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n <br />__ <br />Part III -Distribution of Estimated Revenue for Total Cost Reimbursement Method <br />(a) (b) <br />A. Estimated Eligible and Matchable Costs Number Ratio <br />1. Estimated Eligible Clients 16 <br />2. Estimated ineligible Clients <br />3. Total Clients <br />B. Eligible Costs <br />(1) Matchable (2) Less (3) Net (4) (5) Costs Eligible <br />Costs Earned Matchable Estimated % for Financial <br />[Part I, Line M, Income Costs of Eligible Participation <br />col.. (3) [B. (1) Less (2) ] [A. 1. (b)] [B. (3) x (4)] <br />$ $ $ $ $ <br />A, Program Costs <br />1. Federal/State Funds <br />2. Local Matching Share <br />3. Other Budgeted Funds <br />4. TOTAL REVENUE <br />7. Fees (If Applicable) <br />1. Administrative Fee <br />2. Certification Fee <br />3. TOTAL FEES <br />Amount Source of Funds <br />$ 46,766.51 Work First Program <br />$ 46,766.51 <br /> <br />Part V-Reimbursement Projections (For Title XX Providers Only) <br />Annual Projection .July- September <br />Projection October-June <br />Projection <br />A. $ B. $ C. $ <br />Signed: Date: <br />Provider/Authorized Official <br />Date: <br />County Director or Designee <br />