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17 <br />Part III -Distribution of Estimated Revenue for Total Cost Reimbursement Method <br />A. Estimated Eligible and Matchable Costs Number Ratio <br />1. Estimated Eligible Clients 250 100% <br />2. Estimated ineligible Clients 0 0% <br />3. Total Clients 250 100% <br />B. Eligible Costs <br />(1) Matchable (2) Less (3) Net (4) (5) Costs Eligible <br />Costs Earned Matchable Estimated % for Financial <br />[Part 1, Line M, Income Costs of Eligible Pazticipation <br />col. (3) [B. (I) Less (2)}) [A. 1. (b)] [B. (3) x (4)] <br />$ $ $ $ $ <br />A. Program Costs <br />I, Federal/State Funds <br />2. Local Matching Share <br />3. Other Budgeted Funds <br />4. TOTAL REVENUE <br />Amount <br />$ 29.338 <br />Source of Funds <br />Work First <br />County <br />B. Fees (If Applicable) <br />1. Administrative Fee <br />2. Certification Fee <br />3. TOTAL FEES <br />$ 29.338 <br /> <br />Part V-Reimbursement Proiections (For Title XX Providers Onlyl <br />Annual Projection .luly- September <br />Projection October-.lone <br />Projection <br />A.$ B.$ C.$ <br />Signed: Date: <br />Provider/Authorized Official <br />Date: <br />County Drrector or Designee <br />