Conformity with the Application Monitoring Checklist Form

<strong>Conformity</strong> <strong>with</strong> <strong>the</strong> <strong>Application</strong><strong>Monitoring</strong> <strong>Checklist</strong> <strong>Form</strong>Community Investment and Assistance (CI)Community Development Block ProgramNote: All proposed activities and accomplishments are those as amended at <strong>the</strong> time of<strong>the</strong> monitoring visit.Grantee: ___________________________________Prepared by: ________________________________Grant Number: __________________________Date Prepared: __________________________Project Name: ________________________________________________________________________<strong>Conformity</strong> <strong>with</strong> <strong>the</strong> <strong>Application</strong>1.Does <strong>the</strong> Grantee’s project budget andexpenditures conform to <strong>the</strong> project budget inGMS? Explain any discrepancies.YesNoActivity Line Item Budget Expended (GMS) Expended (Grantee)Total:2.Does <strong>the</strong> Grantee’s Schedule of proposedaccomplishments conform to <strong>the</strong>accomplishments contained in <strong>the</strong> application? Ifnot, explain <strong>the</strong> reason for any discrepancies.YesNoProposed Accomplishments Completed to Date Comments3.Does <strong>the</strong> Grantee’s proposed LMI benefit byactivity match <strong>the</strong> actual LMI by activity? If not,explain <strong>the</strong> reason for any discrepancies.YesNoCDBG FORM #1Revised May 2011www.nccommerce.com/cdbgformsPage 1 of 3

Community Investment and Assistance (CI)Community Development Block Program10.Is <strong>the</strong>re evidence that <strong>the</strong> grantee is using <strong>the</strong>federal and state debarment lists prior toprocuring goods and services? Describe <strong>the</strong>method used by <strong>the</strong> grantee and identify <strong>the</strong>irdocumentation of <strong>the</strong> process.Schedule11.Is <strong>the</strong> grant on schedule? If not what is <strong>the</strong>projected date for completion of grantactivities and close out?YesNo12.How much local money has been expendedon <strong>the</strong> project to date? (Attach evidence oflocal expenditures.)NOTES:CDBG FORM #1Revised May 2011www.nccommerce.com/cdbgformsPage 3 of 3