HomeMy WebLinkAboutAgenda - 06-08-2004-5pORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 8, 2004
Action Agenda
Item No.
SUBJECT: Contract Renewal with Employment Security Commission for Job Placement
Services at the Skills Development Center
DEPARTMENT: Social Services
PUBLIC HEARING: (Y/N) No
ATTACHMENT(S):
Contract
INFORMATION CONTACT:
Nancy Goston, 245-2800
Gwen Price, 245-2800
TELEPHONE NUMBERS:
Hillsborough
Chapel Hill
Durham
Mebane
732-8181
968-4501
688-7331
336-227-2031
PURPOSE: To continue the contract with the Employment Security Commissicn for services to
Work First clients and other residents at the Skills Development/JobLink Center.
BACKGROUND: The Department of Social Services has had a contract with Employment
Security since July 1, 1998. Assisting families make the transition from welfare to 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 Fiscal Year 2004-2005 pays for 50% of a counselor to be located at the Skills
Development Center to assist Work First participants. Employment Security will pay the
remaining costs for afull-time permanent position, This allows for full-time coverage by the
Employment Security Commission at the Skills Development/JobLink Center, The job
counselor registered a combined total of 890 individuals for work and assisted 360 with
obtaining employment in 2003-2004.
Services that will be provided through this contract include: providing labor market information
to employers and jab 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 Fiscal
Year 2003-2004, 253 Work First clients received services and 129 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 cost of the contract for Fiscal Year 2004-2005 is $28,044. These
costs are paid with County funds, but serve as the required Maintenance of Effort in the County
Work First Block Grant. The County Maintenance of Effort is at the same level it has been
since Work First began.
RECOMMENDATION(S): The Manager recommends that the Board accept the Social
Services Board's recommendation and approve the renewal contract.
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) atld Budget (DSS-6844).
This contract shall be in effect from 7/1/2004 to 6/.30/2005..
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 teens 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 prob'am; and
5. Accept fiscal responsibility for deviations fiom 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 Attaclunent 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
result
3, Comply with all State licensing standazds, all applicable accrediting stazrdards azrd
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 terrns of Section 504 of the Rehabilitation Act of 1973 and all
requirements imposed by or pursuant to the regulations of the Deparhnent of
Health and Human Services issued pursuant to that Section, which prohibit
discrimination against handicapped persons in employment azrd 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
of acts of the Provider or any of its officers, employees, agents or representatives,
SECTION II: RESPONSIBILITY FOR LIABILITIES
Each party hereto ab ees 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 terrns 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 Humazr 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 perfornrance
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 prod am
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 fiill cost of the service; and
submit changes, as needed or required, in this Contract, Attaclmnent 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 relevazrt to this
Contract for tlaee years after final payment or until all audits continued beyond this period
az'e completed.. Federal auditors and any persons authorized by the Division of Social
Services or the Department 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 he responsible for the
performance of any subcontractor.
SECTION VI: MAINTENANCE OF EFFORT
The Provider certifies that the fiords to be used under this Contract do not replace or supplant,
in any way, Federal, State or local fiords 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 azr 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 Deparhnent in the event that such amendment is necessary to comply with
applicable laws, regulations, policies and stuidards; and by mutual consent of both parties.
B. Each party to this contraot will notify the other immediately in writing if an amendment
becomes necessary due to alterations in the activities described in Attaclmnent A or for
any
other reason.
SECTION LC: TERMINATION
A. This contract, in whole or in azry part, maybe canceled at any time:
1, By any party, 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, immnediately upon receipt of the notice of
temlination 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 azry 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 pazt, all parties shall continue the performance of this
Contract to the extent not terminated.
C. If this Contract is terminated, in whole or in pazt, the Provider may be 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 pazt 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 ofthe Provider in
which the Division of Social Services has azr 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 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 of6
E- Waiver of any default shall not be deemed to be a waiver of any subsequent default-
Waiver ofbreach 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 modiffcation of the terms
of this Contract unless stated to be such in writing, signed by an authorized representative
of the Depaztment az-rd attached to the Contract.
SECTION X: CONCLUSION
It is expressly understood an ab -eed 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 Attaclmlent A.
It is fiu-ther 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 ndes, regulations, or policies that may be 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 commm~icated to the
Provider°.
