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LuLAL HL8Li1 DEPARTMENT BUDGET Revis. <br /> DepartaciFlt of Human Resources <br /> . , <br /> Division of Hgalth Services Fain P an i • Branch <br /> ,- <br /> Office, Section or Branch <br /> 07 / el 06 / 82 1 6 4 <br /> • — — --- .– <br /> . ..u..................~,.. <br /> Effective Date Termination Date CI <br /> •,. , <br /> 17ontractor: a , . - . . . - • • 1 - . .. • •• -n t, Activity: Larsil,y21anrAm__ <br /> , !reject Director: Jerry Robinson Total Budget: $ . <br /> _--_—_ <br /> ITEM DESCRIPTION CLASSIFICATION ITEM <br /> ------ __----_--- <br /> EXPENDITURES <br /> State: <br /> Salaries"& Fringe Benefits SA/FR 1000 $ <br /> Operating Expenses OP EXP 2000 <br /> Purchase of Equipment EQUIP 5000 <br /> Special Contracted or Purchased Services CNIR SERV 6000 XXXXXX <br /> General GENERAL 6100 <br /> School Health SCH HLTH 6200 XXXXXX: <br /> Professional Services PRO SERV 6800 XXXXXX <br /> Clinician CLN 6863 <br /> Delivery Services DEL SERV 6869 XXXXXX <br /> Laboratory LAB 6862 XXXXXX: <br /> Pharmacy Services RX SERV 6865 XXXXXX: <br /> Other Professional OTHR PRO 6864 <br /> • Local Expenditures LOCAL EXP 9000 <br /> , <br /> TOTAL <br /> , <br /> RECEIPTS <br /> Local Funds: LOCAL 100 XXXXXX) <br /> Appropriation APPROP 101 $ <br /> Insurance INSUR 102 <br /> • Other Receipts OTHR REC 103 <br /> State/Federal/Special Funds ST/FED/SP XXXXXXX <br /> • Title X <br /> • Title XIX <br /> Title XX <br /> TOTAL • <br /> ---- <br /> Object: BUDGET OFFICE USE ONLY • RCC: <br /> — ......„, <br /> Program 1: , . % Program 2: , . % Program 3: <br /> --- <br /> _ — - <br /> CONTRACTOR SIGNATURES DHS SIGNATURES <br /> AUTHORIZED OFFICIAL DATE rmmv"...4 -------- SECTION CHIEF <br /> tratio. <br /> -----MANCE707FICER-----"-- DATE 6UDGET OFFICER •.0.0,...i.. <br /> , DNS Form 2*94E30 Wu*: <br /> Contracts*Administration <br /> .1 <br />