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NAME AND ADpRESS Home and Community Care Block Grant for Older Adults <br />COMMUNITY SERVICE PROVIDER DOA-732 (Rev. 2/04) <br />Joint Orange-Chatham Community Action, Inc. County Fund'Ing Plan County_Orange <br />PO Box 27 July i, 2005 throw h June 30, 2006 <br />Pittsboro, NC 27312 Provider Services Summary REVISION # ,DATE <br /> A B C D E F G H I <br /> Ser. Delivery <br />(Check One) Block Grant Funding <br />Required <br />Net* <br />USDA <br />Total Projected <br />HCCBG Projected <br />Reimburse. Projected <br />HCCBG Projected <br />Total <br />Services Direct torch. Access In-Home Other Total Local Matc Serv Cost Subsidy Funding Units Rate Clients Units <br />Congregate Nutrition X 93895 \\\\\\\\\\\\\\\\\\ 10433 104328 20016 124344 33360 3.127338 400 33360 <br /> \\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\1\\ 0 0 0 <br /> \\\\\\\\\\\1\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\1\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\\ 0 0 0 <br />Total \\\\\\\ \\\\\\1 0 0 93895 93895 10433 104328 20016 124344 33360 \\\\\\\\\\\\\\ 400 33360 <br />*Adult Day Care & Adult Day Health Care Net Service Cost <br />ADC ADHC <br />Daily Caze Certification of required minimum local match availability. ~g' <br />Transportation Required local match will be expended simultaneously u tore, t D to <br />Administrative with Block Grant Funding. Community Serv' ovt <br />Net Ser. Cost Total ie~~~~~ <br />Signature, County Finance Officer Date tgnature, Chairman, Bo o Commis ' Date <br /> <br />