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Part III - Distribution of Estimated Revenue for Total Cost Reimbursement Method 18 <br /> A. Estimated Eligible and Matchable Costs (a) (t <br /> Number Ratio <br /> 1 . Estimated Eligible Clients <br /> 8 100 <br /> 2. Estimated Ineligible Clients <br /> 3. Total Clients j <br /> 8 100 <br /> B. Eligible Costs <br /> (1 ) Matchable (2) Less (3) Net (4-) <br /> �5� Costs Eligible � <br /> Costs <br /> Earned Matchable Estimated for Financial <br /> [Part I , Line M, Income Costs - of Eligibles Participation <br /> col . (3)] [B. (1 ) Less (2)] [A. 1 . (b)] [B. (3) x (4)l <br /> $ 15,072 1 $ -0- <br /> 5 15,072 100% S 15,072 <br /> • <br /> Part IV - Additional Revenue and Fees <br /> A. Program Costs <br /> Amount Source of =ands <br /> 1 . Federal/State Funds <br /> $ 14,235 JOBS <br /> 2. Local Matching Share $ 837 <br /> 3. Other Budgeted Funds $ j <br /> 4. TOTAL REVENUE $ 15,072 <br /> B. Fees (If Applicable) <br /> 1 . Administrative Fee $ <br /> 2. Certification Fee $ <br /> 3. TOTAL FEES $ I <br /> Part V - Reimbursement Projections (For Title XX Providers Only) <br /> July-September <br /> October-June <br /> Annual Projection ! Projection Projection <br /> A. S <br /> --- ....._ B. S � C. S <br /> Signed: Date: <br /> Provider/Authorized Official — -- <br /> Date: <br /> County Director or Designee <br /> JSS-o341 <br /> (?/83) <br /> Family Services <br />