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Excess Local <br />LINE /ITEM JUSTIFICATION <br />Total Cost <br />Federal <br />Non - Federal <br />Support <br />B. Fringe Benefits <br />Please complete the attached work- <br />sheets for each person who is <br />charged to your grant and who is <br />eligible for fringe benefits. If <br />a person is part -time and not <br />eligible, please list the position <br />and indicate they are not eligible. <br />Please list below your agency <br />fringe benefits rates and then <br />complete the worksheets. <br />Agency Fringe Benefits <br />FICA 7.65 % <br />Unemployment % <br />Retirement % <br />Health Insurance % <br />LIfe Insurance % <br />Workmen's Compensation % <br />Total Percentage of <br />Fringe Benefits 7.65 % <br />FICA %7 65 X Total Applicable <br />Wages 4g92 = 5381.89 <br />$381 <br />$381 <br />Unemployment % X Tutal <br />Applicable Wages - <br />Retirement % X Total <br />Applicable Wages = <br />Health Insurance % X Total <br />Applicable Wages = <br />Life Insurance % 'X Total <br />Applicable Wages X <br />Workmen's.Compensation % X <br />Total Applicable Wages = <br />TOTAL FRINGE BENEFITS <br />$381 <br />$381 <br />