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State of North Carolina <br />Division of Social Services <br />Contract Application Page 3 of . R <br />II. Fiscal Provisions <br />A. Amount of Reimbursement: <br />Reimbursement under the terms of this agreement will be limited to a <br />maximum of: <br />$487t2_0 (TOTAL = $ SSBG + $ IV -B + $ RAP + <br />$14p4F JState + $ PRU )County + $31951 @ther (identify): Federal <br />(Optional: County funds consist of $ for <br />(funding source) <br />and $ for <br />(funding source) <br />B. Method of Reimbursement! <br />1. For Purchase Contract (DSS -2497) Total and Unit Cost: <br />(X) a. Reimbursement will be made in accordance with the current budget <br />approved by the Department and on file with both parties. The <br />amount of reimbursement will be based on allowable expenditures <br />made in behalf of eligible clients, determined in accordance with <br />acceptable cost allocation methods. The Provider will report all <br />expenditures made under the terms of the contract. _ <br />( ) b. Reimbursement will be made at a unit cost rate of $ per <br />unit of reimbursement delivered to eligible clients for an <br />estimated number of units. The Provider will document <br />total expenditures made under the terms of the contract to the <br />Department within thirty days after the termination of this <br />contract, or as instructed by the Department. Reimbursement <br />which exceeds actual allowable cost will be adjusted to actual <br />allowable cost. <br />2. For Vendor Agreements (DSS -2252) Fixed Rate <br />Reimbursement will be based on: <br />( ) a. a standard fixed rate or <br />( ) b. an individual fixed rate. <br />C. Reimbursement will be made at a fixed rate of $ --` per <br />unit of (define) for <br />an estimated number of units. Reimbursement will be <br />based on the actual number of units delivered whether over <br />or under the estimated number. If multiple components are <br />being purchased, additional rates and units can be identified <br />as follows: <br />DSS -1292 (4/87) <br />Family Services <br />