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HCCBG Budqet <br />NAME AND ADDRESS Home and Community Care Block Grant for Older Adults <br />COMMUNITY SERVICE PROVIDER DOA -732 (Rev. 03/12) <br />Cabarrus County Human Services County Funding Plan County Cabarrus <br />July 1, 2012 through June 30, 2013 <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 />Projected <br />Total <br />Units <br />(Check One) <br />Direct <br />Purch. <br />Access <br />In -Home <br />Other <br />Total <br />Congregate 180 <br />X <br />99025 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />11003 <br />110028 <br />25000 <br />135028 <br />18838 <br />5.8407 <br />350 <br />50000 <br />Supplemental 182 <br />X <br />10122 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />1125 <br />11247 <br />2500 <br />13747 <br />3896 <br />2.8868 <br />35 <br />3999 <br />Info & Assist 040 <br />X <br />51398 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />5711 <br />57109 <br />0 <br />57109 <br />#DIV /0! <br />#DIV /0! <br />300 <br />0 <br />Adult Day Care 030 <br />X <br />60081 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />6676 <br />66757 <br />0 <br />66757 <br />1886 <br />35.3961 <br />25 <br />1900 <br />Adult Day Health 155 <br />X <br />81639 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />9071 <br />90710 <br />0 <br />90710 <br />1765 <br />51.3859 <br />10 <br />1774 <br />CDS 500- Care Advisor <br />X <br />3686 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />410 <br />4096 <br />0 <br />4096 <br />#DIV /0! <br />#DIV /0! <br />15 <br />#DIV /0! <br />CDS 501 - Personal Assistant <br />X <br />36965 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />4107 <br />41072 <br />0 <br />41072 <br />3500 <br />11.7351 <br />10 <br />3500 <br />CDS 503 - Fiscal Inter <br />X <br />3236 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />360 <br />3596 <br />0 <br />3596 <br />48 <br />74.9167 <br />10 <br />48 <br />CDS 504 - Personal Care, <br />Nutrition Supplements & <br />environment <br />X <br />134 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />15 <br />149 <br />0 <br />149 <br />#DIV /0! <br />#DIV /0! <br />2 <br />#DIV /0! <br />CDS 505 -Home Delivered Meals <br />X <br />964 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />107 <br />1071 <br />0 <br />1071 <br />214 <br />5.0047 <br />2 <br />214 <br />CDS 506 - Emergency <br />Response Equipment <br />X <br />631 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />70 <br />701 <br />0 <br />701 <br />#DIV /0! <br />#DIV /0! <br />3 <br />#DIV /0! <br />CDS 507 - Medical Adaptive <br />Equipment <br />X <br />406 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />45 <br />451 <br />0 <br />451 <br />#DIV /0! <br />#DIV /0! <br />2 <br />#DIV /0! <br />In -Home II- Personal Care 042 <br />122652 <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />13628 <br />136280 <br />136280 <br />9624 <br />14.1597 <br />26 <br />9627 <br />Trans 250 <br />X <br />121761 <br />13529 <br />135290 <br />135290 <br />9664 <br />13.9994 <br />600 <br />135959 <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 />1 <br />1173159 <br />1168674 <br />1 270,8671 <br />592,7001 <br />65857 <br />1 658557 <br />1 27500 <br />1 686057 <br />1 \ \ \ \ \ \ \ \ \ \ \ \ \\ <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />1 1390 <br />\ \ \ \ \ \ \ \ \ \ \ \ \\ <br />"Adult Day Care & Adult Day Health Care Net Service Cost <br />ADC ADHC <br />Daily Care <br />Administrative <br />Net Ser. Cost Total <br />33.0700 <br />40.0000 <br />Certification of required minimum local match <br />availability. Required local match will be expended Authorized Signature, Title Date <br />simultaneously with Block Grant Funding. Community Service Provider <br />2.3261 <br />11.3859 <br />35.3961 <br />51.3859 <br />Signature, County Finance Officer Date <br />Signature, Chairman, Board of Commissioners Date <br />F -3 Page 62 <br />