HomeMy WebLinkAbout20011424.tiff RESOLUTION
RE: APPROVE 2001 ANNUAL AGING PLAN AND BUDGET AND AUTHORIZE CHAIR TO
SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with the 2001 Annual Aging Plan and
Budget from the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, Area Agency
on Aging, to the Colorado Department of Labor and Employment, commencing January 1,
2001, and ending December 31, 2001, with further terms and conditions being as stated in said
Plan and Budget, and
WHEREAS, after review, the Board deems it advisable to approve said Plan and
Budget, copies of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the 2001 Annual Aging Plan and Budget from the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Department of Human Services, Area Agency on Aging, to the Colorado
Department of Labor and Employment be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said Plan and Budget.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 30th day of May, A.D., 2001, nunc pro tunc January 1, 2001.
BOARD OF COUNTY COMMISSIONERS
WELD CNTY, COLORADO
ATTEST: g / �;? IEU\
w,, AT{dlfChir
Weld County Clerk to th ,,tiatn
) 41114,4 4=pia_ar
BY: Zdt, i.i moo. d ' Fi's4 s
Deputy Clerk to the Bo A.,. 4�I
Will H. Jerke�
AP OV D A FORM: •
vi E Lo
oudey
Robert D. Masden
2001-1424
CC ' /A5 HR0072
a
MEMORANDUM ' 65
41114 TO: M. J. Geile
WilDFROM: Walter Speckman, Executive Direct rh\
O Department of Human Services
DATE: May 16, 2001
COLORADO SUBJECT: Area Agency on Aging Final FY 2001 Annual
Plan
•
Enclosed for Board approval is the Area Agency on Aging Final FY 2001 Annual Plan and
Budget for Title III of the Older Americans Act in the amount of$399.072.
This budget supports several county run programs for older adults including the congregate meals
program, the long term care ombudsman program, the senior legal aide program, the food
supplement program, health promotion, and the following contracted services with local
agencies:
• Hispanic elderly outreach - contract with Catholic Charities for $23,650.
• Attorney Consultation for Senior Legal Aide Program - contract with Charles J.
Connell for $7,500.
• Home health care- contract with Rehabilitation and Visiting Nurses Association -
contract for $21,175.
• Adult Day Care - contract with Eldergarden, Inc. for $25,000.
• Home Delivered Meals - contract with Meals on Wheels of Weld County for $31,000
• Peer Counseling - contract with North Range Behavioral Health for $33,000.
You may address questions to Eva Jewell, Director of the Area Agency on Aging at extension
3331.
2001-1424
STATE OF COLORADO
2001 ANNUAL AGING PLAN & BUDGET
Grantee Organization Region: Zg
Original Plan
Revision#
•
Date: 67,96/o/
Area Agency on Aging: telee t' eozur�)ti,i( �y ,ice dry'
Grant Period: January 1, 2001 - Decem r 31, 2001 C
1. I( Executive Summary, attach a summary of any changes since the four-year
area plan.
2. The following forms must be attached:
l9' AAS 200, Title III Award Request
Gd' AAS 220, Area Agency Administration Budget
AAS 230, Service Delivery and Cost Projections
41/40 AAS 230A, Service Delivery and Cost Projections, Long Bill
'71(4❑ AAS 230B, Service Delivery and Cost Projections, 1079
l9' AAS 221, Signed Statement of Assurances
AAS 222, Certification of Maintenance of Effort Title III, