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LJ <br />7 -. <br />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 .O 65 % <br />Unemployment _ 7, <br />Retirement .0494 % <br />Health Insurance _1258 % <br />Life Insurance _0030 % <br />Workmen's Compensation — % <br />Dental .0059 <br />Total Percentage of <br />Fringe Benefits .2606 % <br />FICA % .0765 X Total Applicable <br />Wages 25600 = 1,958 <br />Dental Inaur. <br />t % .0059 X Tutal <br />Applicable Wages 25600 M 150 <br />Retirement % .0494 X Total <br />Applicable Wages 25600 = 1,265 <br />Health Insurance % .1258 X Total <br />Applicable Wages 25600 = 3,221 <br />Life Insurance % .0030 X Total <br />Applicable Wages 25600 X 78 <br />Workmen's Compensation % X <br />Total Applicable Wages - <br />TOTAL FRINGE BENEFITS <br />6,672 <br />1,969 <br />1,278 <br />3,425 <br />LJ <br />7 -. <br />