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39702 Y3 SUBAWARD
BETWEEN
THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
AND
WEST CENTRAL NEBRASKA AREA AGENCY ON AGING
This subaward Is entered Into by and between the Nebraska Department of Health and Human Services, DIVISION OF MEDICAID AND LONG-TERM CARE STATE UNIT ON AGING (hereinafter "DHHS"), and WEST CENTRAL NEBRASKA AREA AGENCY ON AGING (hereinafter "Subreclplent"),
Catalog of Federal Domestic Assistance (CFDA) Title:
Catalog of Federal Domestic Assistance (CFDA) Number (From CFDA.gov): Award Name (from CFDA.gov):
Issue Date: Award Date:
1116 Supportive Services, IIIC1 Congregate Meals, II1C2 Home-Delivered Meals, IIID Preventatlve Health, IIiE NFCSP 93,044, 93,045, 93,043, 93.052
Older Americans Act Title Ill-Grants for State and Community Programs on Aging
10/19/2017 10/01/2017
Federal Agency:
Federal Award Identifier Number (FAIN)
DHHS SUBAWARD MANAGER: Renee Savidge DHHS/ML TC/State Unit on Aging PO Box 95026 Lincoln, NE 68509 DHHS.Aging@nebraska,gov
Administration for Community living.
18AANET3SS, 18AANET3CM, 18AANET3HD, 18AANET3PH, 18AANET3FC
PURPOSE. The purpose of this subaward is to provide funding for servtcesthat meet the requirements of the Older Amerolans Act of 1965, As amended through P,L.114-144, enacted April 19, 2016, other applicable Federal Statutes and their Implementing regulations, Siale of Nebraska statutes, DHHS program regulations, and the terms and conditions of this Subaward.
I. PERIOD OF PERFORMANCE AND TERMINATION
A. PERIOD OF PERFORMANCE. This award is In effect from October 1, 2017 the effective date through September 30, 2020, the completion date,
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B. TIgRMINf\TION. Thlssubawarl;l may P<l t~rmlnated a(anytline up0n mutual Written conS<ll1t QrbY~ltherparty for il11yreason upon submlssiol1 a/written no(lo", to the other parly at least Thirty (30J clays prioxto(h"" effective d~teof termination. DHHS may i!l1$dMmJMtethi~ sUbaWai"dln acoofd wlth tbe pr(Jvtskm~ d!'f$lgnated "FRAUD AND MALFEASANCE," "FWNO[NG'AVAILABILlTY;'and "BREAOH OF SL)J3AWARD," In the ewnt either party termi11ates. 'Il1ls sUbaw~rd, $ubrElt)lpl~nl shall provide. to DHHSall worR In. pto~rels8, work completed, and lrtsterli'llS'proVided by bHH$ln (lonn<'!btJ<mwJththis subawen;lll11medlalely, . - ' , - .
II •. AMOUNT 0" Sl1BAWARO
A. tOTAL. SUBAWA8D .. bHHS shall. pay, $ubreolplent a tolalafnount,h.ot to e)(oel'!d $90;.721,QO (ninety thousahd, savEin h(.ll'idfed twenly-one dollars) for !headfivltles speolfiecl herlOln·. .
)c e, PAYMIENTSTRUnTURE, Paymehtshall bastruoii.lredllsfoflow~;
Requestfor Funds (Form 8) iini·d (hi; Monthly PlnanclaI8eport(a) (l"ormAjas referenned in Attlilohment4, ,shall be submitted electronically by the 16th ofi:iaoh month to thSAtlentlol1 of;
COlJttney Par~r State Unit ort Aging PHH$i Plylslon9J Meqicagland Long Tlirm Cafel Peplirtfft$i:It ofH!$$ith~nd HUJY1~fI~f:lrvfc:es dhha.lJging@oeWa$Rs,gQY
1. As 91'1nsll;!tEintWI.thall·sppllcable fMera!slatutes, te~ulatloM,and pol[cls$, DHH$ shalf relfnborae$lJbreQlpt!$n(fdr Its actu!li,allowaple, reasonable,and illloGable oosts.
2. iSqpr),)olj:Jlent shallsubltllt rll~uestafor rell1'lbut@ift';H1ttoDHHSon a monthly basis,. 3,pq."trelmbl;lr$~):>Ie. 1ilrnoynls ~hall be made up> to the amount In SJ3otloh II, Pllragraph
A, IriaOMrdimM.WIIMh'lilaJ\lprOVed area plli\D bU\:!geIIQcaIEid In Attachment 3 :andtlie orltsrfa as selfou(lfT In this $ubaWattt
Q,8I,J[;)(1?ST CHANGES. T~eaqbr~Qlplent is permrtte~ to reassiglifllhtls fr,bm o.ne 111'1£0 Item to Mother Hne It<i!rrt WlthlntheapproYed bqdget. IHunds .are re~s$lgned between line Items, prlbra~ptoval from DHHS Is req~lredfilr cumUlative, bud~fel tran$fer requeSlslPr alJow('lble q~StSi alldoabie, toil'lesl,Ibawarq eXCee¢tng five peroent (5%) of thecurrenl total apj:JtOV<ilQ ~~.<!get' BLldgetreVllllon reque.lI\sshall beeubmlftl9d In,wrlUng toDHHS, DHHSwIHplO'Jide wrl!lel1 notlJip'i1\llon QfllPpr.ov,,1 9xdlsa@proval of the request within thIrty t:30) d6jYs .dliis . rMelpt
*D. PAYMENT RSQUi:SiS.
1. AJlr\\ql;lesrs forp$Yments 6ubmit\ed by8u~realpient, Whether for reimbursement or otherWl$e,shalioont"lnsUfflcientd~tan to support payment
~, $;ubr~prplen't l11ust be Eible \0 provide $QUroedMumelitatlon or i)therverl~.oatlon 9hill olaimeG! Qosts aareque)s\ed by to DHH$,
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III. STATEMENT OF WORK
A. The Subrecipient shall: Proactively carry out, under the leadership and direction of DHHS, a wide range of functions related to advocacy, planning, coordination, Inter-agency linkages, information sharing, brokering, monitoring and evaluation, designed to lead the development or enhancement of comprehensive and coordinated community based system in, or serving, each community in the agency's planning and service area as outlined In the agency's approved area plan and the current taxonomy. (Attachment 5)
B. DHHS shall: Monitor that services are provided in 8,ocordance with this Subaward, both programmatically and financially, and, contingent on availability of funding, reimburse the SubrecJpient up to the amount In Section II, Paragraph A.
C. SUBRECIPIENT FISCAL MONITORING REQUIREMENTS,
1. The Subrecipient agrees to do the following: a, Ensure training Is provided to program staff related to preparing and reviewing
program budgets and maintaining fiscal accountability related to expending state and federal funds,
b. Employ or contract with an individual with sufficient knowledge and responsibility to ensure that:
• Subreclplent has effective Internal fiscal controls in compliance with guidance Issued by the Comptroller General of the United States or the Committee of Sponsoring Organizations (COSO);
• SubrecJplent's financial statements are prepared In accordance with Generally Acoepted Accounting Principles (GAAP);
• Subreciplent oomplies with this subaward and all applicable state and federal regUlations.
