HomeMy WebLinkAboutAgenda - 06-27-2006-5nORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 27, 2006
Action Agenda
Item No. 5-(~
SUBJECT: Contract Renewal with Orange County Schools System for Adolescent
Parenting Services
DEPARTMENT: Social Services
PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
Renewal Contract
INFORMATION CONTACT:
Nancy Coston, 245-2800
Gwen Price, 245-2800
PURPOSE: To renew the contract with Orange County Schools System to provide specialized
services to pregnant and parenting teens.
BACKGROUND: One of the main goals outlined in the federal welfare reform legislation is to
support teen parents and to avoid additional unplanned pregnancies. Therefore, federal funds
in the Work First Block Grant can be used for this purpose,
The goals of this program are to improve parenting skills, assure that participants complete their
education and delay second pregnancies, The ultimate goals are to help teens prepare to be
self-sufficient and to prevent them from becoming dependent on public assistance, Teen
parents are at high risk for becoming dependent on public assistance, particularly if they drop
out of school, This contract will be ccordinated with the programs at the Department of Social
Services, which have been very effective at helping participants to finish high school and to
delay additional pregnancies. In Fiscal Year 2005-2006, twenty-one teen parents were served
by the expansion program with Orange County Schools, Because of the services provided
under this contract, eleven teen parents will graduate this school year from the Adolescent
Parenting Program (APP). Of the eleven teens, six are from Orange County Schools,
Teen parents have been identified far services next year and there is sufficient need to justify a
full-time social worker in the Orange County Schools System. The renewal contract is based on
a caseload of 12-18 teen parents. The social worker will provide individual and group
interventicns with teens and will try to address issues that might result in the student dropping
out of school. Supportive services (such as housing, transportation, day care, medical care)
may also be arranged by the social workers, The social worker works with the other school
personnel to meet the academic needs of pregnant or parenting students.
This program differs from the Adolescents-in-Need Project because of the social worker
assigned, peer support group meetings, and the mentoring component, In addition, there is a
concentrated focus on the teen remaining in school and the development of good parenting
skills.
The Department of Social Services does not have a contract with the Chapel Hill Carrboro
System. The Department of Social Services will continue to provide services to those teen
parents through agency staff and graduate level interns,
The Social Services Board has reviewed this renewal contract and recommends approving
$46,766.51 for Orange County Schools for Fiscal Year 2006-2007,
FINANCIAL IMPACT: These costs will be paid with 100% federal funds in the County Work
First Block Grant,
RECOMMENDATION(S): The Manager recommends that the Board accept the Social
Services Board recommendation and approve the contract renewal with the Orange County
Schools System and authorize the Chair to sign.
Page 1 of 6
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACT
This Contract is entered into between the Department of Social Services and Orange
County Schools (refereed to as Provider) identified on Attachment A. This contract shall
consist of form DSS-2497, Attachment A (DSS-1292) and Budget (DSS-6844). This
Agreement shall be in effect from July 1, 2006 through June 30, 2007,
The Department will purchase specific services from the Provider as set forth in the
Contract in order to make optimal use of the facilities, staff and programs of the Provider.
This Contract is subject to the provisions of all applicable Federal regulations and State
policies.
Subject to its other provisions, the terms of this contract shall be in effect to and from
the dates specified on Attachment A,
SECTION I: RESPONSIBILITIES
A, The Depaztment will:
1. Determine client eligibility for service(s) in accordance with Federal and
State regulations; and
2, Inform the Provider on Fonn DSS-1.360 concerning the eligibility of each
individual for the service, the period of time for which services are authorized,
and any changes in the individual's eligibility status; and
.3. Reimburse the Provider for service(s) purchased as described in Attachment A
of this Contract for eligible clients; and
4. Keep the Provider informed of any alterations in and/or to the regulations
governing the service program; and
5. Accept fiscal responsibility for deviations from the terms of this Contract as a
result of acts of the Department or airy of its officers, employees, agents or
representatives,
B. The Provider will:
L Provide service(s) as specified in Attachment A of this Contract in accordance
with applicable standards for the service(s); and
2. Furnish information to the Department as required to support the full cost of
service(s) provided pursuant to this Contract; and
Page 2 of 6
3. Comply with all State licensing standards, all applicable accrediting standards and
any other standards or criteria established by the Division of Social Services to
assure quality of services; and
4, Restrict the use or disclosure of information obtained in connection with the
administration of North Carolina's programs for the provision of services
concerning applicants for and recipients of those services to purpose directly
connected with the administration of the service program; and
5. Comply with the terms of Section 504 of the Rehabilitation Act of 197.3 and all
requirements imposed by or pursuant to the regulations of the Depaztment of
Health and Human Services issued pursuant to that Section, which prohibit
discrimination against handicapped persons in employment and in the operation
of programs and activities receiving Federal funds; and
6. Comply with Title VI and VII of the Civil Rights Act of 1964 and all requirements
imposed by or pursuant to the regulations of the Department of Health and Human
Services issued pursuant to that Title; and
7. Accept fiscal responsibility for' deviations from the terms of this Contract as a
result of acts of the Provider or any of its officers, employees, agents or
representatives..
