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t~ <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 Paztieipation <br />cot. (.3) [B. (1) Less (Z)]] [A. L (b)] [B. (3) x (4)] <br />$ $ $ $ $ <br />A, Program Costs <br />1. Federal/State Funds <br />2. Local Matching Share <br />3. Other Budgeted Funds <br />4. TOTAL REVENUE <br />Amount <br /> <br />$ 28.044 <br />Source of Funds <br />Worlc First <br />County <br />B. Fees (If Applicable) <br />1. Administrative Fee <br />2. Certification Fee <br />3. TOTAL FEES <br />e <br />e <br /> <br />Part V- Reimbursement Projections (For Title XX Providers Onlvl <br />Annual Projection .July- September <br />Projection October-.June <br />Projection <br />A. $ B. $ C, $ <br />Signed: Date: <br />Provider/Authorized Official <br />Date: <br />County Director or Designee <br />