HomeMy WebLinkAboutAgenda - 06-03-1996 - VIII-F 1
T S
x ORANGE COUNTY
BOARD OF COMMISSIONERS
Action Agenda
Item No. -E
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 3, 1996
SUBJECT: 1996-97 Contract Between the NC Department of Environment, Health and Natural
Resources and the Orange County Health Department.
DEPARTMENT: HEALTH PUBLIC HEARING: Yes X No
ATTACHMENTS (S): INFORMATION CONTACT:
(1) Twelve Page Contract HEALTH DIRECTOR'S OFFICE X 2412
(2) FEDERAL ASSURANCE AGREEMENTS Hillsborough - 732-8181
(3) Local Health Department Budget Pages Chapel Hill 968-4501
PURPOSE:
To approve the annual consolidated contract.
BACKGROUND:
The attached contract stipulates the state contract support in the amount of Four hundred eighty-
nine thousand eight hundred seventy-nine ($489,879) for the following programs in FY 1996-97:
General CSHS Orthopedic
Communicable Disease MCH Block Grant Nutrition
Tuberculosis Maternal Health
AIDS (Federal) Child Health
Family Planning Adult Health
Child Service Coordination Breast &Cervical Cancer
Immunization Action Plan Health Promotion
Food and Lodging Environmental Health
Each year the state contracts with the health department to render specified, mandated services.
The attached contract outlines the terms in dollar amounts for each program activity as well as local
allocations and revenues which support these mandated services. Minor changes in the contract
terms are acceptable and do not substantially alter the working relationship.
RECOMMENDATION(S): The Manager recommends that the Board approve the contract,
subject to the endorsement of the county attorney and county
purchasing director and authorize the Chair to-sign the contracts,
assurances and budget pages.
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CONSOLIDATED CONTRACT
BETWEEN
THE STATE OF NORTH CAROLINA
AS REPRESENTED BY
THE DEPARTMENT OF ENVIRONMENTAL HEALTH AND NATURAL RESOURCES
(Hereinafter called the "State")
AND
ORANGE COUNTY HEALTH DEPARTMENT
(Local Health Department — Hereinafter called the "Department")
FOR THE PURPOSE OF
MAINTAINING AND STIMULATING THE ADVANCEMENT OF
HEALTH IN NORTH CAROLINA
This Contract Shall Cover a Period From
July 1, 1996 to June 30, 1997
NOW, THEREFORE, the State and the Department agree that the provisions and clauses herein set
forth shall be incorporated in and constitute the terms and conditions applicable for the following
activities involving State funding. (State funding or funds means state, federal, and/or special
funding or funds throughout this contract.)
ACTIVITY
ACTIVITY
General 4110 Health Promotion 5503
Communicable Disease 4510 Immunization Action Plan 5715
Aids (Federal 4545
Environmental Health 4751
Food and Lodaing 4752
Maternal Health 5101
Family Plannina 5151
Child Service Coordination 5318
CSHS Orthopedic 5323
Child Health 5351
MCH Block Grant Nutrition 5402
Comp Breast & Cervical Cancer Control
Adult Health 5502
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A. WCRK TO BE PERFORMED
1. The Department shall perform activities in compliance with applicable program rules
contained in the North Carolina Administrative Code as well as all applicable Federal and
State laws and regulations.
2. The Department shall submit for approval the required Program Contract Addenda for
State funded budgets.
3. The Department shall submit completed reports as required by budgeted funding criteria
and as specified in Listing of Required Fiscal and Statistical Reports (Addenda 1).
4. The Department shall administer and enforce all rules which have been adopted by the
Commission for Health Services or approved by the State and adopted by the Local Board
of Health.
5. The Department shall provide to the State copies of rules adopted by the Local Board of
Health pursuant to G.S. 130A-39 and Public Health Ordinances adopted by the County
Commissioners. Copies of existing rules and ordinances shall be submitted to the State
Health Director within 45 days. Thereafter, copies of rules adopted shall be submitted
within 30 days of adoption.
6. The Department shall provide to the State a Community Diagnosis Prioritization of
Problems every biennium. The Department shall also provide a Community Diagnosis
narrative, if completed.
B. FUNDING STIPULATIONS
1. Funding for this contract is subject to the availability of State, Federal, and special funds for
the purpose set forth in this Contract.
2. During the period of this Contract, the Department shall not use State, Federal or Special
Project funds received under this Contract to reduce locally appropriated funds as reflected
in the Local Health Department Budgets.
1 The Department shall not use personal health program funds to support environmental
health personnel nor use environmental health program funds to support personal health
programs.
4 Fees generated by the Food and Lodging fees collection program may only be used to
support Environmental Health activities.
5 Funds for Childhood Lead Poisoning Prevention may be used to support both
environmental health and child health activities.
6 The Department shall comply with Standards for Mandated Public Health Services, 15A
NCAC 25, Section .0200; and Administrative Procedures Manual for Federal Block Grant
Funds, 1 NCAC 33, Sections .0100 - .1502.
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7. The Department shall maintain employee time records for the contract period documenting
the portion of time that each employee attributes to each activity when State funds are
budgeted for the support of employee salaries and fringe benefits. The percentage of time
each employee spends in each activity shall be converted to dollars based upon the
employees' salary and benefits. These records will serve to document salary and benefit
expenditures reporter! on Local Expenditure Report Form DEHNR 2949 and Local
Expenditure Report -WIC Form DEHNR 2950, and compliance with Chapter 479, Section
99 of the 1985 Session Laws.
8.. The Department participating in Medicaid Reimbursement shall:
a. Comply with the terms of the Interagency Agreement between the Division of
Medical Assistance, Department of Human Resources and the Department of
Environment, Health, and Natural Resources and the Provider Participation
Agreement effective October 1, 1992 and any subsequent approved addenda or
new Agreement approved and established during the period of this contract.
b. Make every reasonable effort to collect its cost in providing services, for which
Medicaid reimbursement is sought, through public or private third party payors
except where prohibited by Federal regulations or State law. No one shall be
refused services solely because of an inability to pay.
9. The Department agrees to match the expenditure of Adolescent Pregnancy Prevention
Project grant funds with any in-kind source or newly generated funds, public or private
available to the project. Payment from the State shall be in accordance with G.S. 130A -
131.15 (d) (5) through (8).
