HomeMy WebLinkAbout1998 S Social Services - Employment Security Commission Work First Job development and Placement 08/18/98 8k
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STAVE OF NORTH CAROLINA
DIVISION OF SOCIAL 9ERV[CES
PURCHASE CONTRACT
ma 6aeo1
This Conva<t is entered loco between the Depacvnem of Social Services and'[he
Employment Seawlty Commission (refned ro as Provider) identified on Anadmrent A.
This contract shall consist of form DSS-249'1, Attachment A (DSS-1292) and Badger (DSS
6844).
The Department will pwchase specific services fiom Ne Provider as set foM in the
Contract in order to make optimal use of Ne f ilities, staffand programs of the Provider.
This Contrazr is subject to dre provisions ofall applicable Federal regulatiom and Smte
policies.
Subject to its other provisions, the tams of wis contract shall be in effect to and from
the dates specified ov Anaclvnenr A.
SECTION I: RESPONSIBILITIES
A. The Department will:
I. Ddermive client eligibility for service(s) In accordance with Pedeml and
Smte regulaticns; and
2. Inform the Provider on Form DSS-1360 concerning the eligibility of each
individual for the service, the period oftitve for which urvices are auNoriud
and any changes yr the individual's eligibility status; and
3. Reimbwse the Provider for service(s) purchased as described m Attachment A
of Ws Contract far eligible clients; and
4. Keep Ne Provider ivtbrtmed ofany Wtemtioms in and/or to the regulaticros
governing the service program; and
5. Accept fiscal responsibility for deviations from the terms oftlris Contract as a
resWr ofacs of the Depamnent or any of its officers, employees, agents or
representatives.
H. The Provider will:
1. Provide service(s) as specified iv Atlachmenr A of Chia Contract in accordan«
with applicable swWards for rha service(s); and
2. Famish information to the Department as r gaited to support the fall cost of
service(s) provided pursuant to this Covtrec[; and
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3. Comply wiN all Stak licensing sundards, atl applicable accrediting standards and
my oNer stmdards or eriteda established by the Divisiov of 9oda19ervices to
assure quality of services; and
4. Restrict the use or disclosure ofiNbcmaticn obtained in correction wiN the
administration of North Carolina's programs for the provision of services
concerning applicmts far and recipients of those services to purpose directly
connected with the admirdstrativn of Ne service program; and
5. Comply with Ne terms of Section 504 of the Rehabilitation Act of 19]3 and all
requirements impoud by or pursumt [o the regulations of the Department of
Health and Humm Services issued pursuant k that Sedioq which prohibit
discrirnination agairvst hmdicapped persons in employment and in the operation
ofprograms and activities receiving Federal funds; and
6. Comply w1N Title VI and VII of Na Civil Righs Act of 1964 and atl requirements
imposed by or pursuant k the regulations of Ne Department of Health and Humm
Services issued pursuant to hat Title; and
]. Accept fiscal responsibility for deviations fiom the krtns ofthis Convect asaresult
ofacts of the Provider or my ofits offices, employees, agents or represevtetives.
SBCTTON H: RESPONSIBILITY FOR LIABILITIES
Each patty hereto ogees to be msponsble kr its own liabilities and that of its officers,
employees, agents, or represevtetive arising our of Nis Convazt.
3ECTIDN III: TREATMBM OF ASSET9
Treatrnent of assets acquved under this Convect shall be subject m Ne following:
A. Ownership ofpropetty DwchasN by Ne Provider under Ne terms ofthis Convector
which reimbmsemm[ by the Depmmsmt is based upon the aztuel purchase cam ofthe
property shall immediakly vest with Ne Department of Human Resources upon such
reimburument.
B. The North Cmolirta DeparMrenr of Hwvm Resources shall have no claimip procerty
purohased by the Provider undo the teens ofthis Contract for which reimbursement by
the Deparment is based upon approved depreciation schedule or use allowmce.
0. The Provider shall mamr,',. and adminimer iv accordmce with sound business practice a
program for the mainlenmce, tepee, protxdon and preservation of propuTy pmcltased
wdn the terms of Ws Covtmct to usure its continued evailabiliry.