SECTION II: RESPONSIBILITY FOR LIABILITIES
Each party hereto agrees to be responsible for its own liabilities and that of its officers,
employees, agents, or representative arising out of this Contract.
SECTION III: TREATMENT OF ASSETS
Treatment of assets acquired under this Contract shall be subject to the following:
A. Ownership of property purchased by the Provider under the terms of this Contract or
which reimbursement by the Department is based upon the actual purchase cost of the
property shall immediately vest with the Department of Human Resources upon such
reimbursement.
B. The North Carolina Department of Human Resources shall have no claim to property
purchased by the Provider under the terms of this Contract for which reimbursement by
the Department is based upon approved depreciation schedule or use allowance.
C. The Provider shall maintain and administer in accordance with sound business practice a
program for the maintenance, repair, protection and preservation of property purchased
under the terms of this Contract to assure its continued availability,
D. Property purchase under the terms of this Contract shall be used only for the performance
of this Contract.
Page .3 of 6
SECTION IV: RECORDS AND REPORTS
A. The Provider agrees to maintain client records which date and document, in accordance
with established policy, the service delivered for the individual, a valid authorization for
service, programs records, documents and other evidence which reflect program
operations.
B, The Provider agrees to famish information to the Depaztment, as requested, to support
provision of service(s) pursuant to this Contract and the full cost of the service; and
submit changes, as needed or required, in this Contract, Attachment A or approved
supporting information for review and approval by the Department.
C. The Provider agrees to maintain books, records, documents and other evidence and
accounting procedures which reflect all direct and indirect costs expended under this
Contract. A current, complete inventory of all equipment purchased under the terms of
this Contract must be kept.
D. The Provider agrees to retain all books, records and other documents relevant to this
Contract for three years after final payment or until all audits continued beyond this period
are completed. Federal auditors and any persons authorized by the Division of Social
Services or the Depaztment shall have the right to examine any of these materials. In
records produced under this Contract will be turned over to the Department,
SECTION V: SUBCONTRACTING
The Provider shall not subcontract any of the work contemplated under this Contract without
obtaining prior written approval from the Department. Any approved subcontract shall be
subject to all conditions of this Contract, The Provider shall be responsible for the
performance of any subcontractor,
SECTION VI: MAINTENANCE OF EFFORT
The Provider certifies that the funds to be used underr this Contract do not replace or supplant,
in any way, Federal, State or local funds for already existing services.
SECTION VII: MONITORING AND EVALUATION
A, The Provider agrees to participate in program, fiscal and administrative monitoring or
audits, making records and staff time available to Federal, State and county staff.
B. The Provider agrees to take necessary steps for corrective action, as negotiated within a
corrective action plan, for any items found to be out of compliance with Federal and State
laws, regulations, standards and/or terms of this Contract,
Page 4 of 6
SECTION VIII: AMENDING THE CONTRACT
This contract in whole or in any part maybe amended at any time:
A. By the Department in the event that such amendment is necessary to comply with
applicable laws, regulations, policies and standards; and by mutual consent of both parties.
B. Each party to this conhact will notify the other immediately in writing if an amendment
becomes necessary due to alterations in the activities described in Attachment A or for
any other reason.
SECTION IX: TERMINATION
A. This contract, in whole or in any pazt, may be canceled at any time:
1. By any party, with cause, upon at ]east .30 days notice, in writing, and delivered by
registered mail with return receipt requested or in person, or
2. By the Department in the event reimbursement to the Deparhnent is not available
and/or continued at an aggregate level sufficient to allow for the purchase of the
indicated quantity of service. The obligations of each party shall be terminated to the
extent specified in the notice of termination, immediately upon receipt of the notice of
termination from the Department, or
3. By the Deparhnent in the event that the Division of Social Services/Department
determines that the Provider is in violation of any or all of the terms of this Contract.
