Contract Module Part1 10-27-08.xls - Department of Elder Affairs

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Contract Module Part1 10-27-08.xls - Department of Elder Affairs Powered By Docstoc
					  Area Plan on Aging
         Contract Module
Template and Instructions for Three-Year Cycle
            1/1/2009 - 12/31/2011

   Contract Year 1: 01/01/2009 - 12/31/2009
                          About This Contract Module File
Instructions:
1. All information needed in the Contract Module portion of your area plan should be placed
in this Excel workbook (Contract Module Part 1.xls), in the file Contract Module Part 2.xls
or a separte file referenced in this workbook. If you want to add additional information to
this workbook, you may insert the information in one or more new worksheets. Worksheets
can be created/inserted by selecting "Worksheet" from the Insert menu. If you want to link
to other files, the names of the files must be referenced in the Attachments tab in this
workbook.
2.Enter your PSA number in the first row of each worksheet next to the text "PSA:." . If you
are entering information for the original submittal of the contract module for the year, enter
the date the file will be submitted to the Department next to the text "Original Submission
Date:". If you are updating information in the worksheet after the original submission, do
not change the original submission date, instead enter the date the contract module is being
resubmitted next to the text "Resubmission Date:."
3. Instructions have been included in italics in a row at the top of most worksheets. After
completing the contract module, we recommend the Instructions row in each worksheet be
hidden to make the document more readable. To hide the row, highlight the row and select
"Row/Hide" from the Format menu.
4. When you are ready to print the entire Contract Module you will need to ensure the page
numbers of Contract Module Part 2 follow those of Contract Module Part 1. The starting
page number in Contract Module Part 2 may need to be changed. Determine the number of
pages in contract Contract Module Part 1, then set the starting page number in Contract
Module Part 2 to the following page number. One way to determine the number of pages in
Contract Module Part 1 is to right-click on any sheet tab, select "Select All Sheets" from the
shortcut menu, then select "Print Preview" from the File menu. Click "Next" until you arrive
at the last page. IMPORTANT: In order to continue editing a worksheet after you have
selected all worksheets, you must ungroup your worksheets. You may do so by right-
clicking on a tab and selecting "Ungroup Sheets" from the menu. Failure to do so will
cause all edits to occur on all selected sheets.
To set the starting page number in the Contract Module Part 2, click on tab C.II.C. in
Contract Module Part 2 and select "Page Setup" from the File menu. Enter the correct
starting page number in the field "First Page Number" then click OK.
General Information About Colors Used in This Workbook
Cells in this workbook are color coded as follows:
 Purple cells are calculated (contain formulas). Data should not be typed into purple cells.
Yellow cells require your input. The information should come directly from the allocation
spreadsheet issued by the department.
Aqua fields require your input if applicable.
Gray cross-hatched cells are not applicable and should not be updated .




                                                     Page 2
                         Contract Module Table of Contents

Instructions: Enter the page number that begins each section in the "Page" column. Page
numbers are automatically added to each tab in this file; use these page numbers to complete
this Table of Contents. If additional tabs are added, they should be added to this page as well.
To identify the page numbers assigned to each tab/section, right-click on any tab and select
"Select All Sheets" from the menu; then select "Print Preview" from the File menu. Remember to
"deselect" all tabs when done by clicking on any tab other than the active tab, making only one
tab white (the others gray). Click on underlined text to move to the named tab.


       Section                                     Item                                  Page
                      Contract Module Certification Page
Section C.I.A.        Allocation to the Planning and Service Area (PSA)
Section C.I.B.        OAA TITLE IIIB Services Expenditures
Section C.I.C.        Service Units and Costs Projections Provider Summary
Section C.I.D.        Blank worksheet to prevent renaming of remaining sections
Section C.I.E.        Service Units and Costs Projections PSAs
Section C.I.F.AAA.    Areawide Funding Profile
Section C.I.F.        County Funding Profile
Section C.I.G.        Areawide Funding Summary
Section C.II.A.       AAA Administration Budget
Section C.II.B.       OAA Budget Summary
Section C.II.C.       Financial and Compliance Audit Schedule
Section C.III.A.      AAA Monitoring Schedule
Section C.IV.A.       Section 504 Assurance
Section C.V.A.        Availability of Documents
Section C.VI.A.       Contract Providers (OAA Contract Agencies)
Section C.VI.A.       Contract Providers (Medicaid Waiver Agencies)
Section C.VI.A.       Contract Providers (All Other Contract Agencies)
Section C.VII.A.      AAA Board of Directors
Section C.VII.B       AAA Advisory Council Members
Section C.VIII.A.     Contract Module Review Checklist
                      Contract Module Attachments




                                                      Page 3
                                Contract Module Certification Page

Instructions: This Certification Page is to be completed as indicated and signed by the Board
President or other authorized official, the Advisory Council chair and the AAA Executive Director.
This form is submitted only with the original submission of the Contract Module. An updated
Certification Page must be submitted when the Area Plan Contract Module is updated to incorporate
General Revenue funds each state fiscal year.


