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NAME AND ADDRESS Home and Community Care Block Grant for Older Adults <br />COMMUNITY SERVICE PROVIDER DOA-732 (Rev. I/00) <br />Oran a Coun DSS County Funding Plan County_Orange <br />July 1, 2003 through June 30, 2004 <br />300 West T on Street <br />Hillsborou h, NC 27278 Provider Services Summary <br /> q B C D E F G H I <br /> Projected Projected Projected Projected <br /> Ser. Delivery <br /> (Check one) Block Grant Fundin Required Net* USDA Total HCCBG Reimburse HCCBG Total <br />Services Direct Purch. Access In-Home Other Total Local Matc Serv Cost Subsid Fundin Units Rate Clients Units <br />To-Home Aid X 34599 \\\\\\\\\\\\\\\\\\ 3844 38443 38399 3840 12.9902 10 2956 <br /> <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 /> \\\\\\\\\\\\\\\\\\ 0 0 0 <br /> \\\\\\\\\\\\\\\\\\ 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 \\\\\\\ \\\\\\\ 0 34599 0 34599 3844 38443 0 38399 3840 10 2956 <br /> <br />*Adult Day Care & Adult Day Health Care Net Service Cost <br />ADC ADHC <br />Daily Care Certification of required minimum local match availability. ~ <br />Transportation Required local match will be expended simultaneously Authoria ignature, Title Date <br />Administrative with Block Grant Funding. Community Service Provider <br />Net Ser. Cost Total <br />Signature, County Finance Officer Date Signature, Chairman, Board of Commissioners Date <br />o~ <br />