community Action
Act. All state and federal regulations and laws will be followed as they apply to this
procedure.
B. Special Consideration:
Consideration may be given to Community Action Agencies designated as “Eligible
Entities” under the provisions of the COATS Act Section 676A.
3.2 - Board Composition Requirements
(1) The board shall consist of fifteen members. One-third of the members of the
board shall be elected public officials currently holding office in the geographical
area to be served by the community action agency or their representatives, except
that if the number of elected officials reasonably available and willing to serve is
less than one-third of the membership of the board, membership on the board of
appointive officials may be counted in meeting the one-third requirement;
(2) at least one-third of the members shall be persons chosen in accordance with
democratic selection procedures adequate to assure that they are representative of
the poor in the area served; and
(3) the other members shall be officials or members of business, industry, labor,
religious, welfare, education or other major groups and interests in the
community.
A. - Representative of Public Officials
Elected Officials or their appointed representatives shall be selected from the
CONTRACTOR’s service area. All such officials shall be afforded equitable opportunity
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to serve or be represented on the Board of Directors.
B. - Representatives of low-income persons
Representatives of low-income persons shall be chosen in accordance with democratic
selection procedures adequate to assure they represent the low-income persons in the
geographic area served by the CAA. Representatives of low-income persons may be
selected either to represent a specific area, group or neighborhood served by the CAA.
Among the selection procedures which may be used either separately or in combination,
are the following:
(1) Nominations and elections, either within the neighborhoods or within the community
as a whole.
(2) Selection at a meeting or conference of low-income persons. The date, time and
place of such a meeting or conference must be adequately publicized and
documented.
(3) Selection on a service area basis (such as a neighborhood or town) of representatives
who in turn select members for the CAA board.
(4) The CAA board may recognize a group(s) or organization(s) composed primarily of
low-income persons and representing the interests of the low-income population,
whose membership may select one or more representatives to the CAA board.
C. Representatives of Private Sector
The Private Sector representatives shall be selected in a manner to assure that the board
will benefit from broad community involvement.
D. Residency requirements
Each member of the board selected to represent a specific geographic area within the
community must reside in the area he/she represents.
E. Limitation on Board Service
No member from the private and low-income sector may serve on a CONTRACTOR’s
board for more than a combined total of ten years. No member from the private and lowincome
sector may serve for more than five consecutive years without a one-year break
in service. Public officials or their representatives serve at the pleasure of the official or
officials selecting them and can serve on the board as such only as long as the public
official is currently holding office. A representative of a public official may not serve
more than ten years even if the public official represented continues to hold office. In
such cases, the public official may choose to serve directly or name a new representative.
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4.0 - CONTRACTOR Dispute Resolution
In the event of a dispute over the interpretation of the COATS Act, the NM Community
Action Act, the NM HSD Professional Services Contract for CSBG, or the NM CSBG
Policy & Procedures Manual a CONTRACTOR may follow the dispute process as
outlined in the HSD Professional Services Contract for CSBG, Article 30, “Disputes”.
IMPORTANT! The Disputes Resolution section does not apply to reduction in funding,
termination or decertification procedures.
4.1 - Dispute Process for CONTRACTORS
A. Initial written notice of the dispute including all relevant references and proposed
provisions for relief must be provided by the CONTRACTOR within fifteen (15)
working days of the activities or incidents underlying the dispute. The Dispute Notice
must be sent at the same time to the WFSB Bureau Chief and the ISD Director.
B. The ISD Director will provide a written response to the initiating party and the WFSB
Bureau Chief within fifteen (15) working days from receipt of the Dispute Notice. If the
ISD Director or other federal and/or state agencies request supplemental information
from either the CONTRACTOR or the WFSB Bureau Chief, the ISD Director’s response
may be delayed by no more than fifteen (15) working days.
C. The WFSB Bureau Chief and the CONTRACTOR will provide all requested
supplemental information to the ISD Director immediately upon request by the ISD
Director.
D. The ISD Director will provide a written resolution of the dispute to the WFSB Bureau
Chief and the CONTRACTOR within fifteen (15) working days of the receipt of all
information.
E. Pending final determination of any disputes, the CONTRACTOR shall proceed diligently
with the performance of the contract/contract amendment.
F. The CONTRACTOR may appeal the ISD Director’s decision within fifteen (15) working
days of the date of decision by submitting the decision, any applicable record, a statement
of the CONTRACTOR position and other supporting information, in writing to the HSD
Secretary or Deputy Secretary.
G. The HSD Secretary or a designee will review the decision and issues presented and issue
a determination in writing which will conclude the administrative appeal process. The
HSD Secretary or his/her designee may require additional information from either the
CONTRACTOR or the WFSB. Such information must be provided immediately upon
that request. The Secretary will notify the CONTRACTOR of his/her decision within
thirty (30) calendar days of the date of the appeal.
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H. Either party’s failure to follow the procedure and time frames set out herein shall be
deemed a waiver of any claim the party might have had.
5.0 - Application for Funds
5.1 - CONTRACTOR Requirements for the Application for CSBG Funds
In order to receive CSBG funds, all eligible entities must submit the following:
A. CSBG Grantee Application. (Attachment 18.1) This form must be completed and
signed by the Executive Director and the Board Chair.
B. CSBG Budget Forms. (Attachment.18.2) This is a detailed line item budget form that
shows all projected costs to be charged to the CSBG grant based on a line item
description known as the Central Accounting System form.
C. Budget Justification. (Attachment 18.3) This is an explanation for each line item in
the CSBG grant budget, showing how the cost was estimated and why the
expenditure is required per ROMA guidelines. In general, this justifies the
expenditures in relationship to the goals, objectives and activities to be charged to
the grant. HSD will schedule meetings with CONTRACTOR fiscal people upon
request by the CONTRACTOR to collaboratively train and network with fiscal
employees.
D. Administrative Cost Report (IRS form 990) Attach the CONTRACTORs most
recently filed IRS form 990.
E. Community Action Plan. (Attachment 18.4) is the suggested guideline for
completing the Community Action Plan.) The Community Action Plan serves
several purposes:
1) It provides the basis for the application for funds;
2) It provides a basis for board and community monitoring and evaluation of
non-profit performance in addressing the poverty-related problems of the
community; and
3) It provides a basis for formal and informal linkages and coordination between
the entity and other public and private efforts to eliminate or alleviate poverty
and its consequences in the community, and to encourage self sufficiency.
4) It is a requirement of Statutory Assurance #11 and is signed by the HSD
Secretary.
5) It is also required by the contract, the CSBG State Plan, and the COATS Act,
Section 676 (b)(11).
F. Client eligibility criteria and application process/procedures. A description of how
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CSBG client eligibility is determined and an accompanying Application for Service
form must be submitted with the application for funds. The client eligibility criteria
should explain how “special” needs people (i.e., handicap, homebound, homeless,
transients, etc.) are served and what is required of them to qualify for services.
G. CSBG Outcome Plan Form. (Attachment 18.5)
The CSBG Outcome Plan should be based on reasonable and measurable objectives
from the community needs assessment. Such objectives must track progress with
ROMA goals and measurements and the 12 National Indicators, and shall be
included as the Scope of Work to the contract.
H. Affirmative Action Plan.
This is a copy of the CONTRACTOR’s affirmative action plan or nondiscrimination
disclaimer.
I. Organizational Chart.
This is the CONTRACTOR’s organizational chart showing positions, chain of
command and programs.
J. IRS Exemption Letter.
This is the CONTRACTOR’s letter from the IRS granting 501(c)(3) status. (If we
have a current letter on file the CONTRACTOR is not required to resubmit the letter.)
K. Board of Director's Roster.
This is the CONTRACTOR’s current board roster that documents that the
CONTRACTOR is in compliance with the provisions of the COATS Act and the NM
Community Action Act regarding the composition of the Community Action Agency's
board. Attached to the roster should be letters from elected officials accepting a
position on the board or appointing someone in their place. The letter should also
contain the length of the term of office to which the public official was elected. The
roster should show the home addresses of all board members, all dates and length of
service on the board and which segment of the board they represent.
Attached to the roster should be a description of the CONTRACTOR’s procedure for
recruiting representatives of the poor according to the federal act which states, “not
fewer than 1/3 of the members are persons chosen in accordance with democratic
selection procedures adequate to assure that these members are representative of lowincome
individuals and families in the neighborhood served.”
L. By-Laws and Articles of Incorporation.
The CONTRACTOR must submit its current by-laws and Articles of Incorporation.
(If WFSB has a current set of by-laws and/or Articles of Incorporation on file, a new
set does not have to be submitted.)
M. Board meeting schedule for the next year.
This is the projected schedule for CONTRACTOR board meetings for the contract
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year. The CONTRACTOR should provide specific dates for such meetings. WFSB
understands that the dates may be subject to change.
5.2 - HSD Responsibilities for the CSBG Application
A. Request for Application
WFSB will send out a request for an application to all eligible entities no later than 6
months prior to the contract target date. The application shall be returned within sixty
(60) days.
B. Review of Documentation
Upon receipt of the application and required documentation, WFSB will review the
CONTRACTOR application packet for completeness according to Section 5.1. If the
application packet as listed and detailed in Section 5.1 is incomplete, WFSB will
notify the CONTRACTOR and the contract may be delayed and funding held up until
the application process is complete. If the application packet is incomplete or
incorrect, WFSB will include instructions for completion in the notification to the
CONTRACTOR.
C. Contract Processing
Upon receipt of a complete and correct application packet (assuming that funds are
available), WFSB will prepare and submit to the ASD, Contracts Management
Bureau (CMB) a Sole Source and Contractual Document Request.
1. The Division/Program Manager will route the Contractual Document Request
form to ASD/CMB for the pre-approval signature process.
2. ASD/CMB will submit the Contractual Document Request form to the ASD
Budget Bureau for approval.
3. Upon receipt of budget approval, ASD/CMB will route the request form to the
Office of Secretary for approval.
Contract/Amendment Development
4. Upon approval of the Contractual Document Request form by the Secretary,
ASD/CMB will develop the draft contract based on the information provided on
the request form.
5. ASD/CMB will route the draft contract to WFSB and ISD for review and
approval.
6. ASD/CMB will route the draft contract to the Office of General Counsel (OGC)
for review and approval.
7. Upon approval by OGC, the draft contract will be finalized.
8. ASD/CMB will process four copies of the final contractual document through the
following signatories:
A. CONTRACTOR (Note: Four original copies of the “Contract” or “Contract
Amendment” will be sent to the CONTRACTOR for signature. All four
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copies must have an original signature and returned to WFSB. WFSB will
route the Contract/Contract Amendments ASD/CMB for processing.)
B. Office of General Counsel (HSD)
C. Office of the Secretary (HSD)
D. Office of the Attorney General
E. The Taxation and Revenue Department
F. The Department of Finance and Administration (DFA)
9. ASD/CMB will track and facilitate the contractual document through the
signature process.
10. After the Contract/Contract Amendment has been processed and approved, an
original copy will be mailed to the CONTRACTOR for their files.
6.0 - Community Action Plan
This plan serves several purposes: Development of such a plan is required by the assurances
signed by the governor and submitted to OCS with HSD’s State Plan. The plan should also
provide the board and executive director with the basis for monitoring the agency’s success in
their efforts in the community. The plan should outline the linkages and cooperative efforts
between the agency and other public and private organizations in the community in addressing
the goals of CSBG/ROMA.
A. Board Responsibility Pertaining to the Community Action Plan
WFSP goal in regard to the CAA board and the Community Action Plan is to ensure ongoing
involvement and participation by the board in the formulation and implementation of the
plan. Under the requirements of ROMA and the National Performance Indicators, a major
responsibility of the CAA board is to participate in the development of a two-year
community action plan that is responsive to the major needs of the low-income population in
the community served by the eligible entity, and to ensure that the plan is completed and
implemented.
In the development of its community action plan, the agency must have active and
continuous board involvement and leadership rather than board ratification of a staffprepared
document. While it is the responsibility of each CAA board to determine the
planning process best suited to its particular situation, WFSB requires that board
involvement and leadership be documented through the minutes of board and committee
meetings held for the purpose of the plan’s development.
B. Local Plan Components
1. The Identification of Major Poverty-Related Problems: (i.e., Community Needs Assessment
including food and nutrition needs) based on the following:
U.S. Census information and other valid statistical data;
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input from low-income individuals;
information from other public and private agencies and organizations; and
other sources of information regarding poverty problems.
The CONTRACTOR must develop a list of the major poverty-related problems within
the community including information such as the cause(s) of those problems; their
distribution by area(s); the total number of persons affected by the problem(s); and other
demographic information about those most affected by the problem(s).
Note:
If surveys are used to collect information, it is suggested that the surveys
be dated so that the time frame in which the survey was completed can be
determined.
2. The Identification of Current Levels of Anti-Poverty Efforts:
For each of the problems identified, the CONTRACTOR should also identify the current
level of effort within the community to resolve or alleviate the problem(s) through the
utilization of private, local, state and federal resources. Such an inventory should include the
identification of any major service gaps at the local level.
(a) The Prioritization of Problems by Magnitude and Severity: The CONTRACTOR
should establish a mechanism for the ranking of local poverty-related problems by
their magnitude (number of persons affected) and by their severity (impact upon
affected individuals).
Although it is assumed that the agency will address some of the highest priority
problems in its action program, it is also recognized that some of these problems
may not be amendable to intervention by the agency directly during the grant
period. It is, nevertheless, important that the board seek to identify and prioritize
all major poverty-related problems as a basis for long-term planning and
advocacy.
(b) The Selection of the Problems to be addressed in the CSBG Outcome Plan Form
(ROMA): When the major problems in the service area are identified, the
CONTRACTOR must determine those problems that will be the target of direct
agency intervention during the period of the plan. In determining those targets,
the CONTRACTOR must provide a justification for their selections in respect to
such factors as need, availability of agency and other resources, ability to
effectively measure results and outcomes and the impact on the individuals and
the community.
(c) The Determination of Measurable Goals: The CONTRACTOR must set goals
within a defined time frame for each of the targeted problems (ROMA). These
goals must state in precise terms what the agency proposes to accomplish through
its activities during the period of the plan.
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(d) The Selection of Strategies, Programs, and Activities: For each set of goals, the
CONTRACTOR must select a set of strategies, programs and objectives which
the agency will utilize in its efforts to meet the objectives. For each strategy,
program and activity, the CONTRACTOR should provide a justification of its
choice.
(e) The Identification of Resources: For each set of strategies, programs and
activities, the CONTRACTOR must identify the resources committed to carry out
these activities. This should include private, local, state and other federal
resources which will be mobilized and focused on a problem. Although such
resource identification need not be formulated as a specific line-item budget, the
CONTRACTOR should attempt to identify and allocate the resources applied to
the project as specifically as possible.
(f) Linkages and Coordination: The CONTRACTOR should show the ways in which
the agency will coordinate and link its activities to other anti-poverty programs in
the community in respect to the over-all activities of the agency and for each of
the specific programs included in its plan. These programs include but are not
limited to local and state welfare and TANF benefits, low-income food and
nutrition programs, local, state and federal job training programs, public housing
authorities, LIHEAP, legal services, programs for the handicapped and education
programs for the economically disadvantaged.
(g) Evaluation: The final and very important section of the plan is the evaluation
component which specifies the manner in which the CONTRACTOR’s board and
staff will evaluate its antipoverty and self-sufficiency programs. Although
ongoing monitoring should be a part of this plan, emphasis should also be on a
comprehensive evaluation of the impact of the strategies, programs, and activities
in effecting measurable changes in the poverty and dependency within the
community. The evaluation component must clearly specify board and staff
responsibilities for this function
3. Public Participation and Review by Elected Officials
The local planning process must be designed in a manner to encourage wide public
participation, including participation by representatives of organizations and agencies
serving the economically disadvantaged and especially by the poor themselves. The
CONTRACTOR must keep a record of such participation. This record shall be kept
available for review during WFSB Performance and Monitoring Evaluations.
(a) Prior to formal adoption of the plan by the Board of Directors, at least one public
meeting must be conducted specifically for the purpose of obtaining community
comment on the plan. This meeting should be advertised locally and publicly and
copies of the proposed plan should be made available in convenient locations at least
10 days prior to the date of the meeting. Public comments on the plan obtained at this
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meeting should be kept with a record of this meeting and must be available for review
by WFSB at monitoring visits.
(b) Following the public meeting and receipt of comments, the board will formally adopt
the plan, including any revisions resulting from comments received, and send the plan
with the other application requirement to WFSB for review.
7.0 - Reporting Requirements
7.1 CONTRACTOR Insurance Reporting Requirements
A. Within thirty (30) days of receiving an approved contract/contract amendment from
WFSB, the CONTRACTOR must send a certificate documenting Worker’s
Compensation coverage on applicable employees according to federal law.
B. Within thirty (30) days of receiving an approved contract/contract amendment from
WFSB, the CONTRACTOR must send HSD-ISD/WFSB documentation of blanket
Fidelity Bond coverage for the activities of the contract in an amount of at least 25% of
the total dollar amount of the total CONTRACTOR budget. The CONTRACTOR will
notify HSD in writing of any change in the CONTRACTOR bond status within thirty
(30) days of such change.
C. Within thirty (30) days of receiving an approved contract/contract amendment from
WFSB, the CONTRACTOR must send WFSB a copy of their Certificate of Insurance
documenting the following liability insurance coverage:
(1) Comprehensive general liability with personal injury, contractual and broad form
property damage liability endorsements, auto liability (if applicable) and products
liability (if applicable). Such insurance provides a minimum limit coverage of
$500,000 combined single limit.
(2) The certificate shall also state that any coverage afforded the certificate holder shall
apply as primary and not in excess to any insurance issued in the name of the
certificate holder, and shall include a thirty (30) day written notice to WFSB in the
event of cancellation or material alteration of the coverage.
(3) Comprehensive board liability insurance. If a CONTRACTOR is unable to provide
any of the above in a timely manner, written notification and explanation to WFSB
within the thirty (30) day time frame will be required.
7.2 – ROMA and 12 National Performance Indicators Reporting
A. CONTRACTOR Responsibilities for ROMA and 12 National Performance
Indicator Reporting:
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FY 2009-2012

