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Part III -Distribution of Estimated Revenue for Total Cost Reimbursement Method <br />37 <br />Estimated Eligible and Matchable Costs Number Ratio <br />1. Estimated Eligible Clients 16 <br />2. Estimated ineligible Clients 0 <br />3. Total Clients <br />B. Eligible Costs <br />16 <br />(1) Matchable (2) Less (3) Net (4) (5) Costs Eligible <br />Costs Earned Matchable Estimated % for Financial <br />[Part I, Line M, Income Costs ofBligible Participation <br />col. (3) [B. (1) Less (2)}] [A. L (b)] [B. (3) x (4)] <br />$ $ $ $ $ <br />A. Program Costs Amount Source of Funds <br />1. Federal/State Funds $ 47,505.00 TANF Block Grant <br />2. Local Matching Share $ <br />.3, Other Budgeted Funds $ <br />4. TOTAL REVENUE $ 47 505.00 <br />B. Fees (If Applicable) <br />L Administrative Fee $ 0 <br />Z. Certification Fee $ 0 <br />3. TOTAL, FEES $ ~ <br />Part V-Reimbursement Projections (For Title XX Providers Only) <br />Annual Projection .Tiny- September <br />Projection October-.Tune <br />Projection <br />A. $ B. $ C. $ <br />Signed: Date: <br />Provider/Authorized Official <br />Date: <br />County Director or Designee <br />