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HCCBG Budget <br />NAME AND ADDRESS <br />Home and Community Care Block Grant for Older Adults <br />COMMUNITY SERVICE PROVIDER <br />DAAS•732 (Rev. TNB) <br />Cabarrus Active Living and Parks <br />County Funding Plan <br />County Cabanus <br />PO Box 707 <br />July 1, 2018 through June 30, 2019 <br />Concord NC 29026 <br />Provider Services Summary <br />RevielorN: Rev Date: <br />A B C <br />D <br />E F G <br />Ser. Delivery <br />Projected Projected Pin <br />(Check One) Bloch Grant Funding Required Ner <br />USDA <br />Total HCCBG Reimburse. Hi <br />Services Direct Purch. Accesslin-Hom4 <br />Other I Total Local Match Sam Cost <br />Subsidy <br />Funding Units Rate C <br />senior came ooemwn 170 <br />89522 \\\\\\\\\%\ 9847 99469 <br />0 <br />0 <br />99469 0 0 <br />ro\\\\e\\\\\ 0 0 <br />0 0 0 <br />\o\%X%k\\ 0 0 <br />0 <br />0 0 0 <br />an\W%A\ 0 0 <br />0 <br />0 0 0 <br />\ue\a\\\\o 0 0 <br />0 <br />0 0 0 <br />\%%%\m o 0 <br />0 <br />0 0 0 <br />Total \\\\1\\ \1\\l\1 0 0 <br />89,522 89,6x2 9947 99469 <br />0 <br />99469 \\\\\\\\\\\\\\ U\\\\\\\\\% <br />*Adult Day Care 8 Adult Day Health Care Net Service Cost <br />ADC ADHC <br />Dally Care <br />of required minimum lural match <br />Transrtation <br />po <br />alabiCertification <br />waraen <br />.vny <br />Authorized Signature, Title <br />Administrative <br />simultaneously with Block Grant Funding. <br />Community Service Provider <br />Net Ser. Cost Total <br />Signature, County Finance Officer Date <br />Signature, Chairman, Board of Commis <br />Attachment number 1 \n <br />F-2 <br />