CONTRACTORs are required to submit written reports on CSBG activities to WFSB.
Pursuant to ROMA guidelines, the initial step for such reporting is completion of a
CSBG Outcome Plan according to the CONTRACTOR’s Community Action Plan and
needs assessment, for attachment to the Contract/Amendment.
At midpoint (six months into the federal fiscal year) March/April, a Midterm ROMA and
National Performance Indicator report must be submitted by the CONTRACTOR.
At the year-end of the federal fiscal year and within ninety (90) days after September 30 th
or an extension date granted by the Department, a Final report on the CSBG Outcome
Plan must be submitted to WFSB.
B. State Responsibilities for ROMA Reporting and 12 National Performance
Indicator Reporting:
Upon receipt of the Midterm report the WFSB program manager will review the reported
information for the following:
(1) The extent to which program services/objectives are being tracked.
(2) Ensure that the program services/objectives are correctly linked to ROMA goals
and measurements and to the national performance indicators.
(3) Compare the CSBG client-track reports to the ROMA reporting to ensure
accuracy and validity.
(4) Review the CONTRACTOR’s conformance with the goals and strategies outlined
in it’s community action plan and the CSBG Outcome Plan form.
(5) If the report indicates any deficiencies, WFSB will notify the CONTRACTOR
and offer technical assistance and corrective action resources.
7.3 - Monthly Client-Track Reports:
Client-Track monthly unduplicated reports should be submitted to WFSB in conjunction
with the monthly expenditure report and not later than the 20 th of the month following the
month of the report. The report shall be forwarded to the program manager who will
review and file it. If report appears to be unusual, the program manager and/or Bureau
Chief will communicate with the CONTRACTOR for clarification and/or request
resolution to any errors.
7.4 - Monthly Expenditure Reports: (Attachment 18.7)
Monthly Expenditure Reports must be submitted no later than the 15 th day of the month
following the month in which expenses are incurred. The program manager may call the
CONTRACTOR for back-up documentation for any expenditure. It is the
CONTRACTORs’ responsibility to supply this back up documentation within ten (10)
days of receipt of such a request unless another time frame is included in the request.
After the accounting cycle is complete, a quarterly Budget/Expenditure Tracking sheet
will be mailed to the CONTRACTOR.
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FY 2009-2012

It is the CONTRACTORs’ responsibility to reconcile the budget tracking and
expenditure sheets with their records. Any discrepancies should be brought to the
attention of the assigned WFSB program manager or financial specialist upon discovery.
Upon receipt of the Monthly Expenditure Reports a WFSB program manager will review
it for adherence to line item descriptions, unusual expenditures and adequate explanation
of such. The Bureau Chief or designee will approve the Monthly Expenditure Report and
forward it to the Financial Specialist for review and budget/expenditure tracking.
7.5 - Budget Adjustment Requests (BARs):
BARs may be submitted to WFSB as needed but not more than four (4) BARs per year.
Upon receipt of a CONTRACTOR’s BAR by mail, the Bureau Chief and/or program
manager will review and implement the adjustments. If a BAR is disapproved, the
Bureau Chief and/or program manager will communicate the reason for the disapproval
to the CONTRACTOR by mail or fax. If the BAR is approved, the Financial Specialist
will apply the BAR to the CSBG budget tracking spreadsheet and retain the original copy
in the State office files. WFSB will fax or mail a copy of the approved BAR to the
CONTRACTOR for their files.
7.6 - Board Meeting Minutes:
Board meeting minutes are to be submitted to WFSB no later than 30 days after a board
meeting is held. These minutes do not have to be ratified prior to submission to WFSB
and can be can be sent via e-mail.
Upon receipt of the CONTRACTOR’s board meeting minutes, the program manager or
the Bureau chief will review them in order to keep abreast of the CONTRACTOR’s
activity. WFSB may request clarification regarding board action or comment on the
minutes. All board meeting minutes will be kept on file at the WFSB office.
7.7 - On-site Performance Reviews:
CONTRACTORs agree that the review may include but not be limited to the following:
1. Meeting with consumers, review of service records and plans, and job
descriptions and meetings with any staff directly or indirectly involved in the
provision of services. All applicable records will be made available to the WFSB
review team.
2. A written response regarding any findings or recommendations made by WFSB
as a result of the Monitoring Review is required from the CONTRACTOR within
30 days after the receipt of the letter from WFSB delineating such findings or
recommendations. The written response should be directed to the Bureau Chief
of WFSB.
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FY 2009-2012

WFSB program managers will schedule on-site performance reviews (as required by the
COATS act) at their discretion but at least every two years. This will enable WFSB to
verify accomplishments, ascertain the extent of problems which may be identified and
identify training and technical assistance needs. The monitoring tool may be revised as
needed. WFSB will advise CONTRACTORs of changes to the tool as they occur. The
monitoring tool (Attachment 18.6) will be an attachment to the manual.
Within thirty (30) days of the exit conference held at the on-site performance review,
WFSB will send a letter to the CONTRACTOR and the CONTRACTOR’s board chair
documenting all findings and recommendations, which were identified during the review.
Upon receipt of a written response from the CONTRACTOR regarding the Monitoring
Review, the program manager and/or Bureau Chief will review the response and reply to
it or file it. All written responses and notes on verbal responses will be kept on file at the
WFSB office.
The following are actions for any findings brought during an Audit and/or Monitoring
Review:
1. Based on audit or review findings, HSD will determine whether any of the costs
or expenditures incurred shall be disallowed as charges against CSBG funds. In
the event of a disallowance, HSD may seek recovery of such sums by the
appropriate means.
2. HSD may also impose additional requirements to assure that conditions which
gave rise to the disallowance have been corrected and are not likely to recur.
3. If HSD determines disallowed costs, HSD will send the CONTRACTOR a
written notice of the determination. Disallowed costs are defined by OMB
Circular A-110 and A-122. Any appeal of disallowed expenditures shall be
submitted in writing to WFSB for review pursuant to the DISPUTE Section 4.1.
7.8 - Closeout reports:
Within ninety (90) days after the end date of each federal fiscal year, each
CONTRACTOR shall submit a closeout report. The closeout report shall consist of the
following:
(1) Amount of carryover funds
(2) Final request for reimbursement/recoupment (for monthly reimbursements status
only)
Upon receipt of the closeout reports the program manager will review and evaluate each
as follows:
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FY 2009-2012