10. Funds budgeted for Adolescent Pregnancy Prevention Activities shall not be expended for
dues or out-of-state travel unless prior approval is received from the program.
11. Subject to the approval of the appropriate Division, a local health department may seek
reimbursement for services covered by a program operating under 15A NCAC 24A rules
when those services are not supported by other state or federal funds. All payment
program rules and procedures as specified in the Purchase of Medical Care Services
manual must be followed.
12. Subject to the availability of funds and approval of the Office of Public Health Nursing, a
local health department may request reimbursement for:
a. Nursing service personnel participating in the Introduction to Principles and
Practices of Public Health and Public Health Nursing course (2 week course) and
the Public Health Nurse Supervisors Training Course (3 week course).
Reimbursement is limited to no more than $200.00 per week per participant upon
successful completion of the course.
b. Community Health Assistants and Public Health Nurses attending certain pre-
approved Continuing Education courses offered by the Office of Public Health
Nursing. Reimbursement is limited to S25.00 per participant per event.
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13. The Department shall have an annual audit performed in accordance with The Single Audit
Act of 1984 as implemented by OMB Circular A-128. The audit report should be submitted
to the Office of the Controller within (six) 6 months following the close of the contract. Audit
findings and resolution of said findings shall be handled by the Office of the Controller.
14. Equipment is a type of fixed asset consisting of specific items of property that: (1) are
tangible in nature; (2) have a life longer than one year; and (3) have a significant value.
a. For Budgeting and Reporting Purposes
1. Equipment purchases meeting the above definition and having an
acquisition cost of$500 or more must be budgeted and reported in Line Item
5000.
b. For Inventory Purposes
1. Equipment must be accounted for in accordance with Local Government
Accounting System Procedure No. 15.
2. Women, Infants and Children Program
All equipment with an acquisition cost of$500.00 or more must be
inventoried with the Division of Maternal and Child Health.
C. For Prior Approval Purposes
1. Equipment purchased or equipment leased where there is an option to
purchase with State/Federal funds must receive prior written approval from
the appropriate Division, Section, or Branch when the acquisition cost
exceeds $500.00.
2. Women, Infants and Children Program
All medical equipment and computer equipment, regardless of cost and all
other equipment with an acquisition cost of$500.00 or more must receive
prior approval from the program office.
3. Equipment purchased with program income generated by the expenditure of
Title X Family Planning Funds with an acquisition cost of$500.00 or more
must receive prior written approval from the program.
4. ' The use of Maternal and Child Health program generated Medicaid fees for
capital improvements requires prior written approval from the program.
C. FI;;AL CONTROL
1. The Department shall comply with the Local Government Budget and Fiscal Control Act,
North Carolina General Statute Chapter 159, Article 3.
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a. The Department shall maintain a purchasing and procurement system in
accordance with generally accepted accounting practices and procedures set forth
by the Local Government Commission.
b. The Department shall execute written agreements with all parties who invoice the
Department for payment for the provision of services to patients.
C. When subcontracting, the following conditions must be met:
1. The Department is not relieved of any of the duties and responsibilities
provided in this contract.
2. The subcontractor will agree to abide by the standards contained herein or
to provide such information as to allow the Department to comply with these
standards.
3. The subcontractor will agree to allow state and federal authorized
representatives access to any records pertinent to its role as a subcontractor
of the Department.
4. The Department will make available to the State upon request a copy of
subcontracts supported with State/Federal funds.
d. The Department shall receive prior approval from the State when subcontracting for
services in the Women, Infants and Children Program.
e. The Department shall retain all budgets, budget revisions, contracts, contract
addenda, and financial records in accordance with the current Records Disposition
Schedule for County and District Health Departments issued by the Division of
Archives and History, Department of Cultural Resources.
2. The Department shall prepare and maintain a budget for each activity covered by this
contract in a manner consistent with instructions provided with Local Health Department
Budget -WIC Form DEHNR 3370 (Revised 2/93) and Local Health Department Budget
Form DEHNR 2948 (Revised 2/93).
a. The Department shall prepare budget revisions for prior approval of the State when
those revisions are in the School Health Program (Line Item 6200).
b. The Department shall prepare budget revisions for prior approval of the State when
State funds will be increased or decreased.
C. The Department shall prepare an informational copy for the State of all other budget
revisions when proposed expenditures exceed the line amount budgeted.
d. The Department shall submit all revisions prior to the end of the term specified in
this Contract. Budget revisions received by the State after the end of the contract
period will be returned without action.
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3. The Department shall observe the following conditions when budgeting and reporting
earned revenues:
a. All payments from persons, and public or private third party payors, shall be utilized
for the activity that generated the revenue and shall not reduce or replace locally
appropriated funds during the period of this contract. The Department may use
revenues from any Division of Maternal and Child Health supported activity in any
other activity supported by the Division.
b. All earned income must be budgeted in the program where earned, except that
income earned by a program which has no activity budget can be budgeted in a
program approved by the State. With regard to revenue generated by maternal and
child health related services, program is defined as any activity supported by the
Division of Maternal and Child Health.
C. All fees collected shall be used in the current year or succeeding fiscal years.
d. Use of program income generated by the expenditure of Federal categorical funds
will be governed by applicable Federal regulations, including but not limited to 45
CFR 74.
e. When budgeting:
i. Line item 9000 on the program budget must be used to budget the total of
line items 101, 102 and 103.
ii. Line item 102 on the program budget must be used to budget TXIX earned
revenues.
iii. Line item 103 on the program budget must be used to budget other earned
revenues.
f. When reporting:
i. Line item 9000 on the Local Expenditure Report must be used to report the
total of line items 101, 102, 103.
ii. Line item 102 on the Local Expenditure Report must be used to report TXIX
earned revenues that were expended.
iii. Line item 103 on the Local Expenditure Report must be used to report other
earned revenues that were expended.
g. A local account shall be maintained for un budgeted/un reported TXIX fees.
Accounts shall be maintained in sufficient detail to identify the program source
generating the fees.
8.
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h. Title XIX revenues carried forward at the end of fiscal year 1997 may not exceed
Title XIX revenues earned during fiscal year 94-95 or $10,000.00 whichever is
greater.
i. Program budgets that do not include an amount of TXIX funds sufficient to meet the
requirements of 3. i. will not be approved by the State.
