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HCCBG Budget <br />NAME AND ADDRESS <br />Home and Community Care Block Grant for Older Adults <br />COMMUNITY SERVICE PROVIDER <br />DAAS732 (Rev. 2116) <br />Ca barrus Co. DHS— Transportation <br />County Funding Plan <br />County Cabarrus <br />1303 S Cannon Blvd., <br />July 1, 2016 through June 30, 2017 <br />Kannapolis, NC 28083 <br />Provider Services Summary <br />REVISION # DATE: <br />A <br />B <br />C <br />D <br />E <br />F <br />G <br />H <br />I <br />Ser. Delivery <br />Projected <br />Projected <br />Projected <br />Projected <br />Block Grant <br />Funding <br />Required <br />Net' <br />USDA <br />Total <br />HCCBG <br />Reimburse. <br />HCCBG <br />Total <br />(Check One) <br />Services <br />Local Match <br />Sery Cost <br />Subsidy <br />Funding <br />Units <br />Rate <br />Clients <br />Units <br />Direct <br />Purch. <br />Access <br />In-Home <br />Other <br />Total <br />Trans 250 <br />X <br />79207 <br />11111111111111 <br />8801 <br />88008 <br />0 <br />88008 <br />4246 <br />20,7273 <br />41 <br />49697 <br />Medical Transp 033 <br />X <br />64806 <br />11111111111111 <br />7201 <br />72006 <br />0 <br />0 <br />1 72,006 <br />3474 <br />20.7271 <br />48 <br />40662 <br />11111111111111 <br />0 <br />0 <br />1 0 <br />0 <br />1 0 <br />0 <br />11111111111111 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />11111111111111 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />11111111111111 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />11111NI11N11 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />Total <br />1111111 <br />1111111 <br />144012 <br />01 <br />0 <br />1 ,012 <br />16002 <br />160014 <br />0 <br />160014 <br />III11111H1111 <br />1111HIIINIII <br />89 <br />#DIV /O? <br />'Adult Day Care & Adult Day Health Care Net Service Cast <br />ADC ADHC <br />Daily Care <br />Certification of required minimum local match <br />� ✓ <br />/ <br />`LA Y <br />T <br />availability. Required local match will be expended <br />Aut onzed Signature, Title <br />Date <br />Administrative <br />simultaneously with Block Grant Funding. <br />Community Service Provider <br />Net Ser. Cost Total <br />Signature, County Finance Officer Date <br />Signature. Chairman, Board of Commissioners Date <br />D <br />m <br />3 <br />7 <br />7 <br />C <br />F -6 <br />Page 127 <br />