(1) Carryover funds.
This report will be forwarded to the Financial Specialist for reconciliation and
agreement. This will be the amount used in rollover of funds process explained in
Section 2.2.
(2) Actual funds received for the respective year.
This report will be forwarded to the Financial Specialist for reconciliation and
agreement. This report will be used for audit requests for information on cash
disbursements.
(3) Actual expenditures on costs incurred. The Actual expenditures/final expenditure
report on costs incurred will be forwarded to the Financial Specialist for
reconciliation and agreement.
(4) Final request for reimbursement/recoupment (for monthly reimbursements status
only) will be processed as explained above in Section 7.4.
(5) Final CSBG Outcome Report
Upon receipt of the Final CSBG Outcome Report, a program manager will
evaluate it for the above criteria and for adequate justification if a goal was not
accomplished.
7.9 - Annual NASCSP Survey/Report
CONTRACTORs must submit to WFSB a detailed evaluation known as the annual
CSBG Information System (CSBG/IS) NASCSP Survey by the designated deadline.
Upon receiving the CSBG Survey from the CONTRACTOR, the program manager and
the financial specialist will compile and report to NASCSP within their designated time
frame.
7.10 - Audit Reports:
The CONTRACTOR shall complete all requirements in Article 11, “Records and Audit”
of the Professional Services Contract between HSD and the CONTRACTOR.
After the end of the CONTRACTOR’s fiscal year, the CONTRACTOR is required to
send three (3) complete and original audit reports to WFSB. The audit report is due as
soon as the audit is completed, but no later than 6 months or in accordance with the audit
schedule of the CONTRACTOR’s cognizant funding source.
Within thirty (30) days after the audit has been completed, the CONTRACTOR shall
provide WFSB with a statement indicating the status of each of the exceptions or findings
in the audit report.
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Upon receipt of the audit report, the WFSB program manager and/or Bureau Chief will
review it for findings and questionable costs. WFSB will request and review the
CONTRACTOR’s corrective action activities in regard to the audit. The report will
remain on file at WFSB and a copy will be forwarded to HSD/OIG. HSD/OIG may
follow up on audits as outlined in Section 11.0.
8.0 - Other CONTRACTOR Requirements
A. CONTRACTOR response to request for information:
CONTRACTOR must respond to all requests for information and/or clarification
regarding the program within thirty (30) days of receipt of such a request unless another
time frame is included in the request. The CONTRACTOR shall be excused from
complying with this responsibility and the performance of any contract provisions if the
delay is a result of an act of God, war, civil disturbance, epidemic, court order, or cause
beyond its reasonable control, and such nonperformance shall not be a ground for
termination or decertification process.
If it is determined that the CONTRACTOR was not covered under one of the above
exceptions, then one or more of the following may occur: suspension of advance funding,
termination and/or decertification process may be initiated by HSD, according to state
and federal regulations.
B. CONTRACTOR attendance of Quarterly Directors’ meetings:
The executive director of the CONTRACTOR shall attend all quarterly meetings of the
CSBG Directors and actively participate with WFSB and the Community Action New
Mexico (CANM) association in identifying mutual problems and solutions related to
CSBG. It is recognized that good communication and active participation will enhance
the success of the CSBG program in New Mexico. If an executive director is unable to
attend a meeting, an appropriate representative shall attend in his/her place.
WFSB shall set quarterly meetings a year in advance in collaboration with the
CONTRACTOR executive directors and CANM association.
9.0 - CONTRACTOR Fiscal Management/Accounting and Procurement
The CONTRACTOR is required to adhere to the following standards regarding Fiscal
Management within their agency:
A. The CONTRACTOR will comply with federal requirements set forth in OMB
Circulars A-87, A-110, A-122 and A-133 as revised. WFSB requires that accounting
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FY 2009-2012

for CONTRACTORs be in accordance with generally accepted accounting principles
and consistently applied.
B. Each CONTRACTOR is required to maintain an updated Financial Procedures
Manual that documents agency procedures to meet fiscal standards as set forth in the
following requirements. This manual will set forth the procedures for the
authorization of purchases, approval of obligations, preparation of vouchers, the
signing of checks, the recording of financial data by date in books or records,
inventory control, property management, and, in general, the safeguarding of assets
and records. The completed manual (and any amendments thereto) must be approved
by the CONTRACTOR’s Board of Directors and be available for review by WFSB.
C. The CONTRACTOR will define the accounting system that will be used for the
financial administration of requested grant funds. The accounting system must be in
accordance with Generally Accepted Accounting Procedures (GAAP) and have
internal controls adequate to safeguard assets, check the accuracy of data, promote
operating efficiency and encourage compliance with WFSB policies. All
expenditures must be fully documented with invoices, statements, time sheets, or
other documentation per the CONTRACTOR’s accounting policies and procedures
or they may be deemed disallowed expenses for CSBG.
D. The CONTRACTOR will utilize checks which require at least two (2) signatures
unless the CONTRACTOR board has authorized and approved another method. If
signature stamps are used, adequate security measures and procedures must be in
place and be approved by the CONTRACTOR’s board.
E. Bank statements will be reconciled to the general ledger and checkbook monthly.
F. CONTRACTORs will establish a cost allocation plan and/or have an approved
indirect cost procedure for determining reasonableness, allowability and allocability
of costs according to terms of the contract. Where costs apply to two or more
funding sources, such costs will be prorated according to the board approved cost
allocation plan.
G. CSBG funds may be spent within approved categories. Line item expenses within a
budget category can be paid as long as there is adequate budget in the category. Line
items 4211, 4221, 4231, 4251, and 4261 all belong to category 4200 (travel and
transportation. If budget is available in 4221 but is needed 4261 where there is no
budget, a BAR is not necessary because there is available budget within the category
4200.
H. Expenditures accumulated prior to the effective date of the contract (the date the
contract or amendment is signed by DFA) cannot be paid with CSBG money.
I. Expenditures obligated during the contract period may be paid from CSBG funds
after the ending date of the contract. All such obligations must be liquidated within
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90 days after the end of the contract. Any obligations made after the ending date of
the contract cannot be paid from grant money.
J. Payment for reimbursable travel expenses shall be made according to the method
approved by the CONTRACTORs governing board but shall not exceed the legal
rates prescribed for state personnel in the New Mexico per diem and mileage
provisions in DFA Rule 95-1 which went into effect July 1, 2003. (Attachment 18.9)
K. The CONTRACTOR assures that any direct or indirect CSBG expenditures will not
be charged to any other CONTRACTOR funding source.
L. Property Management
(1) No real property may be purchased in whole or in part with CSBG funds
unless specifically approved by HSD & HHS in writing.
(2) All purchases, with a purchase price of $5000 or more, must be approved by
WFSB prior to purchase and must follow procurement guidelines. The
approval process requires three price bids on the property. Note: It is
recommended that the board of directors be involved in approving all
purchases over $5000.
(3) When property is purchased with CSBG funds and is no longer needed, the
CONTRACTOR shall request from WFSB disposition instructions or
permission to use the property in other programs consistent with CSBG
purposes. This provision applies to tangible personal property having a useful
life of more than one year and an original value of $5000 or more per unit.
(4) Inventory
a) The CONTRACTOR shall maintain an inventory listing of all property
and equipment with a unit cost of $5000 or more, purchased with or in
part with CSBG funds. This listing shall include the date of purchase,
inventory number, cost, portion of CSBG funds used to purchase the
property (if not fully paid for by CSBG funds) and the location of the
property. This listing shall be kept current at all times and will be made
available to the WFSB monitoring team for review at the time of the
program review.
b) All property with a unit cost of $5000 or more shall be labeled with the
inventory number assigned to it by the inventory listing required below.
c) An annual inventory of all property and equipment shall be taken and the
results reconciled to the inventory list.
(5) The CONTRACTOR shall establish a reasonable plan for maintenance and care
of equipment.
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9.1 - CONTRACTOR Procurement
All procurement shall be in compliance with OMB Circular-110 and the Professional
Services Contract for CSBG with HSD.
10.0 - Board Requirements and Responsibilities
10.1 - Board Bylaws Requirements
The CONTRACTOR’s board by-laws shall include procedures that will ensure the efficient
running of the organization and compliance with State and Federal regulations. The by-laws
shall be based on Robert’s Rules of Order and will include but not be limited to procedures
for board composition and conduct, quorums, recruitment and replacement of board
members.
The CONTRACTOR shall have an official policy addressing Nepotism and Sexual
Harassment for board members and employees.
10.2 - Board Meeting Requirements
Executive sessions may be held when consistent with the CONTRACTOR’s board by-laws
and board approval. The board shall keep written minutes of all meetings in accordance with
Robert’s Rules of Order. All minutes of board meetings will be sent to WFSB within thirty
(30) days of the meeting.
10.3 - Board Powers and Responsibilities
Board members of a CAA must recognize that they are the governing body of the agency to
which the CSBG award is made. The board is responsible for ensuring that funds go to
provide the services needed by the low-income persons of their area and that the funds are
spent appropriately.
The governing board of a CAA has the following powers and responsibilities:
(1) To hire, fire and evaluate the performance of the Executive Director of the CAA.
(2) To determine major personnel, organization, fiscal and program policies.
(3) To determine overall program goals and priorities for the CAA, including provisions
for evaluating programs for performance.
(4) To make final approval of all program proposals and budgets.
(5) To ensure compliance with all contract and grant requirements.
(6) To oversee the extent and the quality of the participation of the poor in the programs of
the CAA.
(7) To determine rules and procedures for the governing board.
(8) To select the officers and the executive committee, if any, of the governing board.
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(9) To hire the auditor.
(10) To review the annual audit report and ensure that any corrective action in regard to the
agency’s audit is taken.
10.4 - Board Responsibility for the CONTRACTOR’s Community Action Plan.
(Attachment 18.4)
A major responsibility of the CONTRACTOR’s board is the development of a Community
Action Plan responsive to the needs of the low-income population in the community served by
the eligible entity.
In the development of its community action plan, the agency must show active and continuous
board involvement and leadership through each step of the planning process, rather than simple
board ratification of a staff-prepared document. While it is the responsibility of each local board
to determine a planning process best suited to its particular situation, WFSB requires, at
minimum, that board involvement and leadership be documented through minutes of board and
committee meetings held for the purpose of plan development.
Board meeting minutes should document any activity where the Community Action Plan was
amended to include or change the goals, objectives, and activities of the program if not
previously included in the agency plan.
11.0 - Audit Requirements
The CONTRACTOR shall complete all requirements in Article 11, “Records and Audit”
of the Professional Service Contract between HSD and the CONTRACTOR.
A. Each CONTRACTOR shall procure the services for an annual audit which
shall cover the CONTRACTOR’s prior fiscal year in total. WFSB
recommends that the CONTRACTOR obtain a list of auditors that are willing
to work statewide to solicit audit services.
The purpose of the annual audit is to confirm that the financial statements prepared by
the non-profit agency presents a fair and accurate financial position of the
CONTRACTOR, that the CONTRACTOR is complying with applicable WFSB
requirements and with general and special contract conditions, and that appropriate
financial and administrative procedures and controls are in place, are operating
effectively, and are consistent with the CONTRACTOR’s Financial Procedures Manual.
All CONTRACTORs receiving funds in excess of $500,000, unless specifically
exempted, will have a uniform organization-wide audit yearly, as required by the Single
Audit Act Amendment of 1996 (31 USC Chapter 75; Public Law 104-156). The
CONTRACTOR shall be subject to a single agency audit annually conducted by an
auditor licensed in the state of New Mexico.
CSBG Policy and Procedures Manual 29
FY 2009-2012

