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<br /> Pen BI - Distribwon of EsomaW Revevue for Tool Cast Reimbwsement Method <br /> C) (b) <br /> A. Estimated Eligible end Matchable Com Nwvbu Ratio <br /> L Estimated Eligible Cliwa 250 100% <br /> 2. Esimatcd ineligible Cliwa 0 0% <br /> 3. Total Clirna 250 100% <br /> B. Eligible Costs <br /> <br /> <br /> <br /> <br /> <br /> <br /> b Program Costs Am°wt Sacme nfFwds <br /> L FedemVStam Fwds g Wock Fvrt <br /> 2. Local Matching Share S Cowty <br /> 3. Other Budgeted Funds $ <br /> 4. TOTAL REVENDE $ 32.916 <br /> B. Pees (IfApplbable) <br /> 1. AdmiWstrative Fee S <br /> 2. CertiSratiovFtt $ <br /> 3. TOTAL FEES $ <br /> <br /> Pan V- Reimbmsavrnt Pcojecuovs (For Title XX Providers OWy) <br /> <br /> AwualProjection 1Wy-September October-Jwe <br /> Projasion Projettion <br /> <br />(p Mamheble (2) [.ass (3) Nat (4) (E) Cosa Eligble <br />Casts Eemed Matchable Esimaed% for Financial <br />[Pert 1, Line M, hsome Costs of Eligibles Participation <br />ml. Pj [B. P) L<ss 2 j [A. L Cb)j [B. C31 x 14)1 <br />S E S E E <br />Signed: <br />Provider/AUNoriud OfB<W <br />Cowry Director or Designtt <br />