D. Progeny purchase ender Ne krtns oftlsis Convect shall be aced oNy far the perfortnmtt
of Nis Contract.
T
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SECTION N: RECORDS AND REPORTS
A. The Provider agees to maintain client records which date avd documevt in accordance
with established policy, [he service delivered forNe individual, a valid auNodzation for
service, programs rewrds, documents and other evidence which reflect program
operations. .
B. The Provider agrees to fiunish iN'ormafion to the Deparlmmq as requested, to support
provislov of service(e) pursuant to this Contract and the full tour of the service; and
submit changes, as needed or requhed, in this Contrazt Anacbmmt A or approved
supporting information foc review and approval by the Departrnent.
C. The Provider agrees to maintain books, records, docwvevts and other evidence and
Quoting procedures which reflect all direct and indirect casts expended under this
Covtrect. A current wmplete invmmry of all equipment purchased under the terms of
this Contract must be kept.
D. The Provider agrees to retain all books, records avd othn documents relevant to this
Contract for throe years after fiwl payment or until all audits continued beyond this cericd
completed. Federal auditors and any persons auNodzed by the Division of Social
Services or Ne Department shell have the right to examine any ofthese materials. In
records produced under this Covtract will be turned over to the Department.
SECTION V: SUBCONTRACTING
The Provide shall not subcontract any ofthe work contemplated under tlils Contract without
obtaining prior written approval from the Department. Any approved subcontrec[ shall be
subject m all condidons ofthis Contract The Provider shall be respomible for the
performance ofany subcontractor.
SECTION VI: MAINTENANCE OF EFFORT
The Provide certifies that the funds m be used under this Contract do not replan or supplant
m arry way, Federal, State or local funds far already existing services..
SECTION VII: MOMTOREJG AND EVALUATION
A. The Provide agrees to participam in program, fiscal and adnwdstradve monitoring or
audits, making records an staRtime available to Federal, State avd cowry staff.
B. The Provider agrees m take necessary steps far corrective action, as negotiated within a
mcdve action plan, for any itavs fowd to be out ofcompliance with Federal and Stare
laws, regulaziovs, standards and/or turns ofthis Con[rect.
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SECTION VIII: AMENDING THE CONTRACT
This contract in whale or iv any pan may be amended at any time:
A. By the Depactrnent iv Ne event that such amendment is necessary to comply with
applicable laws, regulations, policies and standaNs; and by mutual consort of botlt parries.
B. Each party to this contract will notify the other immediately iv writing ifan amendment
becomes necessary due to alterations in the activities described in Anachmenl A m for any
other reazon.
SFATt~IX: TERMINATION
A. This wnnad,mwhole or in any pan, mayberancelledazany rime:
1. Hy any party, with cause, upon at leas[ 30 days notice, in writing, and delivered by
registered mail with return receipt requested or in persaq or
Z Hy the Department in the snort reimbwsemevt to Ne Department is not available
and/or wntivoed at an aggregate level sufflciant to allow for Ne purchase of the
indicated quantity of service. The obligations of each parry shall be terrNnatad to the
octant specified in the noticeof temlinariov, immediaely upon receipt ofthe notice oP
termination from the Depertmrnt or
3. By Ne Department inthe event that the Division of Social ServicesrDeparhnent
de[ermives that the Provider is in violation of any or all ofthe terms of this Contract.
The obligations ofeazh party shall be terminated to the extent specifed in fie notice
of termir~aticn immediately upon receipt of the entice from Ne Depattmmq or
0. BY mutual co~uent of all Parties.
B. In the a ant of termination N pen, all patties shall continue the pertormance ofthis
Contract m the extort not termimted.
G Ifthis Convact is terminated, in whole or in pan, the Provider may be requirN to deliver
and transfer Title or azsigtuvevt of interest to the Division of Social Services or dispose of
any property spxifically produced or acquired for We performance of such part of Nis
Contract u haz been termviated, and the Provider shall, upon the direction ofthe Division
of Social Services, pm[act and preserve property m [M possession ofthe Provider in
which the Division of Social Services has an interest.