   1. AREA AGENCY ON AGING                                     2. GOVERNING BOARD CHAIR:
      INFORMATION:                                                (Name/Address/Phone)
     Legal Name of Agency:



     Mailing Address:

                                                               3. ADVISORY COUNCIL CHAIR:
                                                                  (Name/Address/Phone)
     Telephone: [       ]

     FEDERAL ID NUMBER :


   4. FUNDS ADMINISTERED: (check all that apply)
         OAA Title IIIB                                        o   RELIEF
         OAA Title IIIC                                        o   NSIP
           OAA Title IIID                                      o   ADA Waiver
           OAA Title IIIE                                      o   ALE Waiver
           OAA Title VII                                       o   SHINE
           CCE                                                 o   EHEAP
           HCE                                                     Contracted Services
           ADI                                                     ARC/ADRC
           LSP                                                     Others (List)
   5. CERTIFICATION BY BOARD PRESIDENT, ADVISORY COUNCIL CHAIR, AAA DIRECTOR:
       I hereby certify that the attached document:
           Reflects input from a cross section of service providers, consumers, and caregivers that are
           representative of all areas and culturally diverse populations of the PSA.
           Incorporates the comments and recommendations of the Area Agency’s Advisory Council.
           Has been reviewed and approved by the Area Agency’s Board of Directors.

       I further certify that the contents are true, accurate and complete statements. I acknowledge that intentional
       misrepresentation or falsification may result in the termination of financial assistance. I have reviewed and
       approved the 2009-2011 area plan:
   Name:                                      Signature:                                          Date:
            (President, Board of Directors)

   Name:                                      Signature:                                          Date:
             (Advisory Council Chair)

   Name:                                      Signature:                                          Date:
            (Area Agency on Aging Director)




                                                                     Page 4
PSA:           Original Submission Date:                  Resubmission Date:

Section C.I.A. Allocation to the Planning and Service Area
This worksheet documents all Federal funds allocated to the PSA. The “Original Allocation” row contains the continuation budget amount issued in the original
contract for the year. The amount on this line does not change. The “Revised Allocation” line is the amount of the allocations after the actual federal grant award for
the year is received. It is also where subsequent changes in allocations via contract amendments are reflected.
Less (-) Transfer Amount and Plus (+) Transfer Amount contain transfers between titles. The amounts must be within allowable percentages (B to C or C to B can
be no more than 30 percent; C1 to C2 or C2 to C1 can be no more than 40 percent.) Adjusted Amount is the total after the transfers. Carry Forward Funds must be
exact amounts and allocated to the titles in which they were awarded. Total Funds equals the total after all adjustments have been made. Total OAA plus the GR
AAA admin will equal the contract amount. State General Revenue Allocations and Supplemental Resource Activities (State, Federal and Private) should match
current contract amounts and the amounts detailed in WebDB. Transfer Amount sums up transfers recorded in previous four columns.
Instructions:
Update all yellow and aqua-colored cells as appropriate. Purple cells are calculated automatically. For Title III B, include the total amount for Title III B services
in the table and indicate below the table the portion of this total maintained by the AAA as Title III B set aside. The Title III B set aside currently approved by the
department cannot be increased. Modify the label "ARC/ADRC" below in the SUPPLEMENTAL RESOURCE ACTIVITIES table so it reads "ARC" or "ADRC," as
appropriate for your PSA.


                                           FEDERAL ALLOCATION TO THE PLANNING AND SERVICE AREA

  OAA FEDERAL FUNDING                AAA       TITLE          TITLE            TITLE      TRANSFER      TITLE        TITLE        TITLE         TITLE      TOTAL OAA
        COMPOSITION                 ADMIN       III B         III C1           III C2      AMOUNT       III D1       III D2        III E          VII       Minus VII
Original Allocation
FFY 2008-09                                                                                                                                                       $0.00
Revised Allocation
FFY 2008-09                                                                                                                                                       $0.00
Less (-)
Transfer Amount                                                                                                                                                   $0.00
Plus (+)
Transfer Amount                                                                                                                                                   $0.00
Adjusted Amount
FFY 2008-09                            $0.00      $0.00            $0.00          $0.00                    $0.00        $0.00         $0.00        $0.00          $0.00
Carry Forward Funds
FFY 2008-09                                                                                                                                                       $0.00
TOTAL FUNDS                            $0.00      $0.00            $0.00          $0.00       $0.00        $0.00        $0.00         $0.00        $0.00          $0.00

Title III B Total Funds include $                         in set aside funds (included in the Title III B column).




                                                                                             Page 5
                      STATE GENERAL REVENUE ALLOCATION TO THE PLANNING AND SERVICE AREA
The State General Revenue Allocations and Supplemental Resource Activities (State, Federal and Private) below should match current contract amounts.

                                                                                                                  SUPPLEMENTAL RESOURCE ACTIVITIES
          STATE GENERAL REVENUE ALLOCATIONS                                                                           (STATE, FEDERAL & PRIVATE)
                                                     FY 2008/2009                                                                               AMOUNT
               FUNDING COMPOSITION                                                                                SOURCE OF FUNDING
                                                     GR AMOUNTS                                                                                OF FUNDING

AAA ADMINISTRATION                                                                                       NSIP

CCE ADMINISTRATION                                                                                       EHEAP

CCE SERVICES                                                                                             EHEAP ADMINISTRATION

HCE ADMINISTRATION                                                                                       CONTRACTED SERVICES

HCE CASE MANAGEMENT                                                                                      ADA WAIVER

HCE SUBSIDY                                                                                              ALE WAIVER

ADI ADMINISTRATION                                                                                       MED WAIVER SPECIALIST

ADI SERVICES                                                                                             SHINE

LSP ADMINISTRATION                                                                                       RELIEF

LSP SERVICES                                                                                             ARC/ADRC

                                                                                                         OTHERS (LIST BELOW):




                                                                                     Page 6
PSA:           Original Submission Date:                 Resubmission Date:

Section C.I.B. OAA TITLE IIIB Services Expenditures
This worksheet documents OAA Title IIIB expenditures by service, with services categorized as
priority services or non-priority services.
Instructions: Update all aqua-colored cells as appropriate. Purple cells are calculated
automatically. Funds allocated for Access Services, In-Home Services and Legal Assistance must
be equal to or greater than the following percentages of the total Title IIIB Priority Services: Access
services (20 percent), In-Home (8 percent), and Legal Assistance (1 percent). The "% of Total IIIB
Allocation" column is calculated based on the percentage of the amounts entered on tab C.I.A.
The percentage in the "Total IIIB" row at the bottom must equal 100 percent. If it does not, the
amounts entered in the "Funds Allocated" column do not match those entered on tab C.I.A. IIIB Non-
Priority Services needs to include set aside funds and other funds allocated to the AAA not included
in IIIB Priority Services.

