UCM Worksheets - Excel 2007

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					FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                                                                                                            (Service Reference)               (1)
                                                                                                                                                                                               Facilities & Maintenance Cost
Form Revised December 2011, WCFAAA                                                 2%                                                                         Management & General Cost Pool                 Pool                    Adult Day Care             Adult Day
                                                                                                                                       OTHER
                                                                                                   GROSS                                NON-        NET
                                                               CURRENT         PROPOSED PROPOSED AVAILABLE HOLIDAY    SICK     ANNUAL BILLABLE   AVAILABLE    % OF                  WAGE       % OF                  WAGE       % OF                  WAGE    % OF
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET   HOURS     HOURS    LEAVE     LEAVE    TIME      HOURS       TIME   HR/UNIT        COST       TIME   HR/UNIT        COST       TIME   HR/UNIT        COST    TIME
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.0     -         -           -      -          0.0    0.00%      -            -        0.00%      -            -        0.00%      -            -     0.00%
                                                                                                        0.0     -         -           -      -

TOTAL WAGES                                                            0.00           0.00      0.00                                                                                     -                                -                             -
PERCENTAGE OF WAGES                                                                             0.0%                                                                                    0.0%                             0.0%                          0.0%

TOTAL HOURS                                                                                                                                            0.00                  -                                 -                              -
PERCENTAGE OF HOURS                                                                                                                                    0.0%                0.0%                              0.0%                           0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                      Page 1 of 37                                                                                               2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:            (2)                             (3)                             (4)                          (5)                       (6)


Form Revised December 2011, WCFAAA                                                 2%           Adult Day Health Care               Basic Subsidy            Caregiver Training/Support            Case Aid               Case Management


                                                               CURRENT         PROPOSED PROPOSED                  WAGE         % OF                 WAGE     % OF                 WAGE      % OF              WAGE    % OF              WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET   HR/UNIT         COST         TIME   HR/UNIT       COST     TIME   HR/UNIT       COST      TIME   HR/UNIT    COST    TIME   HR/UNIT    COST
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -
Employee Name         Position Description                          0.00            0.00     0.00      -             -          0.00%      -           -      0.00%      -           -       0.00%      -        -     0.00%      -        -


TOTAL WAGES                                                            0.00           0.00      0.00                     -                             -                              -                         -                            -
PERCENTAGE OF WAGES                                                                             0.0%                    0.0%                          0.0%                           0.0%                      0.0%                         0.0%

TOTAL HOURS                                                                                                 -                               -                               -                            -                        -
PERCENTAGE OF HOURS                                                                                       0.0%                            0.0%                            0.0%                         0.0%                     0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                               Page 2 of 37                                                                                            2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                     (7)                                (8)                        (9)                         (10)                         (11)


Form Revised December 2011, WCFAAA                                                 2%                       Child Day Care                          Chore                Chore (Enhanced)              Companionship             Congregate Meals C1


                                                               CURRENT         PROPOSED PROPOSED       % OF                  WAGE    % OF                    WAGE    % OF               WAGE       % OF                WAGE    % OF                WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT        COST    TIME   HR/UNIT          COST    TIME   HR/UNIT     COST       TIME   HR/UNIT      COST    TIME   HR/UNIT      COST
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -            -     0.00%      -              -     0.00%      -         -        0.00%      -          -     0.00%      -          -


TOTAL WAGES                                                            0.00           0.00      0.00                           -                               -                             -                           -                              -
PERCENTAGE OF WAGES                                                                             0.0%                          0.0%                            0.0%                          0.0%                        0.0%                           0.0%

TOTAL HOURS                                                                                                          -                                  -                          -                           -                            -
PERCENTAGE OF HOURS                                                                                                0.0%                               0.0%                       0.0%                        0.0%                         0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                             Page 3 of 37                                                                                                2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                        (12)                               (13)                       (14)                            (15)                           (16)
                                                                                                                                                                            Counseling (Mental
Form Revised December 2011, WCFAAA                                                 2%                  Congregate Meals (Screening) C1   Counseling (Gereontological)        Health/Screening)             Disease Information             Education/Training


                                                               CURRENT         PROPOSED PROPOSED        % OF                  WAGE       % OF                   WAGE     % OF               WAGE        % OF                WAGE        % OF                 WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET         TIME   HR/UNIT        COST       TIME   HR/UNIT         COST     TIME   HR/UNIT     COST        TIME   HR/UNIT      COST        TIME   HR/UNIT       COST
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00        0.00%      -            -        0.00%      -             -      0.00%      -         -         0.00%      -          -         0.00%      -           -


TOTAL WAGES                                                            0.00           0.00      0.00                              -                                -                              -                               -                              -
PERCENTAGE OF WAGES                                                                             0.0%                             0.0%                             0.0%                           0.0%                            0.0%                           0.0%

TOTAL HOURS                                                                                                             -                                  -                           -                              -                               -
PERCENTAGE OF HOURS                                                                                                   0.0%                               0.0%                        0.0%                           0.0%                            0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                                 Page 4 of 37                                                                                                      2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                    (17)                              (18)                       (19)                           (20)                          (21)
                                                                                                                                                                    Financial Risk Reduction       Financial Risk Reduction
Form Revised December 2011, WCFAAA                                                 2%                  Emergency Alert Response                Escort                    (Assessment)                   (Maintenance)                Health Promotion


                                                               CURRENT         PROPOSED PROPOSED       % OF               WAGE      % OF                   WAGE    % OF                 WAGE      % OF                 WAGE      % OF                 WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT     COST      TIME   HR/UNIT         COST    TIME   HR/UNIT       COST      TIME   HR/UNIT       COST      TIME   HR/UNIT       COST
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -     0.00%      -           -       0.00%      -           -       0.00%      -           -


TOTAL WAGES                                                            0.00           0.00      0.00                          -                              -                              -                              -                              -
PERCENTAGE OF WAGES                                                                             0.0%                         0.0%                           0.0%                           0.0%                           0.0%                           0.0%

TOTAL HOURS                                                                                                          -                                -                           -                              -                             -
PERCENTAGE OF HOURS                                                                                                0.0%                             0.0%                        0.0%                           0.0%                          0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                            Page 5 of 37                                                                                                    2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                    (22)                              (23)                         (24)                           (25)                         (26)
                                                                                                                                                                                                    Home & Community Disaster
Form Revised December 2011, WCFAAA                                                 2%                   Health Risk Assessment         Health Risk Screening               Health Support                 Preparedness            Home Delivered Meals C2


                                                               CURRENT         PROPOSED PROPOSED       % OF               WAGE      % OF                   WAGE       % OF                  WAGE    % OF               WAGE      % OF                 WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT     COST      TIME   HR/UNIT         COST       TIME   HR/UNIT        COST    TIME   HR/UNIT     COST      TIME   HR/UNIT       COST
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -       0.00%      -             -        0.00%      -            -     0.00%      -         -       0.00%      -           -


TOTAL WAGES                                                            0.00           0.00      0.00                          -                                 -                             -                            -                              -
PERCENTAGE OF WAGES                                                                             0.0%                         0.0%                              0.0%                          0.0%                         0.0%                           0.0%

TOTAL HOURS                                                                                                          -                                -                             -                             -                            -
PERCENTAGE OF HOURS                                                                                                0.0%                             0.0%                          0.0%                          0.0%                         0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                            Page 6 of 37                                                                                                    2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                     (27)                              (28)                       (29)                       (30)                           (31)


Form Revised December 2011, WCFAAA                                                 2%                   Home Health Aid Service          Home Injury Control                Homemaker             Housing Improvement                Information


                                                               CURRENT         PROPOSED PROPOSED       % OF                WAGE      % OF                   WAGE      % OF              WAGE    % OF              WAGE         % OF                  WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT      COST      TIME   HR/UNIT         COST      TIME   HR/UNIT    COST    TIME   HR/UNIT    COST         TIME   HR/UNIT        COST
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -       0.00%      -             -       0.00%      -        -     0.00%      -        -          0.00%      -            -


TOTAL WAGES                                                            0.00           0.00      0.00                           -                                -                         -                              -                               -
PERCENTAGE OF WAGES                                                                             0.0%                          0.0%                             0.0%                      0.0%                           0.0%                            0.0%

TOTAL HOURS                                                                                                          -                                 -                          -                          -                              -
PERCENTAGE OF HOURS                                                                                                0.0%                              0.0%                       0.0%                       0.0%                           0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                             Page 7 of 37                                                                                                  2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                    (32)                            (33)                           (34)                          (35)                         (36)


Form Revised December 2011, WCFAAA                                                 2%                         Intake C2              Interpreter/Translating              Legal Assistance                Material Aid            Medication Management


                                                               CURRENT         PROPOSED PROPOSED       % OF               WAGE    % OF                   WAGE         % OF               WAGE       % OF                 WAGE    % OF                WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT     COST    TIME   HR/UNIT         COST         TIME   HR/UNIT     COST       TIME   HR/UNIT       COST    TIME   HR/UNIT      COST
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -         -     0.00%      -             -          0.00%      -         -        0.00%      -           -     0.00%      -          -


TOTAL WAGES                                                            0.00           0.00      0.00                        -                                   -                             -                            -                             -
PERCENTAGE OF WAGES                                                                             0.0%                       0.0%                                0.0%                          0.0%                         0.0%                          0.0%

