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HCCBG Budget <br />NAME AND ADDRESS Home and Community Care Block Grant for OI'der Adults <br />COMMUNITY SERVICE PROVIDER DAAS -732 (Rev, 2116) <br />Cabarrus County Department of Human Services County Funding Plan County Cabarrus <br />1303 S Cannon Blvd. July 1, 2016 through June 30, 2017 <br />Kannapolis, NC 28083 Provider Services Summary REVISION # , DATE: <br />Services <br />Ser. Delivery <br />A <br />B <br />C <br />D <br />E <br />F <br />G <br />H <br />I <br />Block Grant Funding <br />Required <br />Local Match <br />Net' <br />Sery Cost <br />USDA <br />Subsidy <br />Total <br />Funding <br />Projected <br />HCCBG <br />Units <br />Projected <br />Reimburse. <br />Rate <br />Projected <br />HCCBG <br />Clients <br />Projected <br />Total <br />Units <br />(Check One) <br />Direct <br />Purch. <br />Access <br />In -Home <br />Other <br />Total <br />In -Home l l - Personal Care 042 <br />X <br />1411 D2 <br />11111N1111511 <br />11111111111111 <br />15678 <br />156780 <br />0 <br />156780 <br />8610 <br />18.2087 <br />24 <br />9384 <br />In -Home III Personal Care C45 <br />K <br />46376 <br />5153 <br />51529 <br />0 <br />1 51529 <br />2533 <br />20.3431 <br />5 <br />1 2880 <br />Congregate 180 <br />X <br />104510 <br />1111111111114! <br />11612 <br />116122 <br />26629 <br />144751 <br />11406 <br />10.1804 <br />250 <br />40999 <br />Adult Day Care 030 <br />X <br />20102 <br />I11111NN1111 <br />2234 <br />22336 <br />0 <br />22336 <br />676 <br />33.0177 <br />6 <br />678 <br />Adult Day Health 155 <br />X <br />115818 <br />NIIIN111N11 <br />12869 <br />128687 <br />0 <br />0 <br />128687 <br />3217 <br />40.00 <br />20 <br />3218 <br />1NII11NN1N <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />111N111NN11 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />141111NN1111 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />11111111N1111 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />NINN1111411 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />Total <br />11X1111 <br />1111111 <br />0 <br />187478 <br />240,430 <br />427.9081 <br />47546 <br />475454 <br />28629 <br />504083 <br />11111111111111 <br />41111111111111 <br />306 <br />#DIVIOf <br />*Adult Day Care & Adult Day Health Care Net Service Cost <br />ADC ADHC <br />Daily Care 33.07 40 <br />Transportation <br />Administrative <br />Net Ser, Cost Total <br />Certification of required minimum local match <br />availabilRy. Required local match will be expended <br />simultaneously with Block Grant Funding. <br />Signature, County Finance Officer Date <br />_ <br />Authorized Signature, Title Date <br />Community Service Provider <br />Signature, Chairman, Board of Commissioners Date <br />D <br />m <br />3 <br />7 <br />7 <br />C <br />F -6 <br />Page 141 <br />