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D. Estimated Unit Cost or Individual Fixed Rate: $ per <br />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 Eligible Participation <br />col. (3) [B. (1) Less (2)}J [A. 1. (b)] [B. (3) x (4)] <br />$ $ $ $ $ <br />A. Program Costs Amount <br />1. Federal/State Funds $ 32,587 <br />2. Local Matching Share $ <br />3. Other Budgeted Funds $ <br />4. TOTAL REVENUE $ 32,587 <br />B. Fees (If Applicable) <br />1. Administrative Fee $ <br />2. Certification Fee $ <br />3. TOTAL FEES $ <br />Source of Funds <br />Work First <br />County <br />Part V- Reimbursement Proiections (For Title XX Providers Onlyl <br />Annual Projection July- September <br />Projection October-June <br />Projection <br />A. $ B. $ C. $ <br />Signed: ~ p(, <br />Provi er/ uthorized Official <br />Count~rec or or Designee <br />_~ <br />Date: _S~G I 3 ~ Z D © ~ <br />Date: ~~/~~~~ <br />