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N.C.Department of Environment,Health,and Natural Resources Page 1 of 4 <br /> • Division of General Services <br /> FY 97 - 98 <br /> CONTRACT ADDENDUM <br /> Specialized Services Branch 98 53180 068 <br /> Office, Section, or Branch Contract Number <br /> Child Service <br /> Orange __ :; Coordination <br /> Contractor Activity <br /> GOAL <br /> To cooperate and collaborate with families to assure identification of and access to preventative, specialized <br /> and support services for themselves and their children .... and children with special needs will have <br /> maximum opportunity to reach their developmental potential. <br /> SECTION A: NON-MEDICAJID SERVICE L E <br /> Instructions: In the ESTIMATED NUMBER column, enter the projected number of non-Medicaid reimbursable <br /> services that the local agency plans to provide during the contract period. Multiply the ESTIMATED NUMBER <br /> of each service by the reimbursement rate for that service and enter the amount in the ESTIMATED COST <br /> column. If the projected number for a service type is zero, enter "0" in both ESTIMATED NUMBER and <br /> ESTIMATED COST columns. The estimated number for each service type should at least equal the <br /> previous fiscal year's non-Medicaid service level. If declines in service levels are projected, attach a <br /> written explanation. <br /> ESTIMATED ESTIMATED <br /> SERVICE TYPE NUMBER X RATE = COST <br /> Number of active service months* 558 $103.79 $ . 76 <br /> * Number of active months: This number should include the estimated number of months of CSCP <br /> services that your agency intends to provide to non-Medicaid eligible clients. This does not refer to the <br /> number of clients. <br /> Reviewed by <br /> DEHNR 3300 (Revised 2/90) <br /> General Services Division (Review 1/95) f` '© �� <br /> Initials Date <br />