2, The minimum qualifications for this individual are: 1) Bachelor's Degree In Accounting or Finance, and 2) three years of relevant experience, Subreclpient may request DHHS approval, Which In DHHS's role discretion It may grant, for an Individual with 1) an Assoolate's Degree in Accounting and Finance, and 2) at least seven years of relevant experience. Additionally, Subreciplent may request DHHS approval, Which In DHHS's sale discretion It may grant, for an Individual who 1) does not have a dregree, and 2) who has at least ten years of relelvant experience,
3. The Subreclplent shall Immediately notify DHHS, in wliting, If It Is not in compliance with the above reqUirements. During 'any period of noncompliance, DHHS may withhold 10% from all payments due until the nonoompliance Is corrected,
IV. GENERAL TERMS AND ASSURANCES
A. ACCESS TO RECORDS AND AUDIT RESPONSIBILITIES,
1, Ali Subreciplent books, records, and documents regardless of physical form, including data maintained In computer files or on magnetic, optical or other media, relating to work performed or monies received under this subaward shall be subject to audit at any reasonable time upon the provision of reasonable notice by DHHS. Subreciplent shall maintain all records for three (3) years from the date of final payment, except records that fall under the proviSions of the Health Insurance Portability and Accountability Act (HIPAA) shall be maintained for six (6) full years from the date of final payment. In addition to the
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foregoing retention periods, all records shall be maintained until all issues related to an audit, litigation or other action are resolved to the satisfaction of DHHs. The Subreclplent shall maintain Its accounting records in accordance with generally accepted accounting principles. DHHS reserves and hereby exercises the right to require Sub recipient to submit required financial reports on the accrual basis of accounting. If Subrecipient's records are not normally kept on the accrual basis, Subreclplent Is not required to convert Its accounting system but shall develop and submit in a timely manner such accrual Information through an analysis of the documentation on hand (such as accounts payable).
2. Subreclpienl shan provide DHHS any and all written communications received by Subrecipient from an auditor related to Subreciplent's internal control over financial reporting requirements and communication with those charged with governance including those In compliance with or related to Statement of Auditing Standards (SAS) 122. The Subreciplent agrees to provide DHHS with a copy of all such written communications Immediately upon receipt or instruct any auditorlt employs to deliver caples of such written communications to DHHS at the same time caples are delivered to Subreclpient, in which case SUbreclplent agrees to verify that DHHS has received a copy.
3. Subreclplent shall Immediately commence follow-up action on findings arising from audits or other forms of revh,w. Follow-up action inclydes responding to those conducting such examinations with clear, complete views concerning the accuracy and appropriateness of the findings. If the finding is accepted, corrective action, such as repaying disallowed costs, making financial adjustments, or taking other actions should proceed and be completed as rapidly as possible. If the subreclplent disagrees, it should provide an explanation and specific reasons that demonstrate that the finding is not valid.
4. In addition to, and In no way In limitation of any obligation In this subaward, Subreciplent shall be liable for audit exceptions, and shall return to DHHS all payments made under this subaward for whloh an exception has been taken or which has been disallowed because of such an exception, upon demand from DHHS.
>(.. B. ACKNOWLEDGEMENT OF FUNDING.
1. As required by United States Department of Health and Human Services (hereinafter "HHS") appropriations acts, all HHS reoiplents and DHHS Subreclplents of HHS federal awards must acknowledge federal and DHHS funding when issuing statements, press releases, requests for proposals, bid invitations, and other documents describing projects or programs funded in whole or In part with federal and DHHS funds. If the subaward utilizes funds from HHS, Subreciplent Is required to state: (1) the percentage and dollar amounts of the total program or project costs financed with federal and DHHS funds; and (2) the percentage and dollar amount of the total costs financed by nongovernmental sources.
2. For all publications that result from work under thlssubaward not included in (1), above, and for any publications supported by a federal agency other than HHS, Subrecipient shall acknowledge the project was supported by the CFDA, name of award, federal agency and DHHS.
C. AMENDMENT. This subaward may be modified only by written amendment executed by both parties. No alteration or variation of the terms and condition., of this subaward shall be valid unless made in writing and signed by the parties.
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D. ANTI-DISCRIMINATION. The Subreclpient shall comply with all applicable local, state and federal statutes and regulations regarding civil rights and equal opportunity employment, including but !Jot limitlld to Title VI of the Civil Rights Act of '1964, 42 U.S.C. §§ 2000d et seq.; the Rehabilitation Act of 1973, 29 U.S.C. §§ 794 et seq.; the Americans with Disabilities Act of 1990,42 U.S.C. §§ 12101 et seq.; the Age Discrimination In Employment Act, 29 U.S.C. § 621 and the Nebraska Fair Employment Practice Act, Neb. Rev. Stat. §§ 48-1101 to 48-1125. Violation of said statutes and regulations will constitute a material breach of this subaward. The Subrecipient shall insert a similar provision into all subawards and subcontracts. .
E. ASSIGNMENT. The Subreclplent shall not assign or transfer any interest, rights, or duties under this subaward to any person, firm, or corporation without prior written consent of DHHS. In the absence of such written consent, any assignment or attempt to assign shall constitute a breach of this subaward.
F. ASSURANCe. If DHHS, in good faith, has reason to believe that Subreclplent does not intend to, is unable to, has refused to, or discontinues performing material obligations under this subaward, DHHS may demand In writing that Subreclpient give a written assurance of Intent to perform. Failure by Subreclplent to provide written assurance within the number of days specified In the demand may, at DHHS's option, be the basis for terminating this subaward.
G. CLEAN AIR ACT. If the value of this subaward exceeds $150,000, Subreciplent shall comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. §§ 7401 et seq.) and the Federal Water Pollution Control Act as amended (33 U.S.C. §§ 1251 et seq.).
~H. COMPLIANCE WITH LAW. The Subreciplent shall comply with all applicable law, Including but not limited to all applicable federal, state, county and municipal laws, ordinances, rules, and regulations.
I. CONFIDENTIALITY. Any and all confidential or proprietary Information gathered in the performance of this subaward, either Independently or through DHHS, shall be held In the strictest confidence and shall be released to no one other than DHHS without the prior written authorization of DHHS, provided that contrary subaward provisions set forth herein shall be deemed to be authorized exceptions to this general confidentiality provision.
J. CONFLICTS OF INTEREST. In the performance of this subaward, Subreciplent shall avoid all confllots of Interest and all appearances of conflicts of interest. Subreclpient shall not acquire an Interest either directly or Indirectly which will conflict in any manner or degree with performance and shall immediately notify DHHS In writing of any such instances encountered .
.{K DATA OWNERSHIP AND COPYRIGHT.
1. Except as otherwise provided In the Federal Notice of Award, DHHS shall own the rights In data resulting from this project or program. As consistent with federal law, Subreciplent may oopyrlght any of the copyrightable material and may patent any of the patentable products produced in conjunction with the performance required under this sUbaward without written consent from DHHS. .
2. DHHS and any federal granting authority hereby reserve a royalty-free, nonexolusive, and Irrevooable right to reproduce, publish, or otherwise use, and to authorize others to use the copyrightable material for federal or state government purposes. This provision shall survive termination of this subaward.
