Appendix D - Personnel Worksheet 2017 Please include all ADRC staff. Please report subcontracted staff in the designated section. Under the column include: I&A, Options Counseling, Enrollment Counseling, LTCFS, DBS, outreach, and any other ADRC service “All Functions” the employee performs. A function is considered an ADRC function if it is included in the ADRC Scope of Services of the contract. Include activities such as APS if applicable. Include only one staff member per line. See the example below. Meets Waiver of All Functions Education (ADRC and % FTE and and other) % FTE Position Funded by Employee If experience performed by Funded Title Total FTE Annual ADRC Name AIRS approved this individual by Other Method for allocation of Split (please for this Salary (not funding (full first and by ORCD (see example Source Funded Positions indicate Person fringe) (all funds last name) below; include (list if LTE) see note, % of time for source) page 5) ADRC and 100% By Directors/Supervisors Section Time By FTE Work Reporting Effort ADRC John Doe Plans, directs, 1.00 78,000 50% 40% Director implements and OAA monitors 10% operations of County the ADRC 50% Levy and the OAA Programs 40%, and Adult Protective Services 10%. 100% By Other Staff Section Time By FTE Work Reporting Effort I & A Jane Smith I&A, options 1.00 40,000 100%
Appendix D - Personnel Worksheet 2017 Please include all ADRC staff. Please report subcontracted staff in the designated section. Under the “All Functions” column include: I&A, Options Counseling, Enrollment Counseling, LTCFS, DBS, outreach, and any other ADRC service the employee performs. A function is considered an ADRC function if it is included in the ADRC Scope of Services of the contract. Include activities such as APS if applicable. Include only one staff member per line. See the example below. Position Title (please indicate if LTE) Employee Name (full first and last name) If AIRS Meets and Waiver of Education and experience approved by ORCD All Functions (ADRC and other) performed by this individual (see example below; include % of time for ADRC and Total FTE for this Person Annual Salary (not fringe) % FTE Funded by ADRC funding (all funds see note, page 5) % FTE Funded by Other Source (list source) Method for allocation of Split Funded Positions Directors/Supervisors Section 100% Time Reporting By FTE By Work Effort ADRC Director John Doe Plans, directs, implements and monitors operations of the ADRC 50% and the OAA Programs 40%, and Adult Protective Services 10%. 1.00 78,000 50% 40% OAA 10% County Levy Other Staff Section 100% Time Reporting By FTE By Work Effort I & A Jane Smith I&A, options 1.00 40,000 100%
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