4. The Department shall submit a quarterly report of actual receipts and expenditures of the
Department according to instructions provided with Local Expenditure Reports, Form
DEHNR 2949 (Revised 8/95) and Form DEHNR 2950 (Revised 2/93).
a. The Department shall submit quarterly expenditure reports to the State within 45
days from the end of the reporting quarter.
b. The Department shall submit the final Expenditure Report to the State within 45
days after the end of the contract period. Report is due by August 14.
C. The Department shall submit amended or corrected expenditure reports within four
(4) months after the end of the contract period. Any such reports must be prepared
for the specific quarter to be amended or corrected. Reports received after October
31 will be returned without action.
d. The Department shall refund to the State all State funds not supported by
expenditures within 45 days after notification of overpayment. When payment is not
received by the State within 45 days, future payments to the Department may be
reduced by the amount due or payments may be suspended until the refund is
received by the State.
e. The Department shall follow Women, Infants and Children Program and other
Federal program reporting requirements when they differ from those stated above.
f. The Department shall submit monthly WIC expenditure reports to the State no later
than the 8th of the following month. Final expenditure report is due by August 14.
g. Reimbursement of WIC approved expenditures for July, August, and September
cannot exceed one-fourth of the total budget for the contract period.
h. The Department shall submit monthly Maternal Outreach expenditure reports to the
state no later than the 15th of the following month.
i. The Department shall submit expenditure reports for Mosquito Control activity in
accordance with 15A NCAC 186, Sections .0104 and .0107.
j. The Department shall submit request for payment for services provided under 15A
NCAC 24 A rules to the Claims Processing Unit, Purchase of Medical Care
Services, DEHNR.
i
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k. The Department shall submit request for reimbursement for nurse training to the
Office of Public Health Nursing. Form DEHNR 3300 - Public Health Nurse Training
Activity must be used as the invoice for payment.
5. The Department shall submit on an annual basis Staff Time Activity.Report, DEHNR 3389,
Environmental Health Report, DEHNR 3738, and Food and Lodging Report, DEHNR 3888.
The reports shall accompany the final expenditure report and must be received by the
State within 45 days after the end of the contract period.
D. PERSONNEL POLICIES
The Department shall adhere to and fully comply with State personnel policies as found in North
Carolina General Statute, Chapter 126, and 1 NCAC 8. Such policies include, but are not limited
to, the following:
1. Equal employment opportunity;
2. Affirmative action;
3. Policies for local government employment subject to the State Personnel Act;
4. "Local Classification and Salary Range";
5. "Compensation Policy for Local Competitive Services Employees"; and
6. 'Recruitment and Selection Policy and Procedures";
7. Environmental Health Specialists employed by the Department shall be delegated authority
by the State to administer and enforce State environmental health rules and laws as -
directed by the State pursuant to G.S. 130A-4(b). This delegation shall be done according
to 15A NCAC 18A .2300.
a. Local health departments are responsible for sending their newly-employed
environmental health specialists (interns) to 40 days (8 weeks) of initial field
training/orientation at the training center within 180 days from date of employment.
b. Arrangements for initial field training/orientation for newly-employed environmental
health specialists will be handled by the Environmental Health Services Section,
Division of Environmental Health.
The Department shall comply with Minimum Standard Health Department Staffing 15A
NCAC Section .0301(c).
E. :
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person's written consent except as may be otherwise required by applicable law or regulation.
Such information may be disclosed in summary, statistical, or other form which does not directly or
indirectly identify particular individuals.
F. CIVIL RIGHTS
1. The Department shall assure that no person, on the grounds of race, color, age, religion,
sex, marital status, immigration status, or national origin (unless otherwise medically
indicated) or otherwise qualified handicapped individual solely by reason of his/her
handicap be excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity covered by this Contract.
2. The Department shall complete HHS Form 441, Assurance of Compliance with the
Department of Health and Welfare regulations, under Title VI of the Civil Rights Act of
1964; for the Women, Infants and Children Program, FNS-64, Assurance of Compliance
with the Department of Agriculture Food and Nutrition Service, under Title VI of the civil
Rights Act of 1964; and HHS Form 641, Assurance of Compliance with Section 504 of the
Rehabilitation Act of 1973.
3. The American with Disabilities Act 1990 (ADA) makes it unlawful to discriminate in
employment against a qualified individual with a disability and outlaws discrimination
against individuals with disabilities in State and local government services and public
accommodations. The Department certifies that it and its principals and subcontractors will
comply with regulations in A.D.A. Title I (Employment), Title II (Public Services), and Title III
(Public Accommodations) in fulfilling the obligations under this agreement.
G. RESPONSIBILITIES OF THE STATE
1. The State shall provide to the Department upon request technical assistance in the
preparation of the Consolidated Contract/Activity Budgets and Contract Addenda.
2. The State shall specify those administrative forms/reports and their respective revision
dates that are required by particular activities pertaining to the Department's budget with
the State in Listing of Required Fiscal and Statistical Reports (Addendum 1) for the contract
period. New forms/reports not listed in Required Fiscal and Statistical Reports shall be
implemented during a contract period only with the approval of the State Health Director.
3. The State shall provide to the Department within thirty (30) days after receiving an activity
budget from the Department an approved signed copy of the budget.
4. The State shall provide'funds to the Department upon approval of the Contract Addenda,
activity budgets, and signing of this contract.
5. The State shall assist the Department to comply with all applicable laws, regulations, and
standards relating to the activities covered in this contract.
6. The State reserves the right to conduct reviews to determine compliance with the terms of
this contract.
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7. The State shall be assured that the Department maintains expenditure of locally
appropriated funds for maternal health, child health, and family planning activities equal to
or greater than that reported on the Staff Time Activity Report for the period beginning July
1, 1984, and ending June 30, 1985. This maintenance of effort shall be measured by
salary equivalencies which are to be maintained in accordance with Section B. 7. of this
contract.
