HUD-90003 Congregate Housing Services Program Grantee Review

U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner

Congregate Housing
Services Program
Grantee Review

Note: In the case of a grantee with multiple project sites, a separate on-site review and review form must be completed for each project site.
Grantee (Provide full name and address)

Name and address of Project (If different)

Phone Number (include area code)

Phone Number (include area code)

Grant Number

Effective Date of Grant

Reviewer(s)

State/Area Office

FmHA State office

Date of Review (s)

A. Persons contacted for review (list additional persons in Item K Remarks on last page)
Name

B. Participants
1. How many are authorized
per the grant agreement?

2. How many long-term participants have
been in the CHSP for past 12 months?
Number of
Females

Number of
Males

Relationship to CHSP

3. How many temporarily disabled have
been in the CHSP for past 12 months?

White
Black
American Indian
Asian or
(Non-Hispanic) (Non-Hispanic) Alaskan Native Pacific Islander

Hispanic

4. How many applications have
been received in past 12 months?
5. How many accepted?
6. How many rejected?
7. How many on waiting list?
8. How many participants have been
terminated from the CHSP by the PAC?

9. How many
voluntarily?

Basis for appeals listed in item 10b: (what kind of appeals)

11. How many long-term participants have been
in the CHSP since beginning of program?

10a. Have any appeals been
filed against the CHSP?

10b. If Yes,
how many?

Outcome of appeals listed in item 10b:

12. How many temporarily disabled have been
in the CHSP since beginning of the program?

13. Are participatory agreements, signed by the program participants, in place and renegotiated annually?
(Participatory agreements govern the utilization of supportive services and payment of supportive service fees.)
Previous editions are obsolete

Yes
No

Page 1 of 6

Yes

No

form HUD-90003 (9/94)
ref Handbook 4640.1

Number of Units per
Participant per Month

C. Services Under CHSP
1. Service
Case Management

hours

Meals

meals

Housekeeping Aid

hours

Personal Assistance

hours

Transportation

No. of
Participants

Agency Provided
or Subcontracted

Annual %
Other Agency

HUD

Fees

one-way trips

Other

2. a. Check which meal(s) are being provided each day:

Breakfast

Lunch

3. Are special menus provided as necessary for meeting the dietary needs arising from health conditions
and/or religious and ethnic backgrounds?

Dinner

Served Hot?
Served in Group Setting?

Yes

No

Seven days a week?

Diabetic

Low Salt

Kosher

Other:

2. b. If no meals are served in a group setting, why not?

If Yes, please identify:
Low Fat

If No, why not?

4. Has grantee filed in project records the annual certification, prepared and signed by a registered dietitian,
stating that meals meet a minimum of one-third of the minimum daily dietary allowances as established
E\the Food and Nutrition BoaUd of the National Academy of Sciences-National Research Council, or
6WDWHRUlocal standards?
Yes

No

If not, when will it be submitted?

5. Are menus posted in locations conspicuous to the participants?

Yes

Do program participants have any input in the development of the menus?

No

How often are menus changed?

Yes

No

Describe.

Yes

6. Does the program have approval as a retail food store under Section 9 of the Food Stamp Act of 1977?
If so, is grantee accepting food stamp coupons as payment for meal services?

Yes

No

Yes

If not, did the grantee request such approval as required by the statute and grant document?

No

If not, why not?

No

7. Is grantee requesting and using agricultural commodities made available without charge by the Secretary of Agriculture:
Yes

If not, did the grantee request such approval as required by the statute and grant document?

8. Are services being provided to participants in compliance with the grant document?

Previous editions are obsolete

Page 2 of 6

Yes

No

No

If not, why not?

Yes

No

If not, why not?

If not, why not?

form HUD-90003 (9/94)
ref Handbook 4640.1

D. Staff
1. Activities

F/Time

P/Time

Positions

Comments

Case Management
Meals
Personal Assistance
Housekeeping
Transportation
Other

Administrative
2. Are there any staff vacancies?

Yes

No

If so, which positions?
Yes

3. Is a written job description on file for each position?

No

If not, explain.
Yes

4. Are there positions in place consistent with the approved budget?
5. Based on your observations, is the staffing appropriate for the program?

No
Yes

If not, why not?
No

Is the staff adequately trained?