                                                                          # of
                                           % of Total   # Units of
    Title III B             Funds                                     Unduplicated % of Total 60+
                                              IIIB       Services
   Expenditures            Allocated                                   Consumers    Population*
                                           Allocation   Provided
                                                                        Served
   IIIB Priority
      Services
                                            Access Services
Information                             #DIV/0!                                        #DIV/0!
Referral                                #DIV/0!                                        #DIV/0!
Outreach                                #DIV/0!                                        #DIV/0!
Transportation                          #DIV/0!                                        #DIV/0!
Subtotal                       $0.00
             #DIV/0! = amount allocated for Access Services (must be equal to or greater than 20%)
                                       In-Home Services
Homemaker                              #DIV/0!                                       #DIV/0!
Personal Care                          #DIV/0!                                       #DIV/0!
In-Home Respite                        #DIV/0!                                       #DIV/0!
Chore                                  #DIV/0!                                       #DIV/0!
Companionship                          #DIV/0!                                       #DIV/0!
Telephone Reass.                       #DIV/0!                                       #DIV/0!
Subtotal                      $0.00
            #DIV/0! = amount allocated for In-Home Services (must be equal to or greater than 8%)
                                       Legal Assistance
Legal Assistance                        #DIV/0!                                         #DIV/0!
             #DIV/0! = amount allocated for Legal Services (must be equal to or greater than 1%)
IIIB Non-Priority
Services                                #DIV/0!
Total IIIB                     $0.00 #DIV/0!                    0                0

* To have % total 60+ population computed, enter 60+ population:




                                                          Page 7
PSA:           Original Submission Date:                  Resubmission Date:

Section C.I.C. PSA-Wide Service Units and Costs Projections

This worksheet lists the actual unit rate (what providers report as their actual costs to provide a unit of service) and the
adjusted unit rate (the negotiated unit rate/what the Area Agency on Aging agrees to pay for a unit of service) for each
service provider under direct contract with the AAA. Services provided directly by the AAA must also be reflected.

Instructions: Run the WebDB summary report “PSA-wide: C.I.C. Service Units and Costs Projections.” Select your
PSA and run the report for each general revenue program and Older Americans Act title. After each report is run,
select and copy the contents of the report FROM THE PROGRAM NAME DOWN to the bottom of the report and paste
the report into this worksheet. Each report should be pasted one after the other.




                                                            Page 8
Section C.I.D. Service Units and Costs Projections County Summaries

This Section Is No Longer Required for the Area Plan
Worksheet left blank to prevent renaming of remaining sections




                                                        Page 9
PSA:          Original Submission Date:                 Resubmission Date:

C.I.E. Service Units and Cost Projections
This worksheet displays for each program (except Medicaid waivers) the services provided
and for each service the projected cost, number of units to be served, average unit rate,
highest and lowest unit rate, and average, highest and lowest contracted unit rate.

Instructions: Run the WebDB summary report “C.I.E. Service Units and Costs Projections -
PSA Summary.” Select your PSA and run the report for each general revenue program and
Older Americans Act title. After each report is run, select and copy the contents of the
report FROM THE PROGRAM NAME DOWN to the bottom of the report and paste the
report into this worksheet. Each report should be pasted one after the other. Do not use the
report “All Programs: C.I.E. Service Units and Costs Projections - PSA Summary” for this
section because the programs need to be run separately since they span different fiscal
years.
Note: Unduplicated client count and unit rate data must be reported in WebDB. Data
entered in WebDB must reconcile to contract amounts. Printouts from WebDB for each of

(Insert WebDB Pages)




                                                         Page 10
PSA:           Original Submission Date:                      Resubmission Date:

C.I.F.AAA. AREAWIDE FUNDING PROFILE
This worksheet lists the amount retained at the AAA for areawide use. Amounts are separated
out by program and by state and/or federal share. Sixteen C.I.F. tabs have also been included in
this workbook to capture county-level budgets.

Instructions:
Update all aqua-colored cells as appopriate. Purple cells are calculated automatically. Enter
the amount of all funding allocated for areawide activities or handled as a AAA allocation.