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L, DgBABMEWt. SUS)3ENSfON ORP8CLA8;8D INEbIGIBLE. The 6ubrMipienLcMffies thai neither It nor it& I'lrlnclpals ats. deharrad,llWapBnded, propose~for debari11ent, ·dElGlared Ineligible, pr, vol\:1h\!lrllye~olud'ld from partlolpatlon in this transaotion bYanYlllate orfe<ileral ~epartmanior agency, Tha8:upri:l(llpi~mt aertlfl$~that \U~ regislerE.dwllhthe System MAillard llih,nagemenr (€lAM) (I'lttps:llwWiII.sam. gpv) , In good 'Standlnf;! ,!:\ndthaf !heentity'wHi /11~lnlall'l ann.ualoerlff{oatkm inoioqurdanoifWl!h Pe~"raLAoqlilsitlart ReglJlatioM. FailUre 10 oomplvWllh thlsteatlbh,Jhcluaint;Jtf1",rntalnlng aIH\Q,tlVIl reSisttiltion <tndfor go9~, 1ltandlng with SAM, may ((!Isul! In wlltilJ~J¢lpgofpayments or lri'lrnedla~(!II&rmIl1liIIO'ndfthe sUbt\W~rd,
r.t tJQCUMgNtS I(SjCORPQRATED BY Ri1iFER];!NCE. Air raierenoes,in thJs S\lb"wara to laws/ ruiesi regull!lk'l1S, QUWl'lllnas, dlreotiWs, and att~chliiehts whloh S.st forth st",ndards Wid 'pro6.edtJresto bA ftlllowt:!d by 8ubreoij:Jlentln aischarglng itsopligatlons unqerlhlssuhaward sha.llba cle.£lDll'1d Ingorporated by raference and. mads a partot tlils ilupaward with thlil §ama :f.dl'o&i!lr1d. eff"ot as· If s(;!t forth I11MI V;;j(t, het<;lln,
N, g'RtJl$·.i"Il1:1S WbRKPLACE,
1. rHWbreolpJentl~not an Incltvi~Ual under 41 L),$,C,§B1 01 sl s<;)q., Subreclpleht agrees, :ll'f 'all1.liltQal1Oa With: 41 U$Q ~et01l;lt seq., t~ maintain a drll~Hree worj<place by; (1) pvPJ/$hlng .. 1!i t1rllliHree W()tkfjlacestat~rn$lit; (~) (!l$tabltshiJlg .il.drug4f!ila awarE>naas !prqgram: ~3)notifYlnglilmpI9ye.e'!l.as aonslstent with 41 U,$.C.l8iQ3(a)(1)«()ii1hd (~)~(4) '1\)1 laKlng.ectione 'concerning emplq~ee~who ar~ ~QnvlQted of vl9!ating drug 1itafutes In !~~ W<;l,l\plfl(l6);. (~)notlfYin~ bHHS witblntO da)le!lf\et recel\flng hOUc!)()f lim "mployee .Qru~ C'onviot!~h; (6)lftjptl$It:l9'SBJ)Qthm$BQ;llnst empklye.0s as ~equlred ~Y4t )J,f);Q, § @1.o4; and (7) .In aooortialtcewlth2 CfR~1 &2;2~(l, Idshllfy ali worl(pll;lOeS ~nt;!"r Itstaderal award/!. . .
)L.'Zc Ae ·Plilr 12 U,8.0; .§ 8103; If 81lbreolplliltit Is an ii'ldtvidu~l, $vbreolplentagrl'i:1$ ~ot tq -1 '!lOQ$.~·i:1In.lh~ qnlE)wfwi rn~nufl:\llJ:urei. dl$\rlbutlal'l, dlepElMatlon,po$'sessklfl, or .us\') ofa
oontroliet! sObs'tt;(no$ In. <lond(Jctln.gswl1vltYWlll'l thElsubsward.
0, F6D8~AL. EINAi'l¢)ALA8SJ§TANlJE, .Th'Sl $ubreolpien{shall comply With all applicable pr.oYl~lq!1$ ~f; 45 C·,F,R, !Is' 87, 1-87,2. TheSubfe(ji~tl;lnt oJlrtlfll'J$lhat I.t llh!\11 nQt.use direot federal tiI1Mclala!\sl~taMe to engflgEllj1 InherenflyrallglQus. abilvltlE>5, .8t.1Gh as worship, r\7i1b!loU~ IMttuatloh, 'ilnd/orprose[y.tlzatiot\,
p, .E12Jl6RAL ~Ur\!bIN!3 A@MUNtAB1UTVAN);)mANSPARENCY ACT REPORTING. The fi1t.1pre(!/pj",nt shell il6mpleteand eNdorse SUbradiplef1t Information &'Auctltj'{equlrer;r1ent ¢:e1'lifibi\tloI1, At(achmenll; Th\') $wbr.!lciplentosrtlfles fhe.lnformatlo}:) prov\q",d' la ¢0h1pl"tEl, ,trLle;ahd aoourale.
Q,. FQROIEMAjaO~13 •. N~ItJ:!()r pa.rty~i:)arl be iJl;)hlIe;tof alJy, oosts or damalla$re~ultll1g.irdl1lil$ In~p!lI!y \0' p~rforrnElhY o~ Its C!bl(~atlons under!hla e!:lpawart! d.we to ('ll'1a!l,!fal dl~a8te.r, or olhet alll'\lIl:if evant outside thsGi)n!roland not the faUlt offhe l:iffectedparty ("Foroe Mi.\Ieure Eivent"). A Fori;le Majeure EVEinishaH nolconstitute ~ preaoh olthls supaward. Tlie party So ~ffec\l:1d~hall Immediately give notloe .to the Qther party of thl! ForcEl Majeure E;vent Upon sucih Mtloe,all obIlQi'.\tlol'1~ oftha\jfii')ot!3d party undElr this sUbaWard whloh are·teasol1$bly relaleq to the Foroe MajlJUPEl.Svetit shall bEls,rsper(c;!<1ld, AM theaffeotedparty ·shall do ellarythitig r"asot\ably nece.Si:\ry to r(!)s\lmE1perfQrmanoeas SOOri'BS possible, L.abOF dlaput~$ with {he fmpaoted party'sowh,emploY'i)eS wiJI nol hl;loonsl~ereda Foro" Maj~ure Event-and wnl not $usP'ilIJ~ perform~noe reqlill'ari1eMts under thlssub!iw~r({,
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R. FRAUD OR MALFEASANCE. DHHS may ImmediatelY terminate this subaward for fraud, misappropriation, embezzlement, malfeasanoe, misfeasanoe, or illegal oonduct pertaining to performance under the subaward by Subreclpient, its employees, officers, dlreotors, volunteers, shareholders, or subcontractors,
S, FUNDING AVAILABILITY. DHHS may terminate the subaward, in whole or In part, in the event funding is no longer available. Should funds not be appropriated, DHHS may terminate the award with respect to those payments for the fiscal years for which such funds are not appropriated. DHHS shall give Subreclplent written notice thirty (30) days prior to the effective date of any termination. The Subrecipient shall be entitled to receive just and equitable compensation for any authorized work which has been satisfactorily completed as of the tenmination date. In no event, shall Subreciplent be paid for a loss of anticipated profit.
