U.S. Department of Health and Human Services

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

Headquarters
MCAM Assurance Statement

HEADQUARTERS MCAM ASSURANCE STATEMENT


TO:	Senior Assessment Team Through: Director, Office of xxxxxxx (if applicable) Through: Director, MPICS
FROM:	[Headquarters Management Control Area Manager (MCAM)]
SUBJECT:	Assurance Statement on [Management Control Area]

As the Director, [Office/Division/Organization], I am aware of the importance of management controls and of meeting the requirements of the Federal Managers? Financial Integrity Act (FMFIA). I also understand that the concept of reasonable assurance recognizes that the cost of management controls should not exceed their expected benefits. Changing conditions, such as downsizing, streamlining, and doing more with less, have significantly impacted the management control environment, requiring greater accountability by managers.

Taking these conditions into account, we have conducted a self-assessment of the [Management Control Area] and determined that this [Office/Division/Organization] [can/cannot] provide reasonable assurance that:

The program is carried out efficiently, effectively, and in accordance with applicable law and Part 5, Chapter 16, Indian Health Manual, and is achieving the intended results.
Assets/resources are safeguarded against waste, loss, unauthorized use, and misappropriation.
Obligations and costs comply with applicable law.
Revenues and expenditures are properly recorded and accurate financial reports prepared.

[If reasonable assurance cannot be provided, list exceptions and reasons here:]

I understand this assurance statement will be used in support of the Director, Indian Health Service, Annual Assurance Statement to the Secretary of the Department of Health and Human Services. I have therefore made every effort to ensure that our management control systems meet FMFIA requirements.

Sincerely,
[Signature]

NOTE: A stamped signature of the MCAM will not be accepted.