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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 A. 1. b B. 3 x 4 <br />$ $ $ $ $ <br />A. Program Costs <br />Amount <br />Source of Funds <br />1. FederaUState Funds <br />2. Local Matching Share <br />3. Other Budgeted Funds <br />4. TOTAL REVENUE <br /> <br /> <br /> <br />$ 28.044 <br />B. Fees (If Applicable) <br />1. Administrative Fee <br />2. Certification Fee <br />3. TOTAL FEES <br /> <br /> <br /> <br />Work First <br />County <br />Part V-Reimbursement Projections (For Title XX Providers Onlv) <br />Annual Projection July- September <br />Pro'ection October-June <br />Pro'ection <br />A. $ B. $ C. $ <br />Signed: <br />Pro er/ utho 'ze Official <br />oun erector or esignee <br />Date: <br />Date: ~f~j'/ ~~ <br />