Yes

No

Comment on any "No" response.

E. Service Coordinator
1. Based on your observations, is the Service Coordinator performing the duties cited in Section 700.220 or 1944.257 of the CHSP Common Rule, e.g. case
management and referral services, community service provider linkage to program participants, PAC paperwork,
implementation of case plans developed
Yes

by PAC, maintaining individual case files, training other management staff, etc.?
Yes

Is a copy of the Service Coordinator's job description on file?

No

No

Is an updated directory of providers for use by program staff and participants available and easily accessible to them?
If not, is one planned?

Yes

Yes

No

No

When will it be in place?
2. If the Service Coordinator is under contract with a third-party agency, is a copy of the current contract on file containing: beginning and ending dates of
the contract; number and responsibilities of staff hired; rates of pay/costs of services to be provided; location and an agreement to provide HUD access
Yes
No
to the files?
Yes

3. If the Service Coordinator is shared by more than one grantee, is there a signed agreement on file between/amoung owners?
Does it conform to grant agreement?

Yes

No

No

If not, why not:

4. Is the Service Coordinator trained subject to Section 700.220(b) or 1944.257(b) of the Common Rule?
If not, why not and when will the training be completed?
F. Fees
1. Are the fees for meals and other services those that were approved in the grant document?

Yes

Yes

No

No

If not, describe what changes were made to the fees, and what the reasons for the changes were. Has a request for approval of the revised fees been
submitted to the GTR and approved by the Desk Officer?
2.

3.

Are fees collected successfully?

Yes

No

Yes

No

If not, this must be done.

If not, why not?

Are any program participants paying more than 20% of their adjusted incomes for meals and other services?

Yes

No

If so, what arrangements will be made for (1) refunds and (2) budget adjustments if needed?

Previous editions are obsolete

Page 3 of 6

form HUD-90003 (9/94)
ref Handbook 4640.1

4*. Are the fees being collected for meals and other services sufficient to provide at least 10% of the cost of the CHSP?

Yes

No

If not, what does the grantee propose to do to meet this requirement?

5*. Are the utilized meals fees at least 10% of income or cost of service, if less ?

Yes

No

If not, why not?

What changes are needed to bring the fees into compliance with Section 700.240(d) or 1944.262(d) of the Common Rule?
* These items apply only to grants awarded in 1993 or thereafter.
6.
7.

Yes

Are correct fee amounts clearly stated in participatory agreements?

No

Have fees been established for non-CHSP participants residing in the project and non-residents?

Yes

No

N/A

If yes, are the fees in an amount equal to the cost of providing the services?

Yes

No

N/A

If not, are any non-participants or non-residents partaking of CHSP services on any basis?

Yes

No

N/A

(Note: If non-participants or non-residents are taking services at less than cost to CHSP, the project must end this practice immediately.)
8.

Yes

Are fees being charged to CHSP participants for meals provided by an Older American Act Program?

No

If yes, explain.

(This is prohibited per Section 700.240(c) or 1944.262(c) of the Common Rule.)

G. Professional Assessment Committee (PAC)
1. How many members are on the PAC?
______________
Yes

Are these the same persons as approved in the grant document?

No
Yes

If not, were resumes and commitment letters submitted to HUD for approval?

No

If not, make sure the grantee understands the need to make an immediate submission to HUD.
Yes

2. Are current PAC operating procedures in writing and in place?

No

If not, explain, including recommendation(s) to rectify.

Yes

Are current PAC procedures in conformance with the CHSP Common Rule at Section 700.225 or 1944.258?

No

If not, explain, including recommendation(s) to rectify.

Yes

3. Do the eligibility criteria used by the PAC address the Activities of Daily Living per Section 700.105 or 1944.252?

No

4. Does the PAC appear to be practicing nondiscrimination in selection of CHSP participants with respect to race, religion, color, sex, national origin,familial
status or type of handicap?

Yes

5. Are minutes kept of the PAC meetings?

No
Yes

No

If not, are the PAC meetings documented?

Yes

No

6. Are all PAC meetings attended by at least three PAC members, including at least one qualified medical or other health professional and social services
professional?

Yes

No

If not, explain.

