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State or North Carolina <br /> Division of Social Services <br /> Contract Application Pagebef 7 <br /> O 2. The provider certifies through the contract budget attached to its contract that <br /> the matching more in available. Further,it is agreed that the provider will <br /> mport all progma toter;rhea N each month relating to this contract on the <br /> DSS-1571. However,reimbursement will be limited to the fdanIstate <br /> financial participation rate. <br /> (X) 3. The counry department of social services is providing the match <br /> G, Provider Fees(For Perchance CantraNS Only) <br /> (NA) 1. The Provider agtew m pay the Deparhnenv Division uP 0S <br /> pnhanaimuive Fee as paymmt in bill for the admimxtratim of the contact. <br /> The mount of Shot is five percent of the matching shoe contributed"e <br /> Provider. <br /> (NA) 2. The Provides ageser to pay the Deparina mup to$ Certification Fee <br /> as payment in full for the determination and cenifieabon of client eligibility. <br /> The mount of the fee is five pemrut of the matching share co stributeriby the <br /> Provider. <br /> .Uroriioning and Ceni ication Fees,when applicable, will be deducted from the <br /> =me to be reimbursed <br />