T. GRANT CLOSE-OUT. Upon completion or notice of termination of this grant, the following procedures shall apply for close-out of the subaward:
1. The Subreclplent shall not incur new obligations after the termination or completion of the subaward, and shall cancel as many outstanding obligations as possible. DHHS shall give full credit to Subreciplent for the federal share of non-cancelable obligations properly incurred by Subreclpient prior to termination, and costs Incurred on, or prior to, the termination or completion date.
2,
3.
4.
5.
6.
Subreclplent shall Immediately return to DHHS any unobligated balance of cash advanced or shall manage such balance in accordance with DHHS instructions.
Within a maximum of 90 days following the date of expiration or complelion, Subrecipient shall submit all financial, performance, and related reports required by Subreclplent Reporting Requirements, DHHS reserves the right to extend the due date for any report and may waive, in writing, any report It considers to be unnecessary.
DHHS shall make any necessary adjustments upward or downward in the federal share of costs.
The SubreCiplent shall assist and cooperate in the orderly transition and transfer of subaward activities and operations with the objective of preventing disruption of services.
Close-out of this subaward shall not affeot the retention period for, or slate or federal rights of access to, Subrecipient records, or Subrecipient's responsibll1tles regarding property or with respect to any program Income for which Subreolpient Is stili accountable under this subaward. If no final audit Is conducted prior to close-out, DHHS reserves the right to disallow and recover an appropriate amount after fully oonsidering any recommended disallowances resulting from an audit which rnay be conducted at a later time,
U. GOVERNING LAW. The award shall be governed In all respeots by the laws and statutes of the United States and the Stale of Nebraska. Any legal proceedings against DHHS or the State of Nebraska regarding this award shall be brought in Nebraska administrative or judicial forums as defined by Nebraska State law.
V. HOLD HARMLESS.
1. The Subreolpient shall defend, Indemnify, hold, and save harmless DHHS and Its employees, volunteers, agents, and its elected and appointed offiCials ("the Indemnified parties") from and against any and all claims, liens, demands, damages, liability, actions,
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~oaUSBS .of Mb'on,loss$s, judgments, dosts, and expenses of every nature, Inqludlng Invelltlg«tlon cost
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desorlbedln 2 OFR~200,a:3l3!\nq 46 OFR §15,3071, as applicable, IncludIng suspehSlon or debWro",ht, (See also20FR § 180 <it seq, aM 31. U,S.O,~ 33:21),
BB, NESRA§!(A NoNRJg$IDENT INCQME TAX WITHHOLDING, Subreolpient acknowledges that. Nebrf;l"ka 161w requlre:s DHHS to WithhOld Nebrasl(a Inc.oluetax if paym"nts for p~r$onal servtaell ~ra ltif;\!leln eXpe.as .Qf .slx ~~It1dreq dQllars($fJoO) to any SUoreclplehtW!tb js not d,0tyHcUed, In NElbraskabthaa Mtmalnt".iI1.!r.ctf;\parmanenf pll1Q6ofbuslrwss or YI).sldeh<le Ih Neli)r€!/i.l<afora partod Qf at Illast six months, This prbvis/Ona):>plies to: Indlvld\la[sj .19 iii cofporatlon;, If '800/0 ormore.ofth<i: votIng s,tpokcQrthecQ[:por!ltkm Is held~ytM snarehol<:liilrs wlro ,!jre perfWr.rlt1g, persohalseMbes, llhd.'to .~. psrt\ie~hlporlh11ited liability oOl]1pany, lfl3O% or mora cllhE! oapltal intereataf ~rqfltal"terestofthe parthsrshlp oY"lIfYllted,lIal:>ilfty c<)lr\pany Is .held blithe pattnars. or mempw$ Who. are. performing parson\ll servioes·,
TM tJartl'(js.a9l'e~, WhllliapplioiiDls,. to properly ,oomplete the. NebrasKa DapartmMt of I'<.everrt,re N.,braska Wlthholdln~. OertlflQstl)· ftirNpnr<isldant IndIVidUals Form W·4NA Gf Its sUoGeS$or: The form ISE\ve)lIaj)ja !It: h\tp;/lwWJl!,relietJLUpl$.!ilp\!ftax/ourrantlfllf~hllf w-4naa
ce, NElISM~KA rSCHNOLO@Y ACCESS STANDARRg, 'rhe: $QPreoipl\!int $h~1I reVl,ew, the Nepra$K€! Ttmhnology Access Statldard~,fpuhd .Ilt htt!l:Qwww.nflQ.n!l!b[!I!§I<!l.gPVI$tal.ldlJrl.Siik;20thtmIMd eh$Ure lh~l pro.qU~lsa.nqfor servlcErs pfliNldel:! uJ1i:!af fhe$\'I);J~ward G"I11PY with the appllci:lble ¢ti:lndatda. In the eVElm ~UGh $!~i'1dards tihah~e dWlhg SubreOlpleht'~perf()rn)anoe,OHHq may oreateal1ameMmeotlo the,stlbli\w<lrd t6. request that Si:lbril~lpletit comply with the .chang<ld ,at~rndard. ~t a Gost mutuallYi1<loeptabl\f to the parties, .
bt): NEW ElMetOYI$ WORK .ELlGIBILlW STATUS. TheSubreolJ5lehi $h~1I U$ed;\ federal in'\mtgratl(')hVerl!16allon.~ystel11 to dE)(ermlne th!;): vvorK <;!Iigiplli\y status of Mw efr1ployees PhysloaHy Perfprmfng ~ervlcesWl!hihthe .S.tati>01 NeivrMI(a, Afei1er!\llt)imlgr~(lon veriflolllt\on sy.stemmeans !hee]eotron[p vi;lrlffqatlpn oHbi;l work aulhorliatl()hprO!=Jr:am autl1(:irlz~d .py-the rn~9IiUIjlrn'fgrallon RefiilrIiH\hdlmmli;lrf\\ilR.el\p'(!n~lbIHty Alllof199l'3, e t,LS, C, § 1324a, knowh 'ellltlJe.ra-WrllY Pr9gra,m, or!!H aq~lyalEihtfederal program de~lgnated py the Unlt~d Stafes !D!!\p:artmanl df' Holtle.laMSeeur1ty I')r oth.er te.derilla@Elnwaulhorlzed to verify the WorK e.l1g1i:J!Jity .st~!iJ~ ola newlY hlri;)d em~IQyae;
If Subreoipient 1$ an IndividUal bI'SQleJ>roprl~torshfp; the fi;iUowlng applies;
1, The EubrEiillpl::lll! Itlus!¢ompillite thel,lnil.,d states CljlzenshlpAtteala!ion Form, l'IliaJlapla pn the bep<!rtmentof.AdmlnlstratIVe:!:lervloea website at www.das,state,ne.u$,·
~. If' ~\ibreclplent Indloate's on s,Uen::Jtti;l$t(ltl(';nfofm that he or sheTs· aquallflad allen, :S)ul:lreclplen1 :;lgri;l"l\\ to provide the: U.S, Gltil::e):]'shlp and Il1)mlgratRm .o$ervft;es tl0oUlfLerttiltl6li rllqutfe~to v"rfry SUbIi\i~!plent'slawM Pfes~nceln<the Urilted8tate$ u$II1Q th(ilSYstematlo Allen Wrlficil1lof\ fOt E:ntltleltlen!s (MV'f!J Progrl;Jfr1,
3. ilie Sub1::loipienl Ur\derst~nd$ end l3gre~s, that IjjlwfWlpresenoe .In the United Statesla reqUlred.and SUbfeQlplent m<lybe diil(jualfflect or the $upaWard tetmlnaWd If "qoh)awful jlreselloe cannlltbeverffiedEis, requited by Neb, Rev, stat. § 4-1 08.