TOTAL HOURS                                                                                                         -                               -                               -                             -                           -
PERCENTAGE OF HOURS                                                                                               0.0%                            0.0%                            0.0%                          0.0%                        0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                          Page 8 of 37                                                                                                     2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                   (37)                               (38)                         (39)                            (40)                           (41)


Form Revised December 2011, WCFAAA                                                 2%                      Model Day Care               Nutrition Counseling             Nutrition Education            Occupational Therapy                  Other


                                                               CURRENT         PROPOSED PROPOSED       % OF                 WAGE    % OF                   WAGE       % OF                WAGE        % OF               WAGE         % OF               WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT       COST    TIME   HR/UNIT         COST       TIME   HR/UNIT      COST        TIME   HR/UNIT     COST         TIME   HR/UNIT     COST
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -           -     0.00%      -             -        0.00%      -          -         0.00%      -         -          0.00%      -         -


TOTAL WAGES                                                            0.00           0.00      0.00                          -                                 -                               -                               -                            -
PERCENTAGE OF WAGES                                                                             0.0%                         0.0%                              0.0%                            0.0%                            0.0%                         0.0%

TOTAL HOURS                                                                                                         -                                 -                             -                               -                             -
PERCENTAGE OF HOURS                                                                                               0.0%                              0.0%                          0.0%                            0.0%                          0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                            Page 9 of 37                                                                                                       2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                   (42)                             (43)                           (44)                              (45)                                (46)


Form Revised December 2011, WCFAAA                                                 2%                         Outreach                   Personal Care           Pest Control (Enhanced Initiation)     Pest Control (Initiation)          Pest Control (Maintenance)


                                                               CURRENT         PROPOSED PROPOSED       % OF              WAGE    % OF                    WAGE      % OF                   WAGE        % OF                   WAGE          % OF                  WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT    COST    TIME   HR/UNIT          COST      TIME   HR/UNIT         COST        TIME   HR/UNIT         COST          TIME   HR/UNIT        COST
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -        -     0.00%      -              -       0.00%      -             -         0.00%      -             -           0.00%      -            -


TOTAL WAGES                                                            0.00           0.00      0.00                       -                               -                                  -                                      -                               -
PERCENTAGE OF WAGES                                                                             0.0%                      0.0%                            0.0%                               0.0%                                   0.0%                            0.0%

TOTAL HOURS                                                                                                         -                               -                               -                                 -                                   -
PERCENTAGE OF HOURS                                                                                               0.0%                            0.0%                            0.0%                              0.0%                                0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                         Page 10 of 37                                                                                                                 2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                     (47)                                  (48)                        (49)                         (50)                        (51)


Form Revised December 2011, WCFAAA                                                 2%                    Pest Control (Rodent)                 Physical Fitness               Physical Therapy                Recreation              Referral/Assistance


                                                               CURRENT         PROPOSED PROPOSED       % OF                WAGE         % OF                      WAGE    % OF               WAGE       % OF               WAGE    % OF                 WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT      COST         TIME   HR/UNIT            COST    TIME   HR/UNIT     COST       TIME   HR/UNIT     COST    TIME   HR/UNIT       COST
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -          -          0.00%      -                -     0.00%      -         -        0.00%      -         -     0.00%      -           -


TOTAL WAGES                                                            0.00           0.00      0.00                              -                                 -                             -                          -                               -
PERCENTAGE OF WAGES                                                                             0.0%                             0.0%                              0.0%                          0.0%                       0.0%                            0.0%

TOTAL HOURS                                                                                                          -                                     -                            -                            -                           -
PERCENTAGE OF HOURS                                                                                                0.0%                                  0.0%                         0.0%                         0.0%                        0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                                Page 11 of 37                                                                                                 2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:                       (52)                                (53)                           (54)                        (55)                          (56)                                   (57)


Form Revised December 2011, WCFAAA                                                 2%                     Respite (Facility Based)               Respite (In-Home)           Screening/Assessment C2       Shopping Assistance                  Sitter                        Skilled Nursing


                                                               CURRENT         PROPOSED PROPOSED       % OF                   WAGE          % OF                 WAGE       % OF               WAGE      % OF               WAGE        % OF                  WAGE           % OF
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT         COST          TIME   HR/UNIT       COST       TIME   HR/UNIT     COST      TIME   HR/UNIT     COST        TIME   HR/UNIT        COST           TIME
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -           0.00%      -           -        0.00%      -         -       0.00%      -         -         0.00%      -            -            0.00%


TOTAL WAGES                                                            0.00           0.00      0.00                                  -                               -                            -                              -                               -
PERCENTAGE OF WAGES                                                                             0.0%                                 0.0%                            0.0%                         0.0%                           0.0%                            0.0%

TOTAL HOURS                                                                                                           -                                    -                              -                           -                              -
PERCENTAGE OF HOURS                                                                                                 0.0%                                 0.0%                           0.0%                        0.0%                           0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                                Page 12 of 37                                                                                                   2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:             (57)                             (58)                          (59)                          (60)                        (61)
                                                                                                                              Specialized Medical Equipment,
Form Revised December 2011, WCFAAA                                                 2%           Skilled Nursing Services           Services & Supplies              Speech Therapy            Telephone Reassurance           Transportation


                                                               CURRENT         PROPOSED PROPOSED                    WAGE      % OF                   WAGE       % OF                 WAGE    % OF              WAGE      % OF                  WAGE
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET   HR/UNIT           COST      TIME   HR/UNIT         COST       TIME   HR/UNIT       COST    TIME   HR/UNIT    COST      TIME   HR/UNIT        COST
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -
Employee Name         Position Description                          0.00            0.00     0.00      -               -       0.00%      -             -        0.00%      -           -     0.00%      -        -       0.00%      -            -


TOTAL WAGES                                                            0.00           0.00      0.00                    -                                 -                            -                           -                             -
PERCENTAGE OF WAGES                                                                             0.0%                   0.0%                              0.0%                         0.0%                        0.0%                          0.0%

TOTAL HOURS                                                                                                   -                                -                             -                            -                            -
PERCENTAGE OF HOURS                                                                                         0.0%                             0.0%                          0.0%                         0.0%                         0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                                 Page 13 of 37                                                                                                 2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.1. PERSONNEL ALLOCATIONS WORKSHEET (All Funding Sources)
BUDGET YEAR: January 1, 2012 through December 31, 2012
RECIPIENT NAME: Provider Agency Name, Inc

                                                                              % Increased by:
                                                                                                                                            Fundraising & Unallowable
Form Revised December 2011, WCFAAA                                                 2%                  Non-DOEA Services & Activities               Activities

                                                                                                                                                                          %'age
                                                               CURRENT         PROPOSED PROPOSED       % OF                   WAGE         % OF                 WAGE      Check
     STAFF               POSITION DESCRIPTION                   WAGES          INCREASE  BUDGET        TIME   HR/UNIT         COST         TIME   HR/UNIT       COST      Total
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%
Employee Name         Position Description                          0.00            0.00     0.00       0.00%      -             -          0.00%      -           -       0.00%


TOTAL WAGES                                                            0.00           0.00      0.00                               -                                -      (0.00)
PERCENTAGE OF WAGES                                                                             0.0%                              0.0%                             0.0%     0.0%

TOTAL HOURS                                                                                                           -                                   -                (0.00)
PERCENTAGE OF HOURS                                                                                                 0.0%                                0.0%                0.0%




          0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.1. Personnel Allocations )                                                Page 14 of 37                               2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.2. UNIT COST WORKSHEET (All Funding Sources)
 BUDGET YEAR: January 1, 2012 through December 31, 2012
 RECIPIENT NAME: Provider Agency Name, Inc
Form Revised December 2011, WCFAAA                                                                         (Service Reference)              (1)                (2)                  (3)                (4)                  (5)                (6)               (7)               (8)



                                                             Prior Year     Proposed      Proposed Management & Facilities &
                                                             Historical     Increase/      Budget    General Cost Maintenance                               Adult Day                               Caregiver                                 Case
                 LINE ITEM EXPENSES                            Costs        Decrease       Totals       Pool       Cost Pool  Adult Day Care               Health Care         Basic Subsidy Training/Support           Case Aid           Management Child Day Care             Chore
Wages                                                               0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Fringe                                                              0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Travel                                                              0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Education/Training                                                  0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Communications & Postage                                            0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Utilities                                                           0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Printing & Supplies                                                 0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Advertising                                                         0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Insurance                                                           0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Maintenance & Repair                                                0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Space Costs                                                         0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Equipment                                                           0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Professional Fees/Legal/Audit                                       0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Sub-contractors #1                                                  0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Sub-contractors #2                                                  0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Sub-contractors #3                                                  0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Sub-contractors #4                                                  0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Sub-contractors #5                                                  0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Program Supplies                                                    0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Depreciation                                                        0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Food & Food Supplies                                                0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
Other                                                               0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
In-Kind Space                                                       0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
In-Kind Supplies                                                    0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
In-Kind Volunteers                                                  0.00      0.00%             0.00          -            -             -                          -                    -               -                     -                   -             -                         -
TOTAL ALLOWABLE COSTS                                               0.00                        0.00          -            -             -                          -                    -               -                     -                   -             -                         -

Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,000/per contract)                                                    -                   -                    -                 -                    -                   -                 -                 -
Service Subcontract Adjustment                                                                                                                     -                   -                    -                 -                    -                   -                 -                 -

Reallocate Management & General Costs                                                                    #DIV/0!                         #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!
Total Modified Direct Costs                                                                                                                        -                   -                    -                 -                    -                   -                 -                 -

Reallocate Facilities & Maintenance (Space) costs                                                                                -                 -                   -                    -                 -                    -                   -                 -                 -
Square Footage Occupied                                         0.00                                               -                                   -                   -                    -                 -                    -                   -                 -                 -

TOTAL COSTS BY SERVICE                                                                                                                   #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!
Budgeted In-Kind Valuation                                                                                                                         -                   -                    -                 -                    -                   -                 -                 -
Total Costs Less In-Kind by Service                                                                                                      #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!