H. DISBURSEMENT OF FUNDS
The State shall disburse funds to the Department as follows:
1. For departments selecting monthly payments through the GMTS option - - -
Provided the Consolidated Contract is properly executed and all quarterly expenditure
reports are filed within the established time frames, payments equal to 1/12 of the total
program approved budget shall be made in the following months:
July August September October November January February April May
Based on expenditures reported for the first, second, and third quarters, payments shall be
adjusted either upward or downward, in payments made in the following months:
December March June
2. For Departments selecting monthly payments through the check option - - -
Provided the Consolidated Contract is properly executed and all quarterly expenditure
reports are filed within the established time frames, payments equal to 1/12 of the total
program approved budget shall be made in the following months:
July August September October December January March April June
Based on expenditures reported for the first, second, and third quarters, payments shall be
adjusted either upward or downward, in payments made in the following months:
November February May
3. For departments selecting quarterly reimbursement option, payments shall be made when
the quarterly expenditure report is received.
4. For departments receiving Rural Obstetrical Care Incentive funds, payment of such funds
shall be made in one lump sum the month following receipt and approval of the activity
budget.
5. For departments receiving Maternal Outreach project funds, payment will be based on
actual reported expenditures. Monthly payments will be made provided that expenditure
reports are received as required in C. 4. h.
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6. Food and lodging fees will be disbursed to the department in one sum the month following
receipt and approval of the activity budget and any subsequent budget revisions.
7. Funds for Childhood Lead Poisoning Prevention will be disbursed once per quarter. The
amount will be determined by the number of confirmed cases identified in each county.
Funds for training will be disbursed upon request.
8. Funds for injury prevention projects will be disbursed in one lump sum during the first
quarter of the project budget approval.
9. Quarterly payment for reported expenditures in Line Item 1000 shall be limited to one-
fourth of the budgeted amount in that line item.
10. Increased or decreased payments necessitated by changes in the total budgeted amount
will be reflected in the monthly payments subsequent to approval of the budget revision.
11. Payments shall be suspended when expenditure reports are not received by the time
specified in C. 4. a and f. Payments will resume in the months subsequent to receipt of the
expenditure reports.
12. Payment is limited to the total amount of the budget by line item as reported on
Expenditure Report DEHNR 3389.
13. Final payments will be made based on the 4th quarter expenditure report. Final payments
will be equal to the difference between approved reported expenditures and the sum of
previous payments. Final payments should be made not later than September provided
that an original signed copy of an expenditure report for each quarter has been received by
the Office of the Controller. Final payment will be made only after the Staff Time Activity
Report, DEHNR 3389, Environmental Health Report, DEHNR 3788, and Food and Lodging,
DEHNR 3888 are received by the State.
I. AMENDMENT OF CONTRACT
Amendments, modifications, or waivers of this contract may be made at any time by mutual
agreement of all parties. Amendments shall be in writing and signed by appropriate authorities.
J. PROVISION OF TERMINATION
This contract may be terminated for reasons other than non-compliance upon sixty (60) days
written notice by either party. If termination should occur, the Department shall receive payment
only for allowable dxpenditures.
The State may withhold payment to the Department until the State can determine whether the
Department is entitled to further payment or whether the State is entitled to a refund.
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K. COMPLIANCE
1. The State shall assure compliance with all terms of this contract.
a. Upon determination of non-compliance, the State shall give the Department sixty
(60) days written notice to come into compliance. If the deficiency is corrected, the
Department shall submit a written report to the State which sets forth the corrective
action taken.
b. If the above deficiencies should not be corrected to the satisfaction of the State
after the sixty (60) day period, disbursement of funds for the particular activity may
be temporarily suspended pending negotiation of a plan of corrective action.
C. If the deficiency is still not corrected within the next thirty (30) days following
temporary suspension of funding, program funds may be permanently suspended
until the Department can provide evidence that the deficiencies have been
corrected.
d. In the event of the Department's non-compliance with clauses of this contract, the
State may cancel, terminate, or suspend this contract in whole or in part and the
Department may be declared ineligible for further State contracts or agreements.
Such terminations for non-compliance shall not occur until: (1) the provisions of
Section K-1 (a-c) have been followed, documented, and have failed to provide a
resolution, (2) all other reasonable administrative remedies have been exhausted.
2. If the Department or the State should be determined out of compliance with the provisions
of the contract, either party may file a formal appeal with the Office of Administrative
Hearings.
IN WITNESS WHEREOF, the Department and the State have executed this agreement in
duplicate originals, one of which is retained by each of the parties.
LOCAL SIGNATURES DEPARTMENT OF ENVIRONMENT,
HEALTH, AND NATURAL RESOURCES
Jonathan B. Howes, Secretary
Health Director Date
By
Finance Officer Date Department Head's Signature
or Authorized Agent
Chairman of County Commissioners Date
(when required)
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
ASSURANCE OF COMPLIANCE WITH SECTION SO4 OF THE
REHABILITATION ACT OF 1973, AS AMENDED
The undersigned(hereinafter called the"recipient")HEREBY AGREES THAT it will comply
with Section 504 of the Rehabilitation Act of 1973.as ascended(29 U.S.C.7K.all require-
ments imposed by the applicable HHS regulation(45 C.F.R. Part 94).and all guidelines and
interpretations issued pursuant thereto.
Pursuant to 184.5(a)of the regulation (45 C.F.R. 84.5(a)),the recipient gives this Assurance
In consideration of and for the purpose of obtaining any and all Federal grants, for con.
tracts (except procurement contracts and contracts of insurance or guaranty), property,dis-
counts, or other Federal financial assistance extended by the Department of Health and Human
Services after the date of this Assurance, including payments or other assistance made after
such date on applications for Federal financial assistance that were approved before such
date.The recipient recognizes and agrees that such Federal financial assistance will be extended
in reliance on the representations and agreements made irr this Assurance and tha_the United
States will have the right to enforce this Assurance through Lawful means. This Assurance
is binding on the recipient,its successors,transferees, and assignees, and the person or persons
whose signatures appear below are authorized to sign this Assurance on behalf of the recipient.
This Assurance obligates the recipient for the period during which Federal financial assistance
is extended to it by the Department of Health and Human Services or, where the assistance
is in the form of real or personal property, for the period provided for in 184.5(b) of the
regulation 145 C.F.R. 84.5(b)].