MOrlOE OF STATE.pgslGNATt:,oGLuStSR OF PROGBAMS. Pursuant to Z CFR § .2:00,$01, thl$pnlVislbl1 provides MtiO$ that p'HHS has designated the public Health Emt:lrgahoy Rreparedness IHospital Pre~aredhess PfoQram grants (CFbAS S(l,069 $.9$,689, Ul'laer'93.074) a~a Cluster of progr~m$\$$ec2CPR § 200,17). FOr f;\uditing purposes, and as seUorth In 2 CFR§ 200,518;(\ Olust'erof~r0grams m~&t I:>e cQnsidered as one program for
SUbi'!ward Rev, .08/2017
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Ji." Pfi. R/WMElNT oF'bOs.'rSANtJAUDIT REQUIREMeNTS .
• ' \ 1. All ~<lymenh~l1'Iltd", unqer.ihl$$ql:i~~rd 11'I1IS! be Otlnslsteni with 2 CPR § 200et$eq.and litiiybthetreliJ\Jlallol1i;fGirthe federatiul1dln~~(l\1roe, M ~pplloiOlbl~, InQluqij19 gui n.otHmlleq !o 4liGFR 176 at saq.~d4f! CFR §95 etseq, 'tM Slll1ra&lpietlt$hailetiiMe<lll costs requ.~sti'ld \JhdE!r lhl$ :$'i;.IbOlWardi\te: e:$lU(lj, ali~ me.s! all federal allowablllly,. alioMblllt', ~IT~ 'fjj~sonableness requirements for the:fund!j Involved, IhclUding bul not limited to all req\J'iremiiintsfQralJowa~lJi\y unde.r2 OPR §'§ 20004.00 throqgh 475 and 415 OPR §§75.400 t1irou~h477.
11. ~he$ubr!3~'fPI"nt S~:;ill folJowall fadersl aUditreqLilremeflts, Inoludliig bulne! ~mlt~d t() thoil.e In ilCFR§ 200$u/lpart F CS$~ta:bletl~low <lnQ Maohrnet)t1, A,lolt RequlfemM! Certification,) Audililmus! be ~rer'ar,(;idandlss,U$d bYiin Jhde~endent (JertJfl~<I pUb}lQ a'QijoUntanj lI1JeM~4 '1<;> prac!!ce,A Q9P1/0flhe ~nnualor audills to be made elco¢trohfoaHy aViilla!:lle or !3sntlo.:'. Nebra)lka Pepartrl1ahtof Health and Human.Servlcea, Plnlilnci,d S"rvioes; P,O. S'OX9:!S02!3, Lincoln, NEl68609-5026,
.. $10q~OOO tO$749/jlJ9 ~$'t5QOg!Yor 1'tIi:)te /0 ffld(Jtai W(PfJ1'it!I(tIr~$
AllditType
i"lnanoM $tatementAlJdft $1ni;!IItlAlfdlt
~i). PRQG1MMM&ICGHAN('!jS$;.T)1ll$q~rI!jC!pl(tlnts~allreques\ Inwfitiilg WDHHS forapprQval 6f t:>rc.gr. a.ltimall(i. dMnge. s.· .... ID.' HH.' Sshall ,appfov~' ordk:\llppr(jveln whole Qr In pat! In writing wl!hln thitty(0P) <ilayeof receipt ofsudh request. .t HR. PRQMPT pAYMENT, Payment sl'rllil be made Inoor1junctlon with (heS1ate of N",i:)rljal\a Ptoli'l1?1 Paymen1 Aot, Nel), R"v, Slaf, §§ 8:1"2401 throqgh81;2408. Unl.esa otllGtwlse provided hereiH, paYI1lM! shall be made bY ellilQ!ronlomean;e.
11,
a. MtOl1'lilted Ohmlpgfio:uaa IAQi'll Enrollment Form iWglllrements for pmaJit.
.The. S .. Ubree.rp .. le. nt Sha.1I bb. m. p.le.t.e, ~n. deign the State of Nebr~$l<a,AQH anrQllm~nt Pormlln.~ obtl1!ln Ih!!) necessary mfotmatiOh and slgnatutMfrom thafHll1ll)1blal institution. iM completedfoYml11u$! be $ubml\teq before payments to $ubreolplent can be I'h~de. DownlOad ACH Porm: bttp:IIWWW.das.state;ne.us/accQunllngtolsiaddress \JQok lnfo.hlm
fiUBlLlC aDVNSJ;L, In the avent Suhreclplent pl'ovldeshealth and human servldes· to Ihdlvldulils.!li1llehalf of OH'He !.mclllrthEl t~rrns of lhis <\Vi'i:\rd, 8ul'>reclplElntshallsul!mlt to the 'jiJrfst:lfrlft'qn 1;>( tlTe !"ubllQ Coun$el uncleI' Neb. Rev; 8tat.§~e1-$rMO throUgh $1-8;2154wllh r,espso\ to the provi~tonof $€Irvloo:stlndtor thlssubaward, 'this dauseshalrn6t 1:IppLY to subaWards. between.DHHB and 10l1g4arm dare faoJlillss $WPJeot±iJ the )wfsdtpJlon of thlil stale li)n~-termoaraol11budsma1) Jilursuantto the Long.Term Gare OmbUdsman Aot,
REMt;bl};18iF~RNON~COMPLIANGE. As donslst.;!nt WlthajJjJlloable laW;DHHS may, If Sub'reclplent faUsto. Qornplywlthfedel'al statutes, regulatlons,.or the terms and oondltione of t~e ~ubaward:
1. Impose any of the specific cOht!ltloM lI.ste~ In 45 CFR '§ 75.207 or2 CFR § 200,207, as appl1cable;
$ubawarq , Rev.Q812017
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2. Temporarily withhold any payments pending the correction of the deficiency by Subreclplent;
3. Disallow all or part of the cost of the activity or aotion not In compliance; 4. Wholly or partly suspend or terminate this subaward; 5. Recommend suspension or debarment proceedings be initiated by the federal funding
agency; and 6. Take any other remedies that may be legally available.
If DHHS imposes items 3, 4, or 6, above, bHHS may withhold future payments or seek repayment to recoup costs paid by DHHS.
For any of the above actions, DHHS may, in Its sale disoretlon and oonsldering the gravity and nature of the noncompliance, allow Subrecipient to correct a failure or breach of subaward within a period of thirty (30) days or longer ("cure period"). If DHHS provides a cure period, it shall provide notice, which shall be delivered by Certified Mail, Return Receipt Requested, or In-person with proof of delivery. Allowing Subrecipient a cure period to correot a failure to comply does not waive DHHS' right to take other action listed above for the same or different failure to comply that may ocour at a different time.
Nothing In this provision shall preclude the pursuit of other remedies as allowed by law.
KK. RESEARCH. The Subreolpient shall not engage in research utilizing the Information obtained through the performance of this subaward without the express written consent of PHHS. The term "research" shall mean the Investigation, analysis, or review of Information, other than aggregate statistical information, which Is used for purposes unconnected with this subaward.
