Desk Guide Missouri Housing Trust Fund FY2013

Transcription

1 Missouri Housing Trust Fund Desk Guide FY2013

2 Table of Contents INTRODUCTION... 4 GENERAL INFORMATION... 5 COMPLIANCE... 6 REGIONAL HOUSING TEAM MEETINGS / CONTINUUM OF CARE MEETINGS HOMELESS MANAGEMENT INFORMATION SYSTEM (HMIS) ELECTRONIC FILES INCOME ELIGIBILITY GRANT ADMINISTRATION Rental Assistance Initial Grant Documents Request for Payment / Back-Up Forms On-Site Administration Records to Maintain Client File Forms Close Out Operating Funds Initial Grant Documents Request for Payment / Back-Up Forms Administrative Records Other Forms Close Out Construction / Rehabilitation General Information Prevailing Wage Initial Grant Documents Documents Received/Signed at Closing: Request for Payment / Back-Up Forms Contractor Invoice Documentation Other Forms Close Out Effective: April 1, 2013 Page 2

3 Home Repair Initial Grant Documents Request for Payment / Back-Up Forms On-Site Administration Records to Maintain Close Out Emergency Assistance Initial Grant Documents Request for Payment / Back-Up Forms On-Site Administration Records to Maintain Close Out Effective: April 1, 2013 Page 3

4 Introduction Purpose The purpose of the Missouri Housing Trust Fund (MHTF) is to provide funding for housing/service providers proposing housing/service activities, or related social services in the state of Missouri. History The MHTF was created by the RSMo Statute set forth by the 1994 Missouri State Legislature and it is supported by a three dollar recording fee on all real estate documents filed in the state of Missouri. Eligibility Requirements Who can apply? Any housing/service provider proposing housing/service activities or related social services in the state of Missouri can apply for Trust Fund money. Applicants must demonstrate prior successful housing experience and have the financial capacity to successfully complete and operate the housing and/or service proposed. The provider of services must have qualified staff and a successful record of providing the proposed services. Who can be served? As set forth in the RSMo Statute, all individuals served with MHTF must be at or below 50% of the Area Median Income (AMI). The AMI is defined by the Department of Housing and Urban Development (HUD), and can be obtained at the Missouri Housing Development Commission (MHDC) website at MHDC.com 2013 Funding Priorities For the 2013 grant year, the Community Initiatives staff recommended that the funding priorities are set according to the requests from the previous grant year. The MHDC Commissioners approved the following set priorities: 1. Rental Assistance: available to organizations that provide rent assistance to individuals in a permanent lowincome housing community 2. Operating Funds: available for organizations that provide housing or housing services for the purpose of paying salaries, benefits, or overhead costs necessary for operation of the organization 3. Construction/Rehabilitation: available for organizations that provide emergency, transitional, or permanent housing for the purpose of payment costs of new construction, modification, or rehabilitation of existing facilities 4. Home Repair or Modifications: available to organizations that provide housing services for the payments of certain repairs or modifications of homeowner-occupied homes 5. Emergency Assistance: available for organizations that provide assistance to recipients at immediate risk of becoming homeless; eligible uses of these funds include rent assistance and deposits, utility assistance and deposits, mortgage payments assistance, hotel/motel vouchers, and emergency home repair It is the purpose of the MHTF to serve the greatest housing and housing service needs in the state with attention given to the lowest-income residents in the areas where those needs exist. Effective: April 1, 2013 Page 4

5 Funding Regions for the 2013 Grant Cycle Allocation Area St. Louis Metropolitan Area: Crawford, Franklin, Jefferson, Lincoln, St. Charles, St. Louis City, St. Louis, Warren and Washington Counties South Region: Barry, Barton, Butler, Carter, Cedar, Christian, Dade, Dallas, Dent, Douglas, Dunklin, Greene, Hickory, Howell, Jasper, Laclede, Lawrence, McDonald, Mississippi, New Madrid, Newton, Oregon, Ozark, Pemiscot, Polk, Reynolds, Ripley, Scott, Shannon, Stoddard, Stone, Taney, Texas, Vernon, Wayne, Webster and Wright Counties Kansas City Metropolitan Area: Bates, Caldwell, Cass, Clay, Clinton, Jackson, Lafayette, Platte and Ray Counties Central Region: Audrain, Benton, Bollinger, Boone, Callaway, Camden, Cape Girardeau, Cole, Cooper, Gasconade, Henry, Howard, Iron, Johnson, Madison, Maries, Miller, Moniteau, Montgomery, Morgan, Osage, Perry, Pettis, Phelps, Pulaski, Saline, St. Clair, St. Francois and Ste. Genevieve Counties North Region: Adair, Andrew, Atchison, Buchanan, Carroll, Chariton, Clark, Daviess, DeKalb, Gentry, Grundy, Harrison, Holt, Knox, Lewis, Linn, Livingston, Macon, Marion, Mercer, Monroe, Nodaway, Pike, Putnam, Ralls, Randolph, Schuyler, Scotland, Shelby, Sullivan and Worth Counties General Information Distribution Percentage 32% Website All information and forms pertaining to the FY2013 MHTF grant year can be found under FY 2013 Items on the MHDC website at: Contacts Below are the contacts for your FY2013 MHTF grant year. Joselyn Pfliegier is the primary contact for the MHTF grant. Please direct all questions, concerns, updates and submission of documents to her, with the exception of Payment Requests and Back Up forms. All Payment Requests and Back Up forms shall be submitted to Community Initiatives Department, at the below address. Joselyn Pfliegier Community Initiatives Coordinator 3435 Broadway Kansas City, MO (816) Missouri Housing Development Commission Community Initiatives Department 3435 Broadway Kansas City, MO % 24% 15% 11% Effective: April 1, 2013 Page 5

6 Timeline FY2013 NOFA Posted on MHDC Website: June 2012 Application Workshops: August 2012 Proposal Deadline: September 14, 2012 Staff Recommendations: December 11, 2012 Awards Notification: January 2013 Funded Training: February 2013 Grant Year Begins: April 01, 2013 Quarter 1 (Q1): April 1, 2013 June 30, 2013 Q1 Payment Request Deadline (MHDC-KC office): June 28, 2013, 4:40 p.m. Quarter 2 (Q2): July 1, 2013 September 30, 2013 Q2 Payment Request Deadline (MHDC-KC office): September 30, 2013 Quarter 3 (Q3): October 1, 2013 December 31, 2013 Q3 Payment Request Deadline (MHDC-KC office): December 31, 2013 Quarter 4 (Q4): January 1, 2014 March 31, 2014 Q4 Payment Request Deadline (MHDC-KC office): March 31, 2014 Last Day to Expend Funds: March 31, 2014 Final Payment Request Deadline (MHDC-KC office): March 31, 2014, 4:30 p.m. Final Back Up forms Deadline (MHDC-KC office): April 30, 2014, 4:30 p.m. Grant Close Out Deadline: April 30, 2014 Compliance During the grant year, MHDC staff will evaluate the grantee s capacity to administer their MHTF grant. The grantee s capacity will be evaluated using three compliance levels: minor, moderate and major violations. Grantee s capacity will be assessed during on-site compliance visits conducted at the designated grantee location as well as through grantee s ability to meet administrative requirements such as meeting required deadlines and submitting fully complete documents. On-Site Compliance Visits An MHDC staff member will review grantee files at the designated site at least twice during the grant year. One of the visits will be announced and one will be unannounced. During each site visit, the MHDC staff member reviews instances of assistance for direct service grants: Rental Assistance, Home Repair and Emergency Assistance. MHDC staff will review 20% of the instances of assistance with a minimum of five (5) and a maximum of twenty (20) randomly chosen instances per visit to check for the required maintained records. This information is gathered from the HMIS / Detail Report submitted with grantee s back-up. In addition, if grantee chooses to take the 10% administrative fee, MHDC will also review 20% of the amount submitted. For Operating grants, MHDC staff will review 20% of the amount of operating expenses that have been submitted to MHDC for payment. The MHDC staff member will not provide the grantee the names of the files to be checked prior to the visit; this is to ensure that all files will be reviewed in the state in which they are normally kept. The requested files are expected to be produced within fifteen (15) minutes of the MHDC staff Effective: April 1, 2013 Page 6

7 member s arrival. Failure to produce requested files within fifteen (15) minutes will result in a major compliance violation*. Therefore, it is vital that a grantee staff member is always available to assist the MHDC staff member as needed at the location and during the times provided by grantee. At the conclusion of the site visit the MHDC staff member will discuss the findings of the visit with the appropriate grantee staff member. The MHDC staff member will send a site visit report within two weeks after the visit detailing findings. * The only exception is if a staff member is assisting a client. Announced Visit The announced site visit is scheduled by MHDC staff with the grantee. If MHDC staff is unsuccessful in scheduling a site visit after three (3) attempts have been made via telephone and/or , MHDC staff will send a letter to the grantee informing them that they have fifteen (15) days to schedule a site visit, otherwise their funding will be suspended and this will be a major compliance violation, where funds are subject to recapture. Typically, the announced site visit will be conducted before the unannounced site visit. Occasionally, there are exceptions to this, but grantee will be made aware if the unscheduled visit will be conducted first. Unannounced Visit As previously stated, the unannounced site visit is typically conducted after the announced site visit has been completed. The announced visit will be conducted by a MHDC staff member at the location and times furnished by the grantee in the original application, updated on the Site Contact Form or updated via to Joselyn Pfliegier (whichever is most recent). If a MHDC staff member attempts to conduct an unannounced site visit and the designated grantee location is closed or staff is unavailable, this will result in a major compliance violation. It is the grantee s responsibility to notify MHDC if business hours change or if the grantee will be closed for an extended amount of time. Other If any allegations are made regarding employees putting clients in danger; an immediate site visit will take place and the Community Initiatives Manager will determine compliance violation up to and included grant recapture. Effective: April 1, 2013 Page 7

8 Out of Compliance If the MHDC staff member finds that the grantee is out of compliance for reasons such as the files have not been kept to the specified standard, individuals have been assisted who do not meet the income limits or the facility is unsanitary or unsafe, the MHDC staff member will record that the grantee is out of compliance. Until the MHDC staff member has verified that the issue(s) has/have been resolved, funding will be suspended for all MHTF grants awarded to the grantee. During this time, the MHDC staff should be used as a resource to determine what needs to be corrected. If the grantee is out of compliance it will not be until the next completed Back-Up Form is submitted that a MHDC staff member will conduct a follow-up site visit. The follow-up site visit will be based on the most recent back-up documentation. This site visit will be completed within thirty (30) days of receiving the back-up. If the issue(s) that caused the grantee to be out of compliance are resolved after the follow-up site visit review, the MHDC staff member will send the grantee a letter informing them that their funding is no longer suspended. If the issue(s) that caused the grantee to be out of compliance are still not resolved after the follow-up site visit review, the MHDC staff member will send the grantee a letter informing them of their findings and funding will continue to be suspended. If the grantee is determined to be an unclean or an unsafe environment: The grantee will be notified that their funding will be suspended until they have made the necessary accommodations to make the grantee environment clean and safe. A MHDC staff member will return for another site visit to verify changes; upon the MHDC staff members approval, funding will be reinstated. If the grantee is lacking files: The grantee will be notified that their funding will be suspended until they have an appropriate system for maintaining client information. Please utilize MHDC staff as a resource to assist in creating/maintaining a filing system. Once Back-Up Forms have been received, a follow-up site visit will take place. If the files are in order after the follow-up site visit, the MHDC staff member will send the grantee a letter informing them their funding is no longer suspended, but the next time the grantee requests funds, a MHDC staff member will do another file review with names from the new Back-Up Forms before releasing funds. If the files are not in order after the follow-up site visit, the MHDC staff member will send the grantee a letter informing them of their findings, and funding will continue to be suspended. *If a third site visit must be conducted regarding the same compliance issue, grantee funding will be subject to recapture. If no personnel are present at an unannounced visit: The grantee will be sent a letter notifying them of the attempted unannounced site visit and that the grantee is out of compliance. Additionally, if the grantee personnel refuse the site visit, the grantee will be out of compliance. Both incidences will be considered in their future grant applications. If no grantee staff is available for the second attempt, funding will be suspended until a compliance officer is able to complete the site visit. On the third attempt, if no grantee staff is available again the remaining grant is subject to recapture. Effective: April 1, 2013 Page 8

9 Compliance Violations Below is a detail of the minor, moderate and major compliance violations as well as the consequences of each violation. Minor Moderate Major Minor violations will be noted in grantee file and points will be assessed during future application cycles. 1. Client file does not contain all required documentation Moderate violations will be noted in grantee file and points will be assessed during future application cycles. Points assessed for moderate findings will be greater than with minor findings. 1. Funded grant training not attended 2. Funded grant documents not received by deadline 3. Two or more submissions of incomplete/incorrect grant documents by grantee 4. Payment Request and/or Back-Up forms discarded three or more times during a quarter 5. Payment Request and/or Back-Up forms discarded five or more times during grant year 6. Funds not drawn quarterly 7. Construction: Payroll submission incomplete 8. Construction: Payroll submission late 9. Grant not fully closed by due date (All funds backed up, all required documentation received and correct) 10. Did not attend required number of CoC/RHT meetings for grant year 11. Not within 10% of MWOB projections on Close Out 12. Not within 10% of 25/50 AMI projections on Close Out 13. Required Regulatory Agreements not received / approved before work began on Home Repair projects $2000 and over 14. Outcome goals were not met Major violations will be assessed as indicated below: Description Action Taken 1. Grantee not funded within last two funding periods currently Noted points assessed during future application cycles out of compliance with MHTF 2. Grantee out of compliance for more than one site visit Noted points assessed during future application cycles 3. Site Visit Compliance: More than ½ of files reviewed during on-site compliance visit contained a minor finding; Files unable to be reviewed during visit; files not produced within 15 minute time frame 4. Grant partially / fully recaptured resulting from funds not fully expended by end of grant term or other non-compliance. Out of Compliance status; suspension of funds; points assessed during future application cycles; Requires follow up visit to reinstate in compliance status and reinstate funding Noted points assessed during future application cycles 5. Grantee deemed to be unsafe or unsanitary Out of Compliance status; suspension of funds; points assessed during future application cycles; Requires follow up visit to reinstate in compliance status and reinstate funding 6. Grantee will not schedule visit; after multiple attempts and Noted points assessed during future application cycles no response from letter sent within fifteen (15) days of date of letter 7. Files unable to be reviewed during visit Out of Compliance status; suspension of funds; points assessed during future application cycles; Requires follow up visit to reinstate in compliance status and reinstate funding 8. Files not produced within 15 minute time frame Funds subject to recapture; points assessed during future application cycles 9. Allegations of clients being put in danger by grantee Out of Compliance status; funds subject to recapture; suspension of funds; points assessed during future application cycles; Requires follow up visit to reinstate in compliance status and reinstate funding Effective: April 1, 2013 Page 9

