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10 <br />State of North Carolina - <br />Division of Social Services <br />Contract Application, page g of —� -- <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 />$4 R 7 L p CTOTAL = $ SSBG + ; 1V-B + $ RAP <br />$9 d24fi..435 tate + $ ?514 7County + $ 3A_q_S4_5dPther (identify): <br />(Optional: County funds consist of $. for <br />and $ for <br />(funding source) <br />(funding source) <br />B. Method of Reimbursement? <br />1. For Purchase Contract (DSS - 2+97) Total and Unit Cost: <br />(�9 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 S 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 />Q. Reimbursement will be made at a fixed rate of S Der <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 identiz -4 <br />as follows: <br />DSS -1292 (4/67) <br />Family Services <br />