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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 />1. FederaUState Funds <br />2. Local Matching Share <br />3. Other Budgeted Funds <br />4. TOTAL REVENUE <br />Amount Source of Funds <br />$ Work First <br />$ County <br />$ 28,044 <br />B. Fees (If Applicable) <br />1. Administrative Fee <br />2. Certification Fee <br />3. TOTAL FEES <br /> <br /> <br /> <br />Part V- Reimbursement Projections or Title XX Providers Only) <br />Annual Projection July- September <br />Projection October-June <br />Projection <br />A.$ B.$ C.$ <br />Signed: <br />Provider/ thonze Official <br />oun y ector or esignee <br />Date: ~~~~ ~~~ <br />Date: ~,~~1~' ~ <br />