10 Regional Housing Team Meetings / Continuum of Care Meetings In an effort to encourage collaboration and knowledge of services within areas of the state, all Missouri Housing Trust Fund agencies will be required to sign in and attend at least 75% of all Continuum of Care (CoC)/Regional Housing Team Meetings designated in the grant agreement. These meetings bring together many different agencies working toward the improvement of housing and ending homelessness in the state of Missouri. Grantee will be required to submit attendance sheet(s) for meetings attended at the close out of the grant. In the rural communities, these meetings are held quarterly. In urban areas they occur monthly. If you have any questions about which meeting your agency should attend please refer to the grant agreement. The following is the contact information for each area. Here is a link to the map of the Continua of Care regions: Area: Contact Person: Balance of State Marlene Shriver- (314) Kansas City Metro Vickie Riddle-(816) St. Joseph Linda Judah (816) St. Louis City Antoinette Triplett-(314) St. Louis County Pamela Neal-(314) St. Charles Dottie Kastigar-(636) Springfield Michelle Garand-(417) Joplin Tammy Walker (417) Homeless Management Information System (HMIS) All agencies providing Emergency Assistance and Rental Assistance are required to enter data into the HMIS system of their continuum (grantees are exempt from entering data into HMIS systems for specifically excluded populations i.e. domestic violence victims, foster children and clients that do not consent to being entered into an HMIS system). The data must be entered into the HMIS system that represents the county of service. If grantee serves persons with MHTF monies in multiple continua, please ensure that the HMIS data is entered into all appropriate HMIS systems. The following is the contact information for each area: CoC Contact Person: Balance of State, Springfield and Joplin Sandy Wilson- (573) St. Louis City, St. Louis County, & St. Charles Deb Little -(314) Kansas City and St. Joseph John Rich-(816) Electronic Files If the grantee elects to maintain electronic files in lieu of paper files, the grantee will be required to print off all required documentation for compliance visits. As with all files, the time limit to produce these files is fifteen (15) minutes during a site visit. Effective: April 1, 2013 Page 10

11 Income Eligibility As set forth in the RSMo Statute all households assisted through the MHTF are required to be at or below 50% of the Area Median Income (AMI). If the AMI for the county of service is lower than the Missouri State AMI, grantee shall use the AMI for the State to determine eligibility. Please refer to Maximum Income Limits (Form: MHTF-251) to determine recipient eligibility. Grantees are highly encouraged to use Direct Assistance Summary / Income Worksheet (MHTF-245) to determine income eligibility for all instances of assistance. The income limits are to be used throughout the entire FY2013 grant year unless otherwise notified by MHDC. Currently the MHTF program bases its calculation method from HUD s Part 5 definition; however, there are minor differences. Standard Forms of Income Grantees are expected to utilize the list below when calculating their client s income. Inclusions: Income from all members of the household age 18 and over Gross wages Full amount of periodic payments Unemployment, Worker s Compensation, Severance Entitlements (TANF, SSI) Periodic and determinable allowances (alimony and child support) Net income from business operations Interest, dividends or other net income from personal property Exclusions: Income from children under 18 years of age Foster care payments Lump sum payments Reimbursement or payment of medical expenses Income of live-in aide Financial Aid Resident service stipend (part-time work that enhances the quality of life not to exceed $200/month) Temporary, non-recurring income (gifts) Earnings over $480/years for full time students 18 years and older (excluding Head of Household) Adoption assistance payments Amounts paid by state to household with a developmentally disabled child to keep them in the home Food Stamps LIHEAP Earned Income Tax Credit WIC Payments Effective: April 1, 2013 Page 11

12 Additional Forms of Income when a household s assets have a value of $5,000 or over, that should be included as income. Inclusions: Cash held in savings and checking accounts, safe deposit boxes, home, etc. Cash value of revocable trusts Equity in rental property Cash value of stocks, bonds, treasury bills, CDs and money market accounts Individuals Retirement and Keogh Accounts Retirement and pension funds Cash value of life insurance policies Personal property held as an investment Lump sums not intended as periodic payments Exclusions Necessary personal property (clothing, furniture, cars, primary residence, etc.) Interest in Indian Trust Lands Assets not effectively owned by applicant When assets are held in an individual s name, but the benefit is to someone that is not in the household Equity in co-operations in which the family lives Assets not accessible to and that provide no income Term life insurance policies Assets that are part of an active business Effective: April 1, 2013 Page 12

13 Direct Assistance Summary / Income Worksheet (MHTF-245) Applicable Grant Type(s): Rental Assistance, Home Repair, Emergency Assistance, Operating Due Date: Within 30 days of every instance of assistance No Use is HIGHLY recommended Submission / Retention: Retained in client file This form intended to be used to verify income eligibility as well as to summarize all assistance details for every instance of assistance. This form will also serve as a checklist for grantees as well as MHDC staff when an on-site compliance visit is conducted. This form contains all the elements reviewed during a compliance visit. Completion Instructions: The electronic form can be obtained on the MHDC website at MHDC.com. This form should be completed for every instance of assistance. 1. Household Members: Complete Household information for all members of the household. The Total Number of Members in Household will automatically calculate depending on the number of persons listed in the Household Members section. The number of members in the household is used to automatically calculate the AMI for the household size; therefore it is very important that all members of the household are included in that section. 2. Income Calculation: This step must be completed before the calculation of Area Median Income. Once all the members of the household are listed, income will need to be calculated for all members 18 and older. There are eight Income tabs at the bottom of the workbook which contain an income calculation worksheet. A separate tab should be used for each individual in the household that is over 18 years of age. If an individual has zero income please indicate Zero Income under Income Type and record the date the Zero Income Certification was signed under Date of Income / Letter. If individuals share assets (i.e. couple that has a shared savings account) which will be used in calculating income, please only list the assets on ONE income calculation worksheet, otherwise the assets will be calculated twice. 3. Area Median Income (AMI): Once all of the income calculation worksheets have been completed for all members of the household 18 and older, the AMI can be calculated. Choose the county of service from the drop down. If the county of service is not listed then that county s AMI is lower than the State AMI and the MISSOURI - State should be selected. Once the appropriate county is selected the AMI breakdown for that selection should populate. The total household income is automatically calculated and is populated from the individual income calculation worksheets. The service provider can then compare the household income to the AMI breakdown for the county of service to determine if household meets income eligibility requirements. 4. Assistance Information: This section summarizes the assistance information that is required to be kept for MHTF files. This is information that MHDC staff will look at in the client file during the audit. The completion of this section should act as a checklist for required information/items for compliance site visits. Submission Instructions: Retained in client file for every instance of assistance. Effective: April 1, 2013 Page 13

14 Direct Assistance Summary / Income Worksheet (MHTF-245) - Example Effective: April 1, 2013 Page 14

15 Grant Administration Rental Assistance The administration of your FY2013 MHTF grant will consist of forms/documents/information that will be submitted to MHDC and forms/documents/information that is required to be kept on site. This section will discuss, in detail, the requirements for document submission as well as the information that is required to be kept on site for this grant type. Throughout this section, forms that require submission will indicate if a hard-copy or electronic version is required. Below is the information for each submission, please ensure that the document is submitted to the Community Initiatives Department. Hard-Copy Submissions: Electronic Submissions: Missouri Housing Development Commission Community Initiatives Department 3435 Broadway Kansas City, MO jpfliegier@mhdc.com Initial Grant Documents Before any funds can be released, all required initial grant documents must be complete and received by MHDC by April 1, Grant Agreement (Agency Grantee) Due Date: April 1, 2013 The grant agreement is required for Rental Assistance, Operating Funds, Home Repair and Emergency Assistance grantees. The grant agreement specifically details the requirements and expectations for the administration of the grant. It is the grantee s responsibility to know and adhere to all provisions set forth in the grant agreement. Completion Instructions: There are three places where the Grant Agreement must be signed by grantee: 1. Signature page signature and notary. 2. Workforce Eligibility Affidavit signature and notary; and 3. Rider B signature. All signatures must be ORIGINAL and by an authorized signatory as designated in MHTF The entire original signed, notarized agreement must be returned to MHDC to be considered complete. If any pages of the grant agreement are missing, the Grant Agreement will not be considered complete. Please note that the Rider A is a part of your grant agreement and specifically details the eligible uses for the grant year. Submission Instruction: Hard-copy, original signatures to Joselyn Pfliegier Effective: April 1, 2013 Page 15

16 2013 Land Use Restriction Agreement (Rental Assistance) Applicable Grant Type(s): Rental Assistance, Emergency Assistance Due Date: April 1, If grantee is paying rental payments on behalf of a client AND the property is owned by grantee - Community Initiatives Department The Land Use Restriction Agreement (LURA) for Rental Assistance grantees is an agreement between grantee and MHDC stating that the grantee will adhere to terms of the LURA for the period of the current grant year. Terms of the LURA include but are not limited to: grantee designating number of units which will exclusively serve persons at or below 50% AMI. Completion Instructions: A fillable version of the LURA will be provided to the grantee to provide grantee specific information including the legal description of the property. Once grantee completes, grantee will send an electronic version of the LURA with an electronic version of the deed to Joselyn Pfliegier for review and approval. Once approval is received, grantee will submit the hard-copy version with copy of deed to Joselyn Pfliegier for recording. Submission Instructions: Draft electronic version to Joselyn Pfliegier; Approved hard-copy, original signatures to Joselyn Pfliegier Direct Deposit Form (MHTF-340) / Blank Check Due Date: April 1, 2013 All disbursements from MHDC to grantee will occur using an Electronic Funds Transfer (EFT). This form is required to be submitted with initial grant documents. It provides MHDC with the grantee s banking information for the electronic transfer. A blank voided check from the indicated banking institution is also required to be submitted with the Direct Deposit form. Please note that by default your grantee s banking information will be updated for ALL MHDC accounts. If the banking information provided is for Missouri Housing Trust Fund or one grant ONLY it must be indicated on the direct deposit form. Completion Instructions: PDF fillable form can be obtained at MHDC.com. Form must be signed with original signatures by authorized signatory. Submission Instructions: Hard-copy, voided hard-copy check, original signatures to Joselyn Pfliegier Authorized Signature Card (MHTF-240) Due Date: April 1, 2013, updated as needed This form designates all authorized signatories for each grant. All documents/forms that are required to be signed by grantee MUST be signed by a designated authorized signatory from this form. If an unauthorized person signs a document/form, the document/form will be rejected. Completion Instructions: Electronic form can be obtained from MHDC.com. Form must designate AT LEAST two authorized signatories. The form must have ORIGINAL signatures from all designated Effective: April 1, 2013 Page 16

17 Submission Instructions: signatories. Please note the Authorizing Official must sign in the Authorizing Official box as well as at the bottom of the form. Hard-copy, original signatures to Joselyn Pfliegier Outcome Detail Form (MHTF-241) Applicable Grant Type(s): Rental Assistance, Operating, Home Repair and Emergency Assistance Due Date: April 1, 2013 This form will specifically detail the outcomes that will be tracked for the FY2013 grant year. Grantee should concisely detail WHAT, WHEN, WHOM, HOW MUCH, HOW YOU WILL KNOW and OUTPUTS for each outcome. Completion Instructions: Grantee will complete the above information for the two outcomes listed. Grantee should designate two distinct elements that will be observed, measured and reported on for the FY2013 grant year. Submission Instructions: Hard-copy, to Joselyn Pfliegier W-9 Applicable Grant Type(s): Rental Assistance and Emergency Assistance Due Date: April 1, 2013 If grantee is making one or more rental payments for recipient The W-9 is required for grantees that will pay rent payments for recipients. Completion Instructions: A PDF fillable form can be obtained from MHDC.com. The information provided on the W-9 that will be submitted to MHDC is for the grantee. Submission Instructions: Hard-copy to Joselyn Pfliegier Sources and Uses (Grant Agreement) Due Date: April 1, 2013 The Sources and Uses details the program budget for the FY2013 grant year. Completion Instructions: Grantee shall update the Sources and Uses from what was initially provided at time of application. The updated Sources and Uses should reflect the actual amount of MHTF funds awarded for this grant. If grantee received more than one grant with MHTF for the FY2013 grant year. The funds should be designated in separate columns. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier E-Verify Memorandum of Understanding (MOU) Due Date: April 1, 2013 The E-Verify MOU is an agreement between the Department of Homeland Security (DHS) and Grantee stating that grantee agrees to participate in the Employment Eligibility Verification Program (E-Verify). Completion Instructions: Grantee shall submit a copy of the full and complete MOU. Submission Instructions: Hard-copy, to Joselyn Pfliegier Effective: April 1, 2013 Page 17

18 Certificate of Liability Insurance Due Date: April 1, 2013 The Certificate of Insurance is a one page summary of Liability Insurance held by grantee. The insurance held by grantee may include: General Liability, Automobile Liability Umbrella Liability, Excess Liability, Worker s Compensation and Employers Liability. The Certificate of Liability Insurance must be current. If coverage lapses during to the grant year, grantee must provide MHDC with an updated Certificate. Completion Instructions: Grantee shall provide a copy of the Certificate of Liability Insurance. Submission Instructions: Hard-copy to Joselyn Pfliegier Site Contact Form (MHTF - 252) Due Date: April 1, 2013 This form will be submitted with initial grant documents. This form is to ensure that MHDC has updated information for the upcoming grant year. The site visit locations and hours of operation will be used to conduct scheduled / and unscheduled site visits. Completion Instructions: Complete information pertaining to the grant indicated at top of form. Submission Instructions: Hard-copy to Joselyn Pfliegier Request for Payment / Back-Up Forms Before any funds can be released the following criteria must be met: 1. All previous MHTF grants must be completely closed out*: a. All funds expended; b. Close Out form received; c. Updated Sources and Uses; d. Audit/current audit letter are complete and received; and e. Previous grant(s) are fully backed up. 2. All current year grant documents are complete and received. 3. All previous compliance issues are resolved (i.e. grantee is in compliance ). Once all the above criteria are met, grantee may then begin requesting funds from their FY2013 grant. Receiving funds for your MHTF grant is split into two processes: Request for Funds and Back-Up form. This is split into two processes to allow grantees to advance up to 25% of their grant award throughout the year. Once funds are advanced, that amount must be backed up before any further funds will be released. * Exceptions for ongoing MHTF Construction projects with current extension and ongoing Rental Assistance grants from FY2010 and earlier. Request for Payment The grantee may submit a Request for Payment as of April 1, The grantee may choose to draw up to 25% of their total grant award without back-up documentation. The following form must be used for all requests for payment: Effective: April 1, 2013 Page 18

19 Request for Payment (MHTF-301) Due Date: At least quarterly until funds expended The Request for Payment form is required to be submitted for any and all disbursements of grantee funds. Completion Instructions: All fields are required to be completed for Request for Payment form to be accepted and processed. 1. Complete general fields: Date, Grantee, MHTF #, Grant Type, Grant Award Amount and Site Address. 2. Requested Amount. No more than 25% of the grant award amount can be requested without back-up. 3. Place an X for which disbursement is being submitted. If Final Disbursement please indicate. 4. Place an X for type of disbursement. All grantees MUST INDICATE type of disbursement that is being made. a. Rental Assistance grantees: All direct assistance will fall under the Rental Payment category (as deposits and arrears are not eligible expenses under this grant type). Submission Instructions: Hard-copy, original signatures to the Community Initiatives Department Quarterly Draws The grantees must have a minimum of one disbursement per quarter. MHTF quarters and submission deadlines are detailed above under Timeline FY2013 Incomplete/Ineligible Requests for Payment If the grantee submits a Request for Payment that is incomplete/ineligible MHDC will notify grantee that the Request for Payment is incomplete/ineligible, MHDC will discard the Request. Grantee will need to submit a new and complete Request for Payment. EXAMPLES: Unsigned or dated forms, previous request not fully backed-up, compliance issues, etc. Effective: April 1, 2013 Page 19

20 Back-Up Grantee is required to submit the following form to account for all MHTF spending during the FY2013 grant year. Back-Up For Rental Assistance (MHTF-314) Applicable Grant Type(s): Rental Assistance Due Date: Before disbursement of additional funds, after initial disbursement. Completion Instructions: 1. General Information / Back-Up Check List / Summary: All fields in these sections are REQUIRED. If information is missing from these sections, the Back-Up form will be considered incomplete and will be discarded. 2. Summary of Direct Assistance by Region: This section summarizes the information from the attached HMIS report / Non-HMIS Client Detail Report. Please pay attention to the regions in which MHTF monies are spent. Monies cannot be spent outside of the region(s) specified in the grant agreement. 3. Total HMIS Summary: This section is a summary of all HMIS Reports/ Non-HMIS Client Detail Reports submitted with the back-up. Please note that each line should represent the sum of the entire HMIS report / Client Detail Report not the page totals. Please limit each Back-Up form to ten (10) HMIS / Client Detail Reports per submission. Additional Reports will need to be included in a separate back-up form. 4. Administrative Detail Report (if taking 10% administrative fee): If a grantee chooses to take the 10% administrative fee (as indicated in grantee s Rider A ), the Administrative Detail Report form is required to be completed detailing all expenses that will be charged to MHTF. Support for these charges will be kept on site for review during site visits. DO NOT SUBMIT AMINISTRATIVE BACK-UP SUPPORT TO MHDC. This form is a part of the Back-Up form and separate tabs on the Excel Back-Up form. For staff salaries please include the last four digits of the employee s Social Security number in the detail section of the Administrative Detail Report Form. 5. Back-Up Total Summaries: This section sums up all back-up being submitted in report. a. Total Direct Assistance Summary of all HMIS / Client Detail Reports submitted for back-up, summed from the line item detail entered above. This number should equal the Total Spent for all regions from the Summary of Direct Assistance by Region section. b. Total Operating Cost Claims Summary from all Administrative Detail Reports completed with this Excel workbook. This total automatically sums from the Administrative Detail Report completed. c. Total MHTF Grant Funds Expended Summary of Total Direct Assistance and Total Operating Cost Claims Submission Instructions: Hard-copy, original signatures to Community Initiatives Department Effective: April 1, 2013 Page 20

21 Back-Up For Rental Assistance (MHTF-314) - Example 1 2 Auto fill 4 3 a 5 b c Effective: April 1, 2013 Page 21

22 Incomplete/Ineligible Back-Up If the grantee submits a Back-Up form that is incomplete/ineligible MHDC will notify grantee that the Back-Up is incomplete/ineligible, MHDC will discard it. Grantee will need to submit a new and complete Back-Up form, including all attachments and original signatures. Other Back-Up Forms HMIS Report Applicable Grant Type(s): Due Date: Submission / Retention: Completion Instructions: Submission Instructions: Rental Assistance and Emergency Assistance Submitted with Back-Up form Submitted to MHDC with Back-Up form The HMIS report is generated from the respective HMIS systems. The report generated details information about each instance of assistance as well as a sum of the direct assistance. The entering of information and the generating of the report should be executed as instructed by HMIS system. All Rental Assistance and Emergency Assistance recipients should be entered into the appropriate HMIS system unless the recipient is a part of a protected population (i.e. domestic violence, youth) or refuses to be entered into the HMIS system. The HMIS report should be submitted with the appropriate Rental Assistance or Emergency Assistance Back-Up form. The HMIS report does require original signatures by an authorized signatory as designated in MHTF-240. Non-HMIS Client Detail Report Form Emergency Assistance (MHTF-322) / Rental Assistance (MHTF-324) Applicable Grant Type(s): Rental Assistance and Emergency Assistance Due Date: Submitted with Back-Up form (if applicable) ONLY for recipients that are not entered into HMIS (i.e. domestic violence, youth, refused to be entered into HMIS) with Emergency Assistance Back-Up form The Non-HMIS Client Detail Report Form is specifically for recipients that have not been entered into an HMIS system. These recipients would include protected populations (i.e. domestic violence, youth) or recipients which refuse to be entered into the HMIS system. If grantee submits both an HMIS report AND the Non-HMIS Client Detail Report Form, all instances of assistance listed should be distinct from each other. There should be NO DUPLICATION of instances of assistance between the two reports. Completion Instructions: Grantee should complete all fields for every instance of assistance. Therefore if recipient is receiving repeated service (i.e. rent paid for multiple months) every instance of assistance should have its own line on the form. Submission Instructions: The HMIS report should be submitted with the appropriate Rental Assistance or Emergency Assistance Back-Up form. The HMIS report does require original signatures by an authorized signatory as designated in MHTF-240. Effective: April 1, 2013 Page 22

23 On-Site Administration Client Files The Rental Assistance grant is unique among the other grant types; it is used for rent subsidies for single-family units including houses and apartments. Residents are expected to pay 30% of their monthly income on rent, and the grant covers the remaining sum. Grantees will not charge more than Fair Market Rent (MHTF-253) on any unit owned by grantee. It is highly encouraged that Fair Market Rent guidelines are followed for all rental subsidies paid. Eligible Uses: Ineligible Uses: Rental Payments Rental Deposits/Arrears Utility Payments/Deposits/Arrears Shelter Costs Eligible Administrative Costs: Ineligible Administrative Costs: Each sub-grantee can use up to 10% of what was awarded for administration costs as long as it is specified in the grantee s Rider A Examples: Program staff salary, administration building; utility bills, program audits, office supplies, maintenance and travel when clients are present Funds cannot be used for conference and training costs, travel when clients are not present or any food purchases Effective: April 1, 2013 Page 23

24 Records to Maintain All of the following should be kept on file and should be easily accessible for compliance purposes: These items are specified in the Rider A of the grant agreement. Client Records Record Criteria Acceptable forms of Documentation *Direct Assistance Summary/ Use to calculate income eligibility Direct Assistance Summary / Income Worksheet (MHTF-245) Income Worksheet (MHTF- Use not required, but highly 245) encouraged Proof of Residence Piece of mail Copy of lease Letter from landlord Income Verification Must be current within 30 days of each instance of assistance. Proof of gross monthly income needed for all members of the household age 18 and over NO INCOME (18 and older in household): Certification of Zero Income (MHTF-246) found at Payment Contact Documentation of whom assistance was paid to, address, and phone number Pay stub, SSI/SSDI award letter/printout, child support statement Signed/dated statement from employer verifying wages (including cash payments) Certification of Zero Income (MHTF -246) Copy of Lease Letter from Landlord Proof of Payment Payment date must be within 30 days Copy of canceled check or bank ledger from each instance of assistance. Proof of payment should be available to review within 60 days of instance of assistance. Proof of Requested Need Copy of bill Eviction notice, Letter from the landlord Signed program contract or copy of lease Photo Identification Needed for all members of the household age 18 and over Social Security Identification Card/number needed for all members of the household to document number of individuals in the household Consent Form This signed form gives MHDC the right to review files and verifies safe and decent housing. This form needs to be filled out within 30 days of each instance of assistance Form provided by MHDC and can be found on MHDC s website at Driver s license, state ID, temporary ID/license, school ID with photo, passport-u.s. or foreign, U.S. passport card, permanent resident card, employment authorization document, U.S. citizen ID card, military ID, Native American tribal card Copy of Social Security Card Print out from social security office MHTF Consent Form (MHTF- 250) Effective: April 1, 2013 Page 24

25 Administrative Records Record Bills Paid Services Performed Office Supplies Invoice Receipt Acceptable Forms of Documentation (both Cost Incurred and Proof of Payment are required) Cost Incurred Proof of Payment Salary Payroll report with pay period dates, and MHTF portion detailed Copy of pay stubs Last 4 digits of SSN and position at agency Proof of Position Copy of cut check Credit Card Invoice Receipts (only if cash) Ledger must include payment date, check number and amount Client File Forms Direct Assistance Summary / Income Worksheet (MHTF-245) Please see Income Verification section Certification of Zero Income (MHTF-246) Applicable Grant Type(s): Rental Assistance, Home Repair, Emergency Assistance Due Date: Within 30 days of every instance of assistance All members of household without income, 18 and over, for every instance of assistance Submission / Retention: Retained in client file The Certification of Zero Income form must be completed and signed by recipient for every instance of assistance where the recipient does not have income. The current year MHTF-246 form is the only acceptable form of certification of zero income and other versions or alterations of this form will not be accepted. Completion Instructions: All members of household without income, 18 and over must sign a Certification of Zero Income for every instance of assistance. The date of the form must be within 30 days of the instance of assistance. Submission Instructions: The original signed forms retained in client file. Consent Form (MHTF-250) Applicable Grant Type(s): Due Date: Submission / Retention: Completion Instructions: Submission Instructions: Rental Assistance, Home Repair, Emergency Assistance Within 30 days of every instance of assistance For every instance of assistance Retained in client file The consent form must be completed and signed by head of household for every instance of assistance. The current year MHTF-250 form is the only acceptable consent form and other versions or alterations of this form will not be accepted. The head of household must sign the Grant Recipient s Consent to Release Information for every instance of assistance. The date of the form must be within 30 days of the instance of assistance. The head of household must also check one of the boxes at the bottom of the consent form. If a box is not checked then the form is not considered complete. If recipient checks the IS NOT box, please address in client file. The original signed form retained in client file. Effective: April 1, 2013 Page 25

26 Maximum Income Limits (MHTF-251) Due Date: N/A Must use to determine income eligibility of all MHTF recipients Submission / Retention: Retained for grantee reference The Maximum Income Limits designate the maximum income limits, by household size, allowable by MHTF for the FY2013 grant year. This break out of AMI by household is calculated by MHTF statute. These income calculations should be used to determine household eligibility for the entire FY2013 grant year. Completion Instructions: N/A for grantee reference Submission Instructions: N/A for grantee reference Fair Market Rents (MHTF-253) Applicable Grant Type(s): Rental Assistance, Emergency Assistance Due Date: April 1, 2013 If grantee owns property where rents are paid. Strongly recommended that Fair Market Rent guidelines are followed when paying rent outside of grantee s property. Submission / Retention: Retained for grantee reference Fair Market Rents as determined by HUD for These will be in effect for the entire FY2013 MHTF grant year. Adhering to Fair Market Rents is REQUIRED for grantees paying rent on property owned by grantee. Completion Instructions: N/A for grantee reference Submission Instructions: N/A for grantee reference Close Out Once all funds have been expended, grantee is required to Close Out their grant. The Close Out process consists of several components: 1. Close Out Form 2. Sources and Uses 3. Housing Meeting Attendance Form 4. Comprehensive Electronic HMIS Report 5. All funds backed up All complete and final Close Out information is due to MHDC by April 30, Any funds that are not backed up by April 30, 2014 are subject to recapture. Effective: April 1, 2013 Page 26

27 Close Out Forms Close Out Form Rental Assistance (MHTF-443) Applicable Grant Type(s): Rental Assistance Due Date: April 30, 2014 The close out form is a collection of summary questions about the administration of the grant throughout the FY2013 grant year. Completion Instructions: All information is required to be completed. 1. Questions: 1-2: Percentage of Households assisted. Grantee will report on the percentage of households assisted for the entire FY2013 grant year. Please note that these reported numbers will be assessed against your original projections in your FY2013 application. Grantees more than 10% off from their original projections are subject to point deductions in future application rounds. 2. Questions 3-5: Minority / Women Owned Business: Grantee will report on the certified Minority / Women Owned businesses utilized throughout the ENTIRE AGENCY for the FY2013 grant year. Proof of costs incurred and proof of payment for services are NOT required to be submitted with back-up, but MHDC does reserve the right to request that information and those records should be maintained. 3. Question 6: Program Information Breakdown: Grantee will provide a breakdown of funds spent during FY2013 grant year. 4. Questions 7-12: Turn-aways: Throughout the FY2013 grant year, grantees will report a tally of turn-aways for every back-up form submitted. At close out, grantees will report more in-depth information regarding turn-aways. 5. Question 13: Service Demographics. Grantee will report on the categories of clients served in program for FY2013 grant year. 6. Questions 14-39: Outcomes: Grantee will report on outcomes that were indicated in Outcome Detail Form (MHTF-241) provided at the beginning of the grant year. Grantee will provide results of each outcome as well as discussion of the outcome results. 7. Questions 40 42: General Trust Fund information: Grantee will discuss any comments on MHTF and processes, how MHTF has benefited grantee and will attach any additional information about program. 8. Question 43: Clients Served. Grantee will designate the number of individuals served as well as the percentage of total MHTF grant was spent in counties where MHTF funds were spent. If grantee did not spend funds in a county. Please leave blank. Submission Instructions: Electronic submission to Joselyn Pfliegier. Effective: April 1, 2013 Page 27

28 Sources and Uses (Close Out) Due Date: April 30, 2014 The Sources and Uses detail the program budget for the FY2013 grant year. Completion Instructions: Grantee shall update the Sources and Uses from what was provided at the beginning of grant year. The updated Sources and Uses should reflect the actual amount expended in this program. If grantee received more than one grant with MHTF for the FY2013 grant year. The funds should be designated in separate columns. Submission Instructions: Electronic, to Joselyn Pfliegier Housing Meeting Attendance (MHTF-435) Due Date: April 30, 2014 with grant Close Out form The CoC / Regional Housing Team Meeting (RHT) Attendance form will be used by grantees to keep a record of attendance to their designated CoC / RHT meeting as specified in grant agreement. Completion Instructions: Grantee will complete the initial information: Agency, MHTF#, Grant Type, Designated CoC Meeting. The form with the initial completed information will be taken to every CoC / RHT meeting attended. The Meeting Date, Agency Representative, CoC Representative and CoC Representative (signature) will be obtained for every meeting attended. Please note if grantee has more than one grant with MHTF during the FY2013 grant year, a SEPARATE FORM will need to be used for each grant. Submission Instructions: The completed form will be submitted along with grantee s close out form. This form will not be accepted before the close of the grant. Comprehensive Electronic HMIS Report Applicable Grant Type(s): Rental Assistance, Emergency Assistance Due Date: April 30, 2014 with grant Close Out form Electronic comprehensive report of all instances of assistance entered into HMIS system for FY 2013 grant year. Completion Instructions: Grantee will obtain electronic report from HMIS system(s). Submission Instructions: Excel report submitted electronically to Joselyn Pfliegier with Close Out documents Effective: April 1, 2013 Page 28

29 Operating Funds The administration of your FY2013 MHTF grant will consist of forms/documents/information that will be submitted to MHDC and forms/documents/information that is required to be kept on site. This section will discuss, in detail, the requirements for document submission as well as the information that is required to be kept on site for this grant type. Throughout this section, forms that require submission will indicate if a hard-copy or electronic version is required. Below is the information for each submission, please ensure that the document is submitted to the correct individual. Hard-Copy Submissions: Electronic Submissions: Missouri Housing Development Commission Community Initiatives Department 3435 Broadway Kansas City, MO jpfliegier@mhdc.com Initial Grant Documents Before any funds can be released, all required initial grant documents must be complete and received by MHDC by April 1, Grant Agreement (Agency Grantee) Due Date: April 1, 2013 The grant agreement is required for Rental Assistance, Operating Funds, Home Repair and Emergency Assistance grantees. The grant agreement specifically details the requirements and expectations for the administration of the grant. It is the grantee s responsibility to know and adhere to all provisions set forth in the grant agreement. Completion Instructions: There are three places where the Grant Agreement must be signed by grantee: 1. Signature page signature and notary. 2. Workforce Eligibility Affidavit signature and notary; and 3. Rider B signature. All signatures must be ORIGINAL and by an authorized signatory as designated in MHTF The entire original signed, notarized agreement must be returned to MHDC to be considered complete. If any pages of the grant agreement are missing, that Grant Agreement will not be considered complete. Please note that the Rider A is a part of your grant agreement and specifically details the eligible uses for the grant year. Submission Instruction: Hard-copy, original signatures to Joselyn Pfliegier Effective: April 1, 2013 Page 29