                                       Federal/State Share:             Federal: 55.40%
                                                                          State: 44.60%
                                                                AREAWIDE
          PROGRAM                          FEDERAL                STATE              TOTAL
                                            SHARE                 SHARE            BUDGETED
OAA IIIB                                                                                   $0.00
OAA C1                                                                                     $0.00
OAA C2                                                                                     $0.00
OAA IIID1                                                                                  $0.00
OAA IIID2                                                                                  $0.00
OAA IIIE                                                                                   $0.00
OAA VII                                                                                    $0.00
OAA ADMINISTRATION                                   $0.00                $0.00            $0.00
OAA TOTAL                                            $0.00                $0.00            $0.00
ADA WAIVER                                                                                 $0.00
ALE WAIVER                                                                                 $0.00
MED. WAIVER SPECIALIST                               $0.00                $0.00            $0.00
EHEAP                                                                                      $0.00
EHEAP ADMINISTRATION                                 $0.00                                 $0.00
NSIP                                                                                       $0.00
CCE                                                                                        $0.00
CCE ADMINISTRATION                                                        $0.00            $0.00
ADI                                                                                        $0.00
ADI ADMINISTRATION                                                        $0.00            $0.00
HCE                                                                                        $0.00
HCE ADMINISTRATION                                                        $0.00            $0.00
LSP                                                                                        $0.00
LSP ADMINISTRATION                                                        $0.00            $0.00
CONTRACTED SERVICES                                                                        $0.00
SHINE                                                $0.00                                 $0.00
RELIEF                                                                                     $0.00
ARC/ADRC                                                                  $0.00            $0.00
OTHERS (List Below):
                                   0                                                        $0.00
                                   0                                                        $0.00
                                   0                                                        $0.00
                                   0                                                        $0.00
                                   0                                                        $0.00
                                   0                                                        0.00
TOTAL ALL FUNDING
SOURCES                                              $0.00                $0.00             $0.00




                                                                       Page 11
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.1 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 12
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.2 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 13
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.3 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 14
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.4 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 15
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.5 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 16
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.6 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 17
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.7 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 18
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.8 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 19
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.9 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 20
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.10 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 21
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.11 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 22
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.12 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 23
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.13 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 24
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.14 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 25
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.15 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 26
PSA:          Original Submission Date:                Resubmission Date:

C.I.F.16 COUNTY FUNDING PROFILE
This worksheet lists for one county the amount budgeted to each program separated out by state
and/or federal share. Sixteen C.I.F. tabs have been included in this workbook to allow for the
maximum number of counties in a PSA.
Instructions:
Update all aqua-colored cells as appropriate. Purple cells are calculated automatically. Enter
the county name in the first row.

                                                                            Federal/State Share:
                                                                              Federal: 55.40%
                                                                                 State: 44.60%
                                           COUNTY:
          PROGRAM                         FEDERAL          STATE                TOTAL
                                           SHARE           SHARE              BUDGETED
OAA IIIB                                                                              $0.00
OAA C1                                                                                $0.00
OAA C2                                                                                $0.00
OAA IIID1                                                                             $0.00
OAA IIID2                                                                             $0.00
OAA IIIE                                                                              $0.00
OAA VII                                                                               $0.00
OAA TOTAL                                      $0.00                                  $0.00
ADA WAIVER                                                                            $0.00
ALE WAIVER                                                                            $0.00
EHEAP                                                                                 $0.00
NSIP                                                                                  $0.00
CCE                                                                                   $0.00
ADI                                                                                   $0.00
HCE                                                                                   $0.00
LSP                                                                                   $0.00
CONTRACTED SERVICES                                                                   $0.00
RELIEF                                                                                $0.00
OTHERS (List Below):
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
                                  0                                                       $0.00
TOTAL ALL FUNDING
SOURCES                                        $0.00               $0.00                  $0.00




                                                        Page 27
PSA:          Original Submission Date:                    Resubmission Date:

Section C.I.G. Areawide Funding Summary

This worksheet contains the Federal and State share allocations for each program for the
AAA. Amounts are calculated from values entered on the C.I.F. tabs, C.I.F.AAA and
C.I.A.
Instructions: Purple cells are calculated automatically.

                                              FEDERAL           STATE             TOTAL
              PROGRAM                          SHARE            SHARE           BUDGETED
OAA IIIB                                           $0.00                              $0.00
OAA IIIB Set Aside                                 $0.00                              $0.00
OAA C1                                             $0.00                              $0.00
OAA C2                                             $0.00                              $0.00
OAA IIID1                                          $0.00                              $0.00
OAA IIID2                                          $0.00                              $0.00
OAA IIIE                                           $0.00                              $0.00
OAA VII                                            $0.00                              $0.00
OAA ADMINISTRATION                                 $0.00              $0.00           $0.00
OAA TOTAL                                          $0.00              $0.00           $0.00
ADA WAIVER                                         $0.00              $0.00           $0.00
ALE WAIVER                                         $0.00              $0.00           $0.00
MED. WAIVER SPECIALIST                             $0.00              $0.00           $0.00
EHEAP                                              $0.00                              $0.00
EHEAP ADMINISTRATION                               $0.00                              $0.00
NSIP                                               $0.00                              $0.00
CCE                                                                   $0.00           $0.00
CCE ADMINISTRATION                                                    $0.00           $0.00
ADI                                                                   $0.00           $0.00
ADI ADMINISTRATION                                                    $0.00           $0.00
HCE                                                                   $0.00           $0.00
HCE ADMINISTRATION                                                    $0.00           $0.00
LSP                                                                   $0.00           $0.00
LSP ADMINISTRATION                                                    $0.00           $0.00
CONTRACTED SERVICES                                                   $0.00           $0.00
SHINE                                               $0.00                             $0.00
RELIEF                                                                $0.00           $0.00
ARC/ADRC                                                              $0.00           $0.00
OTHERS (LIST):
                                          0         $0.00             $0.00           $0.00
                                          0         $0.00             $0.00           $0.00
                                          0         $0.00             $0.00           $0.00
                                          0         $0.00             $0.00           $0.00
                                          0         $0.00             $0.00           $0.00
                                          0         $0.00             $0.00           $0.00
TOTAL ALL FUNDING SOURCES                           $0.00             $0.00           $0.00



                                                            Page 28
PSA:          Original Submission Date:               Resubmission Date:

C.II.A. AREA AGENCY ON AGING ADMINISTRATIVE BUDGET SUMMARY AND ALLOCATIONS
NAME OF AGENCY:
BUDGET YEAR - 2009

Instructions: Update all aqua-colored cells as appopriate. Purple cells are calculated
automatically. Use the categories provided, adding rows as needed. Note: When adding rows,
formulae in Total columns need to be added. Notes 1 through 4 describe narrative details
needed for specific sections. Include the narratives at the end of the worksheet.

