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qAME AND ADDRESS <br /> <br />:OMMUNITY SERVICE PROVIDER <br />~b~u$ ~. DSS <br />Po l:~y. ~,~ <br />~d ~C 2~-o~ <br /> <br />Ilome and Community Care Block Grant for Older Adults <br /> <br /> County Funding Plan <br /> <br /> Provider Services Summary <br /> <br />DOA-732 (Rev. 1/96) <br /> <br />County <br /> <br />July 1, 1996 through June 30, 1997 <br /> <br />Services <br /> <br /> Total <br /> <br /> I <br />Set. D~liver/ <br /> <br />One) <br /> <br />*Adult Day Care Net Service Cost <br /> <br />Daily Care <br /> <br />Transportation <br /> <br />Administrative <br /> <br />oral <br /> <br />Block Grant Funding <br /> <br />In-Home Other <br />3-/200.00 <br /> <br />Total <br /> <br />Required <br /> <br />Local Match <br /> <br />Cash <br /> <br />Required <br /> <br />Local Match <br />In-Kind <br /> <br />;crv Cost <br /> <br />USDA <br /> <br />Subsidy <br /> <br /> Total <br /> Funding <br /> <br />41422.co <br /> <br />G <br /> <br />Projected <br />Unils <br /> <br />Proj Net <br />Unit Cost <br /> <br />Proj <br /> <br />zh42.oo! <br /> <br />! <br /> <br />52E, O <br /> <br />Certification of required minimum local match availability. <br />Required local match will be expended simultaneously <br />with Block Grant Funding. <br /> <br />"L~,gqq <br /> <br />414'2~.0C <br /> <br />Commun~rovider <br /> <br />lO <br /> <br />o4/iq/~, <br />Date <br /> <br />Signature, Counly Finance Officer , , Date Signature, Chairman, Board of Commissioners Date <br /> <br /> <br />