30 Direct Deposit Form (MHTF-340) / Blank Check Due Date: April 1, 2013 All disbursements from MHDC to grantee will occur using an Electronic Funds Transfer (EFT). This form is required to be submitted with initial grant documents. It provides MHDC with the grantee s banking information for the electronic transfer. A blank voided check from the indicated banking institution is also required to be submitted with the Direct Deposit form. Please note that by default your grantee s banking information will be updated for ALL MHDC accounts. If the banking information provided is for Missouri Housing Trust Fund or one grant ONLY it must be indicated on the direct deposit form. Completion Instructions: PDF fillable form can be obtained at MHDC.com. Form must be signed with original signatures by authorized signatory. Submission Instructions: Hard-copy, voided hard-copy check, original signatures to Joselyn Pfliegier Authorized Signature Card (MHTF-240) Due Date: April 1, 2013, updated as needed This form designates all authorized signatories for each grant. All documents/forms that are required to be signed by grantee MUST be signed by a designated authorized signatory from this form. If an unauthorized person signs a document/form, the document/form will be rejected. Completion Instructions: Electronic form can be obtained from MHDC.com. Form must designate AT LEAST two authorized signatories. The form must have ORIGINAL signatures from all designated signatories. Please note the Authorizing Official must sign the in the Authorizing Official box as well as at the bottom of the form. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier Outcome Detail Form (MHTF-241) Applicable Grant Type(s): Rental Assistance, Operating, Home Repair and Emergency Assistance Due Date: April 1, 2013 This form will specifically detail the outcomes that will be tracked for the FY2013 grant year. Grantee should concisely detail WHAT, WHEN, WHOM, HOW MUCH, HOW YOU WILL KNOW and OUTPUTS for each outcome. Completion Instructions: Grantee will complete the above information for the two outcomes listed. Grantee should designate two distinct elements that will be observed, measured and reported on for the FY2013 grant year. Submission Instructions: Hard-copy, to Joselyn Pfliegier Effective: April 1, 2013 Page 30

31 Sources and Uses (Grant Agreement) Due Date: April 1, 2013 The Sources and Uses details the program budget for the FY2013 grant year. Completion Instructions: Grantee shall update the Sources and Uses that from what was initially provided at time of application. The updated Sources and Uses should reflect the actual amount of MHTF funds awarded for this grant. If grantee received more than one grant with MHTF for the FY2013 grant year. The funds should be designated in separate columns. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier E-Verify Memorandum of Understanding (MOU) Due Date: April 1, 2013 The E-Verify MOU is an agreement between the Department of Homeland Security (DHS) and Grantee stating that grantee agrees to participate in the Employment Eligibility Verification Program (E-Verify). Completion Instructions: Grantee shall submit a copy of the full and complete MOU. Submission Instructions: Hard-copy, to Joselyn Pfliegier Certificate of Liability Insurance Due Date: April 1, 2013 The Certificate of Insurance is a one page summary of Liability Insurance held by grantee. The insurance held by grantee may include: General Liability, Automobile Liability Umbrella Liability, Excess Liability, Worker s Compensation and Employers Liability. The Certificate of Liability Insurance must be current. If coverage lapses during to the grant year, grantee must provide MHDC with an updated Certificate Completion Instructions: Grantee shall provide a copy of the Certificate of Liability Insurance. Submission Instructions: Hard-copy to Joselyn Pfliegier Site Contact Form (MHTF - 252) Due Date: April 1, 2013 This form will be submitted with initial grant documents. This form is to ensure that MHDC has updated information for the upcoming grant year. The site visit locations and hours of operation will be used to conduct scheduled / and unscheduled site visits. Completion Instructions: Complete information pertaining to the grant indicated at top of form. Submission Instructions: Hard-copy to Joselyn Pfliegier Effective: April 1, 2013 Page 31

32 Request for Payment / Back-Up Forms Before any funds can be released the following criteria must be met: 1. All previous MHTF grants must be completely closed out*: a. All funds expended; b. Close Out form received; c. Updated Sources received; d. Audit/current audit letter are complete and received; and e. Previous grant(s) are fully backed up. 2. All current year grant documents are complete and received. 3. All previous compliance issues are resolved (i.e. grantee is in compliance ). Once all the above criteria are met, grantee may then begin requesting funds from their FY2013 grant. Receiving funds for your MHTF grant is split into two processes: Request for Funds and Back-Up form. This is split into two processes to allow grantees to advance up to 25% of their grant award throughout the year. Once funds are advanced, that amount must be backed up before any further funds will be released. * Exceptions for ongoing MHTF Construction projects with current extension and ongoing Rental Assistance grants from FY2010 and earlier. Request for Payment The grantee may submit a Request for Payment as of April 1, The grantee may choose to draw up to 25% of their total grant award without back-up documentation. The following form must be used for all requests for payment: Request for Payment (MHTF-301) Due Date: At least quarterly until funds expended The Request for Payment form is required to be submitted for any and all disbursements for grantee funds. Completion Instructions: All fields are required to be completed for Request for Payment form to be accepted and processed. 1. Complete general fields: Date, Grantee, MHTF #, Grant Type, Grant Award Amount and Site Address. 2. Requested Amount. No more than 25% of the grant award amount can be requested without back-up. 3. Place an X for which disbursement is being submitted. If Final Disbursement please indicate. 4. Place an X for type of disbursement. All grantees MUST INDICATE type of disbursement that is being made. a. Operating grantees: ALWAYS X the Other box. Submission Instructions: Hard-copy, original signatures to Sarah Parsons Effective: April 1, 2013 Page 32

33 Quarterly Draws The grantees must have a minimum of one disbursement per quarter. MHTF quarters and submission deadlines are detailed above under Timeline FY2013 Incomplete/Ineligible Requests for Payment If the grantee submits a Request for Payment that is incomplete/ineligible MHDC will notify grantee that the Request for Payment is incomplete/ineligible, MHDC will discard the Request. Grantee will need to submit a new and complete Request for Payment. EXAMPLES: Unsigned forms, previous request not fully backed-up, compliance issues, etc. Back-Up Grantee is required to submit the following form to account for all MHTF spending during the FY2013 grant year. Back-Up Form Operating Funds (MHTF-312) Applicable Grant Type(s): Operating Due Date: Before disbursement of additional funds, after initial disbursement. This form is a summary of the HMIS reports, Non-HMIS Client Detail Reports (if applicable) and the Administrative Detail Report. Completion Instructions: 1. General Information / Back-Up Check List / Summary: All fields in these sections are REQUIRED. If information is missing from these sections, the Back-Up form will be considered incomplete and will be discarded. 2. Summary of Funds Spent by Region: This section summarized the information from the attached Administrative Detail, summarized by region. Please pay attention to the regions in which MHTF monies are spent. Monies cannot be spent outside of the region(s) specified in the grant agreement. 3. Administrative Detail Report: The Administrative Detail Report form is required to be completed detailing all expenses that will be charged to MHTF. Support for these charges will be kept on site for review during site visits. DO NOT SUBMIT BACK-UP SUPPORT TO MHDC. This form is a part of the Back-Up form and separate tabs on the Excel Back-Up form. For staff salaries please include the last four digits of the employee s Social Security number in the detail section of the Administrative Detail Report Form. 4. Total MHTF Grant Funds Expended: Summary from all Administrative Detail Reports completed with this Excel workbook. This total automatically sums from the Administrative Detail Report(s) completed. Submission Instructions: Hard-copy, original signatures to Sarah Parsons Incomplete/Ineligible Back-Up If the grantee submits a Back-Up form that is incomplete/ineligible MHDC will notify grantee that the Back-Up is incomplete/ineligible, MHDC will discard it. Grantee will need to submit a new and complete Back-Up form, including all attachments and original signatures. Effective: April 1, 2013 Page 33

34 Back-Up Form Operating Funds (MHTF-312) - Example Auto fill 3 Effective: April 1, 2013 Page 34

35 Administrative Records Eligible Uses Eligible Administrative Costs: Each grantee can use grant for administrative costs as long as it is specified in the grantee s Rider A Examples: Program staff salary, administration building; utility bills, program audits, office supplies, maintenance and travel when clients are present Ineligible Administrative Costs: Funds cannot be used for conference and training costs, travel when clients are not present or any food purchases Administrative Back-Up support will be kept on-site for review during site visits. For each cost detailed (each line item) on the Administrative Detail report grantee should maintain Cost Incurred AND Proof of Payment as detailed below: Record Bills Paid Services Performed Office Supplies Acceptable Forms of Documentation (both Cost Incurred and Proof of Payment are required) Cost Incurred Proof of Payment Invoice Receipt Copy of cut check Credit Card Invoice Receipts (only if cash) Ledger must include payment date, check number and amount Salary Payroll report with pay period dates, and MHTF portion detailed Copy of pay stubs Last 4 digits of SSN and position at agency Proof of Position Incomplete/Ineligible Requests for Payment If the grantee submits a Back-Up form that is incomplete/ineligible MHDC will notify grantee that the Back-Up is incomplete/ineligible, MHDC will discard it. Grantee will need to submit a new and complete Back-Up form, including all attachments and original signatures. Other Forms Maximum Income Limits (MHTF-251) Due Date: N/A Must use to determine income eligibility of all MHTF recipients Submission / Retention: Retained for grantee reference The Maximum Income Limits designate the maximum income limits, by household size, allowable by MHTF for the FY2013 grant year. This break out of AMI by household is calculated by MHTF statute. These income calculations should be used to determine household eligibility for the entire FY2013 grant year. Completion Instructions: N/A for grantee reference Submission Instructions: N/A for grantee reference Effective: April 1, 2013 Page 35

36 Close Out Once all funds have been expended, grantee is required to Close Out their grant. The Close Out process consists of several components: 1. Close Out Form 2. Sources and Uses 3. Housing Meeting Attendance Form 4. All funds backed up All complete and final Close Out information is due to MHDC by April 30, Any funds that are not backed up by April 30, 2014 are subject to recapture. Close Out Forms Close Out Form Operating Funds (MHTF-442) Applicable Grant Type(s): Operating Due Date: April 30, 2014 The close out form is a collection of summary questions about the administration of the grant throughout the FY2013 grant year. Completion Instructions: All information is required to be completed. 1. Questions: 1-2: Percentage of Households assisted. Grantee will report on the percentage of households assisted for the entire FY2013 grant year. Please note that these reported numbers will be assessed against your original projections in your FY2013 application. Grantees more than 10% off from their original projections are subject to point deductions in future application rounds. 2. Questions 3-5: Minority / Women Owned Business: Grantee will report on the certified Minority / Women Owned businesses utilities throughout the ENTIRE AGENCY for the FY2013 grant year. Proof of costs incurred and proof of payment for services are NOT required to be submitted with back-up, but MHDC does reserve the right to request that information and those records should be maintained. 3. Question 6: Program Information Breakdown: Grantee will provide a breakdown of funds spent during FY2013 grant year. 4. Questions 7-12: Turn-aways: Throughout the FY2013 grant year, grantees will report a tally of turn-aways for every back-up form submitted. At close out, grantees will report more in-depth information regarding turn-aways. 5. Questions 13-38: Outcomes: Grantee will report on outcomes that were indicated in Outcome Detail Form (MHTF-241) provided at the beginning of the grant year. Grantee will provide results of each outcome as well as discussion of the outcome results. 6. Questions 39 41: General Trust Fund information: Grantee will discuss any comments on MHTF and processes, how MHTF has benefited grantee and will attach any additional information about program. 7. Question 42: Clients Served. Grantee will designate the number of individuals served as well as the percentage of total MHTF grant was spent in counties where MHTF funds were spent. If grantee did not spend funds in a county. Please leave blank. Effective: April 1, 2013 Page 36

37 Submission Instructions: Electronic submission to Joselyn Pfliegier. Sources and Uses (Close Out) Due Date: April 30, 2014 The Sources and Uses detail the program budget for the FY2013 grant year. Completion Instructions: Grantee shall update the Sources and Uses that from what provided at the beginning of grant year. The updated Sources and Uses should reflect the actual amount budgeted in this program. If grantee received more than one grant with MHTF for the FY2013 grant year. The funds should be designated in separate columns. Submission Instructions: Electronic, to Joselyn Pfliegier Housing Meeting Attendance (MHTF-435) Due Date: April 30, 2014 with grant Close Out form The CoC / Regional Housing Team Meeting (RHT) Attendance form will be used by grantees to keep a record of attendance to their designated CoC / RHT meeting as specified in grant agreement. Completion Instructions: Grantee will complete the initial information: Agency, MHTF#, Grant Type, Designated CoC Meeting. The form with the initial completed information will be taken to every CoC / RHT meeting attended. The Meeting Date, Agency Representative, CoC Representative and CoC Representative (signature) will be obtained for every meeting attended. Please note if grantee has more than one grant with MHTF during the FY2013 grant year, a SEPARATE FORM will need to be used for each grant. Submission Instructions: The completed form will be submitted along with grantee s close out form. This form will not be accepted before the close of the grant. Effective: April 1, 2013 Page 37

38 Construction / Rehabilitation The administration of your FY2013 MHTF grant will consist of forms/documents/information that will be submitted to MHDC and forms/documents/information that is required to be kept on site. This section will discuss, in detail, the requirements for document submission as well as the information that is required to be kept on site for this grant type. Throughout this section, forms that require submission will indicate if a hard-copy or electronic version is required. Below is the information for each submission, please ensure that the document is submitted to the correct individual. Hard-Copy Submissions: Electronic Submissions: Missouri Housing Development Commission Community Initiatives Department 3435 Broadway Kansas City, MO jpfliegier@mhdc.com General Information Construction/Rehabilitation funds can be used by agencies for construction needs, rehabilitation of facilities to improve services in the community, and acquisition costs for housing related services. Once the initial grant documents are received by MHDC, grantees must work with the Missouri Housing Development Commission s legal department to go through a formal closing. Through this process, MHDC s attorneys will guide agencies through the requirements for this grant. All new construction must meet the appropriate locally adopted residential building codes, or in the absence of locally adopted codes, the work must adhere to specifications contained in the 2000 Edition of the International Residential Code. All new construction must be done according to the awarded agency s written construction/rehabilitation standards and will be inspected by Missouri Housing Development Commission staff to ensure proper building procedures and Firm Commitment requirements are followed. Contact information must be provided for at least two individuals from the agency who will work closely with the construction. If the funds are matched with other sources, the grant recipient must identify the exact amount of MHTF dollars used for the project. If MHTF dollars finance only a part of the project, the agency must specifically identify exact MHTF uses. Activities must fall under one of the following categories: New Construction Rehabilitation Site Acquisition Agencies may use MHTF dollars for new construction projects to broaden their reach and scope of housing services to their area. Agencies may use MHTF dollars for rehabilitation efforts of existing agency building(s). These improvements include but are not limited to: kitchen, bathroom, roof, HVAC systems, office, sleeping quarters, and security features. Agencies may use MHTF dollars for the purchase of buildings and/or land for MHTF approved services. Prevailing Wage Prevailing wage will apply to any person performing construction labor on the construction site that will be paid through MHTF funds. Persons performing construction labor are listed as laborers and mechanics. Contractors are Effective: April 1, 2013 Page 38

