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P4F 1aa-W5_ aD►s -a4 <br />lep <br />NAME AND ADDRESS Home and Community Care Block Grant for Older Adults <br />COMMUNITY SERVICE PROVIDER DOA -732 (Rev. 2/14) <br />Orange County Department on Aging County Funding Plan County ORANGE <br />2551 Homestead Road July 1, 2015through June 30, 2016 <br />Chapel Hill, NC 27516 Provider Services Summary IREVISION# , DATE: <br />Services <br />A <br />Ser. De►ivery <br />(Check One) Block Grant Funding <br />B <br />C <br />D <br />E <br />F <br />G <br />H <br />I <br />Required <br />Local Match <br />Net* <br />Sery Cost <br />NSIP <br />Subsidy <br />Total <br />Funding <br />Projected <br />HCCBG <br />Units <br />Projected <br />Reimburse <br />Rate <br />Projected <br />HCCBG <br />Clients <br />Projected <br />Total <br />Units <br />Direct <br />Ruch. <br />Access <br />In -Home <br />Other <br />Total <br />Senior Center <br />x <br />76494 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />8499 <br />1 84993 <br />84993 <br />1 185000 <br />na <br />5500 <br />185000 <br />Congregate Meals <br />x <br />139096 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />15455 <br />154551 <br />18000 <br />172551 <br />20300 <br />8.50 <br />625 <br />21000 <br />Information/Assistance <br />x <br />110791 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />12310 <br />123101 <br />123101 <br />8000 <br />na <br />1000 <br />8000 <br />Transportation <br />x <br />60418 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />6713 <br />67131 <br />67131 <br />8000 <br />8.39 <br />50 <br />8300 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />Total <br />\ \ \ \ \ \\ <br />\ \ \ \ \ \\ <br />171209 <br />0 <br />215590 <br />386799 <br />42977 <br />429776 <br />18000 <br />447776 <br />221300 <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />7175 <br />222300 <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 rized Signature, TitIP Date <br />Administrative vi lock Grant Funding. If6mmunity Service Provider <br />Net Ser. Cost Total <br />Signature, County Finance Officer ate Signature, Chairman, Board of Commissioners Date <br />