Since CONTRACTORs whose funding is less than $500,000 are not covered under the
Single Agency Audit Act, they will not receive CSBG funding for an annual audit. An
independent auditor will be hired at the State level to perform an annual audit.
B. The CONTRACTOR will ensure that the auditor is selected by a competitive
bidding process and is licensed to audit in New Mexico as an independent
audit firm.
The same auditor shall not audit a non-profit agency more than 4 consecutive
years. There must be at least a 1-year break in service if an auditor has
audited a non-profit agency for four consecutive years.
C. The CONTRACTOR shall enter into a written agreement with an auditor.
The agreement shall specifically state the scope of the audit, the auditor’s
responsibility, the date by which the audit will be completed, and the fee to be
paid by the CONTRACTOR.
Auditors are to conduct a single agency audit in accordance with OMB Circular A-133 as
well as meet the following criteria:
(1) The annual audit shall cover compliance with Federal Regulations and all
financial transactions for the entire term of the CONTRACTOR’s most
recent, completed fiscal year.
(2) The auditor is required to include an examination of the eligibility criteria
and procedures in use by the CONTRACTOR.
(3) The audit shall contain a report of financial expenditures by category for
each program to facilitate ease of reconciliation by WFSB. This separate
schedule shall include CSBG expenses for Administrative, Program, and
Benefit/Services expenditures (as defined within this manual).
(4) The audit shall include a review of the CONTRACTORs’ personnel
records to ensure proper record-keeping and correct payroll deductions.
D. The CONTRACTOR shall furnish the auditor with copies of the CSBG approved
contract, budget, this procedures manual and all other applicable WFSB
requirements.
E. The CONTRACTOR will deliver three (3) complete and original audit reports to
WFSB no later than thirty (30) days after the audit is completed.
F. Within thirty (30) days after the audit has been completed, the CONTRACTOR
shall provide WFSB with a statement indicating their response to each of the
exceptions or findings in the audit report.
G. The CONTRACTOR will divide the cost of such audit among their funding
sources, as appropriate and according to their board approved cost allocation plan.
CSBG Policy and Procedures Manual 30
FY 2009-2012

H. All CONTRACTOR’s audits are subject to inspection by HSD/OIG, the State
Attorney General, the State Auditor and the cognizant federal agencies. It is the
responsibility of the CONTRACTOR to assure the safekeeping of all records and
to be able to promptly produce them upon the request of authorized State or
Federal Representatives.
12.0 - Subcontracting
The CONTRACTOR shall not subcontract (Article 10) without prior written approval of
WFSB when CSBG funds are involved. Requests should be submitted in writing and
include a copy of the proposed subcontracts. (Note: This requirement for prior approval
by WFSB is not applicable to short-term contracts for employment services with
individuals.) If approved, any subcontractor will be subject to all terms, conditions and
provisions of the CONTRACTOR’s agreement with HSD. The CONTRACTOR shall be
solely responsible for the performance of any subcontractor under such a subcontract(s).
In every case where program activities are subcontracted to another organization, the
CONTRACTOR is held responsible for the performance of the program, including proper
accounting for expenditure of funds.
13.0 - Client Eligibility and Appeal Rights
A. Client eligibility criteria documentation:
CONTRACTORs must maintain accurate records for clients receiving CSBG
assistance. As previously stated, programs, activities and services supported with
funding through the Community Services Block Grant Program shall be intended
for the benefit of persons living at 125% or below the federal guideline poverty as
referenced in the most recently published HHS poverty guide rate.
CONTRACTORs are to follow their written policies and procedures for serving
“special” needs people (i.e. handicap, homebound, homeless, transients, etc.).
B. Client appeals process:
The CONTRACTOR shall establish and maintain a system, acceptable to WFSB,
through which a client may present grievances about the operation of
services/programs. The CONTRACTOR will advise clients of the grievance
procedure. The CONTRACTOR shall supply WFSB with a copy of its grievance
procedure when requested. WFSB shall review the procedure within thirty (30)
days after receipt. Unless the CONTRACTOR is required to modify the
procedure, WFSB shall notify the CONTRACTOR of approval in writing within
that time frame.
C. Client information:
The CONTRACTOR shall furnish WFSB with individual client information at the
times, to the extent, and the manner prescribed by WFSB.
CSBG Policy and Procedures Manual 31
FY 2009-2012

D. Confidentiality:
CONTRACTORS must not disclose any confidential information, as defined in
State or Federal Law, code, rules or regulations, on clients without written
permission from the client or their representative.
E. Maintenance of client records
The CONTRACTOR shall keep the following records on all clients:
(1) Appropriate application with client signature and date in ink.
(2) Backup documentation to ensure client is eligible for services to include
but not be limited to the following:
(a.) Proof of identity--the following verification options are acceptable to
verify identification (revised effective 5/01/2006):
• Birth certificate(s)
• Social Security records
• Baptism certificate
• Social Service records
• Hospital or birth record
• Insurance Policy
• Divorce papers
• Court records
• Alien registration card
• Church records
• Immigration & Naturalization • Voter registration card
Service (INS) records
• Collateral contact letter
• US passport Indian census from doctor, religious
records
official or school official, or
• Family Bible
someone else who knows
• School or day care records the applicant
• Government records
• Applicant sworn statement
(b.) Social Security Number
(c.) Proof of household income.
(d.) Criteria used to document “special” client’s eligibility
(such as transients or homeless clients)
(3) Type of service/assistance provided.
(4) ROMA and National Performance Indicator outcome
14.0 - Personnel
A. Each CONTRACTOR shall have a comprehensive personnel policy in place,
including policies regarding sexual harassment and nepotism, and approved by the
CONTRACTOR’s board of directors.
B. WFSB reserves the right to recommend a change in the CONTRACTOR executive
director, fiscal manager or program coordinator if the person is not performing
adequately. Such a change shall be supported by adequate documentation by WFSB.
C. CONTRACTORs agree to abide by all federal and state laws, rules, regulations and
executive orders of the Governor of the State of NM, and the President of the US
CSBG Policy and Procedures Manual 32
FY 2009-2012

pertaining to equal opportunity. In accordance with all such laws, rules and
regulations, and executive orders, the CONTRACTOR agrees to ensure that no
person shall, on the grounds of race, color, national origin, sex, sexual preference,
age, handicap or religion be excluded from employment with, or otherwise be
subjected to discrimination.
D. The CONTRACTOR shall keep appropriate records of all personnel actions.
15.0 - Advertising
A. Notices, informational pamphlets, press releases, research reports and similar public
notices related to CSBG must include the following statement:
"This project is funded (in part) under an Agreement with the State of New
Mexico Human Services Department."
B. CONTRACTORs shall submit all press releases and public notifications pertaining to
CSBG program activities to WFSB.
C. The CONTRACTOR agrees to advertise their services in their service areas at least
once each quarter of the calendar year.
16.0 - Retention of Records
CONTRACTOR records are considered to be those records relating to the receipt and
expenditure of grant monies including individual client files. Records required for retention
include all accounting records and related original and supporting documents that
substantiate costs charged to CSBG. All recipients are required to maintain accounting
records, identifiable by program year or contract number. Such records shall be maintained
in accordance with the following:
A. The retention period for each year’s records starts from the end date of the
CONTRACTOR’s fiscal year. Records should be retained for three (3) years after the
final audit has been received.
B. In all cases, an overriding requirement exists to retain records until resolution of any
litigation, claim or audit that has not been fully resolved before the expiration of the
three-year period. All relevant records shall be retained until one year after such
resolution.
WFSB will maintain program records to include but not be limited to the following: an
original contract, original contract amendments, incoming and outgoing correspondence,
payment vouchers to include requests for advances and monthly expenditure reports, BARs,
CSBG Policy and Procedures Manual 33
FY 2009-2012

application package, monitoring review, board minutes, CSBG program reports, and other
miscellaneous information. According to State and Federal law, WFSB will retain files for no
less than three (3) years.
17.0 - Reduction in funding or Termination of the Agreement
All actions relating to a reduction in funding or a termination of the agreement between HSD
and the CONTRACTOR shall be governed by the COATS Act, the NM Community Action
Act and the Professional Services Contract for CSBG.
A. Notice of Reduction in Funding or Termination of the Contract
If an entity has failed to comply with the legislative and administrative eligibility
requirements, HSD will issue a Notice of Reduction in Funding or a Notice of
Termination letter to the CAA’s Executive Director and Board of Directors informing
them of the failure or deficiency to be corrected, and requiring that the CONTRACTOR
submit a Corrective Action Plan to address the failure or deficiency be corrected. HSD
will offer help and technical assistance and give the CONTRACTOR sixty (60) days to
correct the deficiency or failure. The letter will contain the specific cause(s) for this
action. These causes shall include one or more of the following:
1. Failure of the CONTRACTOR to meet the legislative requirements of the
Community Services Block Grant Act relative to provision regarding membership on
a Community Action Board;
2. Failure of the CONTRACTOR to comply with federal and state civil rights and
Affirmative Action legislation, and the need for a local anti-poverty agency to
respond to the concerns of all major segments of the low-income population within
the community;
3. Failure of the CONTRACTOR to adhere to fiscal and administrative procedures
adequate to assure responsible management of funds;
4. Failure of the CONTRACTOR to make adequate progress in meeting the goals and
objectives of its CSBG Outcome Plan;
5. Failure of the CONTRACTOR to maintain its tax-exempt status under Section 501
(c)(3) of the IRS code.
6. Failure of the CONTRACTOR to provide services to low-income persons in their
service area.
B. Corrective Action Plan
The CONTRACTOR shall develop and implement a quality improvement plan to correct
the failure or deficiency and submit that plan to HSD within 60 days of the Notice of
Reduction in Funding or Termination of the Agreement.
CSBG Policy and Procedures Manual 34
FY 2009-2012

HSD will approve the plan or specify the reasons why the proposed plan cannot be
approved within 30 days after receiving such a plan. If the plan is adequate to correct the
failure or deficiency HSD will monitor the CONTRACTOR’s progress in implementing
the plan. If the plan is not submitted or is inadequate to correct the failure or deficiency,
HSD will notify the CONTRACTOR that the reduction in funding or termination of the
agreement will proceed and will offer the CONTRACTOR an opportunity for a hearing.
The WFSB notification shall include a date beyond which no CSBG funds may be
expended by the CONTRACTOR, or alternatively, other restrictions on CSBG
expenditures as WFSB may require.
If the CONTRACTOR requests a hearing HSD will contract with a Administrative
Hearing Officer who is not an employee of HSD to chair the hearing and provide a
recommendation to the HSD Secretary or Deputy Secretary within fifteen (15) days of
the hearing. The HSD Secretary shall review the Administrative Hearing Officer's
decision and either agree with it or disagree with it. The HSD Secretary will send a letter
to the CONTRACTOR informing them of the action that will be taken by HSD according
to the hearing results. All reduction and termination procedures will be done according
to the COATS Act and the agreement.
17.1 - Decertification
If the agreement between HSD and the CAA is terminated or expired due to the above process,
HSD will request that the governor of the state revoke the agency’s designation as a CAA in the
State of New Mexico and as an agency eligible to receive CSBG funds. This request will be sent
to the Governor by the HSD Secretary or Deputy Secretary.
The Decertification will be final upon written notice to the CAA of such action by the Governor
or his designee.
17.2 - Interim Services
HSD will ensure that services are provided in an unserved or under-served area according to the
procedures outlined in Section 676A of the COATS Act.
CSBG Policy and Procedures Manual 35
FY 2009-2012