D. After receipt ofa notice of [ermhation, and except az otherwise directed by the
Department, the Pmvidtt shall cease work order the Contract on [he date, an to the
extent specified in We notice oftettninauon. The Deparmrent shall pay the Provider the
,.
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effective date of temdnatien. Reimbursement shall not be made for equipment or supplies
purchaud after the notice oftenWrtation is receivedexcept as approved by she
Departrnent.
E. Waiver of any defaWt shall not be deemed to be a waiver of any subuquent default.
Waiver of broach of any provision oPthe Cov¢act shall not be deemed to be a waiv« oP
any other subsequent breach and shall not be construed to be a modification ofthe terms
of [Itis Contrazt uNess stated to be such m writing, signed by av authorized representative
of the Deperhvent and anached m the Contact.
SECTION X: CONCLGSION
It is expressly wderstood an agreed That the services provided to eligible clients pursuant to
this Contract shall cousin exclusively of drone services specified in Ne attazhed program
description incoryorated into [his Contcc[ az A¢achment A.
is fivther understood and agreed that the provisien ofservices pursuant to this Con¢xt
' shall be subject to the limitations and conditions conmined in the laws. regWatiorvs,
guidelines and plays cited iv this Contact, and that this Con¢azt is subject m renegoGadon or
ov to meet any new or revised rules, regulations, or policies mat may be iuued by the
Deparunevt of Health and Human Services, or the Notth Carolina Social Services
GOmInlsSlon, oc the Deparmsent ofHuman Resources and that aze communicated to the
Provider.
PROVIDER DEPARTr~NT
Employ/m~em Sepcwlty Commission Orange Cowry Deparvntmt of Social Services
"Title: Manager Title: Direcror
Date: ~~~7 /49K Date: b~~/~~9~
This Agreement has been preaudited in the matron required by the Local Govemmen[ Budget
and Fiscal Control Act
ATTEST
County: Orange
Title: F~itmnce~Di/recror
Sigmture: ns<G~ /~~~
Date:
~.
SECTION XL CERTIFICATION
The Orange County Board of Social Services supports the need for this performwce-
based contract with the Gmployment 9ecariry Commission m providejob seareL, wdjob
development and plowmen[ for Work First paztiaipw[s.
~~ /Y~
Rosetta MOOre, Amin Chair
Orange County Boar of Social Services
Assisting f flies make the hwsilion from welfare to work is a pdoriry in Orage
County. The Orange Cowty Board of Cowty Commissioners, in response to the needs
of the Work First population, supports vpproves [he wntraa forjob senmh andjob
development wd plawmeut services from the Employment Seaunty Commission.
Margaret Brown, Ch rtperson
Orange County BOa of County Commissioners
ATTACHMENT A
Sm[e ofNOtth Carolina '
Division of Social Services
Contract Application Pege 1 of Z
L Contract Summary
A. This agreement is between the Orwge Cowty Deparvnent of Social
Services (hereinafter referred to az the "Depemnent")and the Employment Security
Covwission (heretofore and hereinafter referred to az Ne "Provider"j.
B. This agreement shall be in effect from 8/1/98 to 6/30/99
G Services to be Provided:
(p
Service (2)
Service Code (3)
Numberof
Persons Served (4)
Number of Units
of Service (5)
Defw'uon of
Unit of Service
lab Development
wd Placement 546 125 125 One Participant
lab Readiness/
Job Search 54] 250 250 One Participant
Any additioml services should be listed iv III. -Service Program Description
D. Area ro be Served:
State ofNOM Cazolina
Division of Social Services
Contract Application Page 2 of ]
E. Connact lndentificadon:
1. Provide
a Name of Contract Adminimator DoroNy Pewell
Tel.#: (919) 96]-01'1]
b. Name of Proeram COntazt Person: Same
Tel. #:
a Progrem Name, Location and Mailing Address Employmen[ Security Commission
d. Additioval3ervice Delivery Sita:
e. Smtus: (X )Public OPrivate, von-pros[
( )Private, for PmfitO Individual
f Provider Conrcact lD q: 68E01
2. Cowry Deoanmwt of Social Services
a. Name of Contract Adminiso-azor: Marti Pryor-Ccok
TeI. N: (919)"!32-8181
b. Nameof Services Pronam Contact Person Gwendolyn Price
Tel.#: (919) ]32-8181
a. Address of Cowry Dava nmevt of Social Services:
P.O. Box 8181
300 W.Sryov St.
Hillsboroueb. NC 2']2]8
Stare of North Cmolina
Division of Social Services
Contract Application Page 3 of ]
II. Fiscal Provisions
A. Amowtof Reimbwsement:
fteinbutsement undeahe terms ofthis agreement wilt be limited to a maximw of
$ 32,916 TOTAL=$ SSBO+$ IV-B+$ RAp+
$ Smte+$ Cawty+$ Other Qdmdfy): Fedeal, State
and Local TANF Dollars
(Opfioval : Cowry fwds consist of S for wd $
(fuvdlvg source)
for )
H Method Of Reimbursemene
1. For Pumhace Concoct (DSS-249"!) Total and ^Wt Cost
(~ a. Reimbursement will be made in accordance with the current budget approved by
the Departmrnt wd on file with both parties. "lire amowt of reimbursement will be
baud on WlOwable expeMinves made N behalf ofeligible clievh, de[emvined in a
attordwce with acceptable cost sllocatiov methods. The Provider will reprot WI
expenditures made wder the revns of the conrcatt.
O b. Reimburxment will be made at a wit tort ate ofT per wit of
eimbmsement delivered to eligible climts for w enimated number of
units. The Provider will document total expenditures made wdm the terms of Ne
contract m the Department within tltvry days after the temdvation of this convact,
or as irutructed by the Depacmtent. Reimbursement which exceeds actual allowable
cost will be adjusted m amral allowable cost.
2. For Vendor Agrcemmts (DSS-2252)Fixed hate
Reimbursement will be based Ov:
O a. astmdmd fixed m4 or
O b. rn individual fixed raze.
<. Rehnbwsement will be made atafixed raze ofS per unit of
(define)for es esdmaad vwvber of uN[s.
Reimbwsemevt will be baud on Ne acutal numbec of wits delivered whether over
or wder the esthnared number. If mWtiple components are being purchased
additiorW cotes and wits can be identified as fOllOws:
,.
State of North Caroline
Division of Social Services
Cono-act Applicazion Page 4 of ]
C. Reimbwsemmt Reposing:
L Ezpmditures
The Provider will report expendinues monwy iv accordance wilh policy set forth by
the Con[rollei s Offices, Division of Sociat Services, issued via Ne FiecW Manual.
Expmditwes are to be reproed on the DSS Adminisimfive Cost Report (Form DSS-
1591, Part III). Report, are to be submitted to Me Dcpvamavt by the 6fih working
day of the month following the mouth in which services were delivered. the
Department will ceimbmse the Provider monwy, usually by check upon receipt of a
completed and correctly fled report.
2 Reporfivg for We Statewide Services [rSo[mation System (S[S)
In addi4on m the Admitdsttarive Cart Report (DSS-1591, Paz[ Ill), the Provide[ will
mbmit to the Depaammt Ne Monthly Report of Service Delivery (D55 Form 1591,
Part IV). This shoWd be submitted Wong with the Admwstmfive Cost Repoa by the
fifth working day of the monN following the month iv which services were delivered.
The units reported in Column 12 of the 15]1 Pea IV are the units of service defined in
Column 5 of LC. of this Attachment. Smice defw'tiov and reporting irunuctions are
fowd in Family Services Manual, Volume VI, Chaprer IV.