LL. SEVERABILITY. If any term or condition ofthls subaward Is deolared by a oourtofcompetent jurisdiction to be illegal or in conflict with any law, the validity of the remaining terms and conditions shall not be affeoted, and the rights and obligations ofthepartles shan be construed and enforced as if this subaward did not contain the particular provision held to be invalid.
MM. SMOKE FREE. Public Law 103-227, also known as the PrO-Children Act of 1994 (Act), requires that smoking not be permitted In any portion of any Indoor facility owned or leased or oontraoted for by an entily and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by Federal programs either direotly or through Stata or local governments, by Federal grant, contraot, loan,or loan guarantee. The law also applies to children's services that are provided In indoor faoilities that are constructed, operated, or maintained with such federal funds. The law does not apply to children's services provided In private residences; portions of facilities used for inpatient drug or alCOhol treatment; servioe providers whose sole source of applloable Federal funds in Medicare or Medicaid; or facilities where WIC coupons are redeemed. Failure to comply with the prOVisions of the law may result in the imposition of a civil monetary penalty of up to $1000 for each violation and/or the ImpOSition of an administrative compliance order on the responsible entity. By signing, Subreciplent certifies that Subreclpient will oomply with the reqUirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision of services for children as defined by the Act.
NN. SUBRECIPIENTS OR SUBCONTRACTORS. The Subreclpient shall not subaward or subcontract any portion of this award without priorwrlttan consent of DHHS. In subcontracting or subawarding any portions of this subaward, Subrecipient shall follow 2 CFR § 200.300 through 200.345, and 45 CFR § 75.300 through § 75.346, as applicable. The Subreclplent shail ensure that all subcontractors and subreoiplents comply with all requirements of this
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subaward and applicable federal, state, county and munloipal laws, ordinances, rules, and regulations.
SURVIVAL. All provisions hereof that by their nature are to be performed or complied with following the expiration or termination of this subaward, Including but not limited to those clauses that specifically state survival, survive the expiration or termination of this sUbaward.
TIME IS OF THE ESSENCE. Time Is of the essence in this subaward. The acceptance of late performance with or without Objection or reservation by DHHS shall not waive any rights of DHHS nor constitute a waiver of the requirement of timely performance of any oblrgations on the part of Subrecipient remaining.
QQ. WHISTLEBLOWER PROTECTIONS. The Subreclplent shall comply with the provisions of 41 U.S.C. § 4712, Which states an employee of a contractor, subcontractor, grantee, or subrecipient may not be discharged, demoted or otherwise discriminated against as a reprisal for ''whlstleblowlng.'' In addItion, whlstleblower protections cannot be waived by any agreement, policy, form, or condition of employment.
~RR.
1. The Subreclpient's employees are encouraged to report fraud, waste, and abUse. The Subrecipient shall inform their employees In writing they are subject to federel whistieblower rights and remedies. This nolification must be In the predominant native language of the workforce.
2. The Subreclplent shall Inclucil' this requirement In any agreement made with a subcontractor or sub recipient. I
NOTICES. Notices shall be in writing and shall be effective upon maIlIng. Unless otherwise set forth herein, all Subreclplent reporting under the subaward shall be sent to the DHHS Subaward Manager Identified on page 1. Written notices regarding termination of this subaward or breach ofthis subaward shall be sent to the DHHS Subaward Manager identified on page 1,and to the following addresses:
FORDHHS:
Nebraska Department of Health and Human Services - Legal Servloes Attn: Contracts Attorney 301 Centennial Mall South Lincoln, NE 68509-5026
FOR SUBRECIPIENT:
Linda Foreman West Central Nebraska Area Agency on Aging 115 N Vine Street North Platte, NE 69101-5305 (308) 535-8195
DHHS may change the DHHS SUbaward Manager to be notified under this section via letter to Subreclplent sent by U.S. Mall, postage prepaid, or via email.
SUbaward Rev. 0812017
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IN WITNESS THEREOF, the parties have duly executed this subaward hereto, and acknowledge tllat the Individual signing below has authority to legally bind the party to this subaward,
FOR DHHS:
DATE: --'-!.-J-!.:!!!f..!.-!----
Subaward Rev, 08/2017
FOR SUBRECIPIENT:
A~dct~ .9z:,~ linda Foreman Director West Central Nebraska Area Agency on Aging
DATE: // /;0 /; 7 r I
Page 130f18
Attachment 1 SUB RECIPIENT INFORMATION & AUPIT REQUIREMENT CERTIFICATION
Silbreciplent$ receiving fUf1ds from the Nebraska Department: of Health and Human Services are reqll/red to complete this certification,
,·ii .'
Was! Central Nebraska Area Agency on Legal Name: .-'A"'g"'I"'o"'g _____________ _
DBA: ------------------------Address: 115 N Vine
City: North Platte State: Nebraska Zip Code +4: 89101-530",5 __
Subreclplent'a Fiscal Year: _J"'u"'IY'--1'-_______ 20 ..-1l- to Jun,,8,:.3=..O ____ 20 18
DUNS Number: 962077160 tl/:; Principal Place of Performance: CITY North Platte
Parent DUNS: _______ _
STATE Nebraska
Country: __ "'U""SA'-'--____ Zip Code + 4 69101·5~05
CongreSSional District: liIl 1" l1lI. 2nd ~ 3"'
,:.,!" .
All written communications from the Certified Public Accountant (CPA) engaged under #2 or 113 below, given to Subreclpient related to Statement of Auditing Standards (SAS) 122 Communicating Internal Control rela/ed Matters Identified In an AUdit, and Tile Auditor's Communioation with Those Charged WI//) Governanoe, and any additional reports issued by the auditor as a result of this engagement must be provided to the DHHS Immediately upon receipt, unless Subreciplent has directed the CPA to provide the copy directly to the DHHS and has verified this has occurred.
Check either 1, 2, or 3
1. .~ As Subreclplent named above, we expect to expend less than $750,000 from all Federal Financial AssistanCE) sources and do not expect to receive $100,000 or more In sub-awards from DHHS, Including commodities, during our fiscal year Therefore, we arG not subject to the audit requlremenls of 2 CPR 200 and do not need to submit our audited flnanolal statements to DHHS.
2. ~ As Subreclplent named above, we expect to expend less than $750,000 from all Federal Financial Assistance sources and expect to receive $100,000 or more in sub-awards from DHHS, Including commodities, during ourflsoal year Therefore, we are not subject to the audit requirements of 2 CFR 200.
We are, however, responsible for engaging a licensed Certified Public Accountant (CPA) 10 conduct an audit of our organization's flnanolal statements. We acknowledge that the audited financial statements shOUld be presented In accordance with generally accepted accounting prinCiples (accrual basis). If another basis of acoountlng Is more appropriate or If the accrual basis of accounting is overly burdensome, we will notify the DHHS of this Issue and request a waiver of this requirement prior to the end of our fiscal year. We further acknowledge the audit must be completed no laler than nine months after the end of our organization's current fiscal year. A copy of the report must be submitted to DHHS within the earlier of 30 days after receipt of the auditor's report(s), or nine months after the end of the audit period.
