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DAAS-732A
<br />Provider:
<br />County:
<br />Budget Period: July 2025 through June 2026
<br />Other Access Other In-Home In-Home In-Home 0 0 0 0 0 0 0 0
<br />Service Service Service Service Service Service Service Service Service Service Service Service Service Service
<br />Congregate Nutrition Information & Case Assistance Senior Center Operation
<br />In-Home Aide-Level II - Personal
<br />Care Adult Day Health Adult Day Care 0 0 0 0 0 0 0 0
<br />Grand Total 180 040 170 042 155 030 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A
<br />812,562$ 252,555$ 259,418$ 113,984$ 116,141$ 50,000$ 20,464$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) 90,286$ 28,062$ 28,824$ 12,665$ 12,905$ 5,556$ 2,274$
<br /> Total Required Minimum Match - In-Kind 90,286$ 28,062$ 28,824$ 12,665$ 12,905$ 5,556$ 2,274$ -$ -$ -$ -$ -$ -$ -$ -$
<br />90,286$ 28,062$ 28,824$ 12,665$ 12,905$ 5,556$ 2,274$ -$ -$ -$ -$ -$ -$ -$ -$
<br />902,848$ 280,617$ 288,242$ 126,649$ 129,046$ 55,556$ 22,738$ -$ -$ -$ -$ -$ -$ -$ -$
<br />12,800$ 12,800$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br />4) -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$
<br />915,648$ 293,417$ 288,242$ 126,649$ 129,046$ 55,556$ 22,738$ -$ -$ -$ -$ -$ -$ -$ -$
<br />Service Service Service Service Service Service Service Service Service Service Service Service Service Service
<br />Grand Admin.Congregate Nutrition Information & Case Assistance Senior Center Operation In-Home Aide-Level II - Personal Care Adult Day Health Adult Day Care 0 0 0 0 0 0 0 0
<br />Total Cost 180 040 170 042 155 030 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />413,601$ -$ 15,000$ 259,418$ 139,183$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) FICA @ 7.65 31,640$ -$ 1,148$ 19,845$ 10,647$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$
<br />-$
<br />-$
<br />-$
<br />-$
<br />31,640$ -$ 1,148$ 19,845$ 10,647$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br />-$
<br />-$
<br />-$
<br />-$
<br />-$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$ -$
<br /> 1) -$
<br /> 2) -$
<br />3) -$
<br /> 4) -$
<br /> 5) -$
<br /> 6) -$
<br /> 7) -$
<br />8) -$
<br /> C. Subtotal, Fed/State/Required Match Revenues
<br /> F. Subtotal, Local Cash, Non-Match
<br /> Other Revenues, Non-Match
<br /> D. NSIP Cash Subsidy/Commodity Valuation
<br /> E. OAA Title V Worker Wages, Fringe Benefits and Costs
<br /> Local Cash, Non-Match
<br /> 1) Per Diem
<br /> 2) Mileage Reimbursement
<br /> 3) Other Travel Cost
<br />E. Subtotal, Travel
<br /> General Operating Expenses
<br />Local In-Kind Resources Non-Match
<br />C. Subtotal, Local In-Kind Resources Non-Match
<br />D. OAA Title V Worker Wages, Fringe Benefits and Costs
<br /> 6) Other
<br />B. Subtotal, Fringe Benefits
<br /> Staff Salary From Labor Distribution Schedule
<br /> 1) Full-time Staff (do not include Title V workers)
<br /> 2) Part-time staff (do not include Title V workers)
<br />A. Subtotal, Staff Salary
<br /> Fringe Benefits
<br />%
<br /> Travel
<br /> 2) Health Insurance
<br /> 3) Retirement
<br /> 4) Unemployment Insurance
<br /> 5) Worker's Compensation
<br />Division of Aging and Adult Services
<br />Service Cost Computation Worksheet
<br />II. Line Item Expenses
<br /> G. Subtotal, Other Revenues, Non-Match
<br /> Local In-Kind Resources (Includes Volunteer Resources)
<br /> H. Subtotal, Local In-kind Resources, Non-Match
<br /> I. Client Cost Sharing
<br /> J. Total Projected Revenues (Sum I.C,D,E,F,G,H, & I)
<br />ORANGE COUNTY
<br />ORANGE
<br />North Carolina Division of Aging and Adult Services`
<br />Service Cost Computation Worksheet
<br /> Required Minimum Match - In-Kind
<br /> B. Total Required Minimum Match (cash + in-kind)
<br />I. Projected Revenues
<br /> A. Fed/State Funding From the Div. of Aging & Adult Svcs.
<br /> Required Minimum Match - Cash
<br /> Total Required Minimum Match - Cash
<br />Docusign Envelope ID: 33187FF3-2913-4BF6-A737-FFB28C0A4B95
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