PROVIDER DEPARTMENT
Employment Security Commission Orange County Department of Social Services
By
By:
Title: Manager 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
Signature:
Date:
Chair, Orange County Board of County Commissioners
Signature:
Date:
Page 6 of 6
SECTION XI: CERTIFICATON
The Orange County Board of Social Services supports this perfomiatice 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 Worlc First
participants,
Dorothy Gamble, Chair
Orange County Board of Social Services
ATTACHMENT A
State of North Carolina
Division of Social Services
Contract Application
Page 1 of ~
I. Contract Summary
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, 2004 to .June .30, 2005
G 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 Search
547
250
250
One Participant
Any additional services should be listed in IIh -Service Program Description
D, Area to be Served: Orange County
State of North Carolina
Division of Social Services
Contract Application
Page 2 of 7
]0
E. Contract Identification:
1. Provider
a. Name of Contract Administrator Dorothy Pennell
Tel. # : (91 91 644-105 1
b. Nazne of Protrram Contact Person: _.Iinuny Modlin
Tel. #:
c. Program Name, Location and Mailing Address: Employment Security Commission
_T3illslzszxo~glr. NC 27278
d. Additional Service Delivery Sites: Skills Development/.IobL,ink Center_
e. Status : (X) Public ()Private, 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:
Tel. #: (919) 245-2800
Gwendolyn Price
c. Address of Count~partment of Social Services:
NC 27278
11
State of North Carolina
Division of Social Services
Contract Application
Page 3 of
II. Fiscal Provisions
A, Amount of Reimbursement:
Reimbursement under the teens of this agreement will be limited to a maximum of
$ 28,044 TOTAL, _ $ SSBG + $ IV-B + $ RAP +
State + $ County + $
Other (identify) : Worlc First
Block Grant
(Optional : County funds consist of $
for and $
(funding source)
for
B. Method ofReimbursement:
1. For Purchase Contract (DSS-2497) Total and Unit Cost:
(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 teens of the contract.
O b. Reimbursement will be made at a unit cost rate of $ per unit of
reimbursement delivered to eligible clients for azr 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.
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 az e being purchased,
additional rates and units can be identified as follows:
State of North Carolina
Division of Social Services
Contract Application
Page 4 of 7
i?
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 are 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.
Reporting for the Statewide Services Information System (SIS)
h1 addition to the Administrative Cost Report (DSS-1571, Pazt III), the Provider will
submit to the Department the Monthly Report of Service Delivery (DSS Fonn 1571,
Part N). 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 Cohunn 12 of the 1571 Pazt N are the units of service defined in
Column 5 of LC, ofthis Attachment. Service definition and reporting instructions aze
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, 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 ifreimb. $1,000 or over)
An annual audit is to be performed in accordance with OMB Circular A-110 by an
"independent auditor:" hrdependent auditor" means either: (a) a state government
auditor from the Department of Human 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.
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 performed in accordance with OMB Circular A-110,
It is not necessary 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 azmual
audit.
A copy of the audit repoii nmst be provided to the County department of
Social Services upon completion of the azmual audit.
(X) 4. (Applicable to State or Local Govenmlent Agencies)
An amoral audit is to be performed in accordance with OMB Circular A-128
by an independent auditor. Upon completion of the audit, a copy of the audit
report must be forwarded to the county Deparhnent of Social Services.
E. Client Fees for Service
(X) 1. No fees will be chazged 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 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 Form 1.360), 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 terms specified in the Donation
Agreement (DSS-1319).
State of North Carolina
Division of Social Services
Contract Application
Page 6 of
14
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 prob am 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 Department/Division up to
Administrative Fee as payment in full for the administration of the contract.
The aniount of the fee is five percent of the matching share contributed by
the Provider..
(N/A) 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 7
15
III. Service Program Description
Orange County Department of Social Services (DSS) is purchasing the services of a .Job
Development Specialist from the Employrent Security Commission of North Cazolina. The
General Assembly considers the Emplo~nnent Security Commission the state's primary,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,
• .Job Readiness Training and Job Club,
• First Stop Registration,
• Process Unemployment Insurance Claims,
• .Job Development and Placement (placements include direct placements and entered
emploannent),
• Follow-up Services
Job Develoament 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 are not limited to information about employer expectations, appropriate dress and
grooming, resume prepazation, goal setting, and networking.