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1 Attachment 1 SUBRECIPIENT INFORMATION & AUDit REQUIREMENT .. CERTIEICATION
SubreclpiBnts rec«/vlng funds {ram the Nebraska Oepartment of Healt/! and Human Setvlces are requIred to complete thIs certif/ccttfon,
3. ~s Sub reCipient named above, we expect to expend $750,000 or more from all Federal Financial Assistance sources, Including commodities in our current fiscal year. There/ore, we are subject to the single audit requirements of 2 CF'R 200.
We will engage a licensed Certified Public Accountant to conduct and prepare the audit of our organization's financial statements and components of the single audit pertaining to those financial statements. We acknOWledge that the audited flnanclal statements should be presented In aooordance with generally accepted aooounting prtnolples (acorual basis). If another basis of accounting Is more appropriate or if the accrual basis of acoountfng Is overly burdensome, we will notify the DHHS of this Issue and request a waiver of this requirement prior to the end of our fiscal year. We further acknowledge the audit must be completed no laler than nine months after the end of our current flsoal year. We further acknowledge, that a single audit performed in acoordance with 2 cPR 200 must be submitted to the Federal audit Clearinghouse. The reporting package, as evidenoe the audit was completed must contain:
• financial statements, • a sohedule of Expenditure of Federal Awards, • a Summaly Schedule of Prior Audit Findings (If applicable), • a corrective action plan (If applioable) and • the auditor's report(s) which Includes an opinion upon financial statements and Sohedule of
Expenditures of Federal Awards, a report of Internal control, a report of compliance and a Sohedule of Findings and Questioned Costs.
We further acknowledge the auditor and this Subreolplent must complete and submit with the reporting package a Data Colleotlon Form for Reporting on Audits of states, Local Governments and Non-Profit OrganiZations (SF-SAC).
We further aoknowledge, thaI a single audit performed in accordance with 2 CFR 200 must be submitted to the Federal Audit Clearinghouse. The reporting package, as evidence Ihe audit was completed must oontaln:
• financial statements, • a sohedule of Expenditure of Federal Awards, • a Summary Schedule of Prior Audit Findings (if applicable), • a correctiVe action plan (If apPlicable) and • the auditor's report(s) which Includes an opinion upon financial statements and Sohedule of
Expenditures of Federal Awards, a report of Internal oontrol, a report of compliance and a Schedule of Findings and Questioned Costs.
We further aoknowledge the auditor and this Subreclpient must oomplete and submit with the reporting pacllage a Dala Collecllon Form for ReportIng on Audlls of Slates, Local Governments and Non-Profit OrganIzatIons (SF·SAC). We further aoknowledge a oOPY of the sub-reciplent's finanolal statements, auditor's report and SF-SAC must be submitted to the DHHS within the earlier of 30 days after reoelpt of the auditor's report(s), or nine months after the end of the audit period.
For items #2 and #3 above the required Information must be submitted to: Nebrasl<a Department of Health and Human Services Internal Audit Section P.O. Box 95026 LlnDoln. NE 68609-6026
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Page 15 of 18
Attachmenl1 SUB RECIPIENT INfORMATION & AUDIT REQUIREMENT CERTIFICATION
Subrec1plents receiving funds /r'Qm the Nebraska Department at Health and Human Services arc reqlJlred to complete th/$ certlflcatfan.
1~~DJ}~wllml!£§B\~1llMtmlil$~ml&1§lPls!ll1l_l'{fimtfJ'Ji'll:~~\.%~~1(~i:i1%\",;!iIll£~~~,~ti'\7#\W;l\l!!i.~1
1. In your business organization's previous fiscal year, did your business organization (Including parent organization, all branches, and all affiliates worldWide) receive 80% or more of your annual gross revenues In u.s. Federal contracts, subcontracts, loans, grants, sub-awards, and/or cooperative agreements AND $25,000,000.00 (twenty-five million dollars) or more in annual gross revenues from U.S Federal contracts, suboontracts, loans, grants, SUb-awards, and/or cooperative agreements?
lli: Yes - answer Question 2
~ No -not required to provide offloer compensation
2. Does the publio have access to Information about the compensation of the senior execUlive In your business or organization (Including parent organization, all branches, and affiliates worldwide) through periodic reports filed undar §13(a) or 15(b) of the Securities Exohange.Act of 1934(15 U.S.C.78m (a), 780 (d» or §6104 afthe Internal Revenue Code of 1986?
Yes
No - provide the names and total compensation of the five most highly compensated officers of the entity below
COMPENSATION
1. $~ ____ _
2. $ _____ _
3. $ _____ _
4. $ _____ _
6. $ _____ _
Printed Name; Iv I 1J:cA . .$, ~o i2..e JIY') ~ AI Title: c=)( .fr...u..T!0 e.. ~ \ vLee:iD IL-
Signature:c£ I~ cLCL--~ . 70 ~ bate: 11lla/11 .
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Page 16 of 18
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(fATA DATA REPORTING WORKSHEET Attachment 2
Instructions available on Intranet.
SUI3RE:CIPIENT NAME: Wast Centrat Nebraska Area Agency on Aging SUBRECIPIENT DUNS: 962077160
SU13AWARD NUMBER: ______ DHHS SIGNATURE DATE: ______ _
Amount funded from federal Grants: Amount funded from State General Punds:
Amount funded from State Cash Funds: Amount funded from Federal Cash Funds:
Total Subaward 90,721.00
The purpose of this subaward is to provide funding for services that meet tbe requirements of the Older Amerclans Act of 1965,As amended through P.L.114-144, enacted April 19, 2016, other applicable Federal Statutes and their Implementing regulations, state of Nebraska statutes, DHHS program regulations, and tha terms and oonditlons of this Subaward.
Federal Identifier Number GFDA Program (FAIN): 18AANET3SS Number: 93,044
Date added to , " , , Am~,\jnt ,FromTh.ls,I\\V,(lrd,: 11 ,345.00 subaward: 10/31/17
1·::·~A~fi;~::}:;1;~:Y;1~;%~:;;tb~.~:t:;§[,}~;:;}.)~::'!:~i'\:·:;!~~~~:Z:}::.;;·i;:{f:~.~:~·;:~·::;·!i:;'~~: ::",::;:. ,", '\ . :.:. :'':, <~'!~~~!,NC;;!~;;~~i~t.:;~~?)j~~X~S,~}.\t~.~::.:~;~~;:)::~G',\S{~;;.;.;~::f;~':::';·;:::
Federalldenlifier Number GFDA Program (FAI N): .J!lM~tE",Tc.=3-=cC",M __ i:;'N=-;um",b,-=e7-r:;-:r,.-___ 9""3",,O,-,4.=c5 __ _
, Date added to . '';t . ,',' ",. ;.
Federal Identifier Number (FAIN): 18AANET3HD
"','
Federal Identifier Number
Subaward Rev. 08/2017
(FAIN): 18AANET3PH
GFDA Program Number: Date added to
CFDA Program Number: Date added to
9~,045
.... ,:- ,"
93.043
: ... :'; .. :., .,':
Page 17 of 18
."' .: ',:
FFATA DATA REPORTING WORKSHEET
Instructions available on Intranet. Federal Id6ntifier Number
(FAIN): 18MNET3FC CFDA Program Number: Date added to
Amount From This Award: 10,535.00 subaward:
Attachment 2
93.052
10/31/17 (l+ .. ;T::\{!{;~::.'1'~;::,"',;.\':·~~;·::.~3:}{':;:;:)~",:: ~:: i :':::"~:'\':\';;':'\'~:-;\:':::i:;:"\:'1~\:~!\\' .:\:,;.~;')~;:.:. "~'1. 1, \ 1\' '.::.:}:'~'.;:: \':,:; ,:::~ .;":
For Grants Management Use Only: Received by Grants: FATA Processed by: ____ Report MonthlYear ___ _ Subaward Rev. 03/2016
Subaward Rev. 08/2017
Page 18 of 18
ATTACHMENT 3
/~-..
