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rr <br /> State of North Carolina <br /> Division of Social Services <br /> Contract Application Page 3 of 7 <br /> H. Fiscal Provisions <br /> A. Amount of Reimbursement: <br /> Reimbursement under the terms of this agreement will be limited to a maximum of <br /> $ 25,000 TOTAL=$ SSBG+$ IV-B +$ RAP+ <br /> $ State+$ County+$ Other(identify): TANF <br /> (Optional : County funds consist of$ for and$ <br /> (funding source) <br /> for ) <br /> B. Method of Reimbursement: <br /> 1. For Purchase Contract(DSS-2497) Total and Unit Cost: <br /> (X) a. Reimbursement will be made in accordance with the current budget approved by <br /> the Department and on file with both parties. The amount of reimbursement will be <br /> based on allowable expenditures made in behalf of eligible clients, determined in a <br /> accordance with 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 unit of <br /> reimbursement delivered to eligible clients for an estimated number of <br /> units. The Provider will document total expenditures made under the terms of the <br /> contract to the Department within thirty days after the termination of this contract, <br /> or as instructed by the Department. Reimbursement which exceeds actual allowable <br /> cost will be adjusted to actual allowable cost. <br /> 2. For Vendor Agreements(DSS-2252)Fixed Rate <br /> Reimbursement will be based on: <br /> O a. a standard fixed rate or <br /> ( ) b. an individual fixed rate. <br /> c. Reimbursement will be made at a fixed rate of$ per unit of <br /> (define) for as estimated number of units. <br /> Reimbursement will be based on the actual number of units delivered whether over <br /> or under the estimated number. If multiple components are being purchased, <br /> additional rates and units can be identified as follows: <br />