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• <br /> North Carolina • <br /> Department of Human Resources <br /> Division of Social Services <br /> Long Term Care • <br /> 'Grant Application <br /> • <br /> Contact Person: Ms! Ann Gent Title: Social Worker II <br /> Agency::Orange County Dept. Social Services Telephoner 732-9361 <br /> ' I <br /> Address: 300 W. Tryon Street County: Orange . <br /> City: Hillsborough Zip Code: 27278 <br /> "Budget Summary <br /> Check Functions <br /> Agencies to Receive Amount Staffing for Services to LTC Screening <br /> Grant Funds Screening and LTC Clients Program Admin- <br /> . <br /> Case Management istration <br /> 1.Orange County Dept. '$25,000 $22,000 I 0 3 0 <br /> Social Services <br /> 2 <br /> 3. <br /> 4. f J <br /> 5. <br /> Total $25,600 —$22,000 0 <br /> $3,000 <br /> This application has been endorsed by the Board of Commissioners and is <br /> being submitted for the purpose of implementing a Long Term Care Screening <br /> Program under the provisions of HB 405. The Board of Commissioners understands <br /> it is a local responsibility to continue the screening program after the <br /> start-up grantperiod is over. <br /> _ <br /> �.. , . . <br /> / I / /. <br /> Chairman, Board of County Commissioners <br /> Date <br />