WCNAAA
FY 2018 BUDGET - GRAND TOTAL
TITLEill-B& TITLE ill-C(l) &
I CASA CASA
COST CATEGORIES
1. Personnel $ 45,S95.00 $ 62,40S.00
2. Travel $ 5,040.00 $ 6,000.00
3. Print & Supp. $ 325,00 $ 725.00
4. Equipment $ 325,00 $ 150.00
5. Build Space $ 3200,00 $ 4490.00
6. Co=. & Utilit. $ 2,300.00 $ 2,100.00
7. Other $ 8,S70.00 $ , 4,455.00
8a. Raw Food $ · $ .
8b. Contractual $ 575,620.00 $ 1,466,911.00
9. GROSS COST $ 641,575.00 $ 1,547,239.00
NON-MATCHING
10. Other Funding $ 5,184.00 $ 1513S.00
11 •. Title XXlMedicaid $ - $ 33,854.00
lIb. NSIP $ · $ 119398.00
12a. Income Cont./Fees $ · $ 62S,044.00
12b. TOTAL NON-MATCH $ 5,184.00 $ 796,434.00
13. ACTUAL COST $ 686,391.00 $ 75U,805.00
l-\U.TCH
14 •. Local Public",,,,, $ 120,842.00 $ 154,949.00
14b. Local Publlc(fn-Ki=<l.i $ 35,473,00 $ 35,472.00
15a. Local Other (lD.-Kmd) $ - $ · 15b. Local Other·Cash $ 123667.00 $ 167,876.00
16a. TOTAL LOCAL MATCH $ 279,982.00 $ 358,291.00
16b! Cost Less Match $ 356,409.00 $ 392,514.00 FUNDING
17 •. CASA I $ 162,313.00 $ 137300.00
17b. CASA (Used as Match.) $ · $ -18a. Reservation $ 194,096.00 $ 255214.00
18b. Special Award $ · $ · 18c. Care Manrurement $ · 1$ ·
18d TOTAL SUA COST $ 356,409.00 $ _?92,514.00
TITLE ill-C(2) &CASA
$ 39,549.00
$ 5200.00
1$ 390.00
$ 150.00
$ 3190.00
$ 1,190.00
$ 2,900.00
$ -
$ 764,871.00
$ 817,440.UO
$ 3,596.00
$ 122,318.00
$ 47,872.00
$ 199,230,00
$ 878,016.00
$ 444,424-00
$ 92,900.00
$ 35472.00
$ · $ 152,054.00
$ 280,426.00
$ 163,998.00
i $ 64,831.00
$ · $ 99,167.00
$ -$ · $ 163,998.00
,-~ . ,
TITLE ill-D & CASA
$ · $ · $ 500.00
$ -$ -$ · $ 536.00
$ · $ 10,700.00
$ 11,736.00
• $ -: $ -
$ · $ · $ -$ 11,736.00
$ 2,347.00
$ · $ · $ · $ 2,347.00
$ 9,389.00
$ · $ · $ 9,389.00
$ · $ · $ 9,389.00
May 1, 2017
~
Annual Budget FY 2017-18
TITLE ill E & CASAOnly Other Title VII TOTAL CASA Programs (not
funded by SUA)
$ 79,S23.00 $ 232,902.00 $ 50S,316.00 $ - $ 968,893.00
$ 5,972.00 $ 14,100,00 $ 25,720.00 $ · $ 62032.00
$ 770.00 $ 2,100.00 $ 5 100.00 $ - $ 9,910.00
$ 250.00 $ 250.00 $ 4,050.00 $ - $ 5,175.00
$ 5742.00 $ 14,700.00 $ 35,280.00 $ · $ 66,602.00
$ 1,690.00 $ 4,700.00 $ 10,400.00 $ · $ 22,380.00
$ 3,410.00 $ 7,000.00 $ 23,055.00 $ · $ 50,226.00 $ · $ - $ · $ · $ -$ 20,400,00 $ · $ - $ · $ 2,888,502.00
$ 118,057.00 $ 275,752.00 $ 611,921.00 $ - $ 4,023,720.00
$ 4,008.00 $ 40000.00 $ 23,000.00 $ · $ 90,926.00
$ · $ · $ 58S,921.00 $ · $ 745,093.00
$ · $ · $ · $ · $ 167270.00
$ · $ 250.00 $ · $ · $ 827,524.00
$ 4008.00 $ 40,250.00 $ 611,921.00 $ - $ 1,830 813.00 $ 114,049.00 $ 235,502.00 $ - $ $ 2,192,907.00
$ 2036.00 $ · $ · $ - $ 376,068.00
$ · $ - $ · $ · $ 106,417.00
$ · $ · $ · $ · $ -$ · $ · $ · $ · $ 448,597.00
$ 2,036.00 $ - $ - $ - $ 923,082,00
$ 112,013.00 $ 235,502.00 $ - $ - $ 1,269 825.00
$ · $ 76,676.00 $ · $ · $ 441,120.00
$ 34227.00 $ · $ · $ · $ 34,227.00
$ 77,786,00 $ · $ · $ · $ 635,652.00
$ · $ - $ · $ · $ -$ · $ 158826.00 $ · $ · $ 158,826.00 $ 112,013.00 $ 235,502.00 $ - $ - $ ,1,269,825.00
FY18 Submission
',-,
WCNAAA SFY18 Subaw,ard Number:
B C1
C2 D
E Fund Totals Sub-grant Totals
Funding from subaward 34323Y3 Amend 2' Funding from subaward 34323Y3 Amend 3 Funding from this subaward Not funded with this subaward" Budget (lSa. Reservation+ 18b. Special Award)
'remaining balances from SFY17
,--,'
Initial Subaward FY18 Fed FY18 Match
11,345.00 667.00
44,677.00 2,628,00 16,117,00 948,00
2,118.00 106,00
10,535.00 1,580.00 84,792.00 5,929,00
90,721.00
TITLE 111-8 TITlE 1II-C(1) 16,787.79 10,081.62 60,182.21 75,429.38 12,012.00 47,305.00
105,114.00 122,398.00 194,096.00 255,214.00
FY18 Fed FY18 Match FY18 Fed FY18 Match
0.00 0.00 0.00 0.00 0.00 0.00
TITLE 1II-C(2) TITlE III-D TITLE III-E 7,071.84 9,489.36 43,430.61
32,697,16 5,376.00 7,321.64 181,006,39 17,065.00 2,224.00 12,115.00 90,721.00 42,333.00 1,789.00 48,860.00 320,494.00 99,167.00 9,389.00 77,786.00 635,652.00
"additional funding will be provided with an amendment at a later date once DHHS receives another Notice of Award from the Federal gOl
10/1.8/2017
- .....-'
2:15 PM
