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PROVIDER /AAA CHECKLIST <br />Attachment number 1 <br />F -3 Page 97 <br />NOTES: <br />Cabarrus Meals on Wheels <br />DATE: 6/25/12 <br />DATE <br />Aging Funding Plan Draft Forms <br />Submitted <br />DOA -730 <br />DOA -731 <br />DOA -732 <br />6/25/2012 <br />DOA -732A <br />6/25/2012 <br />DOA -732A1 <br />DOA -733 <br />DOA -734 <br />C/P Rights <br />Budget Analysis <br />Matches <br />DOA -732 <br />DOA -732 <br />Grant Funds forFY'2013 = <br />31257 <br />31257 <br />6/25/2012 <br />DOA 732a Revenues Line I.J = <br />37830 <br />6/25/2012 <br />DOA 732a Expenses Line II.J <br />37830 <br />6/25/2012 <br />Revenues Line III. A. I = <br />37830 <br />6/25/2012 <br />Expenses Line 111.6.1 <br />37830 <br />6/25/2012 <br />Revenues Match Line I.J = <br />37830 <br />6/25/2012 <br />Revenues Line 111.6.1 <br />37830 <br />6/25/2012 <br />Expenses Match Line II.J = <br />37830 <br />6/25/2012 <br />Expenses Line III.A.1 <br />37830 <br />6/25/2012 <br />DOA -732a1 Total = <br />0 <br />6/25/2012 <br />DOA732a Line ILA <br />0 <br />6/25/2012 <br />USDA correct for total service units @ 0.6000 <br />#DIV /0! <br />0 <br />0 <br />ADH service cost matches allowable rate <br />Matches <br />DOA732A <br />DOA732 <br />DOA732A <br />DOA732 <br />Block Grant Funding <br />Line LA <br />Col. A Total <br />31257 <br />31257 <br />Required Local Match -Cash & In -Kind <br />Line 1.13 <br />Col. B Total <br />3473 <br />3473 <br />Net Service Cost <br />Line LC <br />Col. C Total <br />34730 <br />34730 <br />USDA Subsidy <br />Line I.D <br />Col. D Total <br />3100 <br />3100 <br />Total Funding <br />Line I.0 +I.D <br />Col. E Total <br />37830 <br />37830 <br />Projected HCCBG Reimbursed Units <br />Line III.0 - Total <br />Col. F Total <br />10353 <br />10353 <br />Total Reimbursement Rate <br />Line 111.6.5 (by Service <br />Col. G (by Service <br />3.3546 <br />3.3546 <br />Projected Total Service Units <br />Line III.F Total <br />Col. I Total <br />10353 <br />10353 <br />Attachment number 1 <br />F -3 Page 97 <br />