39 required to pay those laborers and mechanics a minimum of the locally prevailing wage rates and fringe benefits paid on projects of a similar character. Working Foremen Foreman or supervisors that regularly spend more than 20% of their time performing construction work are covered labor hours or mechanics for labor standards purposes for the time spent performing construction work and must be paid prevailing wage. Administrative, Executive and Clerical Employees or workers whose duties are primarily administrative, executive, or clerical are excluded from Prevailing Wage requirements and should not be paid through MHTF Construction funds. Examples include superintendents who do not perform "hands-on" construction labor, office staff, bookkeepers, and messengers. Wage Rates and Payroll Processing Wage rates used by MHTF are set by following the wage determinations published by the Department of Labor for Davis-Bacon. MHDC require that all contractors and subcontractors pay their laborers and mechanics not less than the prevailing wage rates and fringe benefits for corresponding classes of laborers and mechanics employed on similar projects within the area. Wage Determinations The Wage and Hour Division of the Department of Labor (Division) issues communications known as Wage Determinations (sometimes referred to as Wage Decisions). A Wage Determination is a listing of wage rates and fringe benefit rates for different classifications of laborers and mechanics in a given area for a particular type construction. The Division issues its Wage Determinations by publication of a notice in the Federal Register. Wage Determinations are effective from the date of notice and have no expiration date. Wage Determinations are continually updated and change frequently. However, only one Wage Determination will be applicable to a MHTF Construction project. The Wage Determination that will apply to a grantee s project will be the Wage Determination that is in effect on the date the construction loan documents are signed and will be provided to grantee at that time. The Wage Determination of that date is "locked in" and subsequent updates or modifications to Wage Determinations will not affect the wage rates on the development. Within the body of each Wage Determination, a listing of classifications (laborers and mechanics) will be found. Accompanying those classifications will be basic hourly wage rates and fringe benefit rates that have been determined to be prevailing for the same type of construction within the geographic area covered by the Wage Determination. Classifications Some classifications may include a subclass or group number. Common examples include Operator, Truck Driver, and Painter. Subclasses or groups may have different pay rate requirements. Effective: April 1, 2013 Page 39

40 Wage Amounts All developments with buildings that are four (4) or fewer stories will be required to comply with a "Residential" Wage Determinations. All developments that have buildings with five (5) or more stories must comply with a "Building" Wage Determinations. Wage rates are based upon classification of the worker. The classification is determined based on the type of work actually being performed by the worker during the pay period. It is important to note that the prevailing wage for each classification must be paid to a worker in the classification regardless of the worker s skill level. For example, if a worker is performing duties normally performed by a Carpenter, that worker must be paid prevailing wage for the classification of Carpenter even if the contractor does not consider the worker to be fully trained. In the event a worker performs duties in more than one classification, the employer may pay wage rates separately provided that the employer maintains accurate time records showing the amount of time spent in each classification of work. If time records are not available, the employer must pay the worker the higher of the wage rate of the classifications for the duties performed. Wages may be calculated by various methods such as piecework. Regardless of the method used to calculate wages, the total wages must be converted to an hourly rate for submission on the certified payroll reports, and such hourly rate must meet the minimum prevailing wage rates. Apprentice Rates Apprentices may be paid less than the Wage Determination rate, provided that the person employed is individually registered in a bona fide apprenticeship program registered with the Department of Labor. Usually, the apprentice wage rate is expressed as a series of percentages tied to the amount of time spent in the program. For example, an apprentice of less than six months would receive 65% of the journeyman's wage rate, while an apprentice who has been in the program between six months and one year would receive 70%, etc. An apprenticeship certification from the Department of Labor's Office of Apprenticeship must be provided to MHDC. If no apprenticeship certification is provided, the worker must be paid the prevailing wage for his or her classification. Apprenticeship certifications may be obtained by contacting the Office of Apprenticeship at: Area Phone Facsimile St. Louis (314) (314) Kansas City (816) (816) Springfield (417) (417) Department of Labor (877) Certifications may also be obtained online through use of the Registered Apprenticeship Partners Information Data System (RAPIDS) by companies with their own approved program. Effective: April 1, 2013 Page 40

41 An approved apprenticeship program will regulate the ratio of apprentices to journeymen. The maximum number of apprentices on the development cannot exceed the ratio allowed in the approved program. In the event a program allows for more than a 1:1 ratio, MHDC requires submission of a copy of the apprenticeship ratios schedule for each class of apprentice performing labor on the site. Payroll All workers must be paid weekly. Over time must be paid to all covered workers who work in excess of 40 hours during a work week. The overtime rate must be at least 150% of the Wage Determination basic rate plus 100% of any applicable fringe benefit rate. Fringe benefits are included in some Wage Determinations, and usually are listed as an hourly fringe rate. If the Wage Determination includes a fringe benefit rate for a classification, the fringe benefit rate must be added to the basic hourly rate unless the employer provides bona fide fringe benefits for employees. Fringe benefits can include health insurance premiums, retirement contributions, life insurance, vacation and other paid leave as well as contributions to training funds. Fringe benefits do not include employer payments for contributions required by Federal, State or local laws such as the employer's contribution to FICA. The total hourly wage rates may be no less than the total of the basic wage plus the fringe benefit wage. If the value of provided fringe benefits is less than the fringe benefit rate stated in the Wage Determination, the difference must be added to the basic wage rate. Likewise, if an employer provides fringe benefits with a value higher than that required, the employer may offset the excess amount against the basic rate. For example, assume that a Wage Determination requires a basic wage of $15/hour plus a fringe wage of $5/hour for a total minimum payment of $20/hour to the employee. The prevailing wage requirements would be met under any one of the following examples: a) Providing no fringe benefits and paying $20/hour b) Providing fringe benefits valued at $5/hour and paying $15/hour c) Providing fringe benefits valued at $3/hour and paying $17/hour d) Providing fringe benefits valued at $7/hour and paying $13/hour It should be noted that when a lower basic rate is paid due to an offset of fringe benefits, the overtime rate must be calculated based upon the basic rate as stated on the Wage Determination and not on the basic rate actually paid. Based upon the previous example, when the Wage Determination requires a basic wage of $15/hour and a fringe rate of $5/hour, the total wage rate including overtime would be $27.50/hour (($15 x 150%) + ($5 x 100%). In the event the employer provides fringe benefits valued at $7/hour and therefore pays a basic rate of $13/hour, the employer must nevertheless calculate overtime based on the Wage Determination rate of $15/hour rather than the $13/hour that is actually paid. Reporting MHDC requires the submission of certified payroll on a weekly basis. Each certified payroll report submitted must be the original report with an original signature. Photocopies will not be accepted. Effective: April 1, 2013 Page 41

42 Form Payroll WH-347 / Instructions to Complete WH-347 Applicable Grant Type(s): Construction Due Date: Weekly through duration of MHTF funded portion of construction project Submission / Retention: Completion Instructions: Submission Instructions: Submitted to MHDC This form will be required to be submitted weekly for the duration of the MHTF portion of the construction project. This form will need to be submitted for all labor that will be paid with MHTF funds. Please refer to Instructions to Complete WH-347 on MHDC.com. Due to MHDC office 10 days from end of pay period. Pay stubs do not need to be submitted with payroll. Pay stubs are subject to review and submission, if requested by MHDC staff. Hard-copy, original signatures to Joselyn Pfliegier within 10 days of from end of pay period. Contents Certified payrolls must be complete, legible, properly executed and dated. The certified payroll reports should contain the name of the project and the name of the contractor or subcontractor for identification purposes. If fringe benefits are included in the Wage Determination, paragraph (4) of the certification must be completed by checking box (a) to indicate that fringe benefits are paid into an approved plan; or by checking box (b) to indicate that fringe benefits are paid in cash. In the event the employer offsets part of the basic wage due to the value of fringe benefits, MHDC requires a letter from the employer itemizing the benefit plans with the respective amounts paid to each plan and certifying that fringe benefits were paid on behalf of the employees. In the event a single employer provides fringe benefits to some but not all of its employees, the employer should submit separate payrolls. All deductions that are not required by law or by an order of a proper authority must be authorized in writing by the employee or by a collective bargaining agreement. The written authorization for the deductions should be included with the first payroll. Numbering Certified Payroll reports should be numbered sequentially. The sequential numbering of reports helps MHDC identify whether any reports are missing, and relieves the contractor from having to submit reports when no work was performed on the site. The last report to be filed should be labeled "Final Payroll". A separate certified payroll report with its accompanying payroll certification must be submitted for each payroll for each weekly pay period. Providing one certification for multiple pay periods is prohibited. Classifications A job classification must be listed for each worker on each payroll submitted. The job classification listed must show the current classification for the type of work the person is actually performing during the pay period. Only classifications listed on the applicable Wage Determination may be used. Contact MHDC for assistance in Effective: April 1, 2013 Page 42

43 determining which classification to use if needed. If a job classification has an associated subclass or group number, that subclass the group number should be included on the report. Owner Operated Subcontractors When a company is operated only by its owner(s), the workers must be listed on the certified payroll of the upper-tier contractor. When an owner of a company works with his or her employees, the owner is only required to list his or her name and work classification, along with a notation of Owner and the total hours worked. Owners are not required to report the amount of pay. Inspections When MHDC conducts on-site inspections, it will include interviews with persons performing labor on the construction site. Interviews are confidential. MHDC will attempt to conduct the interviews in a manner causing as little disruption as possible. Records Employers are required to maintain payroll records, including back-up documentation such as timecards for a minimum period of three years after the construction development is completed. General contractors must maintain a copy of the records of all subcontractors for the same period of time. Underpayments and Corrections In the event MHDC discovers any compliance deficiencies in connection with Prevailing Wage, the contractor will be notified immediately. The general contractor is responsible for ensuring that all underpayments are corrected within thirty (30) days. MHDC will require the general contractor to provide our office with: a) An amended certified payroll report showing the corrections and labeled as Restitution Payroll, and b) A copy of the check(s) making the restitution, and c) A signed statement from each of the underpaid worker(s) stating that they have received the required restitution without threat of repercussions. Effective: April 1, 2013 Page 43

44 Initial Grant Documents All required initial grant documents must be complete and received by MHDC by April 1, Construction Firm Commitment Applicable Grant Type(s): Construction Due Date: April 1, 2013 The firm commitment is required for Construction grantees. The firm commitment specifies the terms of the loan that the grantee will enter into with MHDC. The firm commitment also specifically details the requirements and expectations for the administration of the grant. It is the grantee s responsibility to know and adhere to all provisions set forth in the firm commitment. Completion Instructions: The firm commitment must be signed and witnessed. The signatures must be original and the print/title line must be completed to be considered executed. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier Direct Deposit Form (MHTF-340) / Blank Check Due Date: April 1, 2013 All disbursements from MHDC to grantee will occur using an Electronic Funds Transfer (EFT). This form is required to be submitted with initial grant documents. It provides MHDC with the grantee s banking information for the electronic transfer. A blank voided check from the indicated banking institution is also required to be submitted with the Direct Deposit form. Please note that by default your grantee s banking information will be updated for ALL MHDC accounts. If the banking information provided is for Missouri Housing Trust Fund or one grant ONLY it must be indicated on the direct deposit form. Completion Instructions: PDF fillable form can be obtained at MHDC.com. Form must be signed with original signatures by authorized signatory. Submission Instructions: Hard-copy, voided hard-copy check, original signatures to Joselyn Pfliegier Authorized Signature Card (MHTF-240) Due Date: April 1, 2013, updated as needed This form designates all authorized signatories for each grant. All documents/forms that are required to be signed by grantee MUST be signed by a designated authorized signatory from this form. If an unauthorized person signs a document/form, the document/form will be rejected. Completion Instructions: Electronic form can be obtained from MHDC.com. Form must designate AT LEAST two authorized signatories. The form must have ORIGINAL signatures from all designated signatories. Please note the Authorizing Official must sign the in the Authorizing Official box as well as at the bottom of the form. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier Effective: April 1, 2013 Page 44

45 Sources and Uses (Grant Agreement) Due Date: April 1, 2013 The Sources and Uses details the program budget for the FY2013 grant year. Completion Instructions: Grantee shall update the Sources and Uses that from what was initially provided at time of application. The updated Sources and Uses should reflect the actual amount of MHTF funds awarded for this grant. If grantee received more than one grant with MHTF for the FY2013 grant year. The funds should be designated in separate columns. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier E-Verify Memorandum of Understanding (MOU) Due Date: April 1, 2013 The E-Verify MOU is an agreement between the Department of Homeland Security (DHS) and Grantee stating that grantee agrees to participate in the Employment Eligibility Verification Program (E-Verify). Completion Instructions: Grantee shall submit a copy of the full and complete MOU. Submission Instructions: Hard-copy, to Joselyn Pfliegier Certificate of Liability Insurance Due Date: April 1, 2013 The Certificate of Insurance is a one page summary of Liability Insurance held by grantee. The insurance held by grantee may include: General Liability, Automobile Liability Umbrella Liability, Excess Liability, Worker s Compensation and Employers Liability. The Certificate of Liability Insurance must be current. If coverage lapses during to the grant year, grantee must provide MHDC with an updated Certificate Completion Instructions: Grantee shall provide a copy of the Certificate of Liability Insurance. Submission Instructions: Hard-copy, to Joselyn Pfliegier Site Contact Form (MHTF - 252) Due Date: April 1, 2013 This form will be submitted with initial grant documents. This form is to ensure that MHDC has updated information for the upcoming grant year. The site visit locations and hours of operation will be used to conduct scheduled / and unscheduled site visits. Completion Instructions: Complete information pertaining to the grant indicated at top of form. Submission Instructions: Hard-copy to Joselyn Pfliegier Effective: April 1, 2013 Page 45

46 Documents Received/Signed at Closing: 2013 Land Use Restriction Agreement (Construction) Applicable Grant Type(s): Construction Due Date: Closing The Land Use Restriction Agreement (LURA) for construction grantees is an agreement between grantee and MHDC stating that the grantee will adhere to terms of the LURA for a period of eighteen (18) years following the date of the last disbursement of the grant. Terms of the LURA include but are not limited to 100% of persons served in building bound by the LURA are required to be at or below 50% AMI. Completion Instructions: A draft LURA will be provided to grantee at time of funded training for reference. A final version of the LURA will be provided to grantee at time of closing for signature and recording Submission Instructions: Signed by grantee at time of closing. MHDC will record and retain original copy in MHDC office. Project Wage Rate Sheet (MHTF-254) Applicable Grant Type(s): Construction Due Date: Closing (provided by MHDC to grantee at time of closing) ; Project wages designated are required to be followed throughout the duration of the MHTF funded portion of the construction project. Submission / Retention: Retained for grantee reference The Project Wage Rate Sheet will determine the prevailing wage rate that will be required to be paid to all applicable workers during the construction period. The wages set on this sheet will not very and will be in effect for the duration of the MHTF portion of the construction project. The wage rates will be determined within 10 days before the closing of the loan. Completion Instructions: N/A provided by MHDC for grantee reference. Submission Instructions: N/A provided by MHDC for grantee reference. Effective: April 1, 2013 Page 46

47 Request for Payment / Back-Up Forms Before any funds can be released the following criteria must be met: 1. All previous MHTF grants must be completely closed out*: a. All funds expended; b. Close Out form received; c. Updated Sources and Uses; d. Audit/current audit letter are complete and received; and e. Previous grant(s) are fully backed up. 2. All current year grant documents are complete and received. 3. All previous compliance issues are resolved (i.e. grantee is in compliance ). 4. Grantee must close on the loan and sign all required documents 5. Pre-Construction Meeting: Before MHTF portion of work begins, a meeting must be held with Community Initiative staff with grantee and representation of all sub-contractors which will be paid with MHTF funds. This meeting will discuss prevailing wage process and requirements for submitting weekly payroll. Once all the above criteria are met, grantee may then begin requesting funds from their FY2013 grant. Receiving funds for your MHTF grant is split into two processes: Request for Funds and Back-Up form. MHTF Construction Funds are for reimbursement only. Funds will not be released in excess of that work actually performed and material in place. When grantee is ready to request for payment grantee must: 1. Submit Back-Up Form (MHTF-316). Once back-up is processed, a site visit will be scheduled and conducted on the materials/work submitted. 2. Submit Payment Request. Once site visit is completed and satisfactory, grantee may submit for payment not to exceed the amount of back-up previously submitted and processed. * Exceptions for ongoing MHTF Construction projects with current extension and ongoing Rental Assistance grants from FY2010 and earlier. Request for Payment The grantee may submit a Request for Payment as soon all of the above criteria have been met. The following form must be used for all requests for payment: Request for Payment (MHTF-301) Due Date: N/A The Request for Payment form is required to be submitted for any and all disbursements for grantee funds. Completion Instructions: All fields are required to be completed for Request for Payment form to be accepted and processed. 1. Complete general fields: Date, Grantee, MHTF #, Grant Type, Grant Award Amount and Site Address. 2. Requested Amount. No more than 25% of the grant award amount can be requested without back-up. Effective: April 1, 2013 Page 47