Other duties of Job 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 Prob "am, implemented in .July 1995, is one of the most
comprehensive welfare reform efforts in the nation. The guiding principles of Work First
requires parents to take personal responsibility for their children, limits the receipt of Work
First Cash Assistazrce (temporary and short-term), and requires parents to work..
The Orange County Department of Social Services, in conjunction with the Employment
Security Commission have identif ed the following performance measures.
• Locate full-time employment for 100 Work First eligible participants.
• Provide labor market information to employers, applicants, azid other agencies.
• Complete First Stop registration for Work First participants.
• Maintain contact with participazrts and employers for three months after placement.
• Perform,job development activities.
STATE OF NORTH CAROLINA
DIVISION OF SOCIAL, SERVICES
PURCHASE CONTRACT BUDGET
I6
SUMMARY Effective
Provider Fn~pln;m,Pnt 4eeyrj,tys.nmmicci~n ID # f,RFf)1 Peri~~l 7/1/2004 tlu'ou8h 6/30/2005
Part I -Estimated Expenditures
Object of Expenditure Total Non- Matchable Total Matchable
Prob-am Costs Costs Costs
A. Salaries $20,649
B. Fringe Benefits 4 .35.3
C. Staff Development-Services
D. Travel .360
E. Equipment Purchase-Tangible
Property
F. Tratlsportation-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 ~ 68~
M. Totals 28,044
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
t~
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 Paztieipation
cot. (.3) [B. (1) Less (Z)]] [A. L (b)] [B. (3) x (4)]
$ $ $ $ $
A, Program Costs
1. Federal/State Funds
2. Local Matching Share
3. Other Budgeted Funds
4. TOTAL REVENUE
Amount
$ 28.044
Source of Funds
Worlc First
County
B. Fees (If Applicable)
1. Administrative Fee
2. Certification Fee
3. TOTAL FEES
e
e
Part V- Reimbursement Projections (For Title XX Providers Onlvl
Annual Projection .July- September
Projection October-.June
Projection
A. $ B. $ C, $
Signed: Date:
Provider/Authorized Official
Date:
County Director or Designee
Purchase Contract Budget
Supporting Budget Schedules
is
A. Salazy Schedule
~1)
Number
of Persons ~?)
Position or Title C3)
Pay
Grade ~4)
% of
Time CS)
No. of Months
Employed C6)
Amoral
Salary C7)
Total
Cost
1 Iob Development Specialist N/A 50% 12 $41,298 $20,649
Total - Salaries $20,649
B. Fringe Benefits
~1) C2) l3)
Total
Type Method of Computation Cost
FICA $20,649 x 7.65% 1580
Health Ins. 190 x 12 x 50% 1140
Retirement $2Q649 x 7.1.3% 1472
Worker's Compensation $20,(49 x ,60% 124
Unemployment Insurance $20,649 x .18% 37
Total -Fringe Benefits $4,353
19
C. Staff Development -Service Funds Schedule
(1)
Item (~)
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
20
F. Recipient Transportation Schedule
Item Method of Computation Total
Cost
N/A
la. Salaries
# of
Persons Position or Title Pay
Grade % of
Time # of Months
Em to ed Annual
Sala
N/A
lb. Hinge Benefits
N/A
Total Recipient Transportation
21
G. Medical Supplies and Expenses Schedule
(1)
Item (~)
Total
Cost
N/A
Total -Medical Supplies acid Expense
H. Cost of Space -Non-Residential Schedule
~1)
Item ~?)
Total
Cost
N/A
Total Cost of Space -Non-Residential
I. Room and Board Costs -Residential Treatment
Item
Method of Computation Total
Cost
N/A
Total Room and Board Costs - Residential Treatment
~~
J. Service Payment Schedule
(1)
No. of
Units (~)
Item G3)
Cost per Unit (4)
Total
N/A
Total -Service Payment
K. Other Expense Schedule
(I)
Item (~)
Total
Cost
N/A
Total -Other Expense
L. Indirect Cost Schedule
(I)
Rate (2)
Rate Applied To: (3)
Amount Rate Applied To: (4)
Total
12.99% Salary $20,649 $2,682
Total -Indirect Cost $2,682