Period of Part A Contract: March 1, 2019 February 29, 2020 – Agency/Program Name* SUMMARY OF FUNDING SOURCES RYAN RYAN WHITE RYAN RYAN RYAN CITY GENERAL OBJECT CLASS WHITE PART F WHITE WHITE WHITE AND/OR OPERATING/ TOTAL CATEGORIES PART A** (MAI)** PART B PART C PART D HOPWA STATE PRIVATE FEDERAL BUDGET PERSONNEL FRINGE BENEFITS TRAVEL SUPPLIES CONTRACTUAL OTHER TOTAL DIRECT CHARGES ADMINISTRATIVE COSTS TOTAL COSTS PROGRAM INCOME: Identify sources of program income including Medicaid, Medicare, etc. and description of average reimbursement rate for each. 1. *Agency/Program Name - Do not use acronyms. 2. **Based on Funding Request. 3. Administrative Costs for Part A and MAI cannot exceed 10% of total award, unless written approval is given by the Grantee 4. Headings of columns may be changed to accommodate other funding sources.
Period of Part A Contract: March 1, 2019 – February 29, 2020 Agency/Program Name* SUMMARY OF FUNDING SOURCES OBJECT CLASS CATEGORIES RYAN WHITE PART A** RYAN WHITE PART F (MAI)** RYAN WHITE PART B RYAN WHITE PART C RYAN WHITE PART D HOPWA CITY AND/OR STATE GENERAL OPERATING/ PRIVATE FEDERAL TOTAL BUDGET PERSONNEL FRINGE BENEFITS TRAVEL SUPPLIES CONTRACTUAL OTHER TOTAL DIRECT CHARGES ADMINISTRATIVE COSTS TOTAL COSTS PROGRAM INCOME: Identify sources of program income including Medicaid, Medicare, etc. and description of average reimbursement rate for each. 1. *Agency/Program Name - Do not use acronyms. 2. **Based on Funding Request. 3. Administrative Costs for Part A and MAI cannot exceed 10% of total award, unless written approval is given by the Grantee 4. Headings of columns may be changed to accommodate other funding sources.
Summary%20of%20Other%20Funding%20Sources%20&%20Program%20Income.docx