48 Submission Instructions: 3. Place an X for which disbursement is being submitted. If Final Disbursement please indicate. 4. Place an X for type of disbursement. All grantees MUST INDICATE type of disbursement that is being made. a. Construction grantees: ALWAYS X the Other box. Hard-copy, original signatures to Community Initiatives Department Incomplete/Ineligible Requests for Payment If the grantee submits a Request for Payment that is incomplete/ineligible MHDC will notify grantee that the Request for Payment is incomplete/ineligible, MHDC will discard the Request. Grantee will need to submit a new and complete Request for Payment. EXAMPLES: Unsigned forms, previous request not fully backed-up, compliance issues, etc. Back-Up Grantee is required to submit the following form to account for all MHTF spending during the FY2013 grant year. An MHDC compliance officer will conduct a site visit after every Back-Up Packet is submitted, these will be scheduled visits. Back-Up Form Construction (MHTF-316) Applicable Grant Type(s): Construction Due Date: Before disbursement of additional funds, after initial disbursement. Instructions: Completion Instructions: 1. General Information / Back-Up Check List / Summary: All fields in these sections are REQUIRED. If information is missing from these sections, the Back-Up form will be considered incomplete and will be discarded. a. Contractor Invoices Invoices by contractors that are being submitted to MHDC for reimbursement from agency s MHFT grant. b. Project Updates Any changes to the project that deviate from the original application proposal must be reported to MHDC this includes but is not limited to work write-up or architectural drawings, cost-break down, time frame/construction schedule, changes in development team. 2. Total Amount of Construction / Rehabilitation Funds Spent: This section summarized the information from the attached Construction Detail. Please pay attention to the regions in which MHTF monies are spent. Monies cannot be spent outside of the region(s) detailed in the grant agreement. 3. Construction Detail Report: This report details the charges that are being submitted to MHTF for reimbursement. Copies of all support for charges (i.e. invoices/receipts) must be submitted along with the back-up form. This form is a part of the Back-Up form and separate tabs on the Excel Back-Up form. 4. Total MHTF Grant Funds Expended: Summary from all Construction Detail Reports completed with this Excel workbook. This total automatically sums from the Construction Detail Report(s) completed. Submission Instructions: Hard-copy, original signatures to Sarah Parsons Effective: April 1, 2013 Page 48

49 Back-Up Form Construction (MHTF-316) - Example a 1 b Effective: April 1, 2013 Page 49

50 Contractor Invoice Documentation Construction support will be submitted with all construction back-up. For each cost detailed (each line item) on the Construction Detail report, grantee should maintain Cost Incurred AND Proof of Payment as detailed below: Acceptable Forms of Documentation (both Cost Incurred and Proof of Payment are required) Cost Incurred Proof of Payment Invoice Copy of cut check Credit Card Invoice Receipts (only if cash) Ledger must include payment date, check number and amount Incomplete/Ineligible Requests for Payment If the grantee submits a Back-Up form that is incomplete/ineligible MHDC will notify grantee that the Back-Up is incomplete/ineligible, MHDC will discard it. Grantee will need to submit a new and complete Back-Up form, including all attachments and original signatures. Other Forms Maximum Income Limits (MHTF-251) Due Date: N/A Must use to determine income eligibility of all MHTF recipients Submission / Retention: Retained for grantee reference The Maximum Income Limits designate the maximum income limits, by household size, allowable by MHTF for the FY2013 grant year. This break out of AMI by household is calculated by MHTF statute. These income calculations should be used to determine household eligibility for the entire FY2013 grant year. Completion Instructions: N/A for grantee reference Submission Instructions: N/A for grantee reference Effective: April 1, 2013 Page 50

51 Close Out Once all funds have been expended, grantee is required to Close Out their grant. The Close Out process consists of several components: 1. Close Out Form 2. Sources and Uses 3. Housing Meeting Attendance Form 4. All funds backed up All complete and final Close Out information is due to MHDC thirty days after final disbursement. Any funds that are not backed up by within thirty days of final disbursement are subject to recapture. All funds must be disbursed by the date stated in grantee s Firm Commitment. If all funds will not be disbursed by that date, grantee may request a three month extension. Extension must be submitted in writing to the following BEFORE date stated in firm commitment. For subsequent extensions, grantee must submit the request in writing BEFORE the end of extension period. If written requests for extensions are not received before the appropriate deadline, the remainder of grantee s undisbursed funds are subject to recapture. Hard copy requests for extensions sent to: Missouri Housing Development Commission Attn: Heather Bradley-Geary 3435 Broadway Kansas City, MO Close Out Forms Close Out Form Construction (MHTF-444) Applicable Grant Type(s): Construction Due Date: Thirty days after final disbursement The close out form is a collection of summary questions about the administration of the grant throughout the FY2013 grant year. Completion Instructions: All information is required to be completed. 1. Questions 1-3: Minority / Women Owned Business: Grantee will report on the certified Minority / Women Owned businesses utilities throughout the ENTIRE AGENCY for the FY2013 grant year. Proof of costs incurred and proof of payment for services are NOT required to be submitted with back-up, but MHDC does reserve the right to request that information and those records should be maintained. 2. Question 4: Program Information Breakdown: Grantee will provide a breakdown of funds spent during FY2013 grant year. 3. Questions 5 7: General Trust Fund information: Grantee will discuss any comments on MHTF and processes, how MHTF has benefited grantee and will attach any additional information about program. 4. Question 8: Clients Served. Grantee will designate the number of individuals served as well as the percentage of total MHTF grant was spent in counties where MHTF funds were spent. If grantee did not spend funds in a county. Please leave blank. Submission Instructions: Electronic submission to Joselyn Pfliegier. Effective: April 1, 2013 Page 51

52 Sources and Uses (Close Out) Applicable Grant Type(s): Due Date: Completion Instructions: Submission Instructions: All Thirty days after final disbursement The Sources and Uses detail the program budget for the FY2013 grant year. Grantee shall update the Sources and Uses that from what provided at the beginning of grant year. The updated Sources and Uses should reflect the actual amount budgeted in this program. If grantee received more than one grant with MHTF for the FY2013 grant year. The funds should be designated in separate columns. Electronic, to Joselyn Pfliegier Housing Meeting Attendance (MHTF-435) Due Date: April 30, 2014 with grant Close Out form The CoC / Regional Housing Team Meeting (RHT) Attendance form will be used by grantees to keep a record of attendance to their designated CoC / RHT meeting as specified in grant agreement. Completion Instructions: Grantee will complete the initial information: Agency, MHTF#, Grant Type, Designated CoC Meeting. The form with the initial completed information will be taken to every CoC / RHT meeting attended. The Meeting Date, Agency Representative, CoC Representative and CoC Representative (signature) will be obtained for every meeting attended. Please note if grantee has more than one grant with MHTF during the FY2013 grant year, a SEPARATE FORM will need to be used for each grant. Submission Instructions: The completed form will be submitted along with grantee s close out form. This form will not be accepted before the close of the grant. Effective: April 1, 2013 Page 52

53 Home Repair The administration of your FY2013 MHTF grant will consist of forms/documents/information that will be submitted to MHDC and forms/documents/information that is required to be kept on site. This section will discuss, in detail, the requirements for document submission as well as the information that is required to be kept on site for this grant type. Throughout this section, forms that require submission will indicate if a hard-copy or electronic version is required. Below is the information for each submission, please ensure that the document is submitted to the correct individual. Hard-Copy Submissions: Electronic Submissions: Missouri Housing Development Commission Community Initiatives Department 3435 Broadway Kansas City, MO jpfliegier@mhdc.com Initial Grant Documents Before any funds can be released, all required initial grant documents must be complete and received by MHDC by April 1, Grant Agreement (Agency Grantee) Due Date: April 1, 2013 The grant agreement is required for Rental Assistance, Operating Funds, Home Repair and Emergency Assistance grantees. The grant agreement specifically details the requirements and expectations for the administration of the grant. It is the grantee s responsibility to know and adhere to all provisions set forth in the grant agreement. Completion Instructions: There are three places where the Grant Agreement must be signed by grantee: 1. Signature page signature and notary. 2. Workforce Eligibility Affidavit signature and notary; and 3. Rider B signature. All signatures must be ORIGINAL and by an authorized signatory as designated in MHTF The entire original signed, notarized agreement must be returned to MHDC to be considered complete. If any pages of the grant agreement are missing, that Grant Agreement will not be considered complete. Please note that the Rider A is a part of your grant agreement and specifically details the eligible uses for the grant year. Submission Instruction: Hard-copy, original signatures to Joselyn Pfliegier Effective: April 1, 2013 Page 53

54 Direct Deposit Form (MHTF-340) / Blank Check Due Date: April 1, 2013 All disbursements from MHDC to grantee will occur using an Electronic Funds Transfer (EFT). This form is required to be submitted with initial grant documents. It provides MHDC with the grantee s banking information for the electronic transfer. A blank voided check from the indicated banking institution is also required to be submitted with the Direct Deposit form. Please note that by default your grantee s banking information will be updated for ALL MHDC accounts. If the banking information provided is for Missouri Housing Trust Fund or one grant ONLY it must be indicated on the direct deposit form. Completion Instructions: PDF fillable form can be obtained at MHDC.com. Form must be signed with original signatures by authorized signatory. Submission Instructions: Hard-copy, voided hard-copy check, original signatures to Joselyn Pfliegier Authorized Signature Card (MHTF-240) Due Date: April 1, 2013, updated as needed This form designates all authorized signatories for each grant. All documents/forms that are required to be signed by grantee MUST be signed by a designated authorized signatory from this form. If an unauthorized person signs a document/form, the document/form will be rejected. Completion Instructions: Electronic form can be obtained from MHDC.com. Form must designate AT LEAST two authorized signatories. The form must have ORIGINAL signatures from all designated signatories. Please note the Authorizing Official must sign the in the Authorizing Official box as well as at the bottom of the form. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier Outcome Detail Form (MHTF-241) Applicable Grant Type(s): Rental Assistance, Operating, Home Repair and Emergency Assistance Due Date: April 1, 2013 This form will specifically detail the outcomes that will be tracked for the FY2013 grant year. Grantee should concisely detail WHAT, WHEN, WHOM, HOW MUCH, HOW YOU WILL KNOW and OUTPUTS for each outcome. Completion Instructions: Grantee will complete the above information for the two outcomes listed. Grantee should designate two distinct elements that will be observed, measured and reported on for the FY2013 grant year. Submission Instructions: Hard-copy, to Joselyn Pfliegier Effective: April 1, 2013 Page 54

55 Sources and Uses (Grant Agreement) Due Date: April 1, 2013 The Sources and Uses details the program budget for the FY2013 grant year. Completion Instructions: Grantee shall update the Sources and Uses that from what was initially provided at time of application. The updated Sources and Uses should reflect the actual amount of MHTF funds awarded for this grant. If grantee received more than one grant with MHTF for the FY2013 grant year. The funds should be designated in separate columns. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier E-Verify Memorandum of Understanding (MOU) Due Date: April 1, 2013 The E-Verify MOU is an agreement between the Department of Homeland Security (DHS) and Grantee stating that grantee agrees to participate in the Employment Eligibility Verification Program (E-Verify). Completion Instructions: Grantee shall submit a copy of the full and complete MOU. Submission Instructions: Hard-copy, to Joselyn Pfliegier Certificate of Liability Insurance Due Date: April 1, 2013 The Certificate of Insurance is a one page summary of Liability Insurance held by grantee. The insurance held by grantee may include: General Liability, Automobile Liability Umbrella Liability, Excess Liability, Worker s Compensation and Employers Liability. The Certificate of Liability Insurance must be current. If coverage lapses during to the grant year, grantee must provide MHDC with an updated Certificate Completion Instructions: Grantee shall provide a copy of the Certificate of Liability Insurance. Submission Instructions: Hard-copy to Joselyn Pfliegier Site Contact Form (MHTF - 252) Due Date: April 1, 2013 This form will be submitted with initial grant documents. This form is to ensure that MHDC has updated information for the upcoming grant year. The site visit locations and hours of operation will be used to conduct scheduled / and unscheduled site visits. Completion Instructions: Complete information pertaining to the grant indicated at top of form. Submission Instructions: Hard-copy to Joselyn Pfliegier Effective: April 1, 2013 Page 55

56 Request for Payment / Back-Up Forms Before any funds can be released the following criteria must be met: 1. All previous MHTF grants must be completely closed out*: a. All funds expended; b. Close Out form received; c. Updated Sources and Uses; d. Audit/current audit letter are complete and received; and e. Previous grant(s) are fully backed up. 2. All current year grant documents are complete and received. 3. All previous compliance issues are resolved (i.e. grantee is in compliance ). Once all the above criteria are met, grantee may then begin requesting funds from their FY2013 grant. Receiving funds for your MHTF grant is split into two processes: Request for Funds and Back-Up form. This is split into two processes to allow grantees to advance up to 25% of their grant award throughout the year. Once funds are advanced, that amount must be backed up before any further funds will be released. * Exceptions for ongoing MHTF Construction projects with current extension and ongoing Rental Assistance grants from FY2010 and earlier. Request for Payment The grantee may submit a Request for Payment as of April 1, The grantee may choose to draw up to 25% of their total grant award without back-up documentation. The following form must be used for all requests for payment: Request for Payment (MHTF-301) Due Date: At least quarterly until funds expended The Request for Payment form is required to be submitted for any and all disbursements for grantee funds. Completion Instructions: All fields are required to be completed for Request for Payment form to be accepted and processed. 1. Complete general fields: Date, Grantee, MHTF #, Grant Type, Grant Award Amount and Site Address. 2. Requested Amount. No more than 25% of the grant award amount can be requested without back-up. 3. Place an X for which disbursement is being submitted. If Final Disbursement please indicate. 4. Place an X for type of disbursement. All grantees MUST INDICATE type of disbursement that is being made. a. Home Repair grantees: ALWAYS X the Other box. Submission Instructions: Hard-copy, original signatures to Sarah Parsons Effective: April 1, 2013 Page 56

57 Quarterly Draws The grantees must have a minimum of one disbursement per quarter. MHTF quarters and submission deadlines are detailed above under Timeline FY2013 Incomplete/Ineligible Requests for Payment If the grantee submits a Request for Payment that is incomplete/ineligible MHDC will notify grantee that the Request for Payment is incomplete/ineligible, MHDC will discard the Request. Grantee will need to submit a new and complete Request for Payment. EXAMPLES: Unsigned forms, previous request not fully backed-up, compliance issues, etc. Effective: April 1, 2013 Page 57