PERSONNEL SALARIES                                   $0.00
IN KIND SALARIES                                     $0.00
FRINGE BENEFITS                                      $0.00
TOTAL PERSONNEL COSTS                                $0.00
TRAVEL                                               $0.00
BUILDING SPACE                                       $0.00
COMMUNICATIONS & UTILITIES                           $0.00
PRINTING & SUPPLIES                                  $0.00
EQUIPMENT                                            $0.00
OTHER                                                $0.00
REVENUE                                              $0.00




                                                                                             Page 29
C.II.A. AREA AGENCY ON AGING ADMINISTRATIVE BUDGET SUMMARY AND ALLOCATIONS
NAME OF AGENCY:
BUDGET YEAR - 2009

1. PERSONNEL SALARIES
                                                                                                                                                                                                                                                      OTHER      OTHER
                                   GROSS              TOTAL    TOTAL    TITLE              TITLE      TITLE      TITLE      TITLE       OAA         CCE       EHEAP        HCE         MEDICAID     SHINE        ARD/        ADI          LSP       PROJECTS PROJECTS      OTHER     TOTAL    TOTAL
                                 AVAILABLE           BUDGET   BUDGET     III-B              III-B      III-D      VII        III-E      AAA        ADMIN      ADMIN       ADMIN         WAIVER      ADMIN       ADRC        ADMIN        ADMIN         DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                   HOURS             CURRENT PROPOSED SET ASIDE             I&R                                        ADMIN                                          SPECIALISTS               ADMIN                               (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
     TITLE and NAME                                                                                                                                                                      ADMIN
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
                                                                                                                                                                                                                                                                                         $0      $0
OVERTIME                                                                                                                                                                                                                                                                                 $0      $0
BONUS                                                                                                                                                                                                                                                                                    $0      $0
ACCRUED LEAVE                                                                                                                                                                                                                                                                            $0      $0
MEALS                                                                                                                                                                                                                                                                                    $0      $0
TOTAL PERSONNEL
SALARIES                                                     $0          $0          $0          $0         $0         $0         $0          $0         $0          $0          $0            $0         $0           $0          $0          $0           $0             $0   $0       $0      $0
TOTAL GROSS AVAIL HRS                            0

Note 1: Enter on the last page of this Administrative Budget a narrative explanation of the use of funds (salary and other) from Title IIIB Set Aside (LAN); Title IIIB I&R and any other DOEA funded special project (separately for each category of funds). Break out
federally funded expenditures from other sources of funding.
Note 2: Enter on the last page of this Administrative Budget a narrative explanation of bonuses paid that ensures they have been approved by the Board of Directors.




                                                                                                                                                           Page 30
C.II.A. AREA AGENCY ON AGING ADMINISTRATIVE BUDGET SUMMARY AND ALLOCATIONS
NAME OF AGENCY:
BUDGET YEAR - 2009
2. IN-KIND SALARIES
                                                                                                                                                                                                 OTHER      OTHER
                                 TOTAL    TOTAL    TITLE     TITLE     TITLE     TITLE    TITLE      OAA      CCE       EHEAP        HCE      MEDICAID     SHINE     ARD/     ADI      LSP     PROJECTS PROJECTS      OTHER     TOTAL    TOTAL
                                BUDGET   BUDGET     III-B     III-B     III-D     VII      III-E     AAA     ADMIN      ADMIN       ADMIN      WAIVER      ADMIN    ADRC     ADMIN    ADMIN       DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                CURRENT PROPOSED SET ASIDE    I&R                                   ADMIN                                    SPECIALISTS            ADMIN                      (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
                                                                                                                                                ADMIN

VOLUNTEER                                                                                                                                                                                                                           $0      $0

TOTAL IN-KIND SALARIES                $0       $0       $0        $0        $0       $0        $0       $0       $0            $0       $0            $0       $0       $0       $0       $0          $0        $0       $0         $0      $0

TOTAL SALARIES                        $0       $0       $0        $0        $0       $0        $0       $0       $0            $0       $0            $0       $0       $0       $0       $0          $0        $0       $0         $0      $0


3. FRINGE BENEFITS
                                                                                                                                                                                                 OTHER      OTHER
                                 TOTAL    TOTAL    TITLE     TITLE     TITLE     TITLE    TITLE      OAA      CCE       EHEAP        HCE      MEDICAID     SHINE     ARD/     ADI      LSP     PROJECTS PROJECTS      OTHER     TOTAL    TOTAL
                                BUDGET   BUDGET     III-B     III-B     III-D     VII      III-E     AAA     ADMIN      ADMIN       ADMIN      WAIVER      ADMIN    ADRC     ADMIN    ADMIN       DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                CURRENT PROPOSED SET ASIDE    I&R                                   ADMIN                                    SPECIALISTS            ADMIN                      (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
                                                                                                                                                ADMIN

RETIREMENT                                                                                                                                                                                                                          $0      $0

SOCIAL SECURITY                                                                                                                                                                                                                     $0      $0

FL UNEMP. COMP.                                                                                                                                                                                                                     $0      $0

EMPLOYEE INSURANCE                                                                                                                                                                                                                  $0      $0

