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NAME AND ADDRESS Home and Community Care Block Grant for Older Adults DOA-732(Rev.2f04) <br />COMMUNITY SERVICE PROVIDER County Orange <br />County Funding Pla <br />Orange County Dept on Aging July 1, 2005 through Jun e 30, 200 <br />P O Box 8181 <br />Provider Services Sum <br />mary Revision # ,Date: <br />Hillsborough, NC 27278 <br /> Projected Projected Projected Projected <br />Serv. Delivery <br />Re wired <br />Net" USDA <br />Total HCCBG <br />Reimburse. <br />HCCBG <br />Tota <br />(Check One) Block Grant Funding Other Total Local Match Serv Cost Subsidy Funding Units Rate Clients Units <br />Services Direct Purch Access In-Home <br /> <br />se Assistance x <br />C 43,283 11N115\111 4,809 48,092 40,000 <br />549 16,000 <br />81 na <br />5 5.10 na <br />150 40,000 <br />16,654 <br />a <br />Transportation x 73,394 <br />494 <br />76 IIIIIIINII <br />11111111111 8,155 <br />8,499 , <br />84,993 87,310 na 2,600 <br /> <br />45 87,310 <br /> <br />846 <br />5 <br />Senior Center x 78 849 , 11111111111 8,761 87,610 5,067 ~ 15.56 4 , <br />In-Home II x 11111111111 <br />377 <br />244 148 <br />302 <br />11111111111 <br />2, 799 <br />149,810 <br /> 849 <br />677 78 <br />6 494 <br />76 272,020 30,224 <br />, <br />, <br />Total \\\\\\\\\\ , <br />, <br />\\\\\\\\\\\ 11 , <br /> <br />Adult Day Care and Adult <br />Day Health Care Net Service Cost <br />ADC ADHC Certifcetlon of required minimum local match availability. <br /> <br />rized ~gnature, Title <br />~ Date <br />Daily Care Required local match witl be expended slmuNaneousty <br />C mun Service Provider <br /> <br />wtth Bbck Grant Funding. <br />Trans ortation <br />Administrative <br />New Ser. Cost Total r <br />Offker Date gnature, Chairman Data <br /> Signature, County Finance Board of Commissioners <br />