D. Adult Requhements
The Previdec shall be responsible for compiimce with the audit requirements of
Deparvnent of Health and Human Services federal regulation 45 CFR Part ]4,
Adminsuatiov of Gtmts, or Stae Admirdsnative Procedures Mmual far Parietal Block
Grant Fwds, wldchever is applicable. These regWations stipWate that m atmual audit be
pew rmed for the fiuW yeaz W whch rout t funds were received.
O 1. NA
Privae, non-profit if amowt of reimbursement received is wrier E 1,000; private,
for profit or individual
O 2. (Applicabel to Private, Non-Profit Providers if reimb. $1,000 or over)
An amual audit is to be performed w accordmce with OMB Circular A-110 by m
`ivdepmmt auditor." Independent auditor" means eiNer: (a) a state government
auditor from the Department of Human Resources or the Deparmtent of
Admhdsfiafiov, Office m the State Audimq oc (b) a cesifiN public accowtmt.
Upon cotm..pletion of Ne audit, a copy of the audit report must be forwarded to the
COWIy (...yaRlllent Of SOC18I SCNICes.
~.
Smte of North Carolitta
Division of Social Services
Contract Applicaiton Page 5 of ]
O 3. (Applicable tc Public Hospimis. Colleges. and Univenides)
The annual audit must be performN W accordance with OMB ChcWar A-11o.
I[ is no[ nmesssary for the institution o[ program audits performed separately
from av WI-inclusive single audit wNch entails all revenues and expenditures
ofthe public agency. However, it is the resporvsibitity of the contractor to
insure thaz the contract program is included in the institution's single amual
audit.
A copy of Ne audit report must be provided to the County departrvem of
Social Services upon completion of the amuW audit.
(X) 4 (Appliaableto State oe LOCal GOVemmevt Agencies)
M a~muW audit is to be performed in accordantt with OMB CircWm A-12g by
an independent aaditor. Upon completion of [he audit, a copy of the audit
report must be forwarded to the cowry Departrnent of Social Services.
E. Client Fees for Service
(X) L No fees will be charged to individuals deterznived to be eligible for services
by the department of social services.
O 2 Tha smvica(s) under contract witb the Provider are services for which a cllevt
fee may be assessed. Policy regmdmg Ne assessment and collecfian of fees is
mnteined iv Family Services Manual, Volume VI, Chapter III. If a client is to
ro be chaged a fee, the depertrnent wilt itSorm the Provider of the amount of
fee m be charged and of any subsequent changes by way of the Purchase of
Service Refetrel and AuNorimfien (DSS Form 1360). The Provider will
establish a play with We client for collecting the fee on az least a movtlily basis;
and whey fees are no[ paid withimm~ days of the due date, will bill the client in
writing and stud a copy of the bill to the Depac[ment. NO OTHER FEES FOR
SERVICES MAY BE CHARGED iO lliE CLIENT. Client fees aze m be
repotted on the Monddy Report of Service Delivery (DSS Form 15]1, Pan
IV).
F. Maragemrnt pftheFwding/Tlatchivg Share RegWrement
() 1. A rash hansfer of the matching share will be made to the cowry department of
serial services m semrdmce with the terms specified w the Dortation
Agreanmt (DSS-1319).
State ofNotth Carolita
Division of Social Services .
Contract Application Page fi of ]
O 2. The provider certifies Ihmugh the contract budge[ ntlached W this contract that
the matching share m available. Funkier, it is agreed that Ne provider will
report all pmgmm vests incurted each month relating to this contract on the
D59-15]1. Howeveq reimbursement will be limited to the ftderel/state
fituncial participation rote.
(X) 3. The comty depamnem of social services is providing the match.
G. Provider Fees (For Pwchaze Contracts ONyJ
O 1. The Provider agrees to pay the DepartrnenVDivisiov up ro S
Administrative Fre az payment in full for the adrrdtdsvation of the contract.
The amowt ofthe fee is five pemmt of the matching share contibuted by the
Provider.
O 2. The Provider agrees to pay the Departrnwt ep to $ Cedtificafiov Fee
as payment in fidl for the detemdnaifion and certification ofdient eligibility.
The amowt ofthe fee is five percent of the natching share connibumd by the
Providtt.