WORKERS COMPENSATION                                                                                                                                                                                                                $0      $0

TOTAL FRINGE BENEFITS                 $0       $0       $0        $0        $0       $0        $0       $0       $0            $0       $0            $0       $0       $0       $0       $0          $0        $0       $0         $0      $0

TOTAL PERSONNEL COSTS                 $0       $0       $0        $0        $0       $0        $0       $0       $0            $0       $0            $0       $0       $0       $0       $0          $0        $0       $0         $0      $0



4. TRAVEL
                                                                                                                                                                                                 OTHER      OTHER
                                 TOTAL    TOTAL    TITLE     TITLE     TITLE     TITLE    TITLE      OAA      CCE       EHEAP        HCE      MEDICAID     SHINE     ARD/     ADI      LSP     PROJECTS PROJECTS      OTHER     TOTAL    TOTAL
                                BUDGET   BUDGET     III-B     III-B     III-D     VII      III-E     AAA     ADMIN      ADMIN       ADMIN      WAIVER      ADMIN    ADRC     ADMIN    ADMIN       DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                CURRENT PROPOSED SET ASIDE    I&R                                   ADMIN                                    SPECIALISTS            ADMIN                      (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
                                                                                                                                                ADMIN
TRAVEL (In-Area, Out-of-Area,
Out-of State)                                                                                                                                                                                                                       $0      $0

BOARD & VOLUNTEER                                                                                                                                                                                                                   $0      $0

IN-KIND TRAVEL                                                                                                                                                                                                                      $0      $0

TOTAL TRAVEL                          $0       $0       $0        $0        $0       $0        $0       $0       $0            $0       $0            $0       $0       $0       $0       $0          $0        $0       $0         $0      $0




5. BUILDING SPACE
                                                                                                                                                                                                 OTHER      OTHER
                                 TOTAL    TOTAL    TITLE     TITLE     TITLE     TITLE    TITLE      OAA      CCE       EHEAP        HCE      MEDICAID     SHINE     ARD/     ADI      LSP     PROJECTS PROJECTS      OTHER     TOTAL    TOTAL
                                BUDGET   BUDGET     III-B     III-B     III-D     VII      III-E     AAA     ADMIN      ADMIN       ADMIN      WAIVER      ADMIN    ADRC     ADMIN    ADMIN       DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                CURRENT PROPOSED SET ASIDE    I&R                                   ADMIN                                    SPECIALISTS            ADMIN                      (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
                                                                                                                                                ADMIN

DEPRECIATION - BUILDING                                                                                                                                                                                                             $0      $0

INSURANCE                                                                                                                                                                                                                           $0      $0

REPAIR AND MAINTENANCE                                                                                                                                                                                                              $0      $0
RENT, LEASE OR
MORTGAGE                                                                                                                                                                                                                            $0      $0

  IN-KIND                                                                                                                                                                                                                           $0      $0

TOTAL BUILDING SPACE                  $0       $0       $0        $0        $0       $0        $0       $0       $0            $0       $0            $0       $0       $0       $0       $0          $0        $0       $0         $0      $0



6. COMMUNICATIONS & UTILITIES
                                                                                                                                                                                                 OTHER      OTHER
                                 TOTAL    TOTAL    TITLE     TITLE     TITLE     TITLE    TITLE      OAA      CCE       EHEAP        HCE      MEDICAID     SHINE     ARD/     ADI      LSP     PROJECTS PROJECTS      OTHER     TOTAL    TOTAL
                                BUDGET   BUDGET     III-B     III-B     III-D     VII      III-E     AAA     ADMIN      ADMIN       ADMIN      WAIVER      ADMIN    ADRC     ADMIN    ADMIN       DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                CURRENT PROPOSED SET ASIDE    I&R                                   ADMIN                                    SPECIALISTS            ADMIN                      (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
                                                                                                                                                ADMIN

TELEPHONE                                                                                                                                                                                                                           $0      $0




                                                                                                                     Page 31
C.II.A. AREA AGENCY ON AGING ADMINISTRATIVE BUDGET SUMMARY AND ALLOCATIONS
NAME OF AGENCY:
BUDGET YEAR - 2009

POSTAGE                                                                                                                                                                                                                                                                                     $0       $0

UTILITIES                                                                                                                                                                                                                                                                                   $0       $0
TOTAL COMMUNICATION
& UTILITIES                                                  $0          $0            $0        $0         $0         $0         $0           $0         $0          $0         $0            $0         $0            $0          $0          $0          $0        $0       $0           $0       $0




7. PRINTING & SUPPLIES
                                                                                                                                                                                                                                                       OTHER      OTHER
                                                     TOTAL    TOTAL    TITLE                TITLE     TITLE      TITLE      TITLE       OAA          CCE       EHEAP        HCE        MEDICAID     SHINE        ARD/         ADI         LSP        PROJECTS PROJECTS      OTHER     TOTAL    TOTAL
                                                    BUDGET   BUDGET     III-B                III-B     III-D      VII        III-E      AAA         ADMIN      ADMIN       ADMIN        WAIVER      ADMIN       ADRC         ADMIN       ADMIN          DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                                    CURRENT PROPOSED SET ASIDE               I&R                                       ADMIN                                          SPECIALISTS               ADMIN                                (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
                                                                                                                                                                                         ADMIN

GENERAL OFFICE SUPPLIES                                                                                                                                                                                                                                                                     $0       $0
PRINTING AND
REPRODUCTION                                                                                                                                                                                                                                                                                $0       $0
TOTAL PRINTING &
SUPPLIES                                                     $0          $0            $0        $0         $0         $0         $0           $0         $0          $0         $0            $0         $0            $0          $0          $0          $0        $0       $0           $0       $0
Note 3: Enter on the last page of this Administrative Budget a narrative explanation of planned expenditures in the communications category.