The obligations of each party shall be terminated to the extent specified in the notice
of termination immediately upon receipt of the notice from the Department, or
4. By mutual consent of all parties.
B. In the event of termination in part, all parties shall continue the performance ofthis
Contract to the extent not terminated.
C. if this Contract is terminated, in whole or in part, the Provider maybe required to deliver
and transfer Title or assignment of interest to the Division of Social Services or dispose of
any property specifically produced or acquired for the performance of such part of this
Contract as has been terminated, and the Provider shall, upon the direction of the Division
of Social Services, protect and preserve property in the possession of the Provider in
which the Division of Social Services has an interest.
D. After receipt of a notice of temrination, and except as otherwise directed by the
Department, the Provider shall cease work under the Contract on the date, and to the
extent specified, in the notice of termination, The Department shall pay the Provider the
agreed upon amount for the delivery of services under the terms of this Contract up to the
effective date of termination.. Reimbursement shall not be made for equipment or supplies
purchased after the notice of termination is received except as approved by the
Department.
Page 5 of 6
E. Waiver of any default shall not be deemed to be a waiver of any subsequent default.
Waiver of breach of any provision of the Contract shall not be deemed to be a waiver of
any other subsequent breach and shall not be construed to be a modification of the terms
of this Contract unless stated to be such in writing, signed by an authorized representative
of the Department and attached to the Contract,
SECTION X: CONCLUSION
It is expressly understood an agreed that the services provided to eligible clients pursuant to
this Contract shall consist exclusively of those services specified in the attached program
description incorporated into this Contract as Attachment A.
It is further understood and agreed that the provision of services pursuant to this Contract
shall be subject to the limitations and conditions contained in the laws regulations, guidelines
and plans cited in this Contact, and that this Contract is subject to renegotiations or revision to
meet any new or revised rules, regulations, or policies that maybe issued by the Department
of Health and Human Services, or the North Cazolina Social Services Commission, or the
Deparhnent of Human Resources and that are communicated to the Provider,
PROVIDER
Orange County Schools
DEPARTMENT
Orange County Depaztment of Social Services
By: By:
Title: Superintendent Title: Director
Date:
Date:
This Agreement has been preaudited in the manner required by the local Government Budget
and Fiscal Control Act.
ATTEST:
Orange County Finance Officer
Date:
Chair, Orange County Board of County Commissioners
Signature:
Page 6 of 6
SECTION XI: CERTIFICATON
The Orange County Board of Social Services supports this performance based contract with
the Orange County Schools System to provide expanded case management services to
pregnant and parenting teens..
Rosetta Wash, Chair
Orange County Board of Social Services
ATTACHMENT A
State of North Carolina
Division of Social Services
Contract Application
Page 1 of ~
I. Contract Summazy
A. This agreement is between the Orange County Department of Social Services (hereinafter
refesed to as the "Department") and the Orange County Schools (heretofore and hereinafter
referred to as the "Provider").
B. This agreement shall be in effect from 7/01/06 to 6/30/07
C. Services to be Provided:
(1)
Service (2)
Service Code (3)
Number of
Persons Served (4)
Number of Units
of Service (5)
Definition of
Unit of Service
Case Management 522 16 16 1 teen pazent
Information/
Referral
520
Education/Training 527
Any additional services should be listed in III. -Service Program Description
D. Area to be Served: Orange County School District
10
State of North Carolina
Division of Social Services
Contract Application
Page 2 of 7
E. Contract Identification:
1. Provider
a, Name of Contract Administrator Dr. Shirley Cazraway
Tel. # : (919) 732-8126
b, Name of Program Contact Person: Donna Williams
Tel. #: (919) 732-6271
a Program Name, Location and Mailing Address: Orange County Schools
Hillsborough NC 27278
d. Additional Service Delivery Sites:
e. Status : (X) Public ()Private, non-profit
( )Private, for Profit ( )Individual
f. Provider Contract ID #:
2, Count~epaztment of Social Services
a. Name of Contract Administrator: Nancy Coston
Tel. # : (919) 732-8181
b. Name of Services Program Contact Person: Gwen Price
Tel. #: (919) 7.32-8181
c. Address of County Department of Social Services:
300 W. Tryon St.
Hillsborough, NC 27278
State of North Carolina
Division of Social Services
Contract Application
Page .3 of 7
II. Fiscal Provisions
A. Amount of Reimbursement:
Reimbursement under the terms of this agreement will be limited to a maximum of
$ 46,766.51 TOTAL = $ SSBG + $ IV-B + $ RAP +
$ State + $ County + $ Other (identify) :TANF Block
Grant
(Optional : County funds consist of $ for'
(funding source)
for .)