Number of Billing Units (estimated)                                                                                                                    -                   -                    -                 -                    -                   -                 -                 -

UNIT COST (Actual Cost)                                                                                                                  #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!
LESS IN-KIND SUPPORT per unit                                                                                                            #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!
UNIT RATE (Actual Cost LESS In-Kind Support)                                                                                             #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!
         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                                             Page 15 of 37                                                                                                                     2/17/2012, 1:33 PM

ADDITIONAL SUBCONTRACTOR INFORMATION                             Contract     Unit Cost      Ttl Units                               Subcontr Units Subcontr Units Subcontr Units Subcontr Units                      Subcontr Units Subcontr Units Subcontr Units Subcontr Units
Sub-contractors #1:                                                 0.00     #DIV/0!   0            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!
Sub-contractors #2:                                                 0.00     #DIV/0!   0            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!
Sub-contractors #3:                                                 0.00     #DIV/0!   0            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!
Sub-contractors #4:                                                 0.00     #DIV/0!   0            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!
Sub-contractors #5:                                                 0.00     #DIV/0!   0            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!

TOTAL UNIT ANALYSIS INFORMATION
Units from Personnel Alloc. Worksheet (Direct Staff)                                                          N/A             N/A             N/A             N/A             -             -    N/A                      0
Subcontract Units                                                                                                                                                   #DIV/0!       #DIV/0!                       #DIV/0!
Direct Staff Units plus Subcontract Units                                                                                                                           #DIV/0!       #DIV/0!                       #DIV/0!
Checkpoint for Estimated Billing Units                                                                                                                              #DIV/0!       #DIV/0!                       #DIV/0!
DIF %                                                                                                                                                               #DIV/0!       #DIV/0!                       #DIV/0!




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)       Page 16 of 37                                                                                            2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.2. UNIT COST WORKSHEET (All Funding Sources)
 BUDGET YEAR: January 1, 2012 through December 31, 2012
 RECIPIENT NAME: Provider Agency Name, Inc
Form Revised December 2011, WCFAAA                                                                         (9)                  (10)                (11)                  (12)              (13)                   (14)                 (15)                   (16)                  (17)               (18)



                                                             Prior Year     Proposed      Proposed                                                                    Congregate                       Counseling                                                               Emergency
                                                             Historical     Increase/      Budget        Chore                                  Congregate              Meals         Counseling          (Mental                     Disease                                     Alert
                 LINE ITEM EXPENSES                            Costs        Decrease       Totals      (Enhanced)          Companionship         Meals C1           (Screening) C1 (Gereontological) Health/Screening)              Information         Education/Training      Response            Escort
Wages                                                               0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Fringe                                                              0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Travel                                                              0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Education/Training                                                  0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Communications & Postage                                            0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Utilities                                                           0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Printing & Supplies                                                 0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Advertising                                                         0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Insurance                                                           0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Maintenance & Repair                                                0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Space Costs                                                         0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Equipment                                                           0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Professional Fees/Legal/Audit                                       0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Sub-contractors #1                                                  0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Sub-contractors #2                                                  0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Sub-contractors #3                                                  0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Sub-contractors #4                                                  0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Sub-contractors #5                                                  0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Program Supplies                                                    0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Depreciation                                                        0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Food & Food Supplies                                                0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
Other                                                               0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
In-Kind Space                                                       0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
In-Kind Supplies                                                    0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
In-Kind Volunteers                                                  0.00      0.00%             0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -
TOTAL ALLOWABLE COSTS                                               0.00                        0.00           -                        -               -                     -                 -                 -                          -                         -                -                      -

Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,000/per contract)                    -                    -                   -                     -                 -                      -                    -                      -                    -                  -
Service Subcontract Adjustment                                                                                     -                    -                   -                     -                 -                      -                    -                      -                    -                  -

Reallocate Management & General Costs                                                                    #DIV/0!              #DIV/0!             #DIV/0!               #DIV/0!           #DIV/0!                #DIV/0!              #DIV/0!                #DIV/0!              #DIV/0!           #DIV/0!
Total Modified Direct Costs                                                                                        -                    -                   -                     -                 -                      -                    -                      -                    -                  -

Reallocate Facilities & Maintenance (Space) costs                                                                  -                    -                   -                     -                 -                      -                    -                      -                    -                  -
Square Footage Occupied                                         0.00                                                   -                    -                   -                     -                 -                      -                    -                      -                    -                  -

TOTAL COSTS BY SERVICE                                                                                   #DIV/0!              #DIV/0!             #DIV/0!               #DIV/0!           #DIV/0!                #DIV/0!              #DIV/0!                #DIV/0!              #DIV/0!           #DIV/0!
Budgeted In-Kind Valuation                                                                                         -                    -                   -                     -                 -                      -                    -                      -                    -                  -
Total Costs Less In-Kind by Service                                                                      #DIV/0!              #DIV/0!             #DIV/0!               #DIV/0!           #DIV/0!                #DIV/0!              #DIV/0!                #DIV/0!              #DIV/0!           #DIV/0!

Number of Billing Units (estimated)                                                                                    -                    -                   -                     -                 -                      -                    -                      -                    -                  -

UNIT COST (Actual Cost)                                                                                  #DIV/0!              #DIV/0!             #DIV/0!               #DIV/0!           #DIV/0!                #DIV/0!              #DIV/0!                #DIV/0!              #DIV/0!           #DIV/0!
LESS IN-KIND SUPPORT per unit                                                                            #DIV/0!              #DIV/0!             #DIV/0!               #DIV/0!           #DIV/0!                #DIV/0!              #DIV/0!                #DIV/0!              #DIV/0!           #DIV/0!
UNIT RATE (Actual Cost LESS In-Kind Support)                                                             #DIV/0!              #DIV/0!             #DIV/0!               #DIV/0!           #DIV/0!                #DIV/0!              #DIV/0!                #DIV/0!              #DIV/0!           #DIV/0!
         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                                                    Page 17 of 37                                                                                                                              2/17/2012, 1:33 PM

ADDITIONAL SUBCONTRACTOR INFORMATION                             Contract     Unit Cost      Ttl Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units                           Subcontr Units         Subcontr Units Subcontr Units               Subcontr Units Subcontr Units
Sub-contractors #1:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!
Sub-contractors #2:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!
Sub-contractors #3:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!
Sub-contractors #4:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!
Sub-contractors #5:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!

TOTAL UNIT ANALYSIS INFORMATION
Units from Personnel Alloc. Worksheet (Direct Staff)                                                 0               0                0    N/A       N/A       N/A       N/A       N/A                0          N/A
Subcontract Units                                                                          #DIV/0!       #DIV/0!            #DIV/0!                                                         #DIV/0!
Direct Staff Units plus Subcontract Units                                                  #DIV/0!       #DIV/0!            #DIV/0!                                                         #DIV/0!
Checkpoint for Estimated Billing Units                                                     #DIV/0!       #DIV/0!            #DIV/0!                                                         #DIV/0!
DIF %                                                                                      #DIV/0!       #DIV/0!            #DIV/0!                                                         #DIV/0!




