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DocuSign Envelope ID:8A1AB1 BF-ACDB-42A1-A3DE-9E9549E569B4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> contains the same information, and in a similar format, as requested in the <br /> provided template). <br /> Agency Budgets are required to define budget amounts for the previous <br /> program year, current program year, and next program year for the <br /> following categories: Agency Budget Attached** <br /> iii. Does your agency budget show a Surplus or Deficit? Balanced <br /> Is there a significant change?Yes/No No <br /> Please provide a brief explanation for Surplus or Deficit, and significant <br /> changes. <br /> iv.. What is your agency's fiscal year? January 1, 2017 through <br /> December 31, 2017 <br /> (Example: July 1, 2016 through June 30, 2017) <br /> Page 8 of 20 <br />