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VIE AND ADDRESS <br />vIMUNITY SERVICE PROVIDER <br />age County Social Services <br />West Tryon Street <br />~borou4h. NC 27278 <br />Ser. <br />Services Direct Purch. Access <br />In-Home Aide X <br />A <br />Block Grant <br />In-Home <br />48841 <br />Total \\\\\1\ \\\\\\\ 0 48841 <br />*Adult Day Care & Adult Day Health Care Net Service Cost <br />ADC ADHC <br />Daily Care <br />Transportation <br />Administrative <br />Net Ser: Cost Total <br />Home and Community Care Block Grant for Older Adults <br />County Funding Plan <br />Provider Services Summary <br /> B C D <br />Fundin Required Net* USD <br />Other Total Local Matc Serv Cost Subsi <br /> \\\\1\\\\\\\\\\\\\ 5427 54268 <br /> \\\\\\\\\\\\\1\\\ 0 0 <br /> \\\\\\\\\1\\\\\\\\ 0 0 <br /> \\\\\\\\\\\\\1\\\\ 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 <br /> \\\\\\\\\1\\\\\\\\ 0 0 <br /> \\\\\\1\\\\\\\\\\ 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 <br /> \\\\\\\\\\\\\\U\\ 0 0 <br /> \\\\\\\\\\\\\\\1\\ 0 0 <br /> \\\\\\\\\\\\1\\1\\ 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 <br /> \\1\\\\\\\\\\\\\\\ 0 0 <br />0 48841 5427 54268 <br />Certification of required minimum local match availability. <br />Required local match will be expended simultaneously <br />with Block Grant Funding. <br />Signature, Coun Finance Officer Date <br />DOA-732 (Rev. 2/07) <br />County Orange <br />Jul I, 2007 throw h June 30, 2008 <br />REVISION # ,DATE <br /> E F G H I <br /> <br />Total <br />Fundin Projected <br />HCCBG <br />Units Projected <br />eimburse <br />Rate Projected <br />HCCBG <br />Clients Projected <br />Total <br />Units <br /> 54268 3769 14.40 10 3769 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br /> 0 <br />0 54268 3768.61111 \\\\\\\\\\\\\\ 10 3768.6111 <br />~fi~ O <br />Autho 'zed Signature, Title Date <br />Com nity Service Pro ' <br />~~o~ <br />ignature, Chairman, Board of rs ' n s Date <br />• • • <br />