58 Back-Up Grantee is required to submit the following form to account for all MHTF spending during the FY2013 grant year. Back-Up Form Home Repair/Modification (MHTF-315) Applicable Grant Type(s): Home Repair Due Date: Before disbursement of additional funds, after initial disbursement. Instructions: Completion Instructions: 1. General Information / Back-Up Check List / Summary: All fields in these sections are REQUIRED. If information is missing from these sections, the Back-Up form will be considered incomplete and will be discarded. 2. Summary of Direct Assistance by Region: This section summarized the information from the attached Home Repair Detail Reports submitted for each home that has received assistance. Please pay attention to the regions in which MHTF monies are spent. Monies cannot be spent outside of the region(s) specified in the grant agreement. 3. Total Home Repair Detail Summary: This section is a summary of all Home Repair Details completed in the workbook. Each line represents the total of expenses from each HR Detail tab. These totals automatically populate from the detail information entered in the HR Detail tabs. 4. Administrative Detail Report (if taking 10% administrative fee): If the grantee chooses to take the 10% administrative fee (as indicated in grantee s Rider A ), the Administrative Detail Report form is required to be completed detailing all expenses that will be charged to MHTF. Support for these charges will be kept on site for review during site visits. DO NOT SUBMIT BACK-UP SUPPORT TO MHDC. This form is a part of the Back-Up form and separate tabs on the Excel Back-Up form. For staff salaries please include the last four digits of the employee s Social Security number in the detail section of the Administrative Detail Report Form. 5. Back-Up Total Summaries: This section sums up all back-up being submitted in report. a. Total Direct Assistance Summary HR Detail Reports submitted for back-up, summed from line detail entered above. This number should equal the Total Spent for all regions from the Summary of Direct Assistance by Region section. b. Total Operating Cost Claims Summary from all Administrative Detail Reports completed with this Excel workbook. This total automatically sums from the Administrative Detail Report completed. c. Total MHTF Grant Funds Expended Summary of Total Direct Assistance and Total Operating Cost Claims 6. Home Repair Detail Report Form: Each home that is submitted as back-up is required to have a Home Repair Detail Report Form for the corresponding expenses. The expenses for the repair only should be detailed on this form. Submission Instructions: Hard-copy, original signatures to Community Initiatives Department Effective: April 1, 2013 Page 58

59 Incomplete/Ineligible Back-Up If the grantee submits a Back-Up form that is incomplete/ineligible MHDC will notify grantee that the Back-Up is incomplete/ineligible, MHDC will discard it. Grantee will need to submit a new and complete Back-Up form, including all attachments and original signatures. Back-Up Form Home Repair (MHTF-315) - Example 1 2 Auto fill 4 Effective: April 1, 2013 Page 59

60 Back-Up Form Home Repair (MHTF-315) Example (cont.) 3 a 5 b c Auto fill 6 Effective: April 1, 2013 Page 60

61 On-Site Administration Client Files Home Repair funds may be used to assist existing homeowners with the repair, rehabilitation, or reconstruction of owner-occupied single-family home units up to $10,000. All newly constructed elements must adhere to the appropriate locally adopted residential building codes or, in the absence of locally adopted codes, the 2000 Edition of the International Residential Code. All new work must be done according to the awarded agency s written rehabilitation standards, and inspected by agency personnel to validate completed work. Activities must fall under one of the following categories: Weatherization Repair/Replacement of Major Systems Environmental Accessibility Code Violations Emergency Home Repair Any repair not identified below must be approved prior to being completed, please contact Joselyn Pfliegier with any questions regarding repairs: jpfliegier@mhdc.com or (816) Eligible Uses Eligible Uses: Criteria: Costs to meet local codes Repair/replace roof Upgrading of electrical wiring Install/update GFCI outlets Installation of vinyl siding Installation of smoke & radon detectors Remediation of environmental hazards including lead-based Capping/painting of window trim and sashes paint, radon, asbestos, and removal of underground oil Capping/painting of interior wood trim tanks. Costs may include activities such as Capping/painting of exterior Removal and disposal of asbestos pipe insulation or siding Testing and clearance reports Accessibility improvements such as Ramps Installation of handrails and grab bars Replacement of bathtubs with wheel-in showers Lowering of items such as sinks, electrical switches, and cupboards Widening doorways Repair of existing attached garages when incidental to other code required work or to achieve reasonable accommodation of a disabled person Provision of bathroom or bedroom space on the first floor level of the dwelling Effective: April 1, 2013 Page 61

62 Eligible Uses (continued): Energy Improvements such as Installation of heating systems Caulking, weather-stripping and other methods of reducing air infiltration Storm or thermal windows and doors, thermal shades or shutters Thermal insulation for ceilings, walls, floors, roofs. Foundations, pipes, ducts and water heaters including interior vapor barrier and ventilation Heating system modifications o Furnace maintenance and improvements to increase energy efficiency o Automatic clock thermostats o Replacement burners which reduce the amount of fuel used o Flue opening modifications o Electrical or mechanical ignition systems which replace gas or pilot light o Replacement furnace boiler Chimney repair/replacement Hot water systems Any other improvement which is demonstrated by a residential energy audit performed by an energy auditor licensed under state law to have a payback period of not more than fifteen (15) years (energy efficiency savings) Foundation and foundation repairs for single family homes Repair, replacement or upgrade of existing septic systems Repair, replacement or upgrade of existing wells On-site infrastructure costs (such as electrical wiring and connections and sewer and water piping) and off-site utility connections from the property line to an adjacent street Improvements to Manufactured Housing: Manufactured housing must meet the following criteria to be eligible for a loan/grant Septic Repair/Replacement: Rehabilitation or replacement of failed or failing septic systems for single-family residences is allowed. These monies may also be used to replace straight pipe systems. Licensed engineers must design the system and must comply with all applicable state and local codes and regulations. The home must be permanently attached to the land by means of poured concrete foundation The home must be permanently connected to water, sewer, electric, fuel, and similar facilities or utilities The wheels, axles, and hitch must be removed MHTF dollars cannot be used for improvements if the manufactured house is located on leased/rented land Effective: April 1, 2013 Page 62

63 Ineligible Uses Ineligible costs include those repairs that are not reasonable and customary and are considered luxurious in nature. Listed below are ineligible uses. This is not an all-inclusive list; items not appearing are not automatically eligible. For any questions regarding allowable improvements prior to work please contact Joselyn Pfliegier with any questions regarding repairs: or (816) Appliances Kitchen updates and other décor Furniture, personal property Carpet and linoleum replacement Attached greenhouses New construction of garages Projects for barns, sheds, outbuildings Construction of new home or a shell home Construction of a new deck or patio Fences Fire Extinguishers Non-essential fireplace improvements Generators Heating fuel Hot tub, Jacuzzi, whirlpool bath, sauna, bath house Landscaping (unless accessibility issues occur) Pier, steps to lake or water, etc. Portable kerosene heaters Steam cleaning of exterior surface Tree surgery or removal Unfinished structures Vacuum cleaner central systems Installing public infrastructure where none previously existed Effective: April 1, 2013 Page 63

64 Regulatory Agreements Any home repair grant given to an income-eligible owner expending less than $2, of the MHTF dollars DOES NOT require a regulatory agreement. The maximum amount of MHTF dollars utilized for one home is $10, year Regulatory Agreement / 5-year Regulatory Agreement Applicable Grant Type(s): Home Repair Due Date: Before start of Home Repair project MHTF Home Repair Costs Regulatory Agreement $0 - $1, Not Required $2,000 - $4, Year Regulatory Agreement $5,000 - $10,000 5 Year Regulatory Agreement Submission / Retention: Completion Instructions: Submission Instructions: Original submitted to MHDC / recorded copy retained in client files The Regulatory Agreement is between the homeowner receiving services and MHDC. The Agreements binds the homeowner to MHDC for two or five years to prevent home owner from selling property for profit. If the MHTF portion of a project cost will be $2,000 or over, the following items must be sent electronically to Joselyn Pfliegier for approval before any work can begin on the property: 1. 2 Year or 5 Year Regulatory Agreement filled out and the agreement must be fully signed and notarized with original signatures (can be found on website at 2. Exhibit A - the legal description (found on the warranty deed) must be copied verbatim to the Exhibit A, which is a part of the Regulatory Agreement. 3. Warranty Deed a copy of the warranty deed / quit claim deed must be submitted with every Regulatory Agreement. The above items must first be scanned and ed to Joselyn Pfliegier for approval before sending in the original documents. Once the grantee has been given approval by Joselyn Pfliegier, the grantee will send the hard-copy Regulatory Agreement to be recorded which will be done by MHDC staff. Work may not begin on any project until MHDC staff notifies the grantee that the original approved documents have been received. When the items are recorded MHDC will then send a recorded copy to the homeowner as well as an electronic copy to the grantee for their records. The above amounts refer to the MHTF dollars only. If the funds are matched with other sources, the grant recipient must identify the exact amount of MHTF dollars used per household. Effective: April 1, 2013 Page 64

65 Records to Maintain All of the following should be kept on file and should be easily accessible for compliance purposes: These items are specified in the Rider A of the grant agreement. Client Records Record Criteria Acceptable forms of Documentation *Direct Assistance Summary/ Use to calculate income eligibility Direct Assistance Summary / Income Worksheet (MHTF-245) Income Worksheet (MHTF- Use not required, but highly 245) encouraged Proof of Residence Income Verification Must be current within 30 days intake. Proof of gross monthly income needed for all members of the household age 18 and over NO INCOME (18 and older in household): Certification of Zero Income (MHTF-246) found at Proof of Payment Photo Identification Needed for all members of the household age 18 and over Social Security Identification Card/number needed for all members of the household to document number of individuals in the household Consent Form This signed form gives MHDC the right to review files and verifies safe and decent housing. This form needs to be filled out within 30 days of intake Form provided by MHDC and can be found on MHDC s website at Evidence of Title Proof of 3 Bids Work Description Before / After Pictures Inspection Form (MHTF-330) Available at MHDC.com Completion Form (MHTF-331) Available at MHDC.com Regulatory Agreement (if applicable) Piece of mail Mortgage payment receipt Pay stub, SSI/SSDI award letter/printout,, child support statement Signed/dated statement from employer verifying wages (including cash payments) Certification of Zero Income (MHTF -246) Contractor Invoices / Expenses AND Copy of canceled check or bank ledger; Driver s license, state ID, temporary ID/license, school ID with photo, passport-u.s. or foreign, U.S. passport card, permanent resident card, employment authorization document, U.S. citizen ID card, military ID, Native American tribal card Social Security Card Print out from social security office MHTF Consent Form (MHTF- 250) Copy of Title, letter from title company, or mortgage payment receipt Record from Contractors Request for Quotation showing that bids were solicited from a minimum of three parties, with returned bids Approved bid, invoices or work order Before and After pictures of elements of rehabilitation Completed and signed Completed signed by grantee and homeowner Recorded agreement (if recorded agreement has not been received, have approved agreement with from Joselyn) Effective: April 1, 2013 Page 65

66 Administrative Records Record Bills Paid Services Performed Office Supplies Invoice Receipt Acceptable Forms of Documentation (both Cost Incurred and Proof of Payment are required) Cost Incurred Proof of Payment Salary Payroll report with pay period dates, and MHTF portion detailed Copy of pay stubs Last 4 digits of SSN and position at agency Proof of Position Copy of cut check Credit Card Invoice Receipts (only if cash) Ledger must include payment date, check number and amount Costs Both hard costs (the actual cost of rehabilitating the house) and related soft costs are eligible for MHTF use. Costs: Eligible Hard Costs: These include the actual costs of constructing or rehabilitating a housing unit. They include making essential improvements such as Eligible Soft Costs: These include reasonable and necessary costs incurred with the financing or development for rehabilitation Ineligible Soft Costs: These are considered Administrative Costs that are not reimbursed as a soft cost Note: Administrative costs of the Sub-Grantee may not be reimbursed as a soft cost Examples: Energy-related repairs or improvements Improvements necessary to permit the use by persons with disabilities The testing and abatement of lead-based paint hazards Improvements to repair or replace major housing systems in danger of failure Lead Testing/inspections Inspections from a third inspector not currently on the agency s payroll Recording fees Building permits Flood letters Dumpster rentals, etc. Utility and phone bills Insurance Postage Office supplies Reimbursement for agency salaries Mileage reimbursement License fees, etc. Agency Inspections Agencies may be reimbursed for lead inspections performed by their own qualified staff inspectors. Reimbursement is capped at $ and will be a soft cost. Any additional inspections (walk through, code verifications, etc.) will be paid out of the agency s administration cost allowance they receive for each project. The agency may still opt for using a third party inspection service. The agency will then be reimbursed for the actual charges incurred. Invoice copies must be retained in the files. Effective: April 1, 2013 Page 66

67 Emergency Home Repair A situation may be declared an emergency when either: A code enforcement inspector declared the situation an emergency under City code The water, electrical, or gas has been Red Tagged The sewer is backed up The Sub-Grantee program coordinator determines the situation is an immediate threat to the safety of the occupants or to the structure of the house. These repairs must be natural hazards and must be preapproved by MHDC. Client File Forms Direct Assistance Summary / Income Worksheet (MHTF-245) Please see Income Verification section Certification of Zero Income (MHTF-246) Applicable Grant Type(s): Rental Assistance, Home Repair, Emergency Assistance Due Date: Within 30 days of intake All members of household without income, 18 and over, for every instance of assistance Submission / Retention: Retained in client file The Certification of Zero Income form must be completed and signed by recipient for every instance of assistance where the recipient does not have income. The current year MHTF-246 form is the only acceptable form of certification of zero income and other versions or alterations of this form will not be accepted. Completion Instructions: All members of household, 18 and over must sign a Certification of Zero Income for every instance of assistance. The date of the form must be within 30 days of intake Submission Instructions: The original signed forms retained in client file. Consent Form (MHTF-250) Applicable Grant Type(s): Due Date: Submission / Retention: Completion Instructions: Submission Instructions: Rental Assistance, Home Repair, Emergency Assistance Within 30 days of intake For every instance of assistance Retained in client file The consent form must be completed and signed by head of household for every instance of assistance. The current year MHTF-250 form is the only acceptable consent form and other versions or alterations of this form will not be accepted. The head of household must sign the Grant Recipient s Consent to Release Information for every instance of assistance. The date of the form must be within 30 days of the instance of assistance. The head of household must also check one of the boxes at the bottom of the consent form. If a box is not checked then the form is not considered complete. If recipient checks the IS NOT box, please address in client file. The original signed form retained in client file. Effective: April 1, 2013 Page 67

68 Home Repair Inspection Report (MHTF-330) Applicable Grant Type(s): Home Repair Due Date: N/A Submission / Retention: Retained in client file This report indicates that, at minimum, the three criteria detailed on the report have been met for every home repair project Completion Instructions: All blanks, including date must be completed. The report is signed by the grantee. This report should be completed for every home repair project after all repairs have been completed. All criteria indicated on report must be met for every project. Retention Instructions: The completed and signed original certificate is retained in client file for review during on site visit by MHDC staff. Home Repair Completion Certificate (MHTF-331) Applicable Grant Type(s): Home Repair Due Date: N/A Submission / Retention: Retained in client file This certification is signed by the homeowner as well as the grantee making repairs. This certification states that the Grantee and the Homeowner both agree that the repair have been completed and are satisfactorily. Completion Instructions: All blanks, including date must be completed. The certificate is signed by the homeowner and grantee. This certificate should be completed for every home repair project after all repairs have been completed. Retention Instructions: The completed and signed original certificate is retained in client file for review during on site visit by MHDC staff. Maximum Income Limits (MHTF-251) Due Date: N/A Must use to determine income eligibility of all MHTF recipients Submission / Retention: Retained for grantee reference The Maximum Income Limits designate the maximum income limits, by household size, allowable by MHTF for the FY2013 grant year. This break out of AMI by household is calculated by MHTF statute. These income calculations should be used to determine household eligibility for the entire FY2013 grant year. Completion Instructions: N/A for grantee reference Submission Instructions: N/A for grantee reference Effective: April 1, 2013 Page 68