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                               Page 18 of 37                                                            2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.2. UNIT COST WORKSHEET (All Funding Sources)
 BUDGET YEAR: January 1, 2012 through December 31, 2012
 RECIPIENT NAME: Provider Agency Name, Inc
Form Revised December 2011, WCFAAA                                                                         (19)              (20)               (21)                (22)                (23)                 (24)              (25)               (26)                (27)                (28)

                                                                                                                                                                                                                          Home &
                                                             Prior Year     Proposed      Proposed Financial Risk Financial Risk                                                                                        Community               Home
                                                             Historical     Increase/      Budget      Reduction    Reduction                  Health           Health Risk         Health Risk                          Disaster              Delivered          Home Health         Home Injury
                 LINE ITEM EXPENSES                            Costs        Decrease       Totals    (Assessment) (Maintenance)              Promotion          Assessment          Screening           Health Support Preparedness            Meals C2            Aid Service          Control
Wages                                                               0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Fringe                                                              0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Travel                                                              0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Education/Training                                                  0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Communications & Postage                                            0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Utilities                                                           0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Printing & Supplies                                                 0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Advertising                                                         0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Insurance                                                           0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Maintenance & Repair                                                0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Space Costs                                                         0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Equipment                                                           0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Professional Fees/Legal/Audit                                       0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Sub-contractors #1                                                  0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Sub-contractors #2                                                  0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Sub-contractors #3                                                  0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Sub-contractors #4                                                  0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Sub-contractors #5                                                  0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Program Supplies                                                    0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Depreciation                                                        0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Food & Food Supplies                                                0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
Other                                                               0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
In-Kind Space                                                       0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
In-Kind Supplies                                                    0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
In-Kind Volunteers                                                  0.00      0.00%             0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -
TOTAL ALLOWABLE COSTS                                               0.00                        0.00           -             -                        -                  -                   -                    -             -                      -                    -                  -

Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,000/per contract)                    -                 -                  -                   -                   -                    -                 -                  -                   -                   -
Service Subcontract Adjustment                                                                                     -                 -                  -                   -                   -                    -                 -                  -                   -                   -

Reallocate Management & General Costs                                                                    #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!
Total Modified Direct Costs                                                                                        -                 -                  -                   -                   -                    -                 -                  -                   -                   -

Reallocate Facilities & Maintenance (Space) costs                                                                  -                 -                  -                   -                   -                    -                 -                  -                   -                   -
Square Footage Occupied                                         0.00                                                   -                 -                  -                   -                   -                    -                 -                  -                   -                   -

TOTAL COSTS BY SERVICE                                                                                   #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!
Budgeted In-Kind Valuation                                                                                         -                 -                  -                   -                   -                    -                 -                  -                   -                   -
Total Costs Less In-Kind by Service                                                                      #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!

Number of Billing Units (estimated)                                                                                    -                 -                  -                   -                   -                    -                 -                  -                   -                   -

UNIT COST (Actual Cost)                                                                                  #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!
LESS IN-KIND SUPPORT per unit                                                                            #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!
UNIT RATE (Actual Cost LESS In-Kind Support)                                                             #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!           #DIV/0!            #DIV/0!             #DIV/0!             #DIV/0!
         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                                                 Page 19 of 37                                                                                                                           2/17/2012, 1:33 PM

ADDITIONAL SUBCONTRACTOR INFORMATION                             Contract     Unit Cost      Ttl Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units
Sub-contractors #1:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!       #DIV/0!           #DIV/0!
Sub-contractors #2:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!       #DIV/0!           #DIV/0!
Sub-contractors #3:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!       #DIV/0!           #DIV/0!
Sub-contractors #4:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!       #DIV/0!           #DIV/0!
Sub-contractors #5:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!       #DIV/0!           #DIV/0!

TOTAL UNIT ANALYSIS INFORMATION
Units from Personnel Alloc. Worksheet (Direct Staff)                                        N/A       N/A                 N/A      N/A       N/A                0    N/A                0    N/A                N/A
Subcontract Units                                                                                                                                     #DIV/0!                 #DIV/0!
Direct Staff Units plus Subcontract Units                                                                                                             #DIV/0!                 #DIV/0!
Checkpoint for Estimated Billing Units                                                                                                                #DIV/0!                 #DIV/0!
DIF %                                                                                                                                                 #DIV/0!                 #DIV/0!




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                           Page 20 of 37                                                                       2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.2. UNIT COST WORKSHEET (All Funding Sources)
 BUDGET YEAR: January 1, 2012 through December 31, 2012
 RECIPIENT NAME: Provider Agency Name, Inc
Form Revised December 2011, WCFAAA                                                                         (29)                (30)                (31)               (32)                (33)              (34)                (35)                (36)               (37)                 (38)



                                                             Prior Year     Proposed      Proposed
                                                             Historical     Increase/      Budget                            Housing                                                  Interpreter/T        Legal                                 Medication         Model Day            Nutrition
                 LINE ITEM EXPENSES                            Costs        Decrease       Totals      Homemaker           Improvement         Information         Intake C2           ranslating        Assistance         Material Aid        Management            Care              Counseling
Wages                                                               0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Fringe                                                              0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Travel                                                              0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Education/Training                                                  0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Communications & Postage                                            0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Utilities                                                           0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Printing & Supplies                                                 0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Advertising                                                         0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Insurance                                                           0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Maintenance & Repair                                                0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Space Costs                                                         0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Equipment                                                           0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Professional Fees/Legal/Audit                                       0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Sub-contractors #1                                                  0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Sub-contractors #2                                                  0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Sub-contractors #3                                                  0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Sub-contractors #4                                                  0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Sub-contractors #5                                                  0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Program Supplies                                                    0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Depreciation                                                        0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Food & Food Supplies                                                0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
Other                                                               0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
In-Kind Space                                                       0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
In-Kind Supplies                                                    0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
In-Kind Volunteers                                                  0.00      0.00%             0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -
TOTAL ALLOWABLE COSTS                                               0.00                        0.00          -                     -                   -                  -                     -               -                    -                   -                 -                    -

Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,000/per contract)                    -                   -                   -                  -                  -                  -                   -                   -                  -                    -
Service Subcontract Adjustment                                                                                     -                   -                   -                  -                  -                  -                   -                   -                  -                    -

Reallocate Management & General Costs                                                                    #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!             #DIV/0!           #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!              #DIV/0!
Total Modified Direct Costs                                                                                        -                   -                   -                  -              -                      -                   -                   -                  -                    -

Reallocate Facilities & Maintenance (Space) costs                                                                  -                   -                   -                  -                  -                  -                   -                   -                  -                    -
Square Footage Occupied                                         0.00                                                   -                   -                   -                  -                  -                  -                   -                   -                  -                    -

TOTAL COSTS BY SERVICE                                                                                   #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!             #DIV/0!           #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!              #DIV/0!
Budgeted In-Kind Valuation                                                                                         -                   -                   -                  -              -                      -                   -                   -                  -                    -
Total Costs Less In-Kind by Service                                                                      #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!             #DIV/0!           #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!              #DIV/0!

Number of Billing Units (estimated)                                                                                    -                   -                   -                  -                  -                  -                   -                   -                  -                    -

UNIT COST (Actual Cost)                                                                                  #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!             #DIV/0!           #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!              #DIV/0!
LESS IN-KIND SUPPORT per unit                                                                            #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!             #DIV/0!           #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!              #DIV/0!
UNIT RATE (Actual Cost LESS In-Kind Support)                                                             #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!             #DIV/0!           #DIV/0!             #DIV/0!             #DIV/0!            #DIV/0!              #DIV/0!
         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                                                   Page 21 of 37                                                                                                                               2/17/2012, 1:33 PM

ADDITIONAL SUBCONTRACTOR INFORMATION                             Contract     Unit Cost                                                                                        Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units
                                                                                             Ttl Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units
Sub-contractors #1:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!
Sub-contractors #2:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!
Sub-contractors #3:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!
Sub-contractors #4:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!
Sub-contractors #5:                                                 0.00     #DIV/0!   0   #DIV/0!       #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!          #DIV/0!

TOTAL UNIT ANALYSIS INFORMATION
Units from Personnel Alloc. Worksheet (Direct Staff)                                                 0               0        N/A      N/A       N/A                0    N/A       N/A       N/A                           0
Subcontract Units                                                                          #DIV/0!       #DIV/0!                                          #DIV/0!                                            #DIV/0!
Direct Staff Units plus Subcontract Units                                                  #DIV/0!       #DIV/0!                                          #DIV/0!                                            #DIV/0!
Checkpoint for Estimated Billing Units                                                     #DIV/0!       #DIV/0!                                          #DIV/0!                                            #DIV/0!
DIF %                                                                                      #DIV/0!       #DIV/0!                                          #DIV/0!                                            #DIV/0!




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                               Page 22 of 37                                                                      2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.2. UNIT COST WORKSHEET (All Funding Sources)
 BUDGET YEAR: January 1, 2012 through December 31, 2012
 RECIPIENT NAME: Provider Agency Name, Inc
Form Revised December 2011, WCFAAA                                                                         (39)                (40)               (41)             (42)                 (43)                 (44)                (45)                (46)                (47)                (48)



                                                             Prior Year     Proposed      Proposed                                                                                                      Pest Control
                                                             Historical     Increase/      Budget      Nutrition           Occupational                                                                  (Enhanced          Pest Control         Pest Control        Pest Control         Physical
                 LINE ITEM EXPENSES                            Costs        Decrease       Totals      Education             Therapy            Other            Outreach          Personal Care          Initiation)        (Initiation)       (Maintenance)         (Rodent)            Fitness
Wages                                                               0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Fringe                                                              0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Travel                                                              0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Education/Training                                                  0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Communications & Postage                                            0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Utilities                                                           0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Printing & Supplies                                                 0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Advertising                                                         0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Insurance                                                           0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Maintenance & Repair                                                0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Space Costs                                                         0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Equipment                                                           0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Professional Fees/Legal/Audit                                       0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Sub-contractors #1                                                  0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Sub-contractors #2                                                  0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Sub-contractors #3                                                  0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Sub-contractors #4                                                  0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Sub-contractors #5                                                  0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Program Supplies                                                    0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Depreciation                                                        0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Food & Food Supplies                                                0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
Other                                                               0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
In-Kind Space                                                       0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
In-Kind Supplies                                                    0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
In-Kind Volunteers                                                  0.00      0.00%             0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -
TOTAL ALLOWABLE COSTS                                               0.00                        0.00           -                    -                    -              -                    -                      -                  -                  -                   -                   -

Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,000/per contract)                    -                   -                 -                 -                    -                   -                   -                    -                   -                   -
Service Subcontract Adjustment                                                                                     -                   -                 -                 -                    -                   -                   -                    -                   -                   -

Reallocate Management & General Costs                                                                    #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!
Total Modified Direct Costs                                                                                        -                   -                 -                 -                    -                   -                   -                    -                   -                   -

Reallocate Facilities & Maintenance (Space) costs                                                                  -                   -                 -                 -                    -                   -                   -                    -                   -                   -
Square Footage Occupied                                         0.00                                                   -                   -                 -                 -                    -                   -                   -                    -                   -                   -

TOTAL COSTS BY SERVICE                                                                                   #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!
Budgeted In-Kind Valuation                                                                                         -                   -                 -                 -                    -                   -                   -                    -                   -                   -
Total Costs Less In-Kind by Service                                                                      #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!

