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Part III -Distribution of Estimated Revenue for Total Cost Reimbursement Method <br />(a) (b) <br />A. Estimated Eligible and Matchable Costs Number Ratio <br />1. Estimated Eligible Clients 250 100% <br />2. Estimated ineligible Clients 0 0% <br />3. Total Clients 250 100% <br />B. Eligible Costs <br />(1) Matchable (2) Less (3) Net (4) (5) Costs Eligible <br />Costs Earned Matchable Estimated % for Financial <br />[Part 1, Line M, Income Costs of Eligibles Participation <br />col. (3) [B. (1) Less (2)}] [A. 1. (b)] [B. (3) x (4}] <br />$ $ $ $ $ <br /> <br />A. Program Costs ~ Amount Source of Funds <br />1. Federal/State Funds $ Work First <br />2. Local Matching Share $ County <br />3. Other Budgeted Funds $ <br />4. TOTAL REVENUE $ 38.962 <br />B. Fees (If Applicable) <br />1. Administrative Fee $ <br />2. Certification Fee $ <br />3. TOTAL FEES $ <br /> <br /> Part V-Reimbursement Projections (For Title XX Providers Only) <br /> <br /> Annual Projection July- September October-June <br /> Projection Projection <br />A.$ B.$ C.$ <br />Signed: Date: ~~ ~~ <br /> Provider/ uthorized Official <br /> Date: <br /> County Director or Designee <br />