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STATE OF NORTH CAROLINA <br />DIVISION OF SOCIAL SERVICES <br />PURCHASE CONTRACT BUDGET <br />SUMMARY Effective <br />Provider (lrana,~rP, (~n~in Ti~hnnlc ID# period ~/~ /~ through h/~(1/n5 <br />Part I -Estimated Expenditures <br /> <br />Object of Expenditure Total Non- Matchable Total Matchable <br /> Program Costs Costs Costs <br /> ~1) ~2) ~3) <br />A. Salaries 30,682.89 <br />B. Fringe Benefits 7,549.64 <br />C. Staff Development-Services 1,000.00 <br />D. Travel 1,900.00 <br />E. Equipment Purchase-Tangible <br />Property <br />F. Transportation-Recipient. <br />G. Medical Supplies and Expense <br />H. Cost of Space-Non-Residential <br />I. Room &Board-Residential Treatment <br />J. Service Payments <br />K. Other 2200.00 <br />L. Indirect Costs 990.00 <br />M. Totals 44,322.53 <br />Part II -Computation of Unit Cost or individual rixea xate <br />A. 1. Total Matchable Costs $ <br />2. Less: Earned Income for Unit Cost Method $ <br />3. Net Matchable Costs $ <br />B. 1. Total Service Unit Capacity, or <br />2. Total Anticipated Utilization Capacity <br />Method of Computation or Source of Data <br />D. Estimated Unit Cost or Individual Fixed Rate: $ per <br />