B. Method of Reimbursement:
1. For Purchase Contract (DSS-2497) Total and Unit Cost:
and$
(X) a. Reimbursement will be made in accordance with the current budget approved by
the Department and on file with both parties. The amount of reimbursement will be
based on allowable expenditures made in behalf of eligible clients, determined in a
accordance with acceptable cost allocation methods. The Provider will report all
expenditures made under the terms of the contract.
O b. Reimbursement will be made at a unit cost rate of $ per unit of
reimbursement delivered to eligible clients for an estimated number of
units. The Provider will document total expenditures made under the terms of the
contract to the Department within thirty days after the termination of this contract,
or as instructed by the Department, Reimbursement which exceeds actual allowable
cost will be adjusted to actual allowable cost.
2, For Vendor Agreements (DSS-2252) Fixed Rate
Reimbursement will be based on:
O a. a standard fixed rate or
O b. an individual fixed rate.
c. Reimbursement will be made at a fixed rate of $ per unit of
(define) for as estimated number of units.
Reimbursement will be based on the actual number of units delivered whether over
or under the estimated number. If multiple components are being purchased,
additional rates and units can be identified as follows:
12
State of North Carolina
Division of Social Services
Contract Application
Page 4 of 7
C, Reimbursement Reporting:
1, Expenditures
The Provider will report expenditures monthly in accordance with policy set forth by
the Controller's Offices, Division of Social Services, issued via the Fiscal Manual,
Expenditures are to be reported on the DSS Administrative Cost Report (Form DSS-
1571,Part III), Reports aze to be submitted to the Department by the fifth working
day of the month following the month in which services were delivered. The
Department will reimburse the Provider monthly, usually by check, upon receipt of a
completed and correctly filed report.
2, Reporting for the Statewide Services Information System (SIS)
In addition to the Administrative Cost Report (DSS-1571, Part III), the Provider will
submit to the Department the Monthly Report of Service Delivery (DSS Form 1571,
Part IV), This should be submitted along with the Administrative Cost Report by the
fifth working day of the month following the month in which services were delivered.
The units reported in Column 12 ofthe 1571 Part IV are the units of service defined in
Column 5 of hC. of this Attachment, Service definition and reporting instructions are
found in Family Services Manual, Volume VI, Chapter IV.
D. Audit Requirements
The Provider shall be responsible for compliance with the audit requirements of
Department of Health and Human Services federal regulation 45 CFR Part 74,
Administration of Grants, or State Administrative Procedures Manual for Federal Block
Grant Funds, whichever is applicable. These regulations stipulate that an annual audit be
performed for the fiscal year in which contract funds were received.
O 1. Private, non-profit if amount of reimbursement received is under $ 1,000; private,
for profit or individual
O 2. (Applicable to Private, Non-Profit Providers if reimb. $1,000 or over)
An annual audit is to be performed in accordance with OMB Circulaz A-110 by an
"independent auditor." Independent auditor" means either: (a) a state government
auditor from the Department of I-Iurnan Resources or the Department of
Administration, Office to the State Auditor; or (b) a certified public accountant,
Upon completion of the audit, a copy of the audit report must be forwarded to the
county department of social services,
State ofNorth Carolina
Division of Social Services
Contract Application
Page 5 of
1.3
() 3. (Applicable to Public Hospitals, Colleges, and Universities)
The annual audit must be performed in accordance with OMB Circular A-110.
It is not necessazy for the institution to program audits performed separately
from an all-inclusive single audit which entails all revenues and expenditures
of the public agency. However, it is the responsibility of the contractor to
insure that the contract program is included in the institution's single annual
audit,
A copy of the audit report must be provided to the County depaztment of
Social Services upon completion of the annual audit.
(X) 4. (Applicable to State or Local Government Agencies)
An annual audit is to be performed in accordance with OMB Circulaz A-128
by
an independent auditor. Upon completion of the audit, a copy of the audit
report must be forwarded to the county Department of Social Services,
E. Client Fees for Service
(X) 1. No fees will be charged to individuals determined to be eligible for services by
the department of social services.