18.0 - Attachments and Forms
18.1 CSBG Grantee Application
18.2 CSBG Budget Form/Chart of Accounts
18.3 CSBG Budget Justification Form
18.4 Community Action Plan Overview
18.5 CSBG Outcome Plan form/Scope of Work (ROMA)
18.6 OCS Monitoring and Assessment Task Force/ROMA National Goals and Measures
OCS 12 National Performance Indicators
18.7 Monthly Expenditure Report
18.8 Budget Adjustment Request (BAR)
18.9 DFA Rule 95-1 Per Diem and Mileage Act
18.10 Household Definitions and Guidelines
18.11 CSBG Gross Income Guidelines
18.12 CSBG Monitoring Tool
18.1 - CSBG Grantee Application
CSBG Policy and Procedures Manual 36
FY 2009-2012

18.1 CSBG Grantee Application
CSBG Policy and Procedures Manual 37
FY 2009-2012

Work and Family Support Bureau
CSBG GRANTEE APPLICATION
State of New Mexico
Human Service Department/Income Support Division
1. Name of Applicant Organization:
__________________________________________________
2. Mailing address of Applicant Organization:
__________________________________________________
3. Organization’s Federal Tax ID #:
__________________________________________________
4. Organization’s State Tax ID#:
__________________________________________________
5. Telephone Number/ Fax Number: Tele:_________________________
Fax:_________________
6. Name of Board President:
__________________________________________________
7. Name of Executive Director:
__________________________________________________
8. Describe briefly the Outcomes your agency is dedicated to accomplish with
Federal, State, Local, and Private
funding available in your Agency:
TERMS AND CONDITIONS
It is understood and agreed by the undersigned that:
1. Funds granted as a result of this request are to be expended for the purpose set
forth herein and in accordance
with all State and Federal regulation and restrictions.
CSBG Policy and Procedures Manual 38
FY 2009-2012

2. Any proposed changes in Outcomes as approved will be submitted in writing by the
applicant, in accordance
with the CSBG Policy and Procedures Manual, and, upon notification of approval by
this State agency, shall be deemed incorporated into and become part of this
agreement.
3. The undersigned will comply with Title VI of the Civil Rights Act of 1964 and all
requirement imposed by or
pursuant to that law.
4. The undersigned will comply with the CSBG Procedures Manual and all revisions
imposed by or pursuant to that
publication.
5. The undersigned HEREBY GIVES ASSURANCE THAT he/she will immediately take any
measures necessary to effectuate this agreement once an approved contract/amendment
is in your possession.
Type name & Title of
Authorized Official:
_____________________________________________
(Board Chairperson)
Signature:
_______________
_______________________________________________________
___________
Date: _______________________________________________________
___________
Type name & Title of __________________________________________________
Authorized Official: __________
(Executive Director)
Signature: _______________________________________________________
___________
Date: _______________________________________________________
___________
(Gray area for State Office Only. Please do not enter any information in the Gray
area.)
Application packet complete:
Yes
NO
Amount to be contracted out to Agency: Federal Fiscal Year Term:
__________________
_____________________________
CFDA #: 93.569 Contract/Amendment # :
_____________________________
Date approved and contract initiated: Program Manager Initial:
____________________
_____________________________
18.2 CSBG Budget Form/Chart of Accounts
CSBG Policy and Procedures Manual 39
FY 2009-2012

(See electronic format at: http://www.hsd.state.nm.us/isd/cap.html)
18.3 CSBG Budget Justification Form
CSBG Policy and Procedures Manual 40
FY 2009-2012

(See electronic format at: http://www.hsd.state.nm.us/isd/cap.html)
18.4 Community Action Plan Overview
This plan serves several purposes:
CSBG Policy and Procedures Manual 41
FY 2009-2012

Development of such a plan is required by the assurances signed by the governor and submitted to OCS with
HSD’s State Plan.
The plan should also provide the board and executive director with the basis for monitoring
the agency’s success in their efforts in the community.
The plan should outline the linkages and cooperative efforts between the agency and other
public and private organizations in the community in addressing the goals of CSBG/ROMA.
(1) Board Responsibility pertaining to the Community Action Plan
Work and Family Support Bureau’s (WFSP) goal in regard to the CAA board and the
Community Action Plan is to ensure ongoing involvement and participation by the board in
the formulation and implementation of the plan. Under the requirements of ROMA and the
National Performance Indicators, a major responsibility of the CAA board is to participate in
the development of a two-year community action plan that is responsive to the major needs
of the low-income population in the community served by the eligible entity, and to ensure
that the plan is completed and implemented.
In the development of its community action plan, the agency must have active and
continuous board involvement and leadership rather than board ratification of a staffprepared
document. While it is the responsibility of each CAA board to determine the
planning process best suited to its particular situation, WFSB requires that board
involvement and leadership be documented through the minutes of board and committee
meetings held for the purpose of the plan’s development.
(2) Local Plan Components
a. The Identification of Major Poverty-Related Problems: (i.e., Community Needs
Assessment including food and nutrition needs) based on the following:
U.S. Census information and other valid statistical data;
input from low-income individuals;
information from other public and private agencies and organizations; and
other sources of information regarding poverty problems.
The CAA must develop a list of the major poverty-related problems within the
community including information such as the cause(s) of those problems; their
distribution by area(s); the total number of persons affected by the problem(s); and other
demographic information about those most affected by the problem(s).
Note: If surveys are used to collect information, it is suggested that the surveys be
dated so that the time frame in which the survey was completed can be determined.
b. The Identification of Current Levels of Anti-Poverty Efforts:
For each of the problems identified, the CAA should also identify the current level of
effort within the community to resolve or alleviate the problem(s) through the
CSBG Policy and Procedures Manual 42
FY 2009-2012

utilization of private, local, state and federal resources. Such an inventory should
include the identification of any major service gaps at the local level.
c. The Prioritization of Problems by Magnitude and Severity:
The CAA should establish a mechanism for the ranking of local poverty-related
problems by their magnitude (number of persons affected) and by their severity
(impact upon affected individuals). Although it is assumed that the agency will
address some of the highest priority problems in its action program, it is also
recognized that some of these problems may not be amendable to intervention by the
agency directly during the grant period. It is, nevertheless, important that the board
seek to identify and prioritize all major poverty-related problems as a basis for longterm
planning and advocacy.
d. The Selection of the Problems to be addressed in the CSBG Outcome Plan Form
(ROMA and National Performance Indicators):
When the major problems in the service area are identified, the CAA must determine
those problems that will be the target of direct agency intervention during the period
of the plan. In determining those targets, the CAA must provide a justification for
their selections in respect to such factors as need, availability of agency and other
resources, ability to effectively measure results and outcomes and the impact on the
individuals and the community.
e. The Determination of Measurable Goals:
The CAA must set goals within a defined time frame for each of the targeted
problems (ROMA). These goals must state in precise terms what the agency proposes
to accomplish through its activities during the period of the plan.
f. The Selection of Strategies, Programs, and Activities:
For each set of goals, the CAA must select a set of strategies, programs and
objectives which the agency will utilize in its efforts to meet the objectives. For each
strategy, program and activity, the CAA should provide a justification of its choice.
g. The Identification of Resources:
For each set of strategies, programs and activities, the CAA must identify the
resources committed to carry out these activities. This should include private,
local, state and other federal resources which will be mobilized and focused on a
problem. Although such resource identification need not be formulated as a
specific line-item budget, the CAA should attempt to identify and allocate the
resources applied to the project as specifically as possible.
h. Linkages and Coordination:
The CAA should show the ways in which the agency will coordinate and link its
activities to other anti-poverty programs in the community in respect to the over-all
activities of the agency and for each of the specific programs included in its plan.
CSBG Policy and Procedures Manual 43
FY 2009-2012

These programs include but are not limited to local and state welfare and TANF
benefits, low-income food and nutrition programs, local, state and federal job training
programs, public housing authorities, LIHEAP, legal services, programs for the
handicapped and education programs for the economically disadvantaged.
i. Evaluation:
The final and very important section of the plan is the evaluation component which
specifies the manner in which the CAA’s board and staff will evaluate its antipoverty
and self-sufficiency programs. Although ongoing monitoring should be a part of this
plan, emphasis should also be on a comprehensive evaluation of the impact of the
strategies, programs, and activities in effecting measurable changes in the poverty
and dependency within the community. The evaluation component must clearly
specify board and staff responsibilities for this function
(3) Public Participation and Review by Elected Officials
a. The local planning process must be designed in a manner to encourage wide public
participation, including participation by representatives of organizations and agencies
serving the economically disadvantaged and especially by the poor themselves. The
CAA must keep a record of such participation. This record shall be kept available for
review during WFSB Performance and Monitoring Evaluations.
b. Prior to formal adoption of the plan by the Board of Directors, at least one public
meeting must be conducted specifically for the purpose of obtaining community
comment on the plan. This meeting should be advertised locally and publicly and
copies of the proposed plan should be made available in convenient locations at least
10 days prior to the date of the meeting. Public comments on the plan obtained at this
meeting should be kept with a record of this meeting and must be available for review
by WFSB at monitoring visits.
c. Following the public meeting and receipt of comments, the board will formally adopt
the plan, including any revisions resulting from comments received, and send the plan
with the other application requirement to WFSB for review.
18.5 CSBG Outcome Plan form/Scope of Work (ROMA) and 12 National
Performance Indicators
CSBG Policy and Procedures Manual 44
FY 2009-2012

CSBG OUTCOME PLAN FORM
FFY 2009
1) AGENCY: _________________________________
2) FEDERAL OBJECTIVES: GOAL 1: Low-income people become more self-sufficient
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR PROGRAM SERVICE / OBJECTIVE TYPE OF UNIT # EXPECTED TO
ACHIEVE
OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE TYPE OF UNIT # EXPECTED TO
ACHIEVE
OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE TYPE OF UNIT # EXPECTED TO
ACHIEVE
OUTCOME
Scope of Work

CSBG OUTCOME PLAN FORM
FFY 2009
1) AGENCY: _________________________________________
2) FEDERAL OBJECTIVES: Goal 2: The conditions in which low-income people live are improved
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE
TYPE OF
UNIT
# EXPECTED TO
ACHIEVE OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE
TYPE OF
UNIT
# EXPECTED TO
ACHIEVE OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE
TYPE OF
UNIT
# EXPECTED TO
ACHIEVE OUTCOME
Scope of Work
CSBG Policy and Procedures Manual 46 FY 2009-2012
Revised 01-01-01

CSBG OUTCOME PLAN FORM
FFY 2009
1) AGENCY: _________________________________________
2) FEDERAL OBJECTIVES: Goal 3: Low-income people own a stake in their community
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR PROGRAM SERVICE / OBJECTIVE TYPE OF
UNIT
# EXPECTED TO
ACHIEVE OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE
TYPE OF
UNIT
# EXPECTED TO
ACHIEVE OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE
TYPE OF
UNIT
# EXPECTED TO
ACHIEVE OUTCOME
Scope of Work
CSBG Policy and Procedures Manual 47 FY 2009-2012
Revised 01-01-01

CSBG OUTCOME PLAN FORM
FFY 2009
1) AGENCY: _________________________________________
2) FEDERAL OBJECTIVES: Goal 4: Partnerships among supporters and providers of services to low-income people
are achieved.
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE
TYPE OF
UNIT
# EXPECTED TO
ACHIEVE OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE
TYPE OF
UNIT
# EXPECTED TO
ACHIEVE OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE
TYPE OF
UNIT
# EXPECTED TO
ACHIEVE OUTCOME
Scope of Work
CSBG OUTCOME PLAN FORM
FFY 2009
CSBG Policy and Procedures Manual 48 FY 2009-2012
Revised 01-01-01

