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PROVIDERIAAA CHECKLIST <br />County Name FY17 <br />Attachment number 1 \n <br />F -6 Page 170 <br />NOTES: <br />Cabarrus Meals On Wheels <br />DATE: <br />DATE <br />Aging Funding Plan Draft Forms <br />Submitted <br />DAAS -730 <br />5/5/2016 <br />DAAS -731 <br />515!2016 <br />DAAS -732 <br />5/5/2016 <br />DAAS -732A <br />5/5/2016 <br />DAAS -732A1 <br />5/512016 <br />DAAS -733 <br />5/512016 <br />DAAS -734 <br />5/5/2016 <br />C/P Rights <br />5/5/2016 <br />Budget Analysis <br />Matches <br />DAAS -732 <br />DAAS -732 <br />Grant Funds for FY'2017 = <br />70630 <br />70630 <br />DAAS 732a Revenues - Line LJ = <br />614478 <br />DAAS 732a Expenses - Line II.J <br />614478 <br />Revenues Line III. A. I = <br />614478 <br />Expenses Line 111.8.1 <br />614478 <br />Revenues Match Line LJ = <br />614478 <br />Revenues Line III.B.1 <br />614478 <br />Expenses Match Line II.J = <br />614478 <br />Expenses Line 11I.A.1 <br />614478 <br />DAAS -732a1 Total = <br />76000 <br />DAAS732a Line ILA <br />76000 <br />USDA correct for total service units @ 0.75 <br />fr'REF" <br />36000 <br />36000 <br />ADH service cost matches allowable rate <br />Matches <br />DAAS732A <br />DAAS732 <br />DAAS732A <br />DAAS732 <br />Block Grant Funding <br />Line LA <br />Col. A Total <br />70630 <br />70630 <br />Required Local Match -Cash & In -Kind <br />Line 1.13 <br />Col. B Total <br />7848 <br />7848 <br />Net Service Cost <br />Line I.C. <br />Col. C Total <br />78478 <br />78478 <br />USDA Subsidy <br />Line 1.13 <br />Col. D Total <br />36000 <br />36000 <br />Total Funding <br />Line I.0 +I.D <br />Col. E Total <br />114478 <br />114478 <br />Projected HCCBG Reimbursed Units <br />Line 11W - Total <br />Col. F Total <br />#DIV /0! <br />IIINlllllllll <br />Total Reimbursement Rate <br />Line III.B.5 (by Service <br />Col. G (by Service <br />Projected Total Service Units <br />Line II1.F Total <br />Cal. I Total <br />#DIV /O! <br />#DIVIO! <br />Attachment number 1 \n <br />F -6 Page 170 <br />