O 2. The service(s) under contract with the Provider are services for which a client
fee maybe assessed. Policy regarding the assessment and collection of fees is
contained in Family Services Manual, Volume VI, Chapter III. If a client is to
to be chazged a fee, the depaztment will inform the Provider of the amount of
fee to be charged and of any subsequent changes by way of the Purchase of
Service Referral and Authorization (DSS Form 1360). The Provider will
establish a plan with the client for collecting the fee on at least a monthly basis;
and when fees are not paid within ten days of the due date, will bill the client
in writing and send a copy of the bill to the Department. NO OTHER FEES
FOR SERVICES MAYBE CHARGED TO THE CLIENT. Client fees are to
be reported on the Monthly Report of Service Delivery (DSS Form 1571, Part
IV)..
F. Management of the Funding/Matching Share Requirement
O 1. A cash transfer of the matching share will be made to the county
department of social services in accordance with the terms specified in the
Donation Agreement (DSS-1.319).
14
State of North Carolina
Division of Social Services
Contract Application
Page 6 of
O 2, The provider certifies through the contract budget attached to this contract that
the matching share in available, Further, it is agreed that the provider will
report all program costs incurred each month relating to this contract on the
DSS-1571, However, reimbursement will be limited to the federal/state
financial participation rate,
(X) :3. The county depaztment of social services is providing the match.
G. Provider Fees (For Purchase Contracts Only)
(NA) 1. The Provider agrees to pay the Department/Division up to $
Administrative Fee as payment in full for the administration of the contract.
The amount of the fee is five percent of the matching share contributed by the
Provider,.
(NA) 2. The Provider agrees to pay the Department up to $ Certification Fee
as payment in full for the determination and certification of client eligibility.
The amount of the fee is five percent of the matching share contributed by the
Provider.
Monitoring and Certification Fees, when applicable, will be deducted from the
amount to be reimbursed.
State of North Carolina
Division of Social Services
Contract Application
Page 7 of
15
III. Service Proprani Description
The contract between Orange County Department of Social Services and Orange County
Schools was a result of a response to a request for proposals, The Welfaze Reform Task
Force identified the need for services expanded services to teen parents.
The Intensive Teen Support Project was designed to expand case management services to
pregnant and parenting teens. Research studies support that intervention and preventive
services to teen significantly impact their ability to successfully caze for their children and to
be self-sufficient.
The goals of the project are:
• Keep teen parents in school
• Help teens avoid a second pregnancy
• Improve health care for the teen parent and the child
• Assist teens further their education
• Prepare teens for employment and self-sufficiency by strengthening the employability
skills of teen parents
• Enhance parenting skills
Orange County Schools will hire afull-time social worker to provide case management
services to eligible teens, serve on the Adolescent Parenting Community Advisory
Committee, coordinate teen support group meetings, recruit and train volunteers, complete
required documentation, and submit monthly reports. The social worker will facilitate a
school based support group for teen parents focusing on health, academic, and cazeer planning
issues. In an effort to ensure collaboration within the schools, monthly team meetings to
coordinate health caze, education, child care issues and family dynamics will continue.
Reimbursement
Orange County Schools will be reimbursed based for expenditures as outlined in this contract
in the Purchase Contract Budget, Verification of expenditures must be submitted to the
Department of Social Services on a monthly basis and no later than the 5`h of the month
following the month of expenditure. Reimbursement will be processed within 15 days of
receipt.