1) AGENCY: __________________________________________
2) FEDERAL OBJECTIVES: Goal 6: Low-income people, especially vulnerable populations, achieve their
potential by strengthening family and other supportive systems.
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR PROGRAM SERVICE / OBJECTIVE TYPE OF UNIT # EXPECTED TO
ACHIEVE OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE TYPE OF UNIT # EXPECTED TO
ACHIEVE OUTCOME
STATEMENT OF THE PROBLEM
DIRECT MEASURE FROM NATIONAL INDICATOR
PROGRAM SERVICE / OBJECTIVE TYPE OF UNIT # EXPECTED TO
ACHIEVE OUTCOME
CSBG Policy and Procedures Manual 49 FY 2009-2012
Revised 01-01-01

18.6 OCS Monitoring and Assessment Task Force/ROMA National Goals and Measures
OCS 12 National Performance Indicators

12 National Performance Indicators
ROMA Goal 1: Low-Income People Become More Self-Sufficient
National Performance Indicator 1.1 – Employment
The number and percentage of low-income participants in community action employment initiatives who get a job
or become self-employed as measured by one or more of the following:
A. Unemployed and obtained a job.
B. Employed and obtained an increase in employment income.
C. Achieved “living wage” employment and benefits.
Additional: Employed with no increase in employment income.
National Performance Indicator 1.2 – Employment Supports
The number of low-income participants for whom barriers to initial or continuous employment are reduced or
eliminated through assistance from community action as measured by one or more of the following:
A. Obtained pre-employment skills/competencies required for employment and received training program
certificate or diploma.
B. Completed ABE/GED and received certificate or diploma.
C. Completed post-secondary education program and obtained certificate or diploma.
D. Enrolled children in “before” or “after” school programs, in order to acquire or maintain employment.
E. Obtained care for child or other dependant in order to acquire or maintain employment.
F. Obtained access to reliable transportation and/or driver’s license in order to acquire or maintain employment.
G. Obtained health care services for themselves or a family member in support of family stability needed to gain or
retain employment.
H. Obtained safe and affordable housing in support of family stability needed to gain or retain employment.
I. Obtained food assistance in support of family stability needed to gain or retain employment.
Additional: Obtained clothing, tools, licenses, and/or testing in support of employment stability.
National Performance Indicator 1.3 – Economic Asset Enhancement and Utilization
The number and percentage of low-income households that achieve an increase in financial assets and/or financial
skills as a result of community action assistance, and the aggregated amount of those assets and resources for all
participants achieving the outcome, as measured by one or more of the following:
A. Enhancement-
1. Number and percent of participants in tax preparation programs who identify any type of Federal or State tax
credit and the aggregated dollar amount of credits.
2. Number and percentage obtained court-ordered child support payments and the expected annual aggregated
dollar amount of payments.
3. Number and. percentage enrolled in telephone lifeline and or energy discounts with the assistance of the agency
and the expected aggregated dollar amount of savings.
B. Utilization-
CSBG Policy and Procedures Manual 51
FY 2009-2012
Revised 01-01-01

1. Number and percent demonstrating ability to complete and maintain a budget for over 90 days.
2. Number and percent opening an Individual Development Account (IDA) or other savings account and increased
savings, and the aggregated amount of savings.
3. Of participants in a community action asset development program (IDA and others):
a. Number and percent capitalizing a small business due to accumulated savings.
b. Number and percent pursuing post-secondary education due to savings.
c. Number and percent purchasing a home due to accumulated savings.
ROMA Goal 2: The Conditions in Which Low-Income People Live are Improved
National Performance Indicator 2.1 Community Improvement and Revitalization
Increase in, or preservation of opportunities and community resources or services for low-income people in the
community as a result of community action projects/ initiatives or advocacy with other public and private agencies, as
measured by one or more of the following:
Number of
Projects/Initiatives
Number of
Opportunities
A. Accessible “living wage” jobs created or retained in the community. _____________ ____________
B. Safe and affordable housing units created in the community. _____________ ____________
C. Safe and affordable housing units in the community preserved or
improved through construction, weatherization or rehabilitation
achieved by community action activity or advocacy. _____________ ____________
D. Accessible and affordable health care services/facilities for lowincome
people created or maintained. _____________ ____________
E. Accessible safe and affordable childcare or child development
placement opportunities for low-income families created or maintained. _____________ ____________
F. Accessible “before” school and “after” school program placement
for low-income families created or saved from reduction or elimination. _____________ ____________
G. Accessible new or expanded transportation resources, or those
that are saved from reduction or elimination, that are available to
low-income people, including public or private transportation. _____________ ____________
H. Accessible or increased educational and training placement
opportunities, or those that are saved from reduction or elimination,
that are available for low-income people in the community, including
vocational, literacy, and life skill training, ABE/GED, and postsecondary
education. _____________ _____________
Additional: Accessible safe and affordable ADULT day care
placement opportunities created or maintained. _____________ _____________
National Performance Indicator 2.2 -- Community Quality of Life and Assets
The quality of life and assets in low-income neighborhoods are improved by community action initiative or advocacy,
as measured by one or more of the following:
CSBG Policy and Procedures Manual 52
FY 2009-2012
Revised 01-01-01
# of Program # of Community

Initiatives or Assets, Services,
Advocacy or Facilities
Efforts: Preserved or Increased:
A. Increases in community assets as a result of a change in law,
regulation or policy, which results in improvements in quality
of life and assets; _________ __________
B. Increase in the availability or preservation of community
facilities; _________ __________
C. Increase in the availability or preservation of community
services to improve public health and safety; _________ __________
D. Increase in the availability or preservation of commercial
services within low-income neighborhoods; _________ __________
E. Increase in or preservation of neighborhood quality-oflife
resources; _________ __________
Additional: Increase in the availability of food and nutrition and
Preparation information. _________ __________
Goal 3: Low-Income People Own a Stake in Their Community
National Performance Indicator 3.1 – Civic Investment
The number of volunteer hours donated to Community Action.
National Performance Indicator 3.2 – Community Empowerment through Maximum Feasible Participation
The number of low-income people mobilized as a direct result of community action initiative to
engage in activities that support and promote their own well-being and that of their community as measured by
one or more of the following:
A. Number of low-income people participating in formal community organizations, government, boards or
councils that provide input to decision-making and policy setting through community action efforts.
B. Number of low-income people acquiring businesses in their community as a result of community action
assistance.
C. Number of low-income people purchasing their own homes in their community as a result of community
action assistance.
D. Number of low-income people engaged in non-governance community activities or groups created or
supported by community action.
Additional: Number of low-income minority families purchasing their own homes in their community as a
result of community action assistance.
Goal 4: Partnerships Among Supporters and Providers of Service to Low-Income
People are Achieved
CSBG Policy and Procedures Manual 53
FY 2009-2012
Revised 01-01-01

National Performance Indicator 4.1 – Expanding Opportunities through Community-Wide Partnerships
The number of organizations, both public and private, community action actively works with to expand resources and
opportunities in order to achieve family and community outcomes.
Goal 5: Agencies Increase Their Capacity to Achieve Results
National Performance Indicator 5.1 – Broadening the Resource Base
The number of dollars mobilized by community action, including amounts and percentages from:
A. Community Services Block Grant (CSBG)
B. Non-CSBG Federal Programs
C. State Programs
D. Local Public Funding
E. Private Sources (including foundations, and individual contributors, goods and services donated)
F. Value (at Federal minimum wage) of Volunteer Time
Goal 6: Low-Income People, Especially Vulnerable Populations, Achieve Their
Potential by Strengthening Family and Other Supportive Systems
National Performance Indicator 6.1 – Independent Living
The number of vulnerable individuals receiving services from community action that maintain an independent
living situation as a result of those services:
A. Seniors Citizens
B. Individuals with Disabilities
National Performance Indicator 6.2 – Emergency Assistance
The number of low-income individuals or families served by community action that sought emergency assistance
and the percentage of those households for which assistance was provided, including such services as:
A. Food
B. Emergency Vendor Payments, including Fuel and Energy Bills and Rent/Mortgage Payments
C. Temporary Shelter
D. Emergency Medical Care
E. Protection from Violence
F. Legal Assistance
G. Transportation
H. Disaster Relief
I. Clothing
Additional: Emergency School Supply Program
CSBG Policy and Procedures Manual 54
FY 2009-2012
Revised 01-01-01

National Performance Indicator 6.3 – Child and Family Development
The number and percentage of all infants, children, youth, parents, and other adults participating in
developmental or enrichment programs that achieve program goals, as measured by one or more of the
following:
A. Infants and Children
1. Infants and children obtain age appropriate immunizations, medical and dental care.
2. Infant and child health and physical development are improved as a result of adequate nutrition.
3. Children participate in pre-school activities to develop school readiness skills
4. Children who participate in pre-school activities are developmentally ready to enter Kindergarten or 1 st
Grade.
B. Youth
1. Youth improve physical health and development.
2. Youth improve social/emotional development.
3. Youth avoid risk-taking behavior for a defined period of time.
4. Youth have reduced involvement with criminal justice system.
5. Youth increase academic athletic or social skill for school success by participating in before or after
school programs.
C. Adults
1. Parents and other adults learn and exhibit improved parenting skills
2. Parents and other adults learn and exhibit improved family functioning skills.
Additional Family Maintenance:
1. Parents and other adults obtain access to reliable transportation services in order obtain and/or maintain
educational and/or training related services for employment opportunities.
2. Parents and other adults obtain and/or maintain educational and/or training related services for
employment opportunities.
3. Parents and other adults obtain access to reliable child and/or dependent care services in order to obtain
and/or maintain educational and/or training related services.
4. Households obtain access to on-going food and nutrition assistance in order to work toward achievement
of potential.
5. Individuals obtain access to health and safety related assistance in order to work toward achievement of
their potential.
18.7 HSD Monthly Expenditure Report
Agency Name:
Month/Year
_____________________
_
CSBG Policy and Procedures Manual 55
FY 2009-2012
Revised 01-01-01

Line
Item Line Item Description SFY 09 BUDGET
520300 CLASSIFIED PERMANENT POSITIONS - FT
520400 CLASSIFIED PERMANENT POSITIONS - PT
520500 TEMPORARY POSITIONS - FT& PT
PERSONNEL SERVICES TOTAL
521100 GROUP INSURANCE PREMIUM
521200 RETIREMENT CONTRIBUTIONS
521300 F.I.C.A.
521400 WORKER'S COMPENSATION
521500 UNEMPLOYMENT COMPENSATION PREMIUM
521600 EMPLOYEE LIABILITY INSURANCE PREMIUM
521900 OTHER EMPLOYEE BENEFITS
EMPLOYEE BENEFITS TOTAL
535200 PROFESSIONAL SERVICES
535300 OTHER SERVICES
535400 AUDIT SERVICES
535600 INFORMATION TECHNOLOGY SERVICES
CONTRACTUAL SERVICES TOTAL
542100 EMPLOYEE IN-STATE MILEAGE & FARES
542200 EMPLOYEE IN-STATE MEALS & LODGING
542300 BOARD & COMMISSION MEMBER IN-STATE TRAVEL
542500 TRANSPORTATION - FUEL & OIL
542600
TRANSPORTATION - NON-TAXABLE - PARTS & SUPPLIES,
TAXABLE - MAINTENANCE & REPAIR SERVICES
$
-
$
-
$
-
Current
Expenditure Expenditures YTD B
$
-
$
-
$
-
$
$
- $ -
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
$
- $ -
-
$
-
$
-
$
-
$
-
$
$
- $ -
-
$
-
$
-
$
-
$
-
$
-
CSBG Policy and Procedures Manual 56
FY 2009-2012
Revised 01-01-01

