��ࡱ�>�� or����n��������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� ��Hjbjbj�ޤ� 8nƴƴs+�������8 8 {{����������8Lc��46�//EEE����5�5�5�5�5�5�58��:>�5]�������5{{EE��5� � � �L{8E�E�5� ��5� � ��2|�4E�����HY����? LO3{56046a3��:� 4�:$448�:�;4@��� ������5�5� ���46�������������������������������������������������������������������������:���������8 A: Chairperson�s Statement in respect of 20_ _ Organisation Name (As it appears on the Grant Aid Agreement) Organisation Address Amount of HSE grant The Funding provided under this Grant Aid Agreement (GA) is Public Exchequer Funding, and must be administered and managed in line with the terms and conditions of the GA, and the principles as outlined in Appendix 1 �Statement of Principles for Grantees�, issued by the Department of Public Expenditure and Reform, and used only for the purposes as outlined and agreed with the HSE. Please tick below as appropriate 1I can confirm that the grant funding received from the HSE was fully utilised in 20_ _ for the purposes as agreed, and that our organisation has complied with the terms of the Grant Aid Agreement. 2I can confirm that the grant funding received from the HSE was utilised for the purposes as agreed, and that our organisation has complied with the terms of the Grant Aid Agreement. However the grant was not fully utilised during 20_ _ and the amount of � _____________remained unspent at the 31.12.20_ _. Provide explanation below 3I am unable to confirm that the grant funding received from the HSE was utilised for the purposes as agreed, or that our organisation has complied with the terms of the Grant Aid Agreement. Please provide an explanation below  Please be aware that all funding not spent in accordance with the Grant Aid agreement is refundable to the HSE. If your organisation receives public exchequer funding from any other source other than the amount of this Grant, please outline the amounts received below, and confirm that that there is no duplication of funding for the same purpose as agreed under this Grant Aid Agreement. Public Exchequer funding is funding received from the State, a State or public body, or any organisation which is responsible for the distribution of such funding. All funding relates to the calendar year as outlined above. Funding SourceFunding Amount � Expenditure � Brief Description of PurposePlease indicate below if funding was used for same purposes as this HSE GA.No (Yes Please include amount of duplication. �  Please be aware that all duplicate public exchequer funding is refundable to the HSE. Where you have indicated that the other exchequer funding outlined above was received for the same purposes as the Grant please provide an explanation below.  Does your organisation receive over 50% of its total income/funding from the HSE? Yes No Where your organisation does not prepare an annual report on activity, you may wish to outline below, any relevant information pertaining to the outcomes achieved by your organisation, with particular reference to the use of the funding provided under this Grant Aid Agreement. I have read the Governance and Financial Assurance requirements outlined in Appendix 1 and can confirm compliance with all relevant matters. Chairpersons Name Chairpersons signature  Date Appendix 1 Grant Aid Agreements � Governance and Financial Assurance Requirements The Funding provided under your Grant Aid Agreement (GA) is Public Exchequer Funding, and must be administered and managed in line with the terms and conditions of the GA, and the principles as outlined in Appendix 1 �Statement of Principles for Grantees�, issued by the Department of Public Expenditure and Reform, and used only for the purposes as outlined and agreed with the HSE. The Grant Aid Agreement outlines terms