Number of Billing Units (estimated)                                                                                    -                   -                 -                 -                    -                   -                   -                    -                   -                   -

UNIT COST (Actual Cost)                                                                                  #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!
LESS IN-KIND SUPPORT per unit                                                                            #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!
UNIT RATE (Actual Cost LESS In-Kind Support)                                                             #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!              #DIV/0!             #DIV/0!             #DIV/0!
         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                                                   Page 23 of 37                                                                                                                            2/17/2012, 1:33 PM

ADDITIONAL SUBCONTRACTOR INFORMATION                             Contract     Unit Cost      Ttl Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units Subcontr Units
Sub-contractors #1:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!           #DIV/0!
Sub-contractors #2:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!           #DIV/0!
Sub-contractors #3:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!           #DIV/0!
Sub-contractors #4:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!           #DIV/0!
Sub-contractors #5:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!           #DIV/0!

TOTAL UNIT ANALYSIS INFORMATION
Units from Personnel Alloc. Worksheet (Direct Staff)                                        N/A       N/A                 N/A      N/A                0    N/A       N/A       N/A       N/A                N/A
Subcontract Units                                                                                                                           #DIV/0!
Direct Staff Units plus Subcontract Units                                                                                                   #DIV/0!
Checkpoint for Estimated Billing Units                                                                                                      #DIV/0!
DIF %                                                                                                                                       #DIV/0!




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                           Page 24 of 37                                                                   2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.2. UNIT COST WORKSHEET (All Funding Sources)
 BUDGET YEAR: January 1, 2012 through December 31, 2012
 RECIPIENT NAME: Provider Agency Name, Inc
Form Revised December 2011, WCFAAA                                                                         (49)               (50)                (51)              (52)               (53)                (54)              (55)              (56)               (57)                  (58)
                                                                                                                                                                                                                                                                                   Specialized
                                                                                                                                                                                                                                                                                    Medical
                                                             Prior Year     Proposed      Proposed                                                               Respite                               Screening/A                                              Skilled            Equipment,
                                                             Historical     Increase/      Budget       Physical                              Referral/As        (Facility         Respite (In-        ssessment           Shopping                            Nursing             Services &
                 LINE ITEM EXPENSES                            Costs        Decrease       Totals       Therapy            Recreation          sistance           Based)             Home)                 C2             Assistance         Sitter            Services             Supplies
Wages                                                               0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Fringe                                                              0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Travel                                                              0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Education/Training                                                  0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Communications & Postage                                            0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Utilities                                                           0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Printing & Supplies                                                 0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Advertising                                                         0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Insurance                                                           0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Maintenance & Repair                                                0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Space Costs                                                         0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Equipment                                                           0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Professional Fees/Legal/Audit                                       0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Sub-contractors #1                                                  0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Sub-contractors #2                                                  0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Sub-contractors #3                                                  0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Sub-contractors #4                                                  0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Sub-contractors #5                                                  0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Program Supplies                                                    0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Depreciation                                                        0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Food & Food Supplies                                                0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
Other                                                               0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
In-Kind Space                                                       0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
In-Kind Supplies                                                    0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
In-Kind Volunteers                                                  0.00      0.00%             0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -
TOTAL ALLOWABLE COSTS                                               0.00                        0.00           -                    -                -                    -                  -                 -                  -                    -                -                   -

Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,000/per contract)                    -                  -                  -                 -                   -                  -                  -                 -                 -                      -
Service Subcontract Adjustment                                                                                     -                  -                  -                 -                   -                  -                  -                 -                 -                      -

Reallocate Management & General Costs                                                                    #DIV/0!            #DIV/0!             #DIV/0!          #DIV/0!             #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!           #DIV/0!                #DIV/0!
Total Modified Direct Costs                                                                                        -                  -              -                     -                   -               -                     -                 -                 -                      -

Reallocate Facilities & Maintenance (Space) costs                                                                  -                  -                  -                 -                   -                  -                  -                 -                 -                      -
Square Footage Occupied                                         0.00                                                   -                  -                  -                 -                   -                  -                  -                 -                 -                      -

TOTAL COSTS BY SERVICE                                                                                   #DIV/0!            #DIV/0!             #DIV/0!          #DIV/0!             #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!           #DIV/0!                #DIV/0!
Budgeted In-Kind Valuation                                                                                         -                  -              -                     -                   -               -                     -                 -                 -                      -
Total Costs Less In-Kind by Service                                                                      #DIV/0!            #DIV/0!             #DIV/0!          #DIV/0!             #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!           #DIV/0!                #DIV/0!

Number of Billing Units (estimated)                                                                                    -                  -                  -                 -                   -                  -                  -                 -                 -                      -

UNIT COST (Actual Cost)                                                                                  #DIV/0!            #DIV/0!             #DIV/0!          #DIV/0!             #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!           #DIV/0!                #DIV/0!
LESS IN-KIND SUPPORT per unit                                                                            #DIV/0!            #DIV/0!             #DIV/0!          #DIV/0!             #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!           #DIV/0!                #DIV/0!
UNIT RATE (Actual Cost LESS In-Kind Support)                                                             #DIV/0!            #DIV/0!             #DIV/0!          #DIV/0!             #DIV/0!             #DIV/0!           #DIV/0!           #DIV/0!           #DIV/0!                #DIV/0!
         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                                                  Page 25 of 37                                                                                                                              2/17/2012, 1:33 PM

ADDITIONAL SUBCONTRACTOR INFORMATION                             Contract     Unit Cost                                                          Subcontr Units Subcontr Units Subcontr UnitsSubcontr Units Subcontr Units Subcontr Units Subcontr Units
                                                                                             Ttl Units Subcontr Units Subcontr Units Subcontr Units
Sub-contractors #1:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!          #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!        #DIV/0!
Sub-contractors #2:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!          #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!        #DIV/0!
Sub-contractors #3:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!          #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!        #DIV/0!
Sub-contractors #4:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!          #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!        #DIV/0!
Sub-contractors #5:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!          #DIV/0!   #DIV/0!   #DIV/0!       #DIV/0!       #DIV/0!   #DIV/0!   #DIV/0!        #DIV/0!

TOTAL UNIT ANALYSIS INFORMATION
Units from Personnel Alloc. Worksheet (Direct Staff)                                        N/A       N/A               N/A      N/A                0             0    N/A       N/A       N/A             N/A
Subcontract Units                                                                                                                         #DIV/0!       #DIV/0!
Direct Staff Units plus Subcontract Units                                                                                                 #DIV/0!       #DIV/0!
Checkpoint for Estimated Billing Units                                                                                                    #DIV/0!       #DIV/0!
DIF %                                                                                                                                     #DIV/0!       #DIV/0!




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                           Page 26 of 37                                                                        2/17/2012, 1:33 PM
FLORIDA DEPARTMENT OF ELDER AFFAIRS
SIMPLIFIED UNIT COST METHODOLOGY
II.B.2. UNIT COST WORKSHEET (All Funding Sources)
 BUDGET YEAR: January 1, 2012 through December 31, 2012
 RECIPIENT NAME: Provider Agency Name, Inc
Form Revised December 2011, WCFAAA                                                                         (59)                (60)                 (61)                          (62)               (63)

                                                                                                                                                                                                 Fundraising
                                                             Prior Year     Proposed      Proposed                                                                    Total   Non-DOEA                &
                                                             Historical     Increase/      Budget        Speech             Telephone                               Program   Services &         Unallowable         Check for
                 LINE ITEM EXPENSES                            Costs        Decrease       Totals        Therapy           Reassurance         Transportation        Costs     Activities         Activities        Total Costs
Wages                                                               0.00      0.00%             0.00            -                   -                       -            -              -                  -              0.00
Fringe                                                              0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Travel                                                              0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Education/Training                                                  0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Communications & Postage                                            0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Utilities                                                           0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Printing & Supplies                                                 0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Advertising                                                         0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Insurance                                                           0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Maintenance & Repair                                                0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Space Costs                                                         0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Equipment                                                           0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Professional Fees/Legal/Audit                                       0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Sub-contractors #1                                                  0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Sub-contractors #2                                                  0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Sub-contractors #3                                                  0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Sub-contractors #4                                                  0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Sub-contractors #5                                                  0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Program Supplies                                                    0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Depreciation                                                        0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Food & Food Supplies                                                0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
Other                                                               0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
In-Kind Space                                                       0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
In-Kind Supplies                                                    0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
In-Kind Volunteers                                                  0.00      0.00%             0.00            -                   -                       -            -              -                  -               -
TOTAL ALLOWABLE COSTS                                               0.00                        0.00            -                   -                       -            -              -                  -              0.00

