HomeMy WebLinkAboutAgenda - 06-07-2005-5sORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: .June 7, 2005
Action Agenda
Item No. ~r-~
SUBJECT: Contract Renewal with Employment Security Commission for .lob Placement
Services at the Skills Development Center
DEPARTMENT: Social Services PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
Contract
INFORMATION CONTACT:
Nancy Coston, 245-2800
Gwen Price, 245-2800
TELEPHONE NUMBERS:
Hillsborough 732-8181
Chapel Hill 968-4501
Durham 688-7331
Mebane 336-227-2031
PURPOSE: To continue the contract with the Employment Security Commission for services to
Work First clients and other residents at the Skills Development/Jab~ink Center,
BACKGROUND: The Department of Social Services has had a contract with the Employment
Security Commission since .July 1, 1998. Assisting families make the transition from welfare tc
work is crucial for a successful Work First program, The Employment Security Commission is
the state authority for job development and placement, The purpose of this contract is to assist
Work First participants to gain employment by providing job development and placement
services, Services provided under this contract have been instrumental in assisting the County
to meet and exceed the Work First employment goals for the past four years.
The contract for FY2005-2006 pays for fifty percent of a full-time permanent counselor position
to be located at the Skills Development Center to assist Work First participants. Employment
Security pays the remaining fifty percent, This allows for full-time coverage by the Employment
Security Commission at the Skills Development/Job[_ink Center, The job counselor registered
combined total 1,124 individuals for work and assisted 475 in obtaining employment in 2004-
2005.
Services that will be provided through this contract include: providing labor market information
to employers and job seekers, completing first stop registration for Work First participants,
assisting Work First participants to locate employment through referrals and job development,
and maintaining data on employments obtained and job development activities. During FY
2004-2005, 244 Work First clients received services and 133 have obtained full-time
employment.
As required by law, the Social Services Board has reviewed this contract and recommends it to
the Commissioners for approval.
FINANCIAL IMPACT: The contract amount of $29,338 is paid with County funds in Social
Services that serve as the required Maintenance of Effort under the County Work First Block
Grant program.
RECOMMENDATION(S): The Manager recommends that the Board accept the Social
Services Board's recommendation and approve the contract renewal 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 The
Employment Security Commission (referred to as Provider) identified on Attachment A, This
contract shall consist of form DSS-2497, Attaclunent A (DSS-1292) and Budget (DSS-6844),
This contract shall be in effect fiom 7/1/2005 to 6/.30/2006..
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 Department will:
1. Determine client eligibility for service(s) in accordance with Federal and
State regulations; and
2. Inform the Provider on Form 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 any of its officers, employees, agents or
representatives.
B. The Provider will:
1. 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 infornration 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 1973 and all
requirements imposed by or pursuant to the regulations of the Department 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 fire 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 fiom 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 render 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 Departrnent 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
prograrn for the maintenance, repair, protection and preservation of property purchased
under the ternis 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 N: 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 furnish information to the Department, 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 tluee 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 under 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 an staff time available to Federal, State and county staff,
B. The Provider agrees to take necessazy 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 contract 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 DC: TERMINATION
A. This contract, in whole or in any part, maybe canceled at any time:
By any pazty, with cause, upon at least 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 Department 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 Department 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 perforn~ance of this
C.onYract 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 termination, and except as otherwise directed by the
Department, the Provider shall cease work under the Contract on the date, an to the
extent specified, in the notice of termination. The Depaztment 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
Depaztment,
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 constnned 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 rneet any new or revised rules, regulations, or policies that maybe issued by the
Department of Health and Human Services, or the North Carolina Social Services
Commission, or the Department of Human Resources and that are communicated to the
Provider
PROVIDER
Employment Security Commission
DEPARTMENT
Orange County Department of Social Services
By
Title: Manager
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
Signature:
Date:
Chair, Orange County Board of County Commissioners
Signature:
By:
Title: Director
Date;
Page 6 of 6
SECTION XI: CERTIFICATON
The Orange County Board of Social Services supports this performance based contract with
the Employment Security Commission to provide on site First Stop registration, vocational
assessment, job development and placement, and follow-up services for Work First
participants.
Rosetta Wash, Chair
Orange County Board of Social Services
9
ATTACI-IMENT 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 referred to as the "Department")and the Employment Security Commission
(heretofore and hereinafter referred to as the "Provider").
B. This agreement shall be in effect from .July 1, 2005 to .June .30, 2006
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
.Job Development
And Placement
546
100
100
One Participant
.Job Readiness/
Job Seazch
547
250
250
One Participant
Any additional services should be listed in III. -Service Prograrn Description
D. Area to be Served: Orange County
io
State of North Carolina
Division of Social Services
Contract Application
Page 2 of 7
iJ. Contract Identification:
1. Provider
a. Name of Contract Administrator Don Wilson
Tel. # : (91 91 644-105 1
b. Name of Program Contact Person: _Jimmv Modlin
Tel. #:
c, Program Name, Location and Mailing Address: Timployment Security Commission
_Hillsborough. NC 27278
d. Additional Service Delivery Sites: Skills DevelopmenbJobLink Center_
e. Status : (X) Public OPrivate, non-profit
( )Private, for Profit ( )Individual
f. Provider Contract ID #:
2. County Department of Social Services
a. Name of Contract Administrator: Nancy Coston
Tel. # : (919) 245-2800
b. Name of Services Program Contact Person: Gwendolyn Price
Tel. #: (919) 245-2800
c. Address of County Denaztment of Social Services:
300 W. Tryon St.
Hillsborough, NC 27278
State of North Carolina
Division of Social Services
Contract Application
II. Fiscal Provisions
Page 3 of
A. Amount of Reimbursement:
Reimbursement under the terms of this agreement will be limited to a maximum of
$ 29,338 TOTAL = $ SSBG + $ IV-B + $ RAP +
$ State + $ County + $ Other (identify) : Work First
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 Depazhnent. 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:
() a. a standazd fixed rate or
O b. arr 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 Cazolina
Division of Social Services
Contract Application
Page 4 of
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 Manuah
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
Depaztment 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 Depaztment 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 of the 1571 Part IV are the units of service defined in
Colunm 5 of LC.. 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 I, NA
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 if7eimb. $1,000 or over)
An amoral audit is to be performed in accordance with OMB Circular A-110 by an
"independent auditor." Independent auditor" means either: (a) a state govermnent
auditor from the Department of Human Resources or the Department of
Administration, Off ce 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,
13
State of North Carolina
Division of Social Services
Contract Application
Page 5 of
O .3, (Applicable to Public Hospitals, Colleges, and Universities)
The annual audit must be perforned in accordance with OMB Circular A-110.
It is not necessazy for the institution to program audits performed separately
from anal]-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 department of
Social Services upon completion of the annual audit.
(X) 4. (Applicable to State or Local Goverrunent 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 depaztment 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 chugged a fee, the department 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 Fonn 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 MAY BE 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 terrns specified in the Donation
Agreement (DSS-1.319)..
to
State of North Carolina
Division of Social Services
Contract Application
Page 6 of
O 2. The provider certifies through the contract budgeC 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 department of social services is providing the match,
G. Provider Fees (For Purchase Contracts Only)
(N/A) 1. The Provider agrees to pay the DepartmentlDivision 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 shaze contributed by
the Provider.
(N/A) 2, The Provider agrees to pay the Deparhnent 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.
IS
State of North Carolina
Division of Social Services
Contract Application
Page 7 of 7
III. Service Program Description
Orange County Department of Social Services (DSS) is purchasing the services of a Job
Development Specialist from the Employment Security Commission of North Carolina. The
General Assembly considers the Employment Security Commission the state's primazy,job
placement authority. The .Job Development Specialist will be stationed at the DSS and will be
providing services to Work First participants. The following services are included in this
contract:
• Vocational Assessment and Employment Counseling,
• .lob Readiness Training and .lob Club,
• First Stop Registration,
• Process iJnemployment Insurance Claims,
• Job Development and Placement (placements include direct placements and entered
employment),
• Follow-up Services
Job Development Specialist Duties
The Job Development Specialist will assess and counsel Work First participants who are
referred with an objective of locating employment. Job readiness and,job club activities will
include but aze not limited to information about employer expectations, appropriate dress and
grooming, resume preparation, goal setting, and networking.
Other duties of .lob Development Specialist are as follows:
• Interview applicants/participants to determine work history, education, training and skills,
• Conduct file searches of suitable,job openings,
• Refer applicant to employers,
• Perform job development contacts with employers to obtain,job orders,
• Provide labor market information to employers, applicants and other agencies,
• Determine eligibility for unemployment insurance, and
• Follow-up with applicants and employers in an effort to impact,job retention..
Performance Measures
North Carolina's Work First Program, implemented in .July 1995, is one of the most
comprehensive welfare reform efforts in the nation.. The guiding principles of Work Pirst
requires parents to take personal responsibility for their children, limits the receipt of Work
First Cash Assistance (temporary a~ld short-term), and requires parents to work.
The Orange County Depaztment of Social Services, in conjunction with the Employment
Security Commission have identified the following performance measures.
• Locate full-time employment for 100 Work First eligible participants,
• Provide labor market information to employers, applicants, and other agencies,
• Complete First Stop registration for Work First participants.
• Maintain contact with participants and employers for three months after placement.
