Part 5, Chapter 16: Manual Exhibit 5-16-A

1. What are the goals of the review?
   1. Why is the subject area on the Management Control Plan?  (See Section 5-16.4A.)
      1. Program/Subject area is included in the scope of the A-123 Appendix A, ?Internal Controls Over Financial Reporting? assessment, if applicable.
   2. What are the specific areas of risk in the subject area?
   3. What does the Management Control Area Manager expect/desire to accomplish from the program evaluation?
2. What are the applicable laws, regulations, and policies related to the subject area?  (Include Department of Health and Human Services and Indian Health Service policies in place and in progress.)
3. How will the evaluation/review be conducted?
   1. Develop a questionnaire (Self-Assessment/Review Tool).  (Submit a copy with the review plan) AND/OR
   2. Make use of/or revise a current program or independent review tool already in place.  (If there is a review tool in place, submit a copy with the review plan.)
   3. Who will be involved in completing the Self Assessment/Review Tool?  (Areas only? Headquarters only? Both Area and Headquarters?)
4. What is the schedule for the evaluation/review?  (Use the annual Management Control System Timeline as a guide.)

NOTE:  Stamped signatures of the MCAM will not be accepted.