The recipient: (Check (a) or (b)]
a. ( rmploys fewer than fifteen persons;
b. ( ) employs fifteen or more persons and, pursuant to 184.7(a) of the regulation
145 C.F.R. 84.7(a)], has designated the following person(s) to coordinate its
efforts to comply with the HHS regulations:
Daniel B. Reimer
Name of Designee(s) (Type or Print)
Orange County Health Department PO Box 8181
Name of Recipient-{Type or Print) Street Address or P.O. Box
56-6000327 Hillsborough
(IRS) Employer Identification Number City
North Carolina 27278-8181
State Zip
I certify that the above information is complete and correct to the best of my knowltdge.
Date Signature and Title of Authorized Official
If there has been a change in name or ownership within the last year, please PRINT the former
name below:
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ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES REGULATION UNDER
TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
Orange County Health Department
(t
Name of Appliaot ype or priat)
(hereinafter called tte "Applicant")
HEREBY AGREES THAT it will comply with Title VI of the Civil Rights Act of 1964(P.L.
88-352) and all requirements imposed by or pursuant to the Regulation of the Department
of Health and Human Services (45 C.F.R. Part 80) issued pursuant to that title, to the end
that, in accordance with Title VI of that Act and the Regulation, no person in the United
States shall, on the ground of race, color, or national origin, be excluded from participation
in, be denied the benefits of,or be otherwise subjected to discrimination under any program
or activity for which the Applicant receives Federal financial assistance from the Depart-
ment; and HEREBY GIVES ASSURANCE THAT it will immediate!y take any measures
necessary to effectuate this agreement.
If any real property or structure thereon is provided or improved with the aid of Federal
financial assistance extended to the Applicant by the Department. this Assurance shall obligate
the Applicant, or in the case of any transfer of such property, any transferee, for the period
during which the real property or structure is used for a purpose for which the Federal financial
assistance is extended or for another purpose involving the provision of similar.services or
benefits. If any personal property is so provided, this Assurance shall obligate the Applicant
for the period during which it retains ownership or possession of the property. In all other
cases, this Assurance shall obligate the Applicant for the period during which the Federal
financial assistance is extended to it by the Department.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and
all Federal grants, loans, contracts, property, discounts or other Federal financial assistance
extended after the date hereof to the Applicant by the Department, including installment
payments after such date on account of applications for Federal financial assistance which
were approved before such date.The Applicant recognizes and agrees that such Federal finan-
cial assistance will be extended in reliance on the representations and agreements made in
this Assurance, and that the United States shall have the right to seek judicial enforcement
of this Assurance. This Assurance is binding on the Applicant, its successors, transferees.
and assignees, and the person or persons whose signatures appear below are authorized to
sign this Assurance on behalf of the Applicant.
Date Orange County Health Department
Appiteaat (type or pnntl
By
Signature and Title of Authorued Olfiaal
HHS1+1 (Rev. 12/12)
16
tong roorS D.S. DEPARTMn-7 OF AGRICULTURE Beer.e«tae we ..e....
isa+ Food and Nutrition Service
ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF AGRICULTURE,
FOOD AND NUTRITION SERVICE. UNDER TITLE VI OF THE CIVIL RIGHTS ACT OF 1964
Orange County Health Department
%haze of Applicant)
(hereinafter called the "Applicant.")
1LAE3T AGREES THAT it will comply with Title VI any improveme-ts made with Federal financial
of the Civil lights Act of 1961. (?.L. !8-352) assistance extended to the Applicant by the
and all requis ments imposed by the Regulations Department. This includes any Federal agreement,
of the Department of Agriculture (7 cFR Part 15), arrangement, or other contract which has as one
Department of Justice (28 CFR Parts 42 i 50). of Its purposes the provision of assistance such
and FNS directives or regulations issued as food, food stamps, cash assistance for the
pursuant to that Act and the Regulations, to the purchase of food, and cash assistance for purchase
effect that, no person In the United States shall, or rental of food service equipment or any other
on the ground of race. color, or national origin, financial assistance extended in reliance on the
be excluded from participation in. be denied the representations and agreements made in this
benefits of, or be otherwise subject to discrimi- assurance.
nation under any ?:ogre: or activity for which the
Applicant receive: Federal financial assistance BY ACCEPTING THIS ASSURA.SCE, the applicant agrees
from the DepaTtment; and HER13' GIVES ASSUFM CE to compile data, maintain records and submit
TP.AT it will iaedistsly take say measures reports as required, to permit effective enforce-
necessary to efic;:irate this agreement. ment of Title VI and permit authorized USDA
personnel during normal working hours to review
THIS ASSURANCE is given in consideration of and such records. books and accounts as needed to
for the purpose of obtaining any and all Federal ascertain cot;liance with Title V1. If there are
financial assistance, grants and loans of Federal any violations of this assurance, the Department
funds, reimbursab:e expenditures. grant or of Agriculture, Food and Nutrition Service, shall
donation of Federa: property and interest In have the right to seek judicial enforcement of
property, the data:. of Federal personnel, the this assurance.
sale and lease of, and the permission to use,
Federal property or interest is such property or This assurance is binding on the applicant, its
the furnishing of services vitbout consideration successors, transferees, and assignees as long as
or at a noc4 nal cztsideratlon, or at a consider- It receives assistance or retains possession of
ation which is re:.ced for the purpose of assist- any assistance from the Department. The person
ing the recipient, or in recognition of the or persons whose signatures appear below are
public interest t: be served by such sale, lease. authorized to sign this assurance on the behalf of
or furnishing of se-vices to the reclpleaz. cr the applicant.