542700 TRANSPORTATION - TRANSPORTATION INSURANCE
542900 OTHER TRAVEL
TRAVEL AND TRANSPORTATION TOTAL
543100 MAINTENANCE - GROUND & ROADWAYS
543200 MAINTENANCE - FURNITURE FIXTURES & EQUIPMENT
543300 MAINTENANCE - BUILDING & STRUCTURES
543400 MAINTENANCE - PROPERTY INSURANCE
543500 MAINTENANCE - MAINTENANCE SUPPLIES
543700 MAINTENANCE - MAINTENANCE SERVICES
543800 INFORMATION TECHNOLOGY MAINTENANCE
543900 OTHER MAINTENANCE
544000
MAINTENANCE & REPAIRS TOTAL
SUPPLIES - INVENTORY EXEMPT INFORMATION
TECHNOLOGY
544100 SUPPLIES - OFFICE SUPPLIES
544400 SUPPLIES - FIELD SUPPLIES
544800 SUPPLIES - EDUCATION & RECREATIONAL SUPPLIES
544900 SUPPLIES - INVENTORY EXEMPT
SUPPLIES TOTAL
545600 REPORTING & RECORDS
545900 PRINTING & PHOTOGRAPHIC SERVICE
546100 POSTAGE & MAIL SERVICE
546200 BOND PREMIUMS
546300 UTILITIES
546400 RENT OF LAND OR BUILDINGS
546500 RENT OF EQUIPMENT
546600 COMMUNICATIONS
546700 SUBSCRIPTIONS & DUES
546800 EMPLOYEE TRAINING & EDUCATION
546900 ADVERTISING
$
-
$
-
$
-
$
- $ -
$
- $ -
$
- $ -
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-

CONTRACTUAL SVCS TOTAL
547300 CARE & SUPPORT
547900 MISCELLANEOUS EXPENSE
OTHER OPERATING COST TOTAL
548200 FURNITURE & FIXTURES
548300 INFORMATION TECHNOLOGY EQUIPMENT
548400 OTHER EQUIPMENT
548800 AUTOMOTIVE AND AIRCRAFT
CAPITAL OUTLAY TOTAL
549600 EMPLOYEE OUT OF STATE MILEAGE & FARES
549700 EMPLOYEE OUT OF STATE MEALS & LODGING
549800 BOARD MEMBER - OUT-OF-STATE MILEAGE & FARES
549900 BOARD MEMBER - OUT-OF-STATE MEALS & LODGING
OUT OF STATE TOTAL
555100 OTHER FINANCING USES (15% Adm. Indirect Cost)
OTHER FINANCING USES TOTAL
$
-
$
-
$
-
$
-
$
-
$
- $ -
$
- $ -
$
- $ -
$
- $ -
$
- $ -
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
$
-
GRAND TOTAL
CERTIFICATION
$
-
$
- $ -
I/we _________________________ hereby certify that as of the date set forth below, the amounts included on this
Expenditure and Balance Report are complete and accurate.
$
-
Contractor's Signature Date
HSD Approval Date
CSBG Policy and Procedures Manual 58 FY 2009-2012
Revised 01-01-01

CSBG Policy and Procedures Manual 59 FY 2009-2012
Revised 01-01-01

18.8 Budget Adjustment Request (BAR)
Updated October 1, 2005
Updated May 13, 2005
Revised September 18, 2002
Updated January 16, 2003

NEW MEXICO HUMAN SERVICE DEPARTMENT
INCOME SUPPORT DIVISION
WORK AND FAMILY SUPPORT BUREAU
BUDGET ADJUSTMENT REQUEST
Request No. Organization Name Date of Request
Enter No. Enter Name Enter Date
ORG
CODE
LINE
ITEM
Amount
INCREASE
Amount
DECREASE
ORG
CODE
LINE ITEM
Amount
INCREASE
Amount
DECREASE
520300 543500
521100 543700
521200 544000
521300 544100
521400 544400
521500 544900
521600 545900
521900 546100
535200 546200
535300 546300
535400 546400
535600 546500
542100 546600
542200 546800
542300 546900
542500 547300
542600 547900
542700 549600
542900 549700
543200 549800
543300 549900
543400 555100
TOTAL
S $ - $ - TOTALS $ - $ -
GRAND TOTAL $ - $ -
REVENUE CODES
Amount
INCREASE
Amount
DECREASE
REVENUE CODES
Amount
INCREASE
Amount
DECREASE
TOTAL $ - $ - TOTALS $ - $ -
2

S
GRAND TOTAL $ - $ -
Justification (Use page 2)
I certify that the above is required
for efficient program operations
Check one:
____ APPROVED
____ DISAPPROVED
Authorized
Signature
Title
DEPARTMENT OF HUMAN SERVICES ONLY
Date
Authorized
Signature Title Date
3

18.9 DFA Rule 95-1 Per Diem and Mileage Act
http://www.nmcpr.state.nm.us/NMAC/cgibin/hse/homepagesearchengine.exe?url=http://www.nmcpr.state.nm.us/nmac/parts/title02/
02.042.0002.htm;geturl;terms=travel||diem||and||per
4

18.10 Household Definitions and Guidelines
CSBG Household Definitions and Guidelines
Head of Household:
The person who signs the application (must be 18 years or older, or an emancipated youth).
Adult: Must be 18 years of age or older or an emancipated youth.
Child: Under the age of 18 or
18 years of age still attending high school and must reside in the home with his/her parent(s) (does
not have any minor child(ren) of its own).
Household Characteristics:
Single Parent-Female:
Female: 18 years of age or older or an emancipated youth with minor child(ren).
(Parent and child(ren) must reside in the home).
Single Parent-Male:
Male: 18 years of age or older or an emancipated youth with minor child(ren).
(Parent and child(ren) must reside in the home).
Two Parent Household:
Two adults: 18 years of age or older or an emancipated youth) with minor child(ren) residing in the home.
(This includes guardians, step-parents, partners, and same sex partners).
Single Person:
An adult with no minor child(ren) residing in the home.
Two Adults:
Two adults with no minor child(ren) residing in the home.
Other:
Household not meeting the above categories.
18.11 CSBG Gross Income Guidelines
5

CSBG GROSS INCOME GUIDELINE
Effective July 1, 2008
FAMILY MONTHLY ANNUAL
SIZE MAXIMUM MAXIMUM
1
2
3
4
5
6
7
8
For each
additiona
l
person
add:
$
1,083 $ 13,000
$
1,458 $ 17,500
$
1,833 $ 22,000
$
2,208 $ 26,500
$
2,583 $ 31,000
$
2,958 $ 35,500
$
3,333 $ 40,000
$
3,708 $ 44,500
$
375 $ 4,500
Note: Based on 125% of the 2008 HHS Poverty Guidelines
Please update Client-Track with the following information:
1. Go to Master Maintenance
2. Go to Edit Income Guidelines
3. Enter on Poverty level at 100%: 10400.00
4. Enter on For Each Addition Member Add: 3600.00
6

18.12 CSBG Monitoring Tool
NM HUMAN SERVICES DEPARTMENT/ INCOME SUPPORT
DIVISION
WORK AND FAMILY SUPPORT BUREAU
COMMUNITY SERVICES BLOCK GRANT (CSBG)
MONITORING AND ASSESSMENT REPORT
AGENCY:
DESIGNATED SERVICE AREA:
MONITORING DATE:
LAST REVIEW DATE:
REVIEW TEAM:
EXECUTIVE DIRECTOR:
BOARD CHAIRPERSON:
CAA FISCAL OFFICER:
BOARD MEMBERS ATTENDING
EXIT CONFERENCE:
_______________________________________________________
_______________________________________________________
EXECUTIVE DIRECTOR’S
SIGNATURE:
LEAD REVIEWER’S
SIGNATURE:
DATE:
_______________________________________________________
_______________________________________________________
_______________________________________________________
7

ADMINISTRATIVE REVIEW
PERSONNEL: YES NO N/A
Does the agency have written Personnel Policies
and Procedures?
(Date of most recent
revision:_________________________)
Comments
Do the procedures include Equal Opportunity
Employer Certification (non-discrimination
provisions)?
Do the policies and procedures contain the
following:
Leave policies (annual, sick, compensatory,
etc)
Family Medical Leave Act
Hiring/Firing policy
Nepotism policy
Sexual Harassment policy
Conflict of Interest policy
Confidentiality policy
Drug and Alcohol policy
ADA and reasonable accommodations
Work related injuries (worker’s comp)
procedures
Employee Grievance procedures
Disciplinary Action procedures
Evaluation/Performance Review policy
Travel/Per Diem
___
___
___
___
___
___
___
___
___
___
___
___
___
___
__
__
__
__
__
__
__
__
__
__
__
__
__
__
___
___
___
___
___
___
___
___
___
___
___
___
___
___
Are policies and procedures available to all
staff?
Employees are informed of the above personnel
policies and procedures through:
(___) New Staff Orientation
(___) Agency Packet
(___) Training
(___) Reference
(___) Other
______________________________________
Have personnel files been prepared for each staff
member?
Does each employee file contain the following?
W-4
Application/Resume
Job Description
Hire Date
Annual Evaluation
Salary
___
___
___
___
___
___
__
__
__
__
__
__
___
___
___
___
___
___
PERSONNEL: YES NO N/A
Does the Board evaluate the executive director
Comments
Updated October 1, 2005
Updated May 13, 2005
Revised September 18, 2002
Updated January 16, 2003

annually?
Does each employee have I-9 filed (after November
1986)?
Is the proper ID documentation attached to the I-
9?
Is the I-9 filed separate from the employee’s
personnel file?
PROGRAM ADMINISTRATION: YES NO N/A
Do the following employees have access to the CSBG
Policy and Procedures Manual?
Fiscal director
CSBG program coordinator
___
___
___
__
__
__
___
___
___
Comments
Did the agency submit an Organizational Chart with
their CSBG application?
Does the Organizational Chart contain positions,
chain of command, and programs?
Did the agency complete and submit the CSBG
application for funds within the time prescribed?
Does the agency have a certificate documenting
Worker’s Compensation coverage? (CSBG P&P Manual
7.1)
Did the agency submit a copy to the state office?
___
___
__
__
___
___
Does the agency have on file a blanket fidelity
bond coverage for the activities of the contract
in an amount of at least 25% of the total amount
of the total agency budget? (CSBG P&P Manual 7.1)
___
__
___
Did the agency submit a copy to the state office?
___
__
___
Does the agency have a Certificate of Insurance
for comprehensive general liability for not less
than $500,00? (CSBG P&P Manual7.1)
___
__
___
Did the agency submit a copy to the state office?
___
__
___
Does the agency have a Certificate of Insurance
for comprehensive Board liability insurance? (CSBG
P&P Manual 7.1)
Did the agency submit a copy to the state office?
___
___
__
__
___
___
Does the agency have a current 990 on file which
maintains
the 501(c) 3 status as a non-profit?
___
__
___
Was the 990 filed with the Office of the Attorney
General/ Registry of Charitable Organizations?
___
__
___
Does the agency have a current Certificate of Good
Standing and Compliance from the Public Regulation
Commission?
9

BOARD REVIEW
BOARD OF DIRECTORS: YES NO N/A
Does the agency have a current Board of Directors
roster?
Comments
Does the roster include the following?
Address of each Board member
Date of appointment
Length of service
Segment of representation (public, private,
or low income)
County representing (only if the agency
serves more than
one county)
Did the agency submit a copy to the state office
with the CSBG application?
___
___
___
___
___
___
___
__
__
__
__
__
__
__
___
___
___
___
___
___
___
Are letters of acceptance or appointment from
elected officials on file? (Board member
representing the public sector)
___
__
___
Did the agency submit copies to the state office
with the CSBG application?
___
__
___
Does the Board have the required 15 members?
(State Statue)
Is the Board complying with the tri-partite
requirement?
Low Income (no less than 1/3)
Public (1/3)
Private (1/3)
___
___
___
___
__
__
__
__
___
___
___
___
Is the Board in compliance with the term limits
for private and low income representatives?
Does the Board roster contain alternates? If so,
they are in non-compliance with the State Statue.
Are multi-counties represented?
What type of training has the Board received?
BYLAWS/ARTICLES OF INCORPORATION: YES NO N/A
Does the agency have a current copy of their
Articles of Incorporation?
___
__
___
Comments
Did the agency submit a copy to the state office?
___
__
___
BYLAWS/ARTICLES OF INCORPORATION: YES NO N/A
Comments
10

