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qW <br />7—D. <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 .0765 7 <br />Unemployment - % <br />Retirement .0494 % <br />Health Insurance _1665 <br />Llfe Insurance _0029 % <br />Workmen's Compensation - % <br />Dental .0078 <br />Total Percentage of <br />Fringe Benefits .3031 7 <br />FICA .0765 X Total Applicable <br />Wages 19342 = 1,480 <br />- <br />Dental Insur. <br />T,r % .0078 X Tutal <br />Applicable Wages 19342 150 <br />Retirement % .0494 X Total <br />Applicable Wages 19342 - 955 <br />Health Insurance % .1665 X Total <br />Applicable Wages 19342 = 3�o221 _ <br />Life Insurance % .0029 X Total <br />Applicable Wages 19342 X 57 <br />Workmen's Compensation % X <br />Total Applicable Wages = <br />TOTAL FRINGE BENEFITS <br />5,863 <br />1,970 <br />1,278 <br />2,615 <br />qW <br />7—D. <br />