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PROVIDER /AAA CHECKLIST Attachment number 1 F -3 Page 81 NOTES: Cabarrus County Human Services DATE: 4/18/12 DATE Aging Funding Plan Draft Forms Submitted DOA -730 DW 4/20/2012 DOA -731 DW 4/20/2012 DOA -732 DW 4/20/2012 DOA -732A DW 4/20/2012 DOA -732A1 DW 4/20/2012 DOA -733 DOA -734 C/P Rights Budget Analysis Matches DOA -732 DOA -732 Grant Funds for FY'2013 = 592700 592699 4/20/2012 DOA 732a Revenues Line I.J = 2602051 4/20/2012 DOA 732a Expenses Line II.J 2602052 4/20/2012 Revenues Line III. A. I = 2602052 4/20/2012 Expenses Line III.6.1 2602052 4/20/2012 Revenues Match Line I.J = 2602051 4/20/2012 Revenues Line III.6.1 2602052 4/20/2012 Expenses Match Line II.J = 2602052 4/20/2012 Expenses Line III.A.1 2602052 4/20/2012 DOA -732a1 Total = 88277 4/20/2012 DOA732a Line II.A 918074 4/20/2012 USDA correct for total service units @ 0.6000 27500 27500 4/20/2012 ADH service cost matches allowable rate Matches DOA732A DOA732 DOA732A DOA732 Block Grant Funding Line LA Col. A Total 592699 592700 4/20/2012 Required Local Match -Cash & In -Kind Line 1.13 Col. B Total 65858 65857 4/20/2012 Net Service Cost Line LC Col. C Total 658557 658557 4/20/2012 USDA Subsidy Line I.D Col. D Total 27500 27500 4/20/2012 Total Funding Line I.0 +I.D Col. E Total 686057 686057 4/20/2012 Projected HCCBG Reimbursed Units Line III.0 - Total Col. F Total 26385 \ \ \ \ \ \ \ \ \ \ \ \ \\ Total Reimbursement Rate Line III.6.5 (by Service Col. G b Service Projected Total Service Units Line III.F Total Col. I Total 57673 \ \ \ \ \ \ \ \ \ \ \ \ \\ Attachment number 1 F -3 Page 81