69 Close Out Once all funds have been expended, grantee is required to Close Out their grant. The Close Out process consists of several components: 1. Close Out Form 2. Sources and Uses 3. Housing Meeting Attendance Form 4. All funds backed up All complete and final Close Out information is due to MHDC by April 30, Any funds that are not backed up by April 30, 2014 are subject to recapture. Close Out Forms Close Out Form Home Repair/Modifications (MHTF-441) Applicable Grant Type(s): Home Repair Due Date: April 30, 2014 The close out form is a collection of summary questions about the administration of the grant throughout the FY2013 grant year. Completion Instructions: All information is required to be completed. 1. Questions: 1-2: Percentage of Households assisted. Grantee will report on the percentage of households assisted for the entire FY2013 grant year. Please note that these reported numbers will be assessed against your original projections in your FY2013 application. Grantees more than 10% off from their original projections are subject to point deductions in future application rounds. 2. Questions 3-5: Minority / Women Owned Business: Grantee will report on the certified Minority / Women Owned businesses utilities throughout the ENTIRE AGENCY for the FY2013 grant year. Proof of costs incurred and proof of payment for services are NOT required to be submitted with back-up, but MHDC does reserve the right to request that information and those records should be maintained. 3. Question 6: Program Information Breakdown: Grantee will provide a breakdown of funds spent during FY2013 grant year. 4. Questions 7-12: Turn-aways: Throughout the FY2013 grant year, grantees will report a tally of turn-aways for every back-up form submitted. At close out, grantees will report more in-depth information regarding turn-aways. 5. Question 13: Service Demographics. Grantee will report on the categories of clients served in program for FY2013 grant year. 6. Questions 14-39: Outcomes: Grantee will report on outcomes that were indicated in Outcome Detail Form (MHTF-241) provided at the beginning of the grant year. Grantee will provide results of each outcome as well as discussion of the outcome results. 7. Questions 40 42: General Trust Fund information: Grantee will discuss any comments on MHTF and processes, how MHTF has benefited grantee and will attach any additional information about program. 8. Question 43: Clients Served. Grantee will designate the number of individuals served as well as the percentage of total MHTF grant was spent in counties where MHTF funds were spent. If grantee did not spend funds in a county. Please leave blank. Effective: April 1, 2013 Page 69

70 Submission Instructions: Electronic submission to Joselyn Pfliegier. Sources and Uses (Close Out) Due Date: April 30, 2014 The Sources and Uses detail the program budget for the FY2013 grant year. Completion Instructions: Grantee shall update the Sources and Uses that from what provided at the beginning of grant year. The updated Sources and Uses should reflect the actual amount budgeted in this program. If grantee received more than one grant with MHTF for the FY2013 grant year. The funds should be designated in separate columns. Submission Instructions: Electronic, to Joselyn Pfliegier Housing Meeting Attendance (MHTF-435) Due Date: April 30, 2014 with grant Close Out form The CoC / Regional Housing Team Meeting (RHT) Attendance form will be used by grantees to keep a record of attendance to their designated CoC / RHT meeting as specified in grant agreement. Completion Instructions: Grantee will complete the initial information: Agency, MHTF#, Grant Type, Designated CoC Meeting. The form with the initial completed information will be taken to every CoC / RHT meeting attended. The Meeting Date, Agency Representative, CoC Representative and CoC Representative (signature) will be obtained for every meeting attended. Please note if grantee has more than one grant with MHTF during the FY2013 grant year, a SEPARATE FORM will need to be used for each grant. Submission Instructions: The completed form will be submitted along with grantee s close out form. This form will not be accepted before the close of the grant. Effective: April 1, 2013 Page 70

71 Emergency Assistance The administration of your FY2013 MHTF grant will consist of forms/documents/information that will be submitted to MHDC and forms/documents/information that is required to be kept on site. This section will discuss, in detail, the requirements for document submission as well as the information that is required to be kept on site for this grant type. Throughout this section, forms that require submission will indicate if a hard-copy or electronic version is required. Below is the information for each submission, please ensure that the document is submitted to the correct individual. Hard-Copy Submissions: Electronic Submissions: Missouri Housing Development Commission Community Initiatives Department 3435 Broadway Kansas City, MO jpfliegier@mhdc.com Initial Grant Documents Before any funds can be released, all required initial grant documents must be complete and received by MHDC by April 1, Grant Agreement (Agency Grantee) Due Date: April 1, 2013 The grant agreement is required for Rental Assistance, Operating Funds, Home Repair and Emergency Assistance grantees. The grant agreement specifically details the requirements and expectations for the administration of the grant. It is the grantee s responsibility to know and adhere to all provisions set forth in the grant agreement. Completion Instructions: There are three places where the Grant Agreement must be signed by grantee: 1. Signature page signature and notary. 2. Workforce Eligibility Affidavit signature and notary; and 3. Rider B signature. All signatures must be ORIGINAL and by an authorized signatory as designated in MHTF The entire original signed, notarized agreement must be returned to MHDC to be considered complete. If any pages of the grant agreement are missing, that Grant Agreement will not be considered complete. Please note that the Rider A is a part of your grant agreement and specifically details the eligible uses for the grant year. Submission Instruction: Hard-copy, original signatures to Joselyn Pfliegier Effective: April 1, 2013 Page 71

72 2013 Land Use Restriction Agreement (Emergency Assistance) Applicable Grant Type(s): Rental Assistance, Emergency Assistance Due Date: April 1, If grantee is paying rental payments on behalf of client AND the property is owned by grantee The Land Use Restriction Agreement (LURA) for Rental Assistance grantees is an agreement between grantee and MHDC stating that the grantee will adhere to terms of the LURA for the period of the current grant year. Terms of the LURA include but are not limited to: persons served in building bound by the LURA are required to be at or below 50% AMI. Completion Instructions: A fillable version of the LURA will be provided to the grantee to provide grantee specific information including the legal description of the property. Once grantee completes, grantee will send an electronic version of the LURA with an electronic version of the deed to Joselyn Pfliegier for review and approval. Once approval is received, grantee will submit the hard-copy version with copy of deed to Joselyn Pfliegier for recording. Submission Instructions: Draft electronic version to Joselyn Pfliegier; Approved hard-copy original to Joselyn Pfliegier. Direct Deposit Form (MHTF-340) / Blank Check Due Date: April 1, 2013 All disbursements from MHDC to grantee will occur using an Electronic Funds Transfer (EFT). This form is required to be submitted with initial grant documents. It provides MHDC with the grantee s banking information for the electronic transfer. A blank voided check from the indicated banking institution is also required to be submitted with the Direct Deposit form. Please note that by default your grantee s banking information will be updated for ALL MHDC accounts. If the banking information provided is for Missouri Housing Trust Fund or one grant ONLY it must be indicated on the direct deposit form. Completion Instructions: PDF fillable form can be obtained at MHDC.com. Form must be signed with original signatures by authorized signatory. Submission Instructions: Hard-copy, voided hard-copy check, original signatures to Joselyn Pfliegier Effective: April 1, 2013 Page 72

73 Authorized Signature Card (MHTF-240) Due Date: April 1, 2013, updated as needed This form designates all authorized signatories for each grant. All documents/forms that are required to be signed by grantee MUST be signed by a designated authorized signatory from this form. If an unauthorized person signs a document/form, the document/form will be rejected. Completion Instructions: Electronic form can be obtained from MHDC.com. Form must designate AT LEAST two authorized signatories. The form must have ORIGINAL signatures from all designated signatories. Please note the Authorizing Official must sign the in the Authorizing Official box as well as at the bottom of the form. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier Outcome Detail Form (MHTF-241) Applicable Grant Type(s): Rental Assistance, Operating, Home Repair and Emergency Assistance Due Date: April 1, 2013 This form will specifically detail the outcomes that will be tracked for the FY2013 grant year. Grantee should concisely detail WHAT, WHEN, WHOM, HOW MUCH, HOW YOU WILL KNOW and OUTPUTS for each outcome. Completion Instructions: Grantee will complete the above information for the two outcomes listed. Grantee should designate two distinct elements that will be observed, measured and reported on for the FY2013 grant year. Submission Instructions: Hard-copy, to Joselyn Pfliegier W-9 Applicable Grant Type(s): Rental Assistance and Emergency Assistance Due Date: April 1, 2013 If grantee is making one or more rental payments for recipient The W-9 is required for grantees that will pay rent payments for recipients. Completion Instructions: A PDF fillable form can be obtained from MHDC.com. The information provided on the W-9 that will be submitted to MHDC is for the grantee. Submission Instructions: Hard-copy to Joselyn Pfliegier Sources and Uses (Grant Agreement) Due Date: April 1, 2013 The Sources and Uses details the program budget for the FY2013 grant year. Completion Instructions: Grantee shall update the Sources and Uses that from what was initially provided at time of application. The updated Sources and Uses should reflect the actual amount of MHTF funds awarded for this grant. If grantee received more than one grant with MHTF for the FY2013 grant year. The funds should be designated in separate columns. Submission Instructions: Hard-copy, original signatures to Joselyn Pfliegier Effective: April 1, 2013 Page 73

74 E-Verify Memorandum of Understanding (MOU) Due Date: April 1, 2013 The E-Verify MOU is an agreement between the Department of Homeland Security (DHS) and Grantee stating that grantee agrees to participate in the Employment Eligibility Verification Program (E-Verify). Completion Instructions: Grantee shall submit a copy of the full and complete MOU. Submission Instructions: Hard-copy, to Joselyn Pfliegier Certificate of Liability Insurance Due Date: April 1, 2013 The Certificate of Insurance is a one page summary of Liability Insurance held by grantee. The insurance held by grantee may include: General Liability, Automobile Liability Umbrella Liability, Excess Liability, Worker s Compensation and Employers Liability. The Certificate of Liability Insurance must be current. If coverage lapses during to the grant year, grantee must provide MHDC with an updated Certificate Completion Instructions: Grantee shall provide a copy of the Certificate of Liability Insurance. Submission Instructions: Hard-copy to Joselyn Pfliegier Site Contact Form (MHTF - 252) Due Date: April 1, 2013 This form will be submitted with initial grant documents. This form is to ensure that MHDC has updated information for the upcoming grant year. The site visit locations and hours of operation will be used to conduct scheduled / and unscheduled site visits. Completion Instructions: Complete information pertaining to the grant indicated at top of form. Submission Instructions: Hard-copy to Joselyn Pfliegier Effective: April 1, 2013 Page 74

75 Request for Payment / Back-Up Forms Before any funds can be released the following criteria must be met: 1. All previous MHTF grants must be completely closed out*: a. All funds expended; b. Close Out form received; c. Updated Sources and Uses; d. Audit/current audit letter are complete and received; and e. Previous grant(s) are fully backed up. 2. All current year grant documents are complete and received. 3. All previous compliance issues are resolved (i.e. grantee is in compliance ). Once all the above criteria are met, grantee may then begin requesting funds from their FY2013 grant. Receiving funds for your MHTF grant is split into two processes: Request for Funds and Back-Up form. This is split into two processes to allow grantees to advance up to 25% of their grant award throughout the year. Once funds are advanced, that amount must be backed up before any further funds will be released. * Exceptions for ongoing MHTF Construction projects with current extension and ongoing Rental Assistance grants from FY2010 and earlier. Request for Payment The grantee may submit a Request for Payment as of April 1, The grantee may choose to draw up to 25% of their total grant award without back-up documentation. The following form must be used for all requests for payment: Request for Payment (MHTF-301) Due Date: At least quarterly until funds expended The Request for Payment form is required to be submitted for any and all disbursements for grantee funds. Completion Instructions: All fields are required to be completed for Request for Payment form to be accepted and processed. 1. Complete general fields: Date, Grantee, MHTF #, Grant Type, Grant Award Amount and Site Address. 2. Requested Amount. No more than 25% of the grant award amount can be requested without back-up. 3. Place an X for which disbursement is being submitted. If Final Disbursement please indicate. 4. Place an X for type of disbursement. All grantees MUST INDICATE type of disbursement that is being made. a. Emergency Assistance grantees: Rental Payments must be disbursed separately than all other funds. A rental payment is considered payment of current month rent. Rental payments DO NOT include payment of Rent Deposits OR payment of Rent Arrears. Submission Instructions: Hard-copy, original signatures to Sarah Parsons Effective: April 1, 2013 Page 75

76 Quarterly Draws The grantees must have a minimum of one disbursement per quarter. MHTF quarters and submission deadlines are detailed above under Timeline FY2013 Incomplete/Ineligible Requests for Payment If the grantee submits a Request for Payment that is incomplete/ineligible MHDC will notify grantee that the Request for Payment is incomplete/ineligible, MHDC will discard the Request. Grantee will need to submit a new and complete Request for Payment. EXAMPLES: Unsigned forms, previous request not fully backed-up, compliance issues, etc. Effective: April 1, 2013 Page 76

77 Back-Up Grantee is required to submit the following form to account for all MHTF spending during the FY2013 grant year. Back-Up Form Emergency Assistance (MHTF-310) Applicable Grant Type(s): Emergency Assistance Due Date: Before disbursement of additional funds, after initial disbursement. This form is a summary of the HMIS reports, Non-HMIS Client Detail Reports (if applicable) and the Administrative Detail Report. Completion Instructions: 1. General Information / Back-Up Check List / Summary: All fields in these sections are REQUIRED. If information is missing from these sections, the Back-Up form will be considered incomplete and will be discarded. 2. Summary of Direct Assistance by Region: This section summarized the information from the attached HMIS report / Non-HMIS Client Detail Report. Please pay attention to the regions in which MHTF monies are spent. Monies cannot be spent outside of the region(s) specified in the grant agreement. 3. Total HMIS Summary: This section is a summary of all HMIS Report / Non-HMIS Client Detail Reports submitted with the back-up. Please note that each line should represent the sum of the entire HMIS report / Client Detail Report not the page totals. Please limit each Back-Up form to ten (10) HMIS / Client Detail Reports per submission. Additional Reports will need to be included in a separate back-up form. 4. Administrative Detail Report (if taking 10% administrative fee): If the grantee chooses to take the 10% administrative fee (as indicated in grantee s Rider A ), the Administrative Detail Report form is required to be completed detailing all expenses that will be charged to MHTF. Support for these charges will be kept on site for review during site visits. DO NOT SUBMIT BACK UP SUPPORT TO MHDC. This form is a part of the Back Up form and separate tabs on the Excel Back Up form. For staff salaries please include the last four digits of the employee s Social Security number in the detail section of the Administrative Detail Report Form. 5. Back-Up Total Summaries: This section sums up all back up being submitted in report. a. Total Direct Assistance Summary of all HMIS / Client Detail Reports submitted for back up, summed from line detail entered above. This number should equal the Total Spent for all regions from the Summary of Direct Assistance by Region section. b. Total Operating Cost Claims Summary from all Administrative Detail Reports completed with this Excel workbook. This total automatically sums from the Administrative Detail Report completed. c. Total MHTF Grant Funds Expended Summary of Total Direct Assistance and Total Operating Cost Claims Submission Instructions: Hard-copy, original signatures to Sarah Parsons Effective: April 1, 2013 Page 77

78 Back-Up Form Emergency Assistance (MHTF-310) - Example 1 2 Auto fill 4 3 a 5 b c Effective: April 1, 2013 Page 78