8. EQUIPMENT
                                                                                                                                                                                                                                                       OTHER      OTHER
                                                     TOTAL    TOTAL    TITLE                TITLE     TITLE      TITLE      TITLE       OAA          CCE       EHEAP        HCE        MEDICAID     SHINE        ARD/         ADI         LSP        PROJECTS PROJECTS      OTHER     TOTAL    TOTAL
                                                    BUDGET   BUDGET     III-B                III-B     III-D      VII        III-E      AAA         ADMIN      ADMIN       ADMIN        WAIVER      ADMIN       ADRC         ADMIN       ADMIN          DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                                    CURRENT PROPOSED SET ASIDE               I&R                                       ADMIN                                          SPECIALISTS               ADMIN                                (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
                                                                                                                                                                                         ADMIN
DEPRECIATION -
EQUIPMENT                                                                                                                                                                                                                                                                                   $0       $0
SMALL OFFICE
FURN/EQUIPT.                                                                                                                                                                                                                                                                                $0       $0

OFFICE FURN/EQUIPT.                                                                                                                                                                                                                                                                         $0       $0
COMPUTER
HARDWARE/SOFTWARE                                                                                                                                                                                                                                                                           $0       $0
PROGRAM EQUIPMENT
(Total)                                                                                                                                                                                                                                                                                     $0       $0

TOTAL EQUIPMENT                                              $0          $0            $0        $0         $0         $0         $0           $0         $0          $0         $0            $0         $0            $0          $0          $0          $0        $0       $0           $0       $0


9. OTHER COSTS (UNIQUE TO AAA)
                                                                                                                                                                                                                                                       OTHER      OTHER
                                                     TOTAL    TOTAL    TITLE                TITLE     TITLE      TITLE      TITLE       OAA          CCE       EHEAP        HCE        MEDICAID     SHINE        ARD/         ADI         LSP        PROJECTS PROJECTS      OTHER     TOTAL    TOTAL
                                                    BUDGET   BUDGET     III-B                III-B     III-D      VII        III-E      AAA         ADMIN      ADMIN       ADMIN        WAIVER      ADMIN       ADRC         ADMIN       ADMIN          DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                                    CURRENT PROPOSED SET ASIDE               I&R                                       ADMIN                                          SPECIALISTS               ADMIN                                (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
                                                                                                                                                                                         ADMIN
LEGAL, AUDIT,
PROFESSIONAL FEES                                                                                                                                                                                                                                                                           $0       $0

PROGRAM & FOOD SUPPLIES                                                                                                                                                                                                                                                                     $0       $0

ADVERTISING                                                                                                                                                                                                                                                                                 $0       $0

MISCELLANEOUS                                                                                                                                                                                                                                                                               $0       $0

                                                                                                                                                                                                                                                                                            $0       $0

PUBLICATIONS (Total)                                                                                                                                                                                                                                                                        $0       $0

SUB-CONTRACTOR(S)                                                                                                                                                                                                                                                                           $0       $0

                                                                                                                                                                                                                                                                                            $0       $0

RELOCATION EXPENSES                                                                                                                                                                                                                                                                         $0       $0
PARTICIPANT SUPPORT
COSTS                                                                                                                                                                                                                                                                                       $0       $0

TOTAL OTHER COSTS                                            $0          $0            $0        $0         $0         $0         $0           $0         $0          $0         $0            $0         $0            $0          $0          $0          $0        $0       $0           $0       $0

TOTAL ALL COSTS                                              $0          $0            $0        $0         $0         $0         $0           $0         $0          $0         $0            $0         $0            $0          $0          $0          $0        $0       $0           $0       $0
Note 4: Enter on the last page of this Administrative Budget a narrative explanation for planned purchases/expenditures in the equipment & other categories in the Title IIIB Set Aside; Title IIIB I&R and any other DOEA funded special project (separately
for each category of funds). Break out federally funded expenditures from other sources of funding.


10. REVENUES
                                                                                                                                                                                                                                                      OTHER    OTHER
                                                     TOTAL        TOTAL        TITLE        TITLE     TITLE      TITLE      TITLE       OAA         CCE        EHEAP       HCE         MEDICAID     SHINE        ARD/         ADI         LSP        PROJECTS PROJECTS     OTHER    TOTAL        TOTAL




                                                                                                                                                            Page 32
C.II.A. AREA AGENCY ON AGING ADMINISTRATIVE BUDGET SUMMARY AND ALLOCATIONS
NAME OF AGENCY:
BUDGET YEAR - 2009
                                                    BUDGET   BUDGET    III-B                III-B         III-D         VII         III-E         AAA       ADMIN        ADMIN       ADMIN            WAIVER         ADMIN      ADRC       ADMIN      ADMIN         DOEA       DOEA    PROJECTS ALLOCATED BUDGET
                                                    CURRENT PROPOSED SET ASIDE              I&R                                                  ADMIN                                              SPECIALISTS                 ADMIN                            (IDENTIFY) (IDENTIFY) NON-DOEA   FUNDS   CHANGE
                                                                                                                                                                                                       ADMIN
FEDERAL                                                                                                                                                                                                                                                                                                      $0        $0
STATE GENERAL REVENUE                                                                                                                                                                                                                                                                                        $0        $0
PROGRAM INCOME                                                                                                                                                                                                                                                                                               $0        $0
OTHER FUNDS                                                                                                                                                                                                                                                                                                  $0        $0
LOCAL CASH                                                                                                                                                                                                                                                                                                   $0        $0
   (MATCH)                                                                                                                                                                                                                                                                                                   $0        $0
IN-KIND                                                                                                                                                                                                                                                                                                      $0        $0
   (MATCH)                                                                                                                                                                                                                                                                                                   $0        $0
TOTAL REVENUES                                                  $0         $0         $0            $0            $0          $0            $0         $0         $0            $0             $0               $0         $0         $0         $0         $0          $0         $0         $0             $0        $0



TOTAL REVENUES                                                  $0         $0         $0            $0            $0          $0            $0         $0         $0            $0             $0               $0         $0         $0         $0         $0          $0         $0         $0             $0        $0

TOTAL EXPENSES                                                  $0         $0         $0            $0            $0          $0            $0         $0         $0            $0             $0               $0         $0         $0         $0         $0          $0         $0         $0             $0        $0

TOTAL REVENUE - EXPENSES                                        $0         $0         $0            $0            $0          $0            $0         $0         $0            $0             $0               $0         $0         $0         $0         $0          $0         $0         $0             $0        $0

PERCENT REVENUE                                       #DIV/0!        #DIV/0!    #DIV/0!    #DIV/0!       #DIV/0!       #DIV/0!     #DIV/0!       #DIV/0!    #DIV/0!      #DIV/0!     #DIV/0!          #DIV/0!        #DIV/0!    #DIV/0!    #DIV/0!    #DIV/0!     #DIV/0!    #DIV/0!    #DIV/0!    #DIV/0!        #DIV/0!

PERCENT CHANGE


Note 1: Please provide a narrative explanation of the use of funds (salary and other) from Title IIIB Set Aside (LAN); Title IIIB I&R and any other DOEA funded special project (separately for each category of funds). Break out federally funded
expenditures from other sources of funding. If there are no funds allocated in the "Other Projects Non-DOEA" column, provide explanation here.


Enter text here:


Note 2: Please provide a narrative explanation of bonuses paid that ensures they have been approved by the Board of Directors or indicate that none are paid.


Enter text here:


Note 3: Please provide a narrative explanation of planned expenditures in the communications category.


Enter text here:

Note 4: Please provide a narrative explanation for planned purchases/expenditures in the equipment & other categories in the Title IIIB Set Aside; Title IIIB I&R and any other DOEA funded special project (separately for each category of funds). Break
out federally funded expenditures from other sources of funding.

Enter text here:




                                                                                                                                                                      Page 33
PSA:             Original Submission Date:             Resubmission Date:

C.II.B. OAA Budget Summary
Instructions: Update all aqua-colored cells as appropriate. Purple cells are calculated based on values
entered in tab C.I.A.
                                                        (1)         (2)         (3)             (4)
                                                                               Local
                                                     Federal     General       Match/        TOTAL
                                                     Funding     Revenue      CCE/HCE        FUNDS
1. Area Agency Admin
 A. Current Year                                         0.00        $0.00                         $0.00
 B. Prior Year CF (2008)                                 0.00                                      $0.00
 CONTRACT TOTAL                                         $0.00        $0.00         $0.00           $0.00
 C. CCE GR Administration                                                          $0.00           $0.00
 D. HCE GR Administration                                                          $0.00           $0.00
 E. LSP Admin                                                                      $0.00           $0.00
 F. LSP Services                                                                                   $0.00
 G. Local Match                                                                                    $0.00
 TOTAL ADMIN                                            $0.00        $0.00         $0.00           $0.00
2. Title III-B
 A. Supportive Services
  (1) Current Year                                      $0.00                                      $0.00
  (2) Prior Year CF (2008)                              $0.00                                      $0.00
  TOTAL                                                 $0.00                      $0.00           $0.00
 B. IIIB Set-Aside (also included in Total)             $0.00                                      $0.00
3. Title III-C1 Nutrition Services
 A. Current Year                                        $0.00                                      $0.00
 B. Prior Year CF (2008)                                $0.00                                      $0.00
  TOTAL                                                 $0.00                      $0.00           $0.00
4. Title III-C2 Nutrition Services
 A. Current Year                                        $0.00                                      $0.00
 B. Prior Year CF (2008)                                $0.00                                      $0.00
  TOTAL                                                 $0.00                      $0.00           $0.00
5. Title III-D1 Preventive Health
 A. Current Year                                        $0.00                                      $0.00
 B. Prior Year CF (2008)                                $0.00                                      $0.00
 TOTAL                                                  $0.00                      $0.00           $0.00
6. Title III-D2 Preventive Health
 A. Current Year                                        $0.00                                      $0.00
 B. Prior Year CF (2008)                                $0.00                                      $0.00
 TOTAL                                                  $0.00                      $0.00           $0.00
7. Title III-E Caregiver Support Services
  A. Current Year                                       $0.00                                      $0.00
  B. Prior Year CF (2008)                               $0.00                                      $0.00
  TOTAL                                                 $0.00                      $0.00           $0.00
8. Total Federal Current Year Funds Awarded
(Sum of 1.A, 2.A(1), 3.A, 4.A, 5.A., 6.A, 7.A)          $0.00
9. Total CF Funds Awarded
(Sum of 1.B, 2.A(2), 3.B, 4.B, 5.B, 6.B, 7.B)           $0.00
10. Total GR Awarded
(Total of column (2))                                   $0.00
11.Total of All Funds to be Received
(Sum of 8, 9, 10)                                       $0.00



                                                                    Page 34

				
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