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HCCBG Budget <br />NAME AND ADDRESS <br />COMMUNITY SERVICE PROVIDER <br />Department of Human Services <br />1303 S. Cannon Blvd., <br />Kannapolis, NC 28083 <br />Home and Community Care Block Grant for Older Adults <br />DOA -732 (Rev. 1/13) <br />County Funding Plan County Cabarrus <br />July 1, 2014 through June 30, 2015 <br />Provider Services Summary <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 />20 <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 II- Personal Can <br />X <br />1 E +05 <br />47680 <br />\ \ \ \ \ \ \ \ \ \ \ \\\ <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />12366 <br />123663 <br />0 <br />123663 <br />8082 <br />15.301 <br />8085 <br />In -Home III - Personal Car <br />X <br />5298 <br />52978 <br />0 <br />52978 <br />3463 <br />15.2983 <br />8 <br />3466 <br />Congregate 180 <br />X <br />96965 <br />\ \ \ \ \ \ \ \ \ \ \ \\\ <br />10774 <br />107739 <br />12419 <br />120158 <br />16671 <br />6.4627 <br />250 <br />50000 <br />Info & Assist 040 <br />X <br />35821 <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />3980 <br />39801 <br />0 <br />39801 <br />#DIV /0! <br />#DIV /0! <br />550 <br />#DIV /0! <br />Adult Day Care 030 <br />X <br />34894 <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />3877 <br />38771 <br />0 <br />38771 <br />1080 <br />35.8991 <br />10 <br />1081 <br />Adult Day Health 155 <br />X <br />106549 <br />\ \ \ \ \ \ \ \ \ \ \ \\\ <br />11839 <br />118388 <br />0 <br />0 <br />118388 <br />2659 <br />44.5235 <br />22 <br />2660 <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \\\ <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />\ \ \ \ \ \ \ \ \ \ \ \\\ <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />Total <br />\ \ \ \ \ \\ <br />\ \ \ \ \ \\ <br />35821 <br />2E +05 <br />238,408 <br />433,206 <br />48134 <br />481340 <br />12419 <br />493759 <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />860 <br />#DIV /0! <br />'Adult Day Care & Adult Day Health Care Net Service Cost <br />ADC ADHC <br />Daily Care 33.07 40 Certification of required minimum local match <br />Transportation availability. Required local match will be expender <br />Administrative simultaneously with Block Grant Funding. <br />Net Ser. Cost Total 33.07 40 <br />Signature, County Finance Officer Date <br />Authorized Signature, Title Date <br />Community Service Provider <br />Signature, Chairman, Board of Commissioner: Date <br />F -5 Page 286 <br />