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PROVIDERIAAA CHECKLIST Attachment number 1 F -1 Page 134 NOTES: Cabarrus County Transportation Dept. DATE: 6121110 DATE A Plan Draft Forms Submitted DOA -730 6/21 /10 DOA -731 6/21 /10 DOA -732 6121/10 DOA -732A 6/21/10 DOA -732A1 6/21/10 DOA -733 6/21/10 DOA -734 C/P Rights Budget Analysis Matches DOA -732 DOA -732 Grant Funds for FY'2006 = 101865 101865 6/21/10 DOA 732a Revenues - Line I.J = 1945356 6/21/10 DOA 732a Expenses- Line II.J 1945356 6/21/10 Revenues Line III. A. I = 1945356 6/21/10 Expenses Line 111.6.1 1945356 6121/10 Revenues Match Line I.J = 1945356 6121/10 Revenues Line III.B.1 1945356 6/21/10 Expenses Match Line II.J = 1945356 6/21/10 Expenses Line III.A.1 1945356 6/21/10 DOA -732x1 (Total) = 665027 6/21110 DOA732a Line ILA 665027 6/21/10 USDA correct for total service units @ 0.5975 #REFI 0 0 ADH service cost matches allowable rate Matches DOA732A DOA732 DOA732A DOA732 Block Grant Funding Line LA Col. A Total 101865 101865 6/21/10 Required Local Match -Cash & In -Kind Line 1.13 Col. B Total 11318 11318 6/21110 Net Service Cost Line LC Col. C Total 113183 113183 6121/10 USDA Subsidy Line I.D Col. D Total 0 0 6121/10 Total Funding Line I.0 +I.D Col. E Total 113183 113183 6/21/10 Projected HCCBG Reimbursed Units Line III.0 - Total Col. F Total 10473 10473 6/21/10 Total Reimbursement Rate Line 111.6.5 (by Service Col. G (by Service Projected Total Service Units Line III.F Total Col. I Total 180007 180007 6/21/10 Attachment number 1 F -1 Page 134