• Performjob development activities,
16
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL SERVICES
PURCHASE CONTRACT BUDGET
SUMMARY Effective
Provider Fm~nlnyment Security (~nmmissinn ID # 6Rft01 Period 7/1/2005 tluough 6/30/2006
Part I -Estimated Expenditures
Object of Expenditure Total Non- Matchable Total Matchable
Program Costs Costs Costs
(1) (2) C3)
A. Salaries $21,182
B. Fringe Benefits 4 727
C. Staff Development-Services
D. Travel 360
E. Equipment Purchase-Tangible
Property
F. Transportation-Recipient
G. Medical Supplies and Expense
H. Cost of Space-Non-Residential
I. Room &Board-Residential Treatment
J. Service Payments
K. Other
L. Indirect Costs 3,069
M. Totals 29,338
Pazt 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 oPData
D, Estimated Unit Cost or Individual Fixed Rate: $ per
17
Part III -Distribution of Estimated Revenue for Total Cost Reimbursement Method
A. Estimated Eligible and Matchable Costs Number Ratio
1. Estimated Eligible Clients 250 100%
2. Estimated ineligible Clients 0 0%
3. Total Clients 250 100%
B. Eligible Costs
(1) Matchable (2) Less (3) Net (4) (5) Costs Eligible
Costs Earned Matchable Estimated % for Financial
[Part 1, Line M, Income Costs of Eligible Pazticipation
col. (3) [B. (I) Less (2)}) [A. 1. (b)] [B. (3) x (4)]
$ $ $ $ $
A. Program Costs
I, Federal/State Funds
2. Local Matching Share
3. Other Budgeted Funds
4. TOTAL REVENUE
Amount
$ 29.338
Source of Funds
Work First
County
B. Fees (If Applicable)
1. Administrative Fee
2. Certification Fee
3. TOTAL FEES
$ 29.338
Part V-Reimbursement Proiections (For Title XX Providers Onlyl
Annual Projection .luly- September
Projection October-.lone
Projection
A.$ B.$ C.$
Signed: Date:
Provider/Authorized Official
Date:
County Drrector or Designee
Purchase Contract Budget
Supporting Budget Schedules
18
A. Salary Schedule
(1)
Number
of Persons (2)
Position or Title (3)
Pay
Grade (4)
% of
Time (5)
No. of Months
Employed (6)
Annual
Salary (7)
Total
Cost
1 Tob Development Specialist N/A 50% 12 $42,364 $21,182
Total - Salaries $21,338
B. Fringe Benefits
~1) l2) (3)
Total
Type Method of Computation Cost
FICA $21,182 x 7..65% 1620
Health Ins. 238 x 12 x 50% 1432
Retirement $21,182 x 7.13% 1510
Worker's Compensation $21,182 x .60% 127
Unemployment Insurance $2Q649 x ..18% 38
Total -Fringe Benefits $4,727
19
C. Staff Development -Service Funds Schedule
(1)
Item (2)
Total
Cost
Total Staff Development -Service Funds
D. Travel Schedule
(1) (2) (3) (4) (5) Daily Subsistence (8)
No. of
Persons
Position or Title No. of
Miles/Days Rate per
Mile No. of
Days (6)
Rate (7)
Days Total
Cost
I Job
Development
Specialist 1,000 .36 $360
Total -Travel $360
E. Equipment -Tangible Property Schedule
(1)
No, of
Units (2)
Item (3)
Cost per Unit (4)
Total Cost
N/A
Total Equipment -Tangible Property
Zo
F. Rec_i_p_ ient Transportation Schedule
(1)
Item (2)
Method of Computation (3)
Total
Cost
N/A
la. Salaries
# of
Persons Position or Title Pay
Grade % of
Time # of Months
Em to ed Annual
Sal
N/A
1b. Fringe Benefits
IImpnlatinn
N/A
Total Recipient Transportation
zt
G. Medical Supplies and Expenses Schedule
(1)
Item (2)
Total
Cost
N/A
Total -Medical Supplies and Expense
H. Cost ofSpace -Non-Residential Schedule
(1)
Item (2)
Total
Cost
N/A
Total Cost of Space -Non-Residential
I. Room and Board Costs -Residential Treahnent
(1)
Item (Z)
Method of Computation (3)
Total
Cost
N/A
Total Room and Board Costs - Residential Treatment
ii
7. Service Payment Schedule
(1)
No. of
Units (2)
Item (3)
Cost per Unit (4)
Total
N/A
Total -Service Payment
K. Other Expense Schedule
(1)
Item (2)
Total
Cost
N/A
Total -Other Expense
L. Indirect Cost Schedule
(1)
Rate (2)
Rate Applied To: (3)
Amount Rate Applied To: (4)
Total
12.99% Salary $21,182 $3,069
Total -Indirect Cost $3,069