Orange County Health Department
Dated
(Applicant)
1y
(Title of authorized official)
P.O. Box 8181
Hillsborough NC 27278
(Address of Applicsnt)
No further sonic% yr other benefits may be paid out under Food and Nutri:icr. Service Federal assistance
programs unless t.::s Assurance is completed and filed as required by existing regulations (7 CFR 1S).
ape.....a
17
LOCAL HEALTH DEPARTMENT BUDGET
r Revision Number__
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of Adult Health P.O.Number
SFY 1997
7 / 96 6 / 97 97 5452 063
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity COMP Breast&Cervical Cancer Control
Project Director: Daniel B.Reimer Total Budget: S $25,646
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 13,923
X Operating Expenses OP EXP 2000 1,819
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100 9,904
D School Health SCH HLTH 6200
1 Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
E Transfer TXIX 6864
S Subtotal State Expenditures: 25,646
LOCAL EXPENDITURES: LOCAL EXP 9000 0
TOTAL EXPENDITURES-Equal to Total Receipts 25,646
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX T= 102 0
C Other Receipts OTHR REC 103 0
E Subtotal Local Funds 0
I STATE/FEDERAL/SPECIAL FUNDS:
P
T
S
Subtotal State/Federal/Special 25,646
TOTAL RECEIPTS-Equal to Total Expenditures 25,646
Local Authorized Official Signature Date annchHeed Division/Section Signature Date
Ina9I
Finance Officer Signature Datc Acwmtw Fiscal Management Signature Date
ImOfl
DEI INR 2948(Revised 2,93)
Cenenl Se cee Ch-(Rmew 194)
18
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number-02-_
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1997
7 / 96 6 / 1 97 97 535 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Child Health
Project Director. Daniel B.Reimer Total Budget: S $494,313
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 70,243
X Operating Expenses OPEXP 2000 557
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCH HLTH 6200 10,328
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864
Subtotal State Expenditures: 81,128
LOCAL EXPENDITURES: LOCAL EXP 9000 413,185
TOTAL EXPENDITURES-Equal to Total Receipts 494,313
LOCAL FUNDS:
R Appropriation APPROP 101 294,437
E TXIX T= 102 116,307
C Other Receipts OTHR REC 103 2,441
E Subtotal Local Funds 413,185
I STATE/FEDERAL/SPECIAL FUNDS:
P Pediatric Primary Care
T Child Fatality Prev Team 557
S School Health 10,328
_ Health MOthers/Healthy Child 70243
Subtotal State/Federal/Special 81,128
TOTAL RECEIPTS-Equal to Total Expenditures 494,313
Local Authorized Official Signature Date ewe Hnd Division/Section Signature Date
Inew
I-rnance Otlicer Signature D� Fiscal Management Signature
Date
INOd
DEI I1,TR 2948(Revised 2.93)
UmaW Smw.v Diw IR�194)
19
LOCAL HEALTH DEPARTMENT BUDGET
r
N.C.Department of Environment, Revision Number——
Health,and Natural Resources
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1997
7 / 96 6 / 97 97 5318 68
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Child Services Coordination
Project Director. Daniel B.Reimer Total Budget: S $159,956
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 51,876
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health 5CHMTH 6200
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX
6$64
Subtotal State Expenditures: 51,876
LOCAL EXPENDITURES: LOCAL ENP 9000
TOTAL EXPENDITURES-Equal to Total Receipts 108,080
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX TM 102 108,080
C Other Receipts OTHR REC 103 0
E Subtotal Local Funds 108,080
I STATE/FEDERALSPECIAL FUNDS:
P
" T
S
Subtotal State/Federal/Special 51,876
TOTAL RECEIPTS--Equal to Total Expenditures 159,956
Local Authorized Official Signature Date sin Had Division/Section Signature Date
)Ner
Finance 011icer Si gn ature �Ie A.c—t-t Fiscal Management Signature Date
InOnl
DE11NR 2918(Revised 2.'93)
Gmenl Se cm Di u on(Renew 194)
20
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number__ 4
N.C.Department of Environment,
Health,and Natural Resources
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1997
7 / 96 6 / 97 97 5151 068
Effective Date Termination Date Contract Number
Contractor: Orange Cody Health Department Activity Family Planning
Project Director. Daniel B.Reimer Total Budget: S $574,659
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 140,656
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCHELTH 6200'
I Clinician CLN 6863
T -
U Laboratory LAB ' 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864
Subtotal State Expenditures: 140,656
LOCAL EXPENDITURES: LOCAL EX? 9000 434,003
TOTAL EXPENDITURES-Equal to Total Receipts 574,659
LOCAL FUNDS:
R Appropriation APPROP 101 395,504
E TX1X T= 102 23,741
C Other Receipts OTHR REC 103 14,758
E Subtotal Local Funds 434,003
I STATE/FEDERAL/SPECIAL FUNDS:
P FP $41,802
T WHSF $0
S HMHC $98,854
Subtotal State/Federal/Special 140,656
TOTAL RECEIPTS Equal to Total Expenditures 574,659
Local Authorized Official Signature Date amneh Head Division/Section Signature Date
,p Imud
Finance Officer Signature to Accuwtmt Fiscal Management Signature Date
ImaJ
DEl INR 29.18(Revised 2.93)
Omemi 5emca LhY—I R--:.941
� L1
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number__
N.C.Department of Environment,
Health.and Natural Resources _
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1997
7 / 96 6 / 97 97 5101 68
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Maternal Health
Project Director: Daniel B.Reimer Total Budget: S $407,652
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 25,826
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
Ap
D School Health C. """'
I Clinician CLN 6863
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
E Transfer TXIX
S Subtotal State Expenditures: 25,826
LOCAL EXPENDITURES: LOCAL EXP 9000 381,826
TOTAL EXPENDITURES-Equal to Total Receipts 407,652
LOCAL FUNDS:
R Appropriation APPROP 101 180,538
E TXIX Tx1x 102 201,288
C Other Receipts OTHR REC 103 0
E Subtotal Local Funds 381,826
I STATE/FEDERAL/SPECIAL FUNDS:
P Maternal EIealth Subtotal S 25,826 Total DEHNR S
T Healthy Mothers/Healthy Children 25,826
S General MCH Funds 0
25.826
Subtotal State/Federal/Special 25,826