and conditions in relation to your organisation and you should make yourself familiar with these conditions. The HSE will monitor your performance against the Grant Agreement and this document sets out minimum requirements. You must have a written constitution and make this available to the HSE. You must inform the HSE of changes to same You must hold regular meeting of governing body, organising Committee You must have appropriate arrangement outline in the constitution for the appointment, election/selection of members of governing body and adhere to same. You must avoid conflict of interest, i.e. no member should have business/personal interest which directly benefits from the organisation; You must notify the HSE of any change in officers You must have clear policies for The protection of children and vulnerable adults including garda clearance for associated staff if relevant. Freedom from Abuse Complaints, and system of recording all complaints and managing same in line with your service your say. Your Organisation will need to take action to investigate all allegations of inappropriate behaviour by an employee, officer, volunteer or agent of the organisation, and where substantiated take all necessary action including disciplinary action and report same to relevant authorities. You must have current Tax Clearance and provide evidence of this to the HSE You must provide an Annual Chairperson�s Statement to the HSE � See pro-forma Attached. Your organisations must maintain proper accounting arrangements and internal controls You must have a separate Bank account in the name of the organisation which is used for all organisational banking purposes. Bank Accounts should be strictly managed with appropriate authorisation procedures for payments to include two signatures one of which should be a non executive board member. Credit Cards as a general rule are not advisable however where they are deemed by the governing body to be necessary should be managed with appropriate authorisation procedures etc. The number of Bank Accounts and Credit Cards should be kept to a minimum. Arrangement for Paying taxes and pensions as appropriate Where possible payments should be made by cheque or electronic transfer Appropriate arrangements relating to the secure handling of Cash receipts/Petty Cash and income. Income and Expenditure reports checks and reconciliations to budgets etc. Regular reporting to the governance body Written financial procedures should be in place as appropriate. You must provide Annual Accounts to the HSE, which separately identify the HSE Grant Funding and expenditure related thereto. +,->@hjkm������������ ����ķ����Ě��Ě�m\m\Ohs!`hY8CJOJQJ!h�G�CJOJQJ\�^JmH sH 'hs!`hY8CJOJQJ\�^JmH sH 0jhF�hF�CJOJQJUmHnHtH uhs!`h�%<CJ OJQJaJ hs!`h�%<6�CJOJQJhs!`h�%<CJOJQJhs!`h�%<CJOJQJaJh�%<h�%<CJOJQJaJhU �5�CJOJQJaJhWC�h�%<5�CJOJQJaJ,-jklm���������� A B D ������������������������$d�$Ifa$gd�b�$d�&dP��a$gd�%< $d�a$gd�%<� � �   , @ A B C � � � � � � � � ���ĵ����rdWrJ=Jrh�b�hU �CJOJQJh�b�h!=CJOJQJh�b�h�j6CJOJQJh�b�h�j6>*CJOJQJh�b�h�lTCJOJQJh�b�h�4CJOJQJh�G�h�lTCJ OJQJaJ hs!`h�4CJOJQJhs!`h�lTCJOJQJh�G�hY8CJ OJQJaJ hs!`h�%<CJOJQJhs!`hY8CJOJQJhs!`huo~CJOJQJ'hs!`huo~CJOJQJ\�^JmH sH � �    q r � � � � � � v | � � � � � � � &����ʱ檝���ِ�v��v�gY���Lh�b�hWC�CJOJQJh�b�h�$.6�CJOJQJh�b�h�$.CJ OJQJaJ h�b�hU �CJOJQJh�b�h!=CJOJQJh�b�h�$.CJOJQJh�b�h�4CJOJQJ hs!`h�lT0jh�b�hF�CJOJQJUmHnHtH uh�b�h�1�CJ OJQJaJ h�b�h�1�CJOJQJh�b�h�lTCJOJQJh�b�h�G�CJOJQJ  � � � � � � qbJJJJJb$d�$&d IfP�� a$gd�b�$d�$Ifa$gd�b��kd$$If�l��F���� <'� t��0�������6�� ���� ���� ���� ���4�4� la�yt�b�� � � � � ����$d�$Ifa$gd�b� $d�$&d (d IfP�� R�� a$gd�b� $d�$$d &d IfN�� P�� a$gd�b�� � � &'LMNqbbbbbB $d�$$d &d IfN�� P�� a$gd�b�$d�$Ifa$gd�b��kd�$$If�l��F���� <'� t��0�������6�� ���� ���� ���� ���4�4� la�yt�b�&'QRSTU������t�����˷�������reVI:h�Fh�4CJ OJQJaJ hs!