Does the agency have a current copy of the Board
Bylaws?
Date of most recent revision
(______________________)
___
___
__
__
___
___
Did the agency submit a copy to the state office?
Does the Board have policies to address the
following:
conflict of interest?
nepotism?
sexual harassment?
___
___
___
__
__
__
___
___
___
Do the bylaws adequately outline the board’s
responsibilities:
(CSBG Policies & Procedures Manual 10.3)
1. Development of the Community Action Plan?
2. Hire/fire and evaluate the performance of
the executive
director?
3. Determine major personnel, organization,
fiscal, and
program policies?
4. Determine overall program goals and
priorities, including
provisions for evaluating programs for
performance?
5. Make final approval of all program
proposals and
budgets?
6. Determine rules and procedures for the
governing board?
7. Hire an auditor?
8. Review the agency’s annual audit and
ensure that any
corrective action is taken?
___
___
___
___
___
___
___
___
__
__
__
__
__
__
__
__
___
___
___
___
___
___
___
___
Do the bylaws define:
Mission and/or purpose?
Election of officers?
Geographic service area?
Board membership/composition?
Term of office?
Quorum requirements?
Recruitment of new members?
Vacancies and removal of officers?
Duties of committees?
Duties of the executive director?
Frequency of Board meetings?
Code of ethics?
Democratic selection process--
representatives of the poor?
___
___
___
___
___
___
___
___
___
___
___
___
___
__
__
__
__
__
__
__
__
__
__
__
__
__
___
___
___
___
___
___
___
___
___
___
___
___
___
BOARD MINUTES/MEETINGS: YES NO N/A
Are Board minutes recorded and submitted to the
state office within 30 days after each meeting?
(no signature required)
Comments
11

Are the minutes on file at the agency fully
executed? (Robert Rules of Order)
Do the minutes reflect a quorum was attained where
business was conducted? (Robert Rules of Order)
Has the Board followed its bylaws regarding the
number and time frames of meetings to be held?
___
__
___
Did the agency submit a schedule to the state
office with the CSBG application?
___
__
___
Do the minutes reflect that the Board reviewed and
approved the CSBG application for funding?
Were the CSBG contracts and/or amendments
presented to the board for review and approval?
Do the minutes reflect the Board’s involvement in
the following decisions:
Approving expenditures over $5000?
Salary increases (staff and executive
director)?
Approval on all program proposals and
budgets?
Hiring of an auditor?
___
___
___
___
__
__
__
__
___
___
___
___
Are monthly financial statements presented,
reviewed, and approved by the Board at every
meeting?
Was the agency’s single audit presented, reviewed,
and approved by the Board following the release of
the audit report?
Is there any indication the CSBG funds are being
used to support lobbying or other political
activities?
PROGRAM REVIEW
CONTRACT/ CSBG POLICY & PROCEDURES YES NO N/A
Did the agency submit a Community Action Plan to
the state office within the time prescribed
annually?
Comments
Is the Plan modified or revised yearly?
Does the Plan include the following: (CSBG
Contract 2.G)
1. Description of the service delivery system
for low
income people in the service area?
___
___
__
__
___
___
12

2. Description of how linkages will be developed
…information and referral, case
management..?
3. Description of how funding under this
contract will be
coordinated with other public and private
resources?
___ __
___
Has the agency conducted a community needs
assessment?
Date of most recent community needs assessment
(_________________________).
___ __ ___
Does the agency have procedures for CSBG related
services?
Does the agency have written policy and procedures
for the following:
program requirements?
poverty guidelines?
client eligibility criteria?
application intake, referral, and processing?
confidentiality?
release of information?
client grievance/appeals process?
client rights and responsibilities?
maintenance of client records?
household definitions and guidelines?
(5/20/02)
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Are staff members aware and familiar of these
written policy and procedures (including staff
located at the satellite sites)?
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Did the agency submit a copy of their client
eligibility criteria and application
process/procedures to the state office with their
CSBG application?
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Did the client eligibility criteria explain how
“special” needs people (disabled, homebound,
homeless, transients, etc.) are served and the
eligibility requirements?
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CONTRACT/ CSBG POLICY & PROCEDURES YES NO N/A
Does the agency notify clients that they have the
right to appeal and/or file a grievance?
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Comments
Is the client complaint procedure:
Posted?
Issued to the client at the time of the
application?
Explained to the client during the time of
their
interview? (Verification form signed by
client)
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Does the agency have policy governing the receipt
of assistance by:
Employees and/or their relatives?
Board members and/or their relatives?
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13

Are the correct gross income guidelines used?
Does the agency take appropriate steps to ensure
privacy and confidentiality of client information?
Are all client service locations accessible to
persons with disabilities?
Are clients notified that services are provided to
all regardless of race, color, national origin,
gender, sexual preference, age, handicap, or
religion (non-discrimination disclaimer)?
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Non-discrimination is:
posted at the agency (including satellite
sites) that is visible
to all clients?
on the agency’s application for services?
listed in the agency’s brochures/flyers?
other (____________________________)
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What does the agency use to inform the service
area(s) of its programs and services:
brochures?
newsletter?
radio/newspaper announcements?
advertisement?
press release?
agency web site?
annual reports?
posters?
other (_____________________)?
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CONTRACT/ CSBG POLICY & PROCEDURES YES NO N/A
Does the agency advertise their services in their
service area(s) at least once each quarter of the
calendar year? (Article 33)
Comments
Are quarterly announcements available:
in the newspaper?
in the community for the general public
(community
centers, schools, churches, hospitals, etc)?
in business?
employment & training agencies?
human services agencies?
local government agencies?
public transportation outlets?
other (_______________________)?
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Is the agency’s outreach activities sufficient to
reach the majority of low-income people in the its
service area(s)?
Has the agency established linkages to other
organizations to enhance services to low income
people:
other community action agencies?
other non-profit agencies?
local governments?
local business?
state agencies?
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14

community development organizations?
advocacy organization?
other (___________________________)?
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SCOPE OF WORK: YES NO N/A
Does the agency have reasonable and measurable
objectives outlined in their scope of work?
Comments
Did the agency use the ROMA and National
Performance Indicator measurements outlined by the
state office?
Did the agency link their services to the correct
ROMA measurements and National Performance
Indicators?
Did the agency provide:
a statement of the problem?
program service and objective?
identified the type of unit correctly?
# expected to achieve outcome?
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REPORTING/CLIENT-TRACK: YES NO N/A
Did the agency track and report services outlined
in their Scope of Work on the NASCSP report:
Fiscal section?
ROMA section?
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Comments
Did the agency meet their goal as outlined in the
scope of work?
Did the agency report other services (not
specified in the scope of work) on the NASCSP
report:
Fiscal section?
ROMA section?
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Does the agency submit the following within a
timely manner:
monthly CSBG report?
mid-year ROMA report (signed by Board
chairperson)?
annual CSBG NASCSP/IS survey (yr. end
report)?
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The agency reported on the following National
Goals:
Goal 1: Self Sufficiency
Goal 2: Community Revitalization (Conditions
improved)
Goal 3: Community Revitalization (..people
own a stake..)
Goal 4: Agency (Partnerships)
Goal 5: Agency (Increase capacity to achieve
results)
Goal 6: Family Stability
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Did the agency update Client Track with the
correct poverty income level?
15

Did the agency update Client-Track with the
services approved by the state office?
Did the agency update Client-Track with services
not approved by the state office?
Did the agency update Client-Track with the ROMA
and National Performance Indicator measurements
approved by the state office?
Did the agency update Client-Track with
measurements not approved by the state office?
Did the agency update Client-Track with system
updates provided by Shah Software?
REPORTING/CLIENT-TRACK: YES NO N/A
Comments
Is the agency using Client-Track to track client services?
Is the agency using Client-Track to track ROMA
measurements and National Performance Indicators
regarding individuals and families?
Does the agency retain their records for a period of three
years?
16

FISCAL REVIEW
FISCAL MANAGEMENT/ACCOUNTING
Does the agency have a Financial Procedures Manual?
Date of most recent revision
(______________________)
YES NO N/A
Comments
Does the procedures manual describe:
Accounts payable
Accounts receivable
Internal Control
Purchasing (over $5,000)
Check signing policies
Payroll
Cash receipts
Procurements
Property management
Petty Cash
Timesheets
Travel
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Describe from the following those that are
utilized or maintained by the agency/grantee:
Cash Receipts Journal
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Cash Disbursement Journal
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General Journal
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General Ledger
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Bank Statements/Cancelled Checks
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Monthly Balance Sheets
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Other
_________________________________________
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17

_________________________________________
Does the general ledger reflect all funding
sources? (GAAP)
FISCAL MANAGEMENT/ACCOUNTING
Does the agency have a Cost Allocation Plan?
Does it clearly identify and distribute all costs?
YES NO N/A
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Comments
Does the agency have a chart of accounts?
Does the agency prepare a report to compare actual
versus budgeted expenditures?
Does the agency maintain a bank account balance under
$100,000 or at the federal insurance amount?
Does the agency use a line of credit?
What is the max? (_______________________)
What is the average monthly balance?
(_______________)
Are bank reconciliations current? (GAAP)
18

Does the agency’s check signing policy have a check
and balance system in place? (At least 2 people involved
in the check signing procedure.) CSBG P&P Manual 9.0
Are checks signed manually on every corporate check
and/or are the corporate checks signed with a signature
stamp?
List of persons and titles who have authority to
sign and/or persons and titles whose names appear
on the checks.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
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Does the agency have written policies regarding the use
of a signature stamp?
Do all of the authorized check signers have Board or Bylaw
approval to sign checks? (GAAP) (CSBG P&P
Manual 9.0)
Are their current bank signature cards on file
with the financial institution(s)?
FISCAL MANAGEMENT/ACCOUNTING
Are deposits being tracked appropriately and made
within 24 hours?
Could a sample of cash disbursements be traced
from original accounting entries to:
YES NO N/A
Comments
Cancelled checks?
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Appropriate purchase orders or other
contracts for goods
and services?
Approved activities identified in the
contract?
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Appropriate bills and invoices?
Are reimbursement requests (expenditure reports)
submitted by the 20 th
of each month? (CSBG Contract
3. F.)
19

Are the closeout reports submitted within the ninety days
after the end date of each grant year?
Are expenditures approved appropriately and according
to the agency’s Financial Procedures Manual?
Are the limits for accrued leave, specified in the agency’s
personnel and/or other policy manuals adhere to?
Are the employees work and leave time tracked,
documented, and compensated according to the
agency’s policy?
Are payroll taxes submitted to the Internal
Revenue Service and the NM Taxation and Revenue
Department timely?
How often does the agency pay its employees:
weekly?
bi-weekly?
monthly?
bi-monthly?
other (________________________)
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Review per diem files (per diem paid with CSBG funds)
to determine whether the agency is in compliance with
state DFA rule.
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PROPERTY:
Does the agency have a current property inventory
record?
When was the last physical inventory conducted?
(_________________________)
YES NO N/A
Comments
Does the property inventory reflect Department approval
and title for property with a purchase price of $5000 or
greater?
(CSBG Contract 17)
Is there a program in place for maintenance,
repair, and protection of property? (CSBG Contract
17)
21

How often are fixed assets depreciated?
(_________________________________________________
)
AUDIT:
Did the agency submit their annual audit timely? (Six to
nine months after the agency’s fiscal year end or within
the audit schedule of the agency’s cognizant funding
source.)
YES NO N/A
Comments
Does the agency have a competitive bid process to
select an auditor?
Has the agency retained the same auditor for more than
four consecutive years? (If yes, they are in noncompliance
with the contract.)
Does the audit contain a report of financial expenditures
by category for each program?
Has the agency resolved all audit findings?
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