TOTAL RECEIPTS-Equal to Total Expenditures 407,652
Local Authorized Official Signature Date Branch Herd DivisioniSLetion Signature Date
Initial
-14� �i� 4ate�Finance Otlicer Si ature Fiscal Management Signature Date
Imnal
DF1 LNR 2918(Revised 2.9 3)
.;enrfal Semce Crenaun iKevew:.uJ1
22
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number �
N.C.Department of Environment, ——
Health.and Natural Resources
Division of General Services Division of Epidemiology P.O.Number
SFY 1997
7 / 96 6_/_97 97 4545 68
Effective Date Termination Date Contract Number
Contractor: Orange Countv Health Department Activity Aids(Federal)
Project Director. Daniel B.Reimer Total Budget: S $31,000
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 29,750
X Operating Expenses OP EX? 2000 1,250
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SC14 HLTH 620Q
I Clinician CLN 6$63
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864
Subtotal State Expenditures: 31,000
LOCAL EXPENDITURES: LOCAL EXP 9000 0
TOTAL EXPENDITURES-Equal to Total Receipts 31,000
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX TM 102 0
C Other Receipts OTHR REC 103 0
E Subtotal Local Funds 0
I STATE/FEDERAL/SPECIAL FUNDS:
iP
T DEHNR 31,000
IS
Subtotal State/Federal/Special 31,000
TOTAL RECEIPTS-Equal to Total Expenditures 31,000
Local Authorized Official Signature Date amnch Ifead Division/Section Signature Date
buhat
Finance Otficer Signature 4De lcco-mt Fiscal Management Signature Date
Waal
DG11NR 29.18(Revised 2.93)
i 7enenJ Smica Ulinon 1 Revmw:.aJl
23
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of General Services P.O.Number
SFY 1997
7 1 96 6 1 97 97 4110 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity General
Project Director. Daniel B.Reimer Total Budget: S $560,869
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 54,363
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCH'EL.TH 6200
j Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
E Transfer TXIX 6864
S Subtotal State Expenditures: 54,363
LOCAL EXPENDITURES: LOCAL EXP 9000 506,506
TOTAL EXPENDITURES-Equal to Total Receipts 560,869
LOCAL FUNDS:
R Appropriation APPROP 101 331,191
E TXIX TXIX 102 106,466
C Other Receipts OTHR REC 103 68,849
E Subtotal Local Funds 506,506
I STATE/FEDERAL/SPECIAL FUNDS:
P
T
S
Subtotal State/Federal/Special 54,363
TOTAL RECEIPTS-Equal to Total Expenditures 560,869
Local Authorized Official Signature Date emnen Ilefd Division/Section Signature Date
Imwl
Finance ance Otlicer Signature Date Aeeomtmt Fiscal Management Signature Date
Waal
DF I LNR 2943(Revised 93)
k.ml Senun Llm—n 1 Rmew:1)1)
24 f
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number__ �
N.C.Department of Environment,
Health,and Natural Resources
Division of General Services Division of Epidemiology P.O.Number
SFY 1997
7 / 96 6 / 97 97 4510 68
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Communicable Disease
Project Director. Daniel B.Reimer Total Budget: S $204,557
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 17,018
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCH HLTH ° 'r 620Q
_...._.
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864
Subtotal State Expenditures: 17,018
LOCAL EXPENDITURES: LOCAL EXP 9000 187,539
TOTAL EXPENDITURES-Equal to Total Receipts 204,557
LOCALFUNDS:
R Appropriation APPROP 101 170,878
E TXIX Tame 102 4,161
C Other Receipts OTHR REC 103 12,500
E Subtotal Local Funds 187,539
I STATE/FEDERAUSPECIAL FUNDS:
_ P
T DEHNR
S
Subtotal State/Federal/Special 17,018
TOTAL RECEIPTS-Equal to Total Expenditures 204,557
Local Authorized Official Signature Date Brunch Had Division/Section Signature Date
war
Finance Officer Signature ate A--tam Fiscal Management Signature Date
war
DEI INR 2948(Revised 2.93)
G"wW Se m Dt m on(Renew 194)
► 25
LOCAL HEALTH DEPARTMENT BUDGET
► Revision Number-
N.C.Department of Environment,
Health,and Natural Resources
Division of General Services Division of Environmental Health P.O.Number
SFY 1997
7 / 96 6 / 97 97 4751 68
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Environmental Health
Project Director: Daniel B.Reimer Total Budget: S $557,758
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000
X Operating Expenses OP EXP 2000 6,000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCHHLTH 6200+'
I Clinician CLN " 6863 `
T
U Laboratory LAB 6862 '
R Pharmacy Services RX SERV 6865
S Transfer TXIX = 6864
Subtotal State Expenditures: 6,000
LOCAL EXPENDITURES: LOCAL EYP 9000 551,758
TOTAL EXPENDITURES-Equal to Total Receipts 557,758
LOCAL FUNDS:
R Appropriation APPROP 101 300,758
E TXIX TXDC 102 0
C Other Receipts OTHR REC 103 251,000
E Subtotal Local Funds 551,758
I STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR 6,000
S
Subtotal State/Federal/Special 6,000
TOTAL RECEIPTS-Equal to Total Expenditures 557,758
Local Authorized Official Signature Date a=ch seW Division/Section Signature Date
Imad
Finance Otlicer Jignature Da a Acc—au,l Fiscal Management Signature Date
huaal
DEI INR 2948(Revised 2.93)
C,."S—....Dien..i R.,—].9.11
LOCAL HEALTH DEPARTMENT BUDGET zb
Revision Number
N.C.Department of Environment, ——
Health,and Natural Resources
Division of General Services Division of Environmental Health P.O.Number
SFY 1997
7 / 96 6 / 97 97 4752 68
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Food and Lodging
Project Director: Daniel B.Reimer Total Budget: S $750
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000
X Operating Expenses OP EXP 2000 750
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCHHLTH 6200
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864
Subtotal State Expenditures: 750
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES-Equal to Total Receipts 750
LOCAL FUNDS:
R Appropriation APPROP 101
E TXIX TXDC 102
C Other Receipts OTHR REC 103
E Subtotal Local Funds $ p
I STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR 750
S
Subtotal State/Federal/Special 750
TOTAL RECEIPTS-Equal to Total Expenditures 750
1
Local Authorized Official Signature Date 13 u hHnd Division/Section Signature Date
Inutid
[:inane 011iicer Signature Date Accowtat Fiscal Management Signature Date
Imnd
