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HCCBG Budget <br />NAME AND ADDRESS Home and Community Care Block Grant for Older Adults <br />COMMUNITY SERVICE PROVIDER DOA -732 (Rev. 1113) <br />Cabarrus Meals on Wheels County Funding Plan County Cabarrus <br />1701 S Main St. July 1, 2014 through June 30, 2015 <br />Kannapolis, NC 28081 Provider Services Summary <br />Services <br />Ser. Delivery <br />A <br />B <br />C <br />D <br />F <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 />Home Delivered 020 <br />X <br />46932 <br />411111111111111 <br />5215 <br />52147 <br />67500 <br />115647 <br />10026 <br />5.0487 <br />50 <br />115003 <br />0 <br />IIN11111111H1 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />111H11111111U <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />- <br />1111111t1111N1 <br />- 0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />iu1ut111t1111 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />1111111111111 \1 <br />0 <br />0 <br />0 <br />0 <br />0 1 <br />0 <br />0 <br />Tota# <br />111 m <br />1111111 1 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />11111111111111 I <br />1111111111110 1 <br />01 <br />0 <br />'Adult Day Care & Adult Day Health Care Net Service Cost <br />ADC ADHC <br />Daily Care Certification of required minimum local match <br />Transportation availability. Required local match will be expended ' Authorized Signal, re, Title Date <br />Administrative simultaneously with Block Grant Funding. Community Ser' 4& Provider J 5VZ12 -01 Y <br />Net Ser. Cost Total <br />Signature, County Finance Officer Date Signature, Chairman, Board of Commissioners Date <br />Attachment number 3 <br />F -5 Page 125 <br />