Motdmring and Certificafion Fees, when applicable, will be deducted from the
amount to be revnbmsed.
Stme of NOM Carolire Page]of]
Division of Social Services
Contr t Application
III. Service Program Description
Orange County Depanment of Socml3ervices (DSS) is pwchasmg ^ta services ofa Job
Development Specialist Gom the Employment Secwity Commission ofNorth Caroline.
The GererW Assembly considers tlw Empoyment Secwity Commission the state's
prmuvyjob placeme[rc emhoray. The Job Developme[rc Speialirt will be stetiotwd et the
DSS and will be provid'mg services to Work First participmns. The foPowhig services
are includM b this wntrt:
• Vocational Assessmem aM Employment Counseling,
• Job Readiness Tra'nting and lob Club,
• Fkst Stop Registration,
• Process UnemplpymerR [reursnce Claims
• lob Developmeta etW Plarzmm[ (placemems hmlude dvece placements aM
entered empbymevts),
• Folbw-up Services
Job Developmeo[ Specialist Duliea
The lob Development Spmulist will assess and coureel Work Fvs[ partxiparrts who rare
refrtN with m objective of beating empoyment. lob reed'mess avdjob club activhics
will hxlude but are not Wvited to mfonation show employer expectatbn, approprete
dress aM groaning, resume preparation, goal settwg and networking.
O[hr denies ofthe lob Developmera Specalist areas follows:
• Interview aPPlicants/pmticiPents to detemdne work history, eduwtioq having, erW
St:il~,
• Cotduct file searches of sadeblejob openings,
• Ref applicant m e~loYws,
• Pertbrmjob devebpment comans with empbyers to obtainjob orders,
• Provide labor rrerket information to empbyers, applicants, and outer agereies
Detemdve eligibilrtY for urcmploYment hmaavice, aM
• Folbw-up wrth applicantsaM employers inmeffort to impadjob retentiom
Performance Measures
NoM Camlvm's Work Fvst Program, implemented N 1Wy 1995, E are ofthe vnst
comprehmisive weware refirm efforts w Hx nation. The gwdwg principles of Work Fvst
regWres Parems to take perso[ml responsibility Cor then children, limfts the receipt of
Work F'as[ Cash Assivaance (temporary aM shad-term), and requves pereas to work.
The Orange Cowry Department ofSocial Services, vt conjunction whh tM Employmem
Secwuy Commisien have identified Hx Polbwing paformavce measves.
• Locate full-time empbymevt for 125 work F"vrt pardcipenu.
• Pertbrtn 45empbym visits to developjob openngs for Work Fvst participeMS.
• Conduct muNhlYjob readiness workshops.
Maintaw covmc[ wah participants and empbyers for three months after placement.
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACTHUDGET
SUMMARY Effective
Provider Employment Se<uriTy Commission ID)F SSE01 Period 8/1/98 though 6/90/99
Pan [ -Extimated Expenditures
Object of Expenditure Total Non-Marchable Total Matchable
Program Costs Costs
Costs (Z) (3)
(D
A. Salaries $23,353
H. FringeHmefic 6028
C. SEaff Development-Services 100
D. Tmvel 500
E. Equipmem Purchase-imgible Property
F. Transportation-Recipiml
G. Medical Supplies end Expense
H Cost of Spxe-Non-Residemial
I. Room &Board-Residential Treatment
I. Servioe Payments
K. Other
L. Indirect Costs
$ 2,935
M. Totals 532,916
rvt ll - lompntation of
A. L Toml Matchable Costs S N/A
2. Less: Earned Ivmme for Unit Cost Method 5
3. Ne[ Matchable Costs g
B. 1. Total Service Unit Capacity, or
2. Taml AndcipatN Utiliuuon Capacity
Method of Computation or Source of Data
D. Estimated Unit Cost or Individual Fixed Rate: S ner
,.
