1. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH Local Health Department Submission, Certification, Proposal & Assessment Checklist September 2014 Financial Management Branch, CDPH

2. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 1 Provide an overview of new process for LHDs to submit their Indirect Cost Rate (ICR) including:  Submission, Certification & Proposal  LHD ICR Assessment, Checklist, and Crosswalk Review Submission Requirements and Timeline Review Available Resources Financial Management Branch, CDPH

3. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH Year that ICR proposal is for 2 Identifies: LHD Contact for questions 1.Submitted for use in FY: 20 / Based on the most recent independently audited financials for FY: 20 / 2.LHD Contact for ICR: First & Last Name : Title/Position : LHD Contact Email: @ LHD’s Contact Phone: Financial Management Branch, CDPH

4. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH Personnel Services Total Allowable Direct Costs 3 Identifies ICR options 3.Identify the ICR methodology that the LHD will use for CDPH contracts, unless otherwise designated/ restricted by federal grant requirements. Select ONE method (EITHER A or B) from above (percentage MUST match ICR Worksheet): A. Total Personnel Costs (Salaries, Wages & Fringe Benefits): % ** OR ** B. Total Allowable Direct Costs: % Financial Management Branch, CDPH

5. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 4 Certification of Proposal By filing this certification I have noticed that this information will be used by CDPH programs to verify the LHD's ICR. This rate will be used to approve the maximum ICR allowed by CDPH policy as indicated below, unless otherwise designated by State or Federal funding restrictions and/or requirements. I further certify that the costs used to calculate the ICR are based on the most recently available independently audited actual financials. 25% cap for ICR calculated based on Total Personnel (Salaries, Wages and Fringe Benefits) 15% cap for ICR calculated based on Total Allowable Direct Costs Agency / Department Official:__________________________ Title / Position: _________________________ Signature: _____________________________ Date: _________________________ Financial Management Branch, CDPH

6. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH Auditor Certification Auditor Controller (or Designee): ____________________________________________________________ Print Name ____________________________________________________________ Title/Position ____________________________________________________________ Signature 5 Financial Management Branch, CDPH

7. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 6 Requires Explanation/Justification Direct to CDPH and in either ICR or CCAP Costs not listed  May be disallowed If in ICR or County Cost Allocation Plan  Add Financial Management Branch, CDPH

8. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 7 If Charged Direct to CDPH  Explanation/Justification Required  Specify CDPH Program/Project(s) Charged “Direct”  Specify Different Circumstances Financial Management Branch, CDPH

9. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 8 ICR Checklist and Assessment Financial Management Branch, CDPH

10. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 9 ICR Schedule Financial Management Branch, CDPH

11. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 10 ICR Crosswalk Financial Management Branch, CDPH

12. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 11 ICR Crosswalk - Example Financial Management Branch, CDPH

13. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH LHD ICR Certification & Proposal (CDPH 2345) Certification: Signatures Required, Page 1 Proposal: Signatures Required, Page 3 ICR Checklist and Assessment (Excel) Signature Required Additional Documentation Countywide Cost Allocation Plan ICR Summary Spreadsheet (See Sample) 12 Financial Management Branch, CDPH

14. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH Electronically: CDPH-ICR-mailbox@cdph.ca.gov 13 November 14, 2014: LHDs submit ICR Certification and Proposal Financial Management Branch, CDPH

15. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH November 2014: CDPH reviews ICR Documents January 2015: CDPH posts each LHD ICR July 1, 2015: Posted ICR will be applied to all contracts, agreements and grants with July 1, 2014 start dates. 14 Financial Management Branch, CDPH

16. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 2015/16 State Fiscal Year (FY) 2015/16 LHD ICR capped at 15% of Total Personnel Costs Salaries/Wages + Fringe Benefits 2016/17 & Beyond FY 2016/17 LHD ICR capped at 10% of Total Personnel Costs Salaries, Wages & Fringe Benefits 15 Financial Management Branch, CDPH

17. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH Utilize approved ICR for each LHD agreement (from posting on website) Review direct program budget to ensure that there is no overlap with items within the ICR; if there is overlap ensure that there is a legitimate reason. Verify that the Indirect Rate for subcontracts is applied to the first $25,000 for each subcontract. 16 Financial Management Branch, CDPH

18. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH Programs should seek to understand: How do budgeted items support the activities in the Scope of Work? Where is the program housed? What method is used to allocate and track the cost to an individual program? Are there joint costs that benefit multiple programs? 17 Financial Management Branch, CDPH

19. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH CDPH Contract Bulletin 13-07 Internal Certification of Indirect Cost Rate Proposal Indirect Cost Rate Checklist & Assessment FAQ on ICR Method Sample Backup Documentation: ICR Summary Questions: CDPH-ICR-mailbox@cdph.ca.govCDPH-ICR-mailbox@cdph.ca.gov 18 Financial Management Branch, CDPH

20. Susan Fanelli, Deputy Director Emergency Preparedness Office, CDPH 19 Financial Management Branch, CDPH