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11 <br />State of North Carolina <br />Division of Social Services <br />Contract Application <br />Page 3 of <br />II. Fiscal Provisions <br />A, Amount of Reimbursement: <br />Reimbursement under the teens of this agreement will be limited to a maximum of <br />$ 28,044 TOTAL, _ $ SSBG + $ IV-B + $ RAP + <br />State + $ County + $ <br />Other (identify) : Worlc First <br />Block Grant <br />(Optional : County funds consist of $ <br />for and $ <br />(funding source) <br />for <br />B. Method ofReimbursement: <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 teens of the contract. <br />O b. Reimbursement will be made at a unit cost rate of $ per unit of <br />reimbursement delivered to eligible clients for azr 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 />For Vendor Agreements (DSS-2252) Fixed Rate <br />Reimbursement will be based on: <br />O a. a standard fixed rate or <br />O 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 az e being purchased, <br />additional rates and units can be identified as follows: <br />