Part III - Dsmbuuon of Esttmatd Revenue [or ToW Cos[ Rewbwsement Mtthod
(e) (b)
A Estimated Eligible and Matchable Costs Number ario
1. Estimated Eligible Clients - 250 100%
2. Estimated ineligible Clirnts p p~
3. Toml Clients 250 100%
B. Eligible Costs
(1)Matchable (2) Lass (3) Net (4) (5)Costs Eligible
Costs tamed Matchable Estimatad% for Financial
[Part 1, Line M, Income Costs of Eligibles Panicipafion
coL (3) [B. (p Less (2)}] [A. L (b)] [B. (3) x (4)]
$ $ S $ $
A. Program COSCa Amowt $ouroe ofFwd•
L FederaVStare Fwds $ Work Fvst
2. Local Matching Share T Cowty
3. ONer Budgeted Fwds $
4. TOTAL REVENUE $ 32916
B. Fees (IPApplicable)
1. Admirdstrative Fee $
2. CertiScation Fee $
3. TOTAL FEES $
Part V-Reimbursement Projecfiom (Far Title XX Providers Only)
ArmuW Projection 1Wy-Septeruber Octobm-Jwe
Projection ProjecCOn
Signed: Date:
Provider/AUthoriud OfficW
Dale:
County Dvector or Designee
Purchase Convatt Budged
Supporting Badger Schedoles
~
~
0) (z) (3) (a) W (6) Ol
Number PaY %of No. o[ Asmual Tout
of Persons Positlon or Title Gude Time Monhs Salary Cos[
Employed
1 ]ab Developmen[Specfalist N/A 100% 11 $23,353 $2],353
ToW - Sal aries
B. Fringe Hemfits
lp C2) l3)
'. Total
Type Method of Campuution Cast
FICA ].65X23.353 1989
Health Ins. 158.18 X 11 Months 1040
Retirement 10.461 % X 23.353 2,443
Worker's Compensation .10% X 23,333 $ 23
Unemployment Insurance .15%X23,353 $ 35
Total -Fringe Benefits
-__~_._... _~......w.,~,"e~we
P)
Item -
<Y)
Toral
Cost
Staff Development wd Training 5100
Toml Sm[f Development -Service Fwds
$100
D. Tmvel Schedule
(t) C~) (3) (q) (5) Dail Subsistence (g)
No. of
Persons
Posifion or Title No. of
Miles/Days Rare per
Mile No. o[
Days (b)
Rate C])
Days Total
Cost
~ Iob
Development
Specialist 11
Mouths $500
Total -Travel $500
E. Equipmenr - Twgible Property Schedule
ll)
No. of
DNtb f2)
ltpn (3)
(]nst pe[UNl" C4)
ToW Cost
N/A
Total Equi pment -Tangible Pmpetry
F. Recipient Transportation SchedWe
P)
Item
(2)
McNod of Compuraton
(3)
Total
Cost
N/A
Is. $alariEs
# of
Persons Position or Title Pay
Grade °A of
Time # of Months
Employed Atmuat
Salary
N/A
Ib. Fringe Benefits
Type McNod of Computation
N/A
Toml Recipient Tmmportation
,~~~~~, a.~ upc.uea ~~ueuwc
(t)
Item (2)
Tnt~
Con
N/A
Toml -Medical Supplies and Expense
H. Cast of Space -Non-Residenral SChedWe
P)
Item (z7
Total
Cosr
N/A
ToW Cost of Spae -Non-Residential
1. Room and Board Costs -Residential Treatment
C)
Item (z)
Method of Computation (3)
Total
Cort
N/A
Tore) Roam and Boats Cans - Residential Treamtevt
I. Service Payment $chedWe
0)
No. of
units <2)
Item (3)
Cosl:P°<(lnit (4)
Tow
NA
Tow - Serdce Payment
K. Othev Expeme Scheudle
CD
Item CI)
Total
Cost
N/A
Total - Otber Expevse
L. Inn'.act Cost SchedWe
(t)
Rate (2)
Rate Applied TO: (3)
Amom[RateA lied TO: (4)
Tow
12.56]% Salary $23,3$3 $2,935
Total - Ind¢ect COSS $2,935