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PROVIDER/AAA CHECKLIST <br />County Name Cabarrus FY15 <br />Attachment number 1 <br />F -5 Page 95 <br />NOTES: <br />Department of Human Services <br />DATE: Arpil 11, 2014 <br />- <br />DATE <br />Aging Funding Plan Draft Forms <br />Submitted <br />DOA -730 <br />4114114 <br />DOA -731 <br />4114114 <br />DOA -732 <br />4114114 <br />DOA -732A <br />4114114 <br />DOA -732A1 <br />4114114 <br />DOA -733 <br />4114114 <br />DOA -734 <br />4114114 <br />C/P Rights <br />4114114 <br />Budget Analysis <br />Matches <br />DOA -732 <br />DOA -732 <br />Grant Funds for FY'2015 = <br />433206 <br />433206 <br />4114/14 <br />DOA 732a Revenues - Line I.J = <br />709355 <br />4/14114 <br />DOA 732a Expenses Line II.J <br />804180 <br />4114114 <br />Revenues Line III. A. I = <br />804180 <br />4114114 <br />Expenses Line 111.6.1 <br />709355 <br />4114114 <br />Revenues Match Line LJ = <br />709355 <br />4114114 <br />Revenues Line III.B.1 <br />709355 <br />4114114 <br />Expenses Match Line IIJ = <br />804180 <br />4114114 <br />Expenses Line III.A.1 <br />804180 <br />4114114 <br />DOA -732a1 Total = <br />205728 <br />4114114 <br />DOA732a Line II.A <br />205728 <br />4114114 <br />USDA correct for total service units @ 0.75 <br />#REFI <br />12419 <br />12419 <br />4114114 <br />ADH service cost matches allowable rate <br />Matches <br />DOA732A <br />DOA732 <br />DOA732A <br />D5A732 <br />Block Grant Funding <br />Line LA <br />Col. A Total <br />433206 <br />433206 <br />Required Local Match -Cash & In -Kind <br />Line I.B <br />Col. B Total <br />48134 <br />48134 <br />Net Service Cost <br />Line LC <br />Col. C Total <br />481340 <br />481340 <br />USDA Subsidy <br />Line LD <br />Col. D Total <br />12419 <br />12419 <br />Total Funding <br />Line I.0 +I.D <br />Cot. E Total <br />493759 <br />493759 <br />Pro HCCBG Reimbursed Units <br />Line IILC -Total <br />Col. F Total <br />#DIV /01 <br />11111111111111 <br />Total Reimbursement Rate <br />Line III.B.S (by Service <br />Cal. G (by Service <br />Projected Total Service Units <br />Line III.F Total <br />Col. I Total <br />#DIV101 <br />#DIViO! <br />Attachment number 1 <br />F -5 Page 95 <br />