DEI INR 29.18(Revised 2,93)
UenaW Smirn Unnun IReview:.4J1
LOCAL HEALTH DEPARTMENT BUDGET 27
Revision Number_
N.C.Department of Environment,
Health,and Natural Resources
Division of General Services Division of Maternal and Ch'Id Health P.O.Number
SFY 1997
7 / 96 6 / 97 97 5323 68
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity CSHS Orthopedic
Project Director. Daniel B.Reimer Total Budget: $ $634
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 634
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCH MR 6200
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864
Subtotal State Expenditures: 634
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES-Equal to Total Receipts 634
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX T= 102 0
C Other Receipts OTHR REC 103 0
E Subtotal Local Funds 0
j STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR
S
Subtotal State/Federal/Special 634
TOTAL RECEIPTS-Equal to Total Expenditures 634
Local Authorized Official Signature Date emcb and DivisioniSection Signature Date
Imoal
Finance Officer Signature Da� Accamt.nt Fiscal Management Signature Date
Imoal
DEI INR 2918(Revised 2.93)
Umend Semen(hvmvn(Rmea I9J)
29
LOCAL HEALTH DEPARTMENT BUDGET
Revision Number-
N.C.Department of Environment,
Health,and Natural Resources _
Division of General Services Division of Maternal and Child Health P.O.Number
SFY 1997
7 / 96 6 / 97 97 5402 68
EtTective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity MCH Block Grant Nutrition
Project Director: Daniel B.Reimer Total Budget: S $2,450
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 2,450
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCH'HLTH 6200
j Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864
Subtotal State Expenditures: 2,450
LOCAL EXPENDITURES: LOCAL EXP 9000 0
TOTAL EXPENDITURES-Equal to Total Receipts 2,450
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX T= 102 0
C Other Receipts OTHR REC 103 0
E Subtotal Local Funds 0
I STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR
S
Subtotal State/Federal/Special 2,450
TOTAL RECEIPTS-Equal to Total Expenditures 2,450
Local Authorized Official Signature Date Burch Hnd DivisioniSection Signature Date
Imad
Finance Oiliccr Signature D'to accountant Fiscal Management Signature Date
WtW
DEI INR 2948(Revised 2.93)
lrnenl Senun Dn mvn Rrview:�n
'
LOCAL HEALTH DEPARTMENT BUDGET 29
f Revision Number
N.C.Department of Environment, ——
Health,and Natural Resources
Division of General Services Division of Adult Health P.O.Number
SFY 1997
—7—/-96-- 6 / 97 97 5502 68
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Adult Health
Project Director. Daniel B.Reimer Total Budget: S 108,562
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 5,502
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health
I Clinician CLN 6863
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX
Subtotal State State Expenditures: 5,502
LOCAL EXPENDITURES: LOCAL EXP 9000 103,060
TOTAL EXPENDITURES-Equal to Total Receipts 108,562
LOCAL FUNDS:
R Appropriation APPROP 101 103,060
E TXIX T= 102 0
C Other Receipts OTHR REC 103 0
E Subtotal Local Funds 103,060
I STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR 5,502
S
Subtotal State/Federal/Special 5,502
TOTAL RECEIPTS-Equal to Total Expenditures 108,562
Local Authorized Official Signature Date Bn h Hnd Division/Section Signature Date
hutw
T-7
Finance OtTicer Signature ate dccuwlrnt Fiscal Management Signature Date
INnal
DEI QJR 2948(Revised 2.93)
' Gmrd Semcn Dnnon IRmrw,b9J1
LOCAL HEALTH DEPARTMENT BUDGET 30
Revision Number_
N.C.Department of Environment,
Health,and Natural Resources
Division of General Services Division of Adult Health P.O.Number
SFY 1997
7 / 96 6 / 97 97 5503 068
Effective Date Termination Date Contract Number
Contractor: Orange County Health Department Activity Health Promotion
Project Director. Daniel B.Reimer Total Budget: S 0 $23,988
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 22,116
X Operating Expenses OP EXP 2000
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SCHH£:TH 6200
I Clinician CLN 6863
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864 ,
Subtotal State Expenditures: 22,116
LOCAL EXPENDITURES: LOCAL EYP 9000 1,872
TOTAL EXPENDITURES-Equal to Total Receipts 23,988
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX T= 102 0
C Other Receipts OTHR REC 103 1,872
E Subtotal Local Funds 1,872
I STATE/FEDERAL/SPECIAL FUNDS:
P
T DEHNR
S
Subtotal State/Federal/Special 22,116
TOTAL RECEIPTS-Equal to Total Expenditures 23,988
Local Authorized Official Signature Date 6,.nce Hnd Division/Section Signature Date
wed
Finance Officer Signature at'LJ e� Amom t Fiscal Management Signature Date
INnV
DEI{NR 2913(Revised 2193)
General Semcn Diw n(Renew L94)
t
LOCAL HEALTH DEPARTMENT BUDGET 31
Revision Number
—
Health,Department of Environment, ——
Health,and Natural Resources
Division of General Services Division of Epidemiology P.O.Number
SFY 1997
7 / 96 6 / 97 97 5715 68
Effective Date Termination Date Contract Number
Contractor: _ Orange County Health Department Activity Immunization Action Plan
Project Director. Daniel B.Reimer Total Budget: S $24,914
Item Description CLASSIFICATION ITEM AMOUNT
STATE EXPENDITURES:
E Salaries and Fringe Benefits SA/FR 1000 17,731
X Operating Expenses OP EXP 2000 7,183
P Purchase of Equipment EQUIP 5000
E General Contracted or
N Purchased Services GENERAL 6100
D School Health SC1412LTH 6200
I Clinician CLN" 6863 ... ..,j: .. ,.. ..
T
U Laboratory LAB 6862
R Pharmacy Services RX SERV 6865
S Transfer TXIX 6864"
Subtotal State Expenditures: 24,914
LOCAL EXPENDITURES: LOCAL EXP 9000
TOTAL EXPENDITURES-Equal to Total Receipts 0
LOCAL FUNDS:
R Appropriation APPROP 101 0
E TXIX TXIX 102 0
C Other Receipts OTHR REC 103 0
E Subtotal Local Funds 0
I STATE/FEDERAUSPECIAL FUNDS:
P
T
S
Subtotal State/Federal/Special 24,914
TOTAL RECEIPTS-Equal to Total Expenditures 24,914
Local Authorized Official Signature Date Bn h Hed Division/Section Signature Date
wad
Finance Officer Signature Date Accountant Fiscal Management Signature Date
Imod
DEI INR 2943(Revised 2;93)
General Semmes Lhvmon lRevtew 194)