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State of North Carolina <br /> Division of Social Services <br /> Contract Application Page 6 of 7 <br /> ( ) 2. The provider certifies through the contract budget attached to this contract that <br /> the matching share in available. Further, it is agreed that the provider will <br /> report all program costs incurred each month relating to this contract on the <br /> DSS-1571. However, reimbursement will be limited to the federal/state <br /> financial participation rate. <br /> (X) 3. The county department of social services is providing the match. <br /> G. Provider Fees (For Purchase Contracts Only) <br /> (NA) 1. The Provider agrees to pay the Department/Division up to $ <br /> Administrative Fee as payment in full for the administration of the contract. <br /> The amount of the fee is five percent of the matching share contributed by the <br /> Provider. <br /> (NA) 2. The Provider agrees to pay the Department up to $ Certification Fee <br /> as payment in full for the determination and certification of client eligibility. <br /> The amount of the fee is five percent of the matching share contributed by the <br /> Provider. <br /> Monitoring and Certification Fees,when applicable,will be deducted from the <br /> amount to be reimbursed. <br /> 12 <br />