Performance Measures
• Maintain a caseload of 12-16 teen parents
• Develop a case plan with each teen parent outlining specific goals
• Participate in bi-monthly CAC meetings
• Submit a monthly status report by the 2"d workday of the month
• Recruit, train and match volunteers with teens
• Maintain data on number of teen parents within school system
Outcomes
• 85 percent of teen mothers active in the program will avoid a second pregnancy
• 85 percent of teen mothers will continue their education
16
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACT BUDGET
SUMMARY Effective
Providers ~~~R~h~nl~ ID# period ~~~ ~~h +hrough 613n~n7
Part I -Estimated Expenditures
Object of Expenditure Total Non- Matchable Total Matchable
Program Costs Costs Costs
ll) (2) (3)
A, Salaries 32,920.86
B. Fringe Benefits 8,617.65
C. Staff Development-Services 500.00
D. Travel 1,000.00
E. Equipment Purchase-Tangible
Property
F. Transportation-Recipient
G. Medical Supplies and Expense
H. Cost of Space-Non-Residential
I. Room & Boazd-Residential Treatment
J. Service Payments
K, Other 2,.300,00
L. Indirect Costs 1,428,00
M. Totals 46,766.51
Part II -Computation of Unit Cost or Individual Fixed Rate
A. 1. Total Matchable Costs $
2. Less: Earned Income for Unit Cost Method $
3. Net Matchable Costs $
B. 1. Total Service Unit Capacity, or
2. Total Anticipated Utilization Capacity
Method of Computation or Source of Data
D. Estimated Unit Cost or Individual Fixed Rate: $ per
n
__
Part III -Distribution of Estimated Revenue for Total Cost Reimbursement Method
(a) (b)
A. Estimated Eligible and Matchable Costs Number Ratio
1. Estimated Eligible Clients 16
2. Estimated ineligible Clients
3. Total Clients
B. Eligible Costs
(1) Matchable (2) Less (3) Net (4) (5) Costs Eligible
Costs Earned Matchable Estimated % for Financial
[Part I, Line M, Income Costs of Eligible Participation
col.. (3) [B. (1) Less (2) ] [A. 1. (b)] [B. (3) x (4)]
$ $ $ $ $
A, Program Costs
1. Federal/State Funds
2. Local Matching Share
3. Other Budgeted Funds
4. TOTAL REVENUE
7. Fees (If Applicable)
1. Administrative Fee
2. Certification Fee
3. TOTAL FEES
Amount Source of Funds
$ 46,766.51 Work First Program
$ 46,766.51
Part V-Reimbursement Projections (For Title XX Providers Only)
Annual Projection .July- September
Projection October-June
Projection
A. $ B. $ C. $
Signed: Date:
Provider/Authorized Official
Date:
County Director or Designee
IS
Purchase Contract Budget
Supporting Budget Schedules
A. Salary Schedule
(1) (2) (3) (4) (5) (6) (7)
Number Pay % of No. of Annual Total
of Persons Position or Title Grade Time Months Salary Cost
Employed
1 Social Worker 100% 11 32,920.86 32920.:86
Total - Salaries 32,920.86
B. Fringe Benefits
(1) (2) (3)
Total
Type Method of Computation Cost
Social Security 32,920.86 x ,075 % 2,518.45
Retirement 32,920.86 x .0682% 2,245,20
Hospitallnsurance .350...36 x 11 .3,854,00
Total -Fringe Benefits 8,617.65
19
C. Staff Development -Service Funds Schedule
(1)
Item (2)
Total
Cost
Conference and training workshops 500
Total Staff Development -Service Funds 500
D. Travel Schedule
(I) (2) (3) (4) (5) Dail Subsistence (8)
No, of
Persons
Position or Title No, of
Miles/Days Rate per
Mile No. of
Days (6)
Rate (7)
Days Total
Cost
~ Social Worker 2,247 @..445 mile iooo
Total -Travel 1000.00
E. Equipment -Tangible Property Schedule
(1)
No. of
Units (2)
Item (3)
Cost per Unit (4)
Total Cost
Total Equipment -Tangible Property
20
P. Recipient Transportation Schedule
-------
~1~
Item C2)
Method of Computation C3)
Total
Cost
la. Salaries
# of
Persons Position or Title Pay
Grade % of
Time # of Months
Employed Annual
Salary
lb. Fringe Benefits
Type Method of Computation
Total Recipient Transportation
zt
G. Medical Supplies and Expenses Schedule
(I)
Item (2)
Total
Cost
Total -Medical Supplies and Expense
H. Cost of S ace -Non-Residential Schedule
(1)
Item (2)
Total
Cost
Total Cost of S ace -Non-Residential
I. Room and Boazd Costs -Residential Treatment
(1)
Item (2)
Method of Computation (3)
Total
Cost
Total Room and Board Costs - Residential Treatment
zz
J. Service Payment Schedule
(1)
No. of
Units (2)
Item (3)
Cost per Unit (4)
Total
Total -Service Payment
K. Other Ex ense Schedule
(1)
Item (2)
Total
Cost
Instructional Materials
Compensation Bonus
Social Worker Supplies (Cell phone usage) 1000,00
600.00
700,.00
Total -Other Expense 2300.00
L. Indirect Cost Schedule
(1)
Rate (2)
Rate Applied To: (3)
Amount Rate Applied To: (4)
Total
Indirect Cost @3,15% 1,428,00
Total -Indirect Cost