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,. <br />Part III - Dsmbuuon of Esttmatd Revenue [or ToW Cos[ Rewbwsement Mtthod <br /> (e) (b) <br />A Estimated Eligible and Matchable Costs Number ario <br />1. Estimated Eligible Clients - 250 100% <br />2. Estimated ineligible Clirnts p p~ <br />3. Toml Clients 250 100% <br />B. Eligible Costs <br /> (1)Matchable (2) Lass (3) Net (4) (5)Costs Eligible <br /> Costs tamed Matchable Estimatad% for Financial <br /> [Part 1, Line M, Income Costs of Eligibles Panicipafion <br /> coL (3) [B. (p Less (2)}] [A. L (b)] [B. (3) x (4)] <br /> $ $ S $ $ <br />A. Program COSCa Amowt $ouroe ofFwd• <br />L FederaVStare Fwds $ Work Fvst <br />2. Local Matching Share T Cowty <br />3. ONer Budgeted Fwds $ <br />4. TOTAL REVENUE $ 32916 <br />B. Fees (IPApplicable) <br />1. Admirdstrative Fee $ <br />2. CertiScation Fee $ <br />3. TOTAL FEES $ <br /> <br />Part V-Reimbursement Projecfiom (Far Title XX Providers Only) <br /> <br />ArmuW Projection 1Wy-Septeruber Octobm-Jwe <br /> Projection ProjecCOn <br /> <br />Signed: Date: <br />Provider/AUthoriud OfficW <br />Dale: <br />County Dvector or Designee <br />