`h�4CJOJQJhs!`hU`CJOJQJ^Jhs!`hU`CJOJQJ"hWC�h�lT5�6�CJ OJQJaJ hWC�5�6�CJOJQJhWC�hWC�5�6�CJOJQJhWC�hWC�CJ OJQJaJ hs!`hWC�'h�b�hWC�CJOJQJmHnHtH u0jh�b�hF�CJOJQJUmHnHtH uh�b�hWC�CJOJQJh�b�hWC�CJ OJQJaJ NOPQS����$d�$&d IfP�� a$gd�b� $d�$$d &d IfN�� P�� a$gd�b�$d�$Ifa$gd�b�STU����xz|~qff[[[[[[[ $d�a$gd�%< $d�a$gdWC��kdR$$If�l��F���� <'� t��0�������6�� ���� ���� ���� ���4�4� la�yt�b� �26^`b�&(Rtvxz����������ȸ������wk\OKO=h�b�h�1�5�CJOJQJh�Fh�b�h�FCJOJQJh�FhWC�CJ OJQJaJ hWC�CJ OJQJaJ h�lTCJ OJQJaJ hs!`h�lT6�CJOJQJhrJ*6�CJOJQJ^Jh��6�CJOJQJ^Jhs!`6�CJOJQJ^Jhs!`hs!`6�CJOJQJ^Jhs!`h�46�CJOJQJ^Jhs!`6�CJOJQJhs!`hs!`6�CJOJQJhs!`hU`6�CJOJQJ~�����������$��������������$d�$Ifa$gd�b� $d�a$gd�%< �������I:::::$d�$Ifa$gd�b��kd�$$If�l4��r���� g!<'` `E`o`�  t��0�������6�������������������������4�4� la�yt�b�������LNP\^jlxz����������#./01������֤֤֤֤֤֤֤��x�x�ndZh�j6CJOJQJhiCJOJQJhWC�CJOJQJhWC�5�6�CJOJQJhWC�hWC�5�6�CJOJQJhihiCJ OJQJaJ h�Fh�b�h�F6�CJOJQJaJh�b�h�1�6�CJOJQJaJh�b�h�1�5�CJOJQJh�b�h�FCJOJQJ j��h�b�h�1�CJOJQJh�b�h�1�CJOJQJ�NPRT�'���kd�$$If�l4�ֈ���� g!�<'   E o � �U t��0�������6�����������������������������4�4� la�yt�b�$d�$Ifa$gd�b�TVXZ\����$d�$Ifa$gd�b�\^`bd8)))$d�$Ifa$gd�b��kd�$$If�l�ֈ���� g!�<' Eo� �U t��0�������6�����������������������������4�4� la�yt�b�dfhjl���)�kd�$$If�l�ֈ���� g!�<' Eo� �U t��0�������6�����������������������������4�4� la�yt�b�$d�$Ifa$gd�b�lnprtvx������$d�$Ifa$gd�b�xz|~�8)))$d�$Ifa$gd�b��kd�$$If�l�ֈ���� g!�<' Eo� �U t��0�������6�����������������������������4�4� la�yt�b���������)�kd�$$If�l�ֈ���� g!�<' Eo� �U t��0�������6�����������������������������4�4� la�yt�b�$d�$Ifa$gd�b��������������$d�$Ifa$gd�b������8)))$d�$Ifa$gd�b��kd�$$If�l�ֈ���� g!�<' Eo� �U t��0�������6�����������������������������4�4� la�yt�b���������)�kd�$$If�l�ֈ���� g!�<' Eo� �U t��0�������6�����������������������������4�4� la�yt�b�$d�$Ifa$gd�b��������������$d�$Ifa$gd�b����08-" $d�a$gdWC� $d�a$gd�%<�kdk $$If�l�ֈ���� g!�<' Eo� �U t��0�������6�����������������������������4�4� la�yt�b�01���������9:;RST���������������� $d�a$gd�]�$ �� d�a$gd�#� $d�a$gdWC�$d�&d (d P�� R�� a$gd�]�$d�$d &d N�� P�� a$gd�%< $d�a$gd�%<����������89:;DE\��������θ�⡗؍�rfZBf.jhF�CJOJQJUaJmHnHtH uh�%<CJOJQJaJhKvCJOJQJaJhs!`h� �CJOJQJh� �h� �6�CJOJQJhoW/CJOJQJh�%<CJOJQJhs!`h�%<CJOJQJh�#�CJOJQJ*jhF�CJOJQJUmHnHtH uhWC�CJOJQJh�]�CJOJQJhiCJOJQJh�j6CJOJQJh�1�CJOJQJTUVWXYZ[\���������������� $d�a$gd�%<$d�&d (d P�� R�� a$gd�%<$d�&d (d P�� R�� a$gd�]�$d�&d (d P�� R�� a$gd�]�$d�$d &d N�� P�� a$gd�]�"$%2z�{����Yc|~���$��;<��h i !!i!j!���;岥����z�z�z�zl�z�z�^�^�^�^�lz^h�?�h� �6�CJOJQJh�r�h� �6�CJOJQJh� �CJOJQJh�?�h� �CJOJQJ'h�?�h� �CJOJQJ\�^JmH sH h� �5�CJOJQJaJh� �CJOJQJaJh�%<h�%<CJOJQJaJhKvCJOJQJaJhrJ*CJOJQJaJh�%<CJOJQJaJhKvhKvCJOJQJaJ$#$%&'2yz����Mx�Y�7����������������������$ & Fd�a$gd� �$ & Fd�a$gd� � $d�a$gd� � $d�a$gd`l� $d�a$gdKv7��"A��<�i !j!�!�!M"�"�"##"g�g>hi�i�����������������������$��d�^��a$gd�S$ & Fd�a$gd� �$ & Fd�a$gd� �$ & Fd�a$gd� �j!�!�!�!�!L"M"�"�"�"�"##,#}#~#$f g"g�g�g:h h j@jBjDjFjHj����������������������������������������~�z�h�a�h��h�"#mH sH h�"#mH sH h�SmHnHuh�"#jh�"#Uh�*�jh�*�Uh�%<h� �CJOJQJaJUh�SCJOJQJh� �CJOJQJh�r�h� �6�CJOJQJh�?�h� �6�CJOJQJh�?�h� �CJOJQJ0if your organisation has turnover in excess of � 150,000 these must be audited, for charitable organisations this threshold is reduced to � 100K. An income and expenditure account is sufficient in smaller organisations. Your organisation must ensure that it has all necessary insurances. You must inform the HSE of any issues which relate to the funding and provide any requested information The HSE may ask for evidence of the above by submission of documentation or additional information returns.      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