Yes

7. Is complete confidentiality of information maintained in compliance with the Privacy Act of 1974?

H. Case Files
1. Does the grantee maintain individual files on accepted and rejected CHSP applicants?
If not, how does the grantee maintain a record of CHSP applicants and participants?
2. Are the files kept in a secure place?

Yes

No

Yes

No

No

If not, where are the files kept?

3. Who has access to the files?

Previous editions are obsolete

Page 4 of 6

form HUD-90003 (9/94)
ref Handbook 4640.1

4. Are the following items kept in each CHSP participant file? (Check one)

Yes

No

If not, how does grantee plan to rectify?

Participant's Application to CHSP
Race, Ethnicity, and Gender information
Fee Scale Computation
Current, Signed Participatory Agreement
Service Plan
Date of Entry to CHSP
PAC Assessment/Reassessments
Service coordinator's notes on monitoring of services received
Notes on all meetings with client/family
Info related to any reports of human or civil rights abuse, any type of
adult abuse, including followup, case resolution, or status, as appropriate.
Date of termination from CHSP
Appeals
I. Community Involvement
1. Is the owner/grantee maintaining a relationship with the Area Agency/State or local agency serving the elderly?

Yes

No

If not, why not?

Yes

2. Is the owner/grantee maintaining a relationship with the local agency serving the disabled?

No

If not, why not?

J. Financial Management
1. Is the grantee's books, records, and accounts for the CHSP independent from other sets of records and accounts?

Yes

No

If not, grantee must be directed to set up separate books immediately.
2. Is the grantee maintaining the following accounting records and other materials relative to CHSP?

Yes

No

If not, how does grantee plan to rectify?

Financial Statements
Trial Balance
General Ledger
General Journal
Cost Ledgers
Payroll Distribution Ledger
Employee Timecards showing actual time spent on CHSP
Cancelled Checks
Invoices to Support Payments to Subcontractors
Personnel Folders of CHSP Employees
Summary Schedule of Total Costs by Cost Category
Agreements, e.g. subcontractors
Personnel policies, including pay rate schedules, etc.
ADP and CHSP Equipment Inventory
Depreciation Policies and Basis
Copy of current Assistance Award (1044), grant document and attachments and all amendments thereto

All requests for advance or reimbursement, HUD-90198
Participant fee and match information to support the SF-269
All financial status reports, SF-269
Documentation of Indirect Costs
Procurment records showing all procurements made with CHSP funds, and documentation
of the history of the placement, administration, and closeout of the procurement
Previous editions are obsolete

Page 5 of 6

form HUD-90003 (9/94)
ref Handbook 4640.1

3. Do grantee financial records conform to Federal requirements and identify adequately the source and application of CHSP funds?
Yes

4. Are the financial records supported by documentation?

No

Yes

No

If not, what is the grantee doing to provide proper documentation?

Yes

5. Has the grantee established controls over and accountability for all CHSP funds and property?

No

If not, how do they propose to rectify the situation?

6. Does the grantee maintain time sheets for all CHSP staff showing actual time spent on the CHSP?
7. Are the grantee's financial reports, form HUD-90198 and SF-269, to HUD up to date?
8a. Are sufficient matching funds available to meet program requirements?

Yes

Yes

Yes

No

No

No

8b. Matching funds (other than participant fees) must meet the percentage of the total supportive service cost stated in the grant document.
If not, how does the grantee propose to meet and maintain the required percentage?

8c. If the grantee cannot meet this percentage, it must submit to HUD a request to have an adjustment made to decrease the Federal grant share accordingly.
Has this been done?

Yes

No

N/A

If not, when will they submit it?

K. Remarks.
1. Based upon your review of the records, is the program being carried out in a nondiscriminatory manner, in compliance with the civil rights requirements
applicable to this program?

2. Provide any comments, observations or recommendations not covered in any other section. Also, provide complete responses to other questions and your
general observation on the overall performance of the grantee. (add additional pages as necessary)

I certify that the grantee is operating the CHSP in compliance with HUD/FmHA requirements.
GTR (or Reviewer) (name, signature, and title)

Date

Reviewed: Chief Loan Management or Assisted Housing/Indian Housing Management or FmHA Management (name and title)

Date

Previous editions are obsolete

Page 6 of 6

form HUD-90003 (9/94)
ref Handbook 4640.1