Service Subcontract Allowance (input subcont. amount if <$25,000 or up to $25,000/per contract)                    -                   -                    -                            -                  -
Service Subcontract Adjustment                                                                                     -                   -                    -                            -                  -

Reallocate Management & General Costs                                                                    #DIV/0!             #DIV/0!              #DIV/0!                      #DIV/0!             #DIV/0!           #DIV/0!
Total Modified Direct Costs                                                                                        -                   -                    -                        -                   -

Reallocate Facilities & Maintenance (Space) costs                                                                  -                   -                    -                            -                  -              -
Square Footage Occupied                                         0.00                                                   -                   -                    -                            -                  -               -

TOTAL COSTS BY SERVICE                                                                                   #DIV/0!             #DIV/0!              #DIV/0!                      #DIV/0!             #DIV/0!            #DIV/0!
Budgeted In-Kind Valuation                                                                                         -                   -                    -                        -                   -                 -
Total Costs Less In-Kind by Service                                                                      #DIV/0!             #DIV/0!              #DIV/0!                      #DIV/0!             #DIV/0!            #DIV/0!
                                                                                                                                                                                                                    $      -
Number of Billing Units (estimated)                                                                                    -                   -                    -                 n/a                n/a

UNIT COST (Actual Cost)                                                                                  #DIV/0!             #DIV/0!              #DIV/0!                         n/a                n/a
LESS IN-KIND SUPPORT per unit                                                                            #DIV/0!             #DIV/0!              #DIV/0!
UNIT RATE (Actual Cost LESS In-Kind Support)                                                             #DIV/0!             #DIV/0!              #DIV/0!                         n/a                n/a
         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                                                   Page 27 of 37                                                                                2/17/2012, 1:33 PM

ADDITIONAL SUBCONTRACTOR INFORMATION                             Contract     Unit Cost      Ttl Units Subcontr Units Subcontr Units Subcontr Units
Sub-contractors #1:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!
Sub-contractors #2:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!
Sub-contractors #3:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!
Sub-contractors #4:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!
Sub-contractors #5:                                                 0.00     #DIV/0!   0   #DIV/0!   #DIV/0!            #DIV/0!   #DIV/0!

TOTAL UNIT ANALYSIS INFORMATION
Units from Personnel Alloc. Worksheet (Direct Staff)                                        N/A       N/A                 N/A
Subcontract Units                                                                                                                 #DIV/0!
Direct Staff Units plus Subcontract Units
Checkpoint for Estimated Billing Units
DIF %




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.2. Unit Cost Worksheet)                           Page 28 of 37                2/17/2012, 1:33 PM
West Central Florida Area Agency on Aging - PSA 6                                  II.B.3. SUPPORTING BUDGET SCHEDULE BY PROGRAM ACTIVITY
County Name:
Period: January 1, 2012 through December 31, 2012
Provider Agency Name:                                                              Funding Source                                  Funding Source
                                                                                                                         Funding Source
                                                                                         ( ) Title III B                          ( ) ADI
ORIGINAL DATE:                                                                           ( ) Title III C1                         ( ) CCE
REVISED DATE:                                                                            ( ) Title III C2                         ( ) HCE
REVISION NUMBER:                                                                         ( ) Title III D                          ( ) LSP
                                                                                         ( ) Title III E                          ( ) MW
                                                                                         ( ) NSIP                                 ( ) Other
                                                                                         ( ) Other

Form Revised December 2011, WCFAAA                           (Service Reference)       (1)          (2)            (3)          (4)            (5)          (6)            (7)          (8)             (9)            (10)



                                                                                                                Caregiver
                                                                 TOTAL             Adult Day Adult Day   Basic Training/S             Case    Child Day                                              Chore    Compani
                     DESCRIPTION                                SERVICES             Care   Health Care Subsidy  upport   Case Aid Management   Care                                  Chore        (Enhanced) onship
1. Total Budgeted Cash Costs                                     #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!  #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!                                #DIV/0!        #DIV/0!   #DIV/0!
1. (a) Add Inkind Cost                                           #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!  #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!                                #DIV/0!        #DIV/0!   #DIV/0!
1. (b) Total Budgeted Costs                                      #DIV/0!            #DIV/0!   #DIV/0!   #DIV/0!  #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!                                #DIV/0!        #DIV/0!   #DIV/0!

2. Total Budgeted Units                                              0                 0            0              0            0              0            0              0            0                0              0

2.(a) Total Cost Per Unit of Service                                n/a             #DIV/0!       #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!         #DIV/0!

3. Less NSIP                                                                0.00           0.00           0.00         0.00           0.00         0.00           0.00         0.00         0.00              0.00          0.00

4. Less Cash Match                                                          0.00           0.00           0.00         0.00           0.00         0.00           0.00         0.00         0.00              0.00          0.00

5. Less Inkind Match                                              #DIV/0!           #DIV/0!       #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!         #DIV/0!

6. Less Co-Pay Used as Match                                                0.00           0.00           0.00         0.00           0.00         0.00           0.00         0.00         0.00              0.00          0.00

   Sub-Total Match:                                               #DIV/0!           #DIV/0!       #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!         #DIV/0!

7. Less Program Income                                                      0.00           0.00           0.00         0.00           0.00         0.00           0.00         0.00         0.00              0.00          0.00

7.(a) Less Co-Pay Not Used as Match                                         0.00           0.00           0.00         0.00           0.00         0.00           0.00         0.00         0.00              0.00          0.00

8. Less Other Non-Matching Cash                                             0.00           0.00           0.00         0.00           0.00         0.00           0.00         0.00         0.00              0.00          0.00

9. Adjusted Budgeted Costs                                        #DIV/0!           #DIV/0!       #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!         #DIV/0!

10. Adjusted Cost Per Unit of Service                               n/a             #DIV/0!       #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!      #DIV/0!        #DIV/0!         #DIV/0!


11. Estimated Number of UNDUPLICATED Clients                         0                 0            0              0            0              0            0              0            0                0              0




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.3. Support Bud by Prog Act)          Page 29 of 37                                                                               2/17/2012, 1:33 PM
West Central Florida Area Agency on Aging - PSA 6
County Name:
Period: January 1, 2012 through December 31, 2012
Provider Agency Name:

ORIGINAL DATE:
REVISED DATE:
REVISION NUMBER:




Form Revised December 2011, WCFAAA                           (Service Reference)       (11)                (12)            (13)            (14)            (15)            (16)            (17)            (18)

                                                                                                                           Counseling
                                                                                               Congregate    Counseling      (Mental                        Emergency
                                                                 TOTAL             Congregate    Meals      (Gereontologi Health/Screen Disease Education/T   Alert
                     DESCRIPTION                                SERVICES            Meals C1 (Screening) C1      cal)          ing)    Information raining  Response                                     Escort
1. Total Budgeted Cash Costs                                     #DIV/0!             #DIV/0!     #DIV/0!       #DIV/0!       #DIV/0!      #DIV/0!  #DIV/0!   #DIV/0!                                     #DIV/0!
1. (a) Add Inkind Cost                                           #DIV/0!             #DIV/0!     #DIV/0!       #DIV/0!       #DIV/0!      #DIV/0!  #DIV/0!   #DIV/0!                                     #DIV/0!
1. (b) Total Budgeted Costs                                      #DIV/0!             #DIV/0!     #DIV/0!       #DIV/0!       #DIV/0!      #DIV/0!  #DIV/0!   #DIV/0!                                     #DIV/0!

2. Total Budgeted Units                                              0                  0                   0               0               0               0               0               0               0

2.(a) Total Cost Per Unit of Service                                n/a              #DIV/0!             #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!

3. Less NSIP                                                                0.00              0.00                0.00            0.00            0.00            0.00            0.00            0.00          0.00

4. Less Cash Match                                                          0.00              0.00                0.00            0.00            0.00            0.00            0.00            0.00          0.00

5. Less Inkind Match                                              #DIV/0!            #DIV/0!             #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!

6. Less Co-Pay Used as Match                                                0.00              0.00                0.00            0.00            0.00            0.00            0.00            0.00          0.00

   Sub-Total Match:                                               #DIV/0!            #DIV/0!             #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!

7. Less Program Income                                                      0.00              0.00                0.00            0.00            0.00            0.00            0.00            0.00          0.00

7.(a) Less Co-Pay Not Used as Match                                         0.00              0.00                0.00            0.00            0.00            0.00            0.00            0.00          0.00

8. Less Other Non-Matching Cash                                             0.00              0.00                0.00            0.00            0.00            0.00            0.00            0.00          0.00

9. Adjusted Budgeted Costs                                        #DIV/0!            #DIV/0!             #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!

10. Adjusted Cost Per Unit of Service                               n/a              #DIV/0!             #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!


11. Estimated Number of UNDUPLICATED Clients                         0                  0                   0               0               0               0               0               0               0




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.3. Support Bud by Prog Act)             Page 30 of 37                                                                       2/17/2012, 1:33 PM
West Central Florida Area Agency on Aging - PSA 6
County Name:
Period: January 1, 2012 through December 31, 2012
Provider Agency Name:

ORIGINAL DATE:
REVISED DATE:
REVISION NUMBER:




Form Revised December 2011, WCFAAA                           (Service Reference)       (19)              (20)              (21)          (22)            (23)            (24)             (25)             (26)

                                                                                     Financial                                                                                          Home &
                                                                                       Risk     Financial Risk                                                                        Community          Home
                                                                 TOTAL               Reduction    Reduction     Health  Health Risk Health Risk Health                                 Disaster         Delivered
                     DESCRIPTION                                SERVICES           (Assessment) (Maintenance) Promotion Assessment Screening Support                                 Preparedness       Meals C2
1. Total Budgeted Cash Costs                                     #DIV/0!              #DIV/0!      #DIV/0!      #DIV/0!   #DIV/0!     #DIV/0!   #DIV/0!                                 #DIV/0!          #DIV/0!
1. (a) Add Inkind Cost                                           #DIV/0!              #DIV/0!      #DIV/0!      #DIV/0!   #DIV/0!     #DIV/0!   #DIV/0!                                 #DIV/0!          #DIV/0!
1. (b) Total Budgeted Costs                                      #DIV/0!              #DIV/0!      #DIV/0!      #DIV/0!   #DIV/0!     #DIV/0!   #DIV/0!                                 #DIV/0!          #DIV/0!

2. Total Budgeted Units                                              0                     0              0                 0             0               0               0                0                0

2.(a) Total Cost Per Unit of Service                                n/a              #DIV/0!           #DIV/0!           #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!          #DIV/0!

3. Less NSIP                                                                0.00               0.00               0.00          0.00            0.00            0.00          0.00               0.00             0.00

4. Less Cash Match                                                          0.00               0.00               0.00          0.00            0.00            0.00          0.00               0.00             0.00

5. Less Inkind Match                                              #DIV/0!            #DIV/0!           #DIV/0!           #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!          #DIV/0!

6. Less Co-Pay Used as Match                                                0.00               0.00               0.00          0.00            0.00            0.00          0.00               0.00             0.00

   Sub-Total Match:                                               #DIV/0!            #DIV/0!           #DIV/0!           #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!          #DIV/0!

7. Less Program Income                                                      0.00               0.00               0.00          0.00            0.00            0.00          0.00               0.00             0.00

7.(a) Less Co-Pay Not Used as Match                                         0.00               0.00               0.00          0.00            0.00            0.00          0.00               0.00             0.00

8. Less Other Non-Matching Cash                                             0.00               0.00               0.00          0.00            0.00            0.00          0.00               0.00             0.00

9. Adjusted Budgeted Costs                                        #DIV/0!            #DIV/0!           #DIV/0!           #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!          #DIV/0!

10. Adjusted Cost Per Unit of Service                               n/a              #DIV/0!           #DIV/0!           #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!          #DIV/0!


11. Estimated Number of UNDUPLICATED Clients                         0                     0              0                 0             0               0               0                0                0




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.3. Support Bud by Prog Act)          Page 31 of 37                                                                           2/17/2012, 1:33 PM
West Central Florida Area Agency on Aging - PSA 6
County Name:
Period: January 1, 2012 through December 31, 2012
Provider Agency Name:

ORIGINAL DATE:
REVISED DATE:
REVISION NUMBER:




Form Revised December 2011, WCFAAA                           (Service Reference)      (27)             (28)              (29)            (30)            (31)             (32)              (33)              (34)



                                                                                     Home             Home
                                                                 TOTAL             Health Aid         Injury                     Housing                                                Interpreter/T  Legal
                     DESCRIPTION                                SERVICES            Service          Control         Homemaker Improvement Information                 Intake C2         ranslating Assistance
1. Total Budgeted Cash Costs                                     #DIV/0!            #DIV/0!          #DIV/0!           #DIV/0!    #DIV/0!     #DIV/0!                   #DIV/0!            #DIV/0!    #DIV/0!
1. (a) Add Inkind Cost                                           #DIV/0!            #DIV/0!          #DIV/0!           #DIV/0!    #DIV/0!     #DIV/0!                   #DIV/0!            #DIV/0!    #DIV/0!
1. (b) Total Budgeted Costs                                      #DIV/0!            #DIV/0!          #DIV/0!           #DIV/0!    #DIV/0!     #DIV/0!                   #DIV/0!            #DIV/0!    #DIV/0!

2. Total Budgeted Units                                              0                 0                0                 0               0               0                0                 0                 0

2.(a) Total Cost Per Unit of Service                                n/a             #DIV/0!          #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!           #DIV/0!           #DIV/0!

3. Less NSIP                                                                0.00             0.00             0.00              0.00            0.00            0.00             0.00              0.00              0.00

4. Less Cash Match                                                          0.00             0.00             0.00              0.00            0.00            0.00             0.00              0.00              0.00

5. Less Inkind Match                                              #DIV/0!           #DIV/0!          #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!           #DIV/0!           #DIV/0!

6. Less Co-Pay Used as Match                                                0.00             0.00             0.00              0.00            0.00            0.00             0.00              0.00              0.00

   Sub-Total Match:                                               #DIV/0!           #DIV/0!          #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!           #DIV/0!           #DIV/0!

7. Less Program Income                                                      0.00             0.00             0.00              0.00            0.00            0.00             0.00              0.00              0.00

7.(a) Less Co-Pay Not Used as Match                                         0.00             0.00             0.00              0.00            0.00            0.00             0.00              0.00              0.00

8. Less Other Non-Matching Cash                                             0.00             0.00             0.00              0.00            0.00            0.00             0.00              0.00              0.00

9. Adjusted Budgeted Costs                                        #DIV/0!           #DIV/0!          #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!           #DIV/0!           #DIV/0!

10. Adjusted Cost Per Unit of Service                               n/a             #DIV/0!          #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!           #DIV/0!           #DIV/0!


11. Estimated Number of UNDUPLICATED Clients                         0                 0                0                 0               0               0                0                 0                 0




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.3. Support Bud by Prog Act)            Page 32 of 37                                                                                  2/17/2012, 1:33 PM
West Central Florida Area Agency on Aging - PSA 6
County Name:
Period: January 1, 2012 through December 31, 2012
Provider Agency Name:

ORIGINAL DATE:
REVISED DATE:
REVISION NUMBER:




Form Revised December 2011, WCFAAA                           (Service Reference)     (35)              (36)            (37)            (38)             (39)            (40)            (41)             (42)            (43)




                                                                 TOTAL             Material         Medication Model Day  Nutrition                  Nutrition Occupational                                            Personal
                     DESCRIPTION                                SERVICES            Aid            Management    Care    Counseling                  Education   Therapy               Other          Outreach           Care
1. Total Budgeted Cash Costs                                     #DIV/0!           #DIV/0!           #DIV/0!    #DIV/0!    #DIV/0!                    #DIV/0!    #DIV/0!              #DIV/0!          #DIV/0!          #DIV/0!
1. (a) Add Inkind Cost                                           #DIV/0!           #DIV/0!           #DIV/0!    #DIV/0!    #DIV/0!                    #DIV/0!    #DIV/0!              #DIV/0!          #DIV/0!          #DIV/0!
1. (b) Total Budgeted Costs                                      #DIV/0!           #DIV/0!           #DIV/0!    #DIV/0!    #DIV/0!                    #DIV/0!    #DIV/0!              #DIV/0!          #DIV/0!          #DIV/0!

2. Total Budgeted Units                                              0                0                 0               0               0                0               0               0                0               0

2.(a) Total Cost Per Unit of Service                                n/a            #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!

3. Less NSIP                                                                0.00            0.00              0.00            0.00            0.00             0.00            0.00            0.00             0.00            0.00

4. Less Cash Match                                                          0.00            0.00              0.00            0.00            0.00             0.00            0.00            0.00             0.00            0.00

5. Less Inkind Match                                              #DIV/0!          #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!

6. Less Co-Pay Used as Match                                                0.00            0.00              0.00            0.00            0.00             0.00            0.00            0.00             0.00            0.00

   Sub-Total Match:                                               #DIV/0!          #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!

7. Less Program Income                                                      0.00            0.00              0.00            0.00            0.00             0.00            0.00            0.00             0.00            0.00

7.(a) Less Co-Pay Not Used as Match                                         0.00            0.00              0.00            0.00            0.00             0.00            0.00            0.00             0.00            0.00

8. Less Other Non-Matching Cash                                             0.00            0.00              0.00            0.00            0.00             0.00            0.00            0.00             0.00            0.00

9. Adjusted Budgeted Costs                                        #DIV/0!          #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!

10. Adjusted Cost Per Unit of Service                               n/a            #DIV/0!           #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!


11. Estimated Number of UNDUPLICATED Clients                         0                0                 0               0               0                0               0               0                0               0




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.3. Support Bud by Prog Act)           Page 33 of 37                                                                             2/17/2012, 1:33 PM
West Central Florida Area Agency on Aging - PSA 6
County Name:
Period: January 1, 2012 through December 31, 2012
Provider Agency Name:

ORIGINAL DATE:
REVISED DATE:
REVISION NUMBER:




Form Revised December 2011, WCFAAA                           (Service Reference)       (44)               (45)            (46)            (47)            (48)            (49)             (50)            (51)            (52)



                                                                                   Pest Control                                           Pest                                                                           Respite
                                                                 TOTAL              (Enhanced Pest Control Pest Control                  Control        Physical        Physical                   Referral/As           (Facility
                     DESCRIPTION                                SERVICES             Initiation) (Initiation) (Maintenance)             (Rodent)        Fitness         Therapy         Recreation sistance               Based)
1. Total Budgeted Cash Costs                                     #DIV/0!               #DIV/0!     #DIV/0!       #DIV/0!                 #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!     #DIV/0!              #DIV/0!
1. (a) Add Inkind Cost                                           #DIV/0!               #DIV/0!     #DIV/0!       #DIV/0!                 #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!     #DIV/0!              #DIV/0!
1. (b) Total Budgeted Costs                                      #DIV/0!               #DIV/0!     #DIV/0!       #DIV/0!                 #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!     #DIV/0!              #DIV/0!

2. Total Budgeted Units                                              0                  0                  0               0               0               0               0                0               0               0

2.(a) Total Cost Per Unit of Service                                n/a              #DIV/0!            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!

3. Less NSIP                                                                0.00              0.00               0.00            0.00            0.00            0.00            0.00             0.00            0.00            0.00

4. Less Cash Match                                                          0.00              0.00               0.00            0.00            0.00            0.00            0.00             0.00            0.00            0.00

5. Less Inkind Match                                              #DIV/0!            #DIV/0!            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!

6. Less Co-Pay Used as Match                                                0.00              0.00               0.00            0.00            0.00            0.00            0.00             0.00            0.00            0.00

   Sub-Total Match:                                               #DIV/0!            #DIV/0!            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!

7. Less Program Income                                                      0.00              0.00               0.00            0.00            0.00            0.00            0.00             0.00            0.00            0.00

7.(a) Less Co-Pay Not Used as Match                                         0.00              0.00               0.00            0.00            0.00            0.00            0.00             0.00            0.00            0.00

8. Less Other Non-Matching Cash                                             0.00              0.00               0.00            0.00            0.00            0.00            0.00             0.00            0.00            0.00

9. Adjusted Budgeted Costs                                        #DIV/0!            #DIV/0!            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!

10. Adjusted Cost Per Unit of Service                               n/a              #DIV/0!            #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!         #DIV/0!          #DIV/0!         #DIV/0!         #DIV/0!


11. Estimated Number of UNDUPLICATED Clients                         0                  0                  0               0               0               0               0                0               0               0




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.3. Support Bud by Prog Act)             Page 34 of 37                                                                              2/17/2012, 1:33 PM
West Central Florida Area Agency on Aging - PSA 6
County Name:
Period: January 1, 2012 through December 31, 2012
Provider Agency Name:

ORIGINAL DATE:
REVISED DATE:
REVISION NUMBER:




Form Revised December 2011, WCFAAA                           (Service Reference)      (53)          (54)          (55)          (56)          (57)            (58)            (59)          (60)              (61)
                                                                                                                                                          Specialized
                                                                                                                                                           Medical
                                                                                             Screenin                                        Skilled      Equipment,
                                                                 TOTAL               Respite g/Assess Shopping                              Nursing       Services &        Speech   Telephone
                     DESCRIPTION                                SERVICES           (In-Home) ment C2 Assistance                Sitter       Services       Supplies         Therapy Reassurance Transportation
1. Total Budgeted Cash Costs                                     #DIV/0!             #DIV/0!  #DIV/0!  #DIV/0!                #DIV/0!        #DIV/0!        #DIV/0!         #DIV/0!   #DIV/0!       #DIV/0!
1. (a) Add Inkind Cost                                           #DIV/0!             #DIV/0!  #DIV/0!  #DIV/0!                #DIV/0!        #DIV/0!        #DIV/0!         #DIV/0!   #DIV/0!       #DIV/0!
1. (b) Total Budgeted Costs                                      #DIV/0!             #DIV/0!  #DIV/0!  #DIV/0!                #DIV/0!        #DIV/0!        #DIV/0!         #DIV/0!   #DIV/0!       #DIV/0!

2. Total Budgeted Units                                              0                 0             0             0             0             0               0               0             0                  0

2.(a) Total Cost Per Unit of Service                                n/a             #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!           #DIV/0!

3. Less NSIP                                                                0.00           0.00          0.00          0.00          0.00          0.00              0.00          0.00            0.00               0.00

4. Less Cash Match                                                          0.00           0.00          0.00          0.00          0.00          0.00              0.00          0.00            0.00               0.00

5. Less Inkind Match                                              #DIV/0!           #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!           #DIV/0!

6. Less Co-Pay Used as Match                                                0.00           0.00          0.00          0.00          0.00          0.00              0.00          0.00            0.00               0.00

   Sub-Total Match:                                               #DIV/0!           #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!           #DIV/0!

7. Less Program Income                                                      0.00           0.00          0.00          0.00          0.00          0.00              0.00          0.00            0.00               0.00

7.(a) Less Co-Pay Not Used as Match                                         0.00           0.00          0.00          0.00          0.00          0.00              0.00          0.00            0.00               0.00

8. Less Other Non-Matching Cash                                             0.00           0.00          0.00          0.00          0.00          0.00              0.00          0.00            0.00               0.00

9. Adjusted Budgeted Costs                                        #DIV/0!           #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!           #DIV/0!

10. Adjusted Cost Per Unit of Service                               n/a             #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!       #DIV/0!         #DIV/0!         #DIV/0!       #DIV/0!           #DIV/0!


11. Estimated Number of UNDUPLICATED Clients                         0                 0             0             0             0             0               0               0             0                  0




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.3. Support Bud by Prog Act)           Page 35 of 37                                                                                 2/17/2012, 1:33 PM
West Central Florida Area Agency on Aging - PSA 6                                  END
County Name:
Period: January 1, 2012 through December 31, 2012
Provider Agency Name:

ORIGINAL DATE:
REVISED DATE:
REVISION NUMBER:




Form Revised December 2011, WCFAAA                           (Service Reference)




                                                                 TOTAL
                     DESCRIPTION                                SERVICES
1. Total Budgeted Cash Costs                                     #DIV/0!
1. (a) Add Inkind Cost                                           #DIV/0!
1. (b) Total Budgeted Costs                                      #DIV/0!

2. Total Budgeted Units                                              0

2.(a) Total Cost Per Unit of Service                                n/a

3. Less NSIP                                                                0.00

4. Less Cash Match                                                          0.00

5. Less Inkind Match                                              #DIV/0!

6. Less Co-Pay Used as Match                                                0.00

   Sub-Total Match:                                               #DIV/0!

7. Less Program Income                                                      0.00

7.(a) Less Co-Pay Not Used as Match                                         0.00

8. Less Other Non-Matching Cash                                             0.00

9. Adjusted Budgeted Costs                                        #DIV/0!

10. Adjusted Cost Per Unit of Service                               n/a


11. Estimated Number of UNDUPLICATED Clients                         0




         0bbd4e90-634b-4e57-b95d-6062ccce9b3c.xlsx.xls (II.B.3. Support Bud by Prog Act)   Page 36 of 37   2/17/2012, 1:33 PM
       SERVICE DESCRIPTION

1    Adult Day Care
2    Adult Day Health Care
3    Basic Subsidy
4    Caregiver Training/Support
5    Case Aid
6    Case Management
7    Child Day Care
8    Chore
9    Chore (Enhanced)
10   Companionship
11   Congregate Meals C1
12   Congregate Meals (Screening) C1
13   Counseling (Gereontological)
14   Counseling (Mental Health/Screening)
15   Disease Information
16   Education/Training
17   Emergency Alert Response
18   Escort
19   Financial Risk Reduction (Assessment)
20   Financial Risk Reduction (Maintenance)
21   Health Promotion
22   Health Risk Assessment
23   Health Risk Screening
24   Health Support
25   Home & Community Disaster Preparedness
26   Home Delivered Meals C2
27   Home Health Aid Service
28   Home Injury Control
29   Homemaker
30   Housing Improvement
31   Information
32   Intake C2
33   Interpreter/Translating
34   Legal Assistance
35   Material Aid
36   Medication Management
37   Model Day Care
38   Nutrition Counseling
39   Nutrition Education
40   Occupational Therapy
41   Other
42   Outreach
43   Personal Care
44   Pest Control (Enhanced Initiation)
45   Pest Control (Initiation)
46   Pest Control (Maintenance)
47   Pest Control (Rodent)
48   Physical Fitness
49   Physical Therapy
50   Recreation
51   Referral/Assistance
52   Respite (Facility Based)
53   Respite (In-Home)
54   Screening/Assessment C2
55   Shopping Assistance
56   Sitter
57   Skilled Nursing Services
58   Specialized Medical Equipment, Services & Supplies
59   Speech Therapy
60   Telephone Reassurance
61   Transportation
62   Non-DOEA Services & Activities
63   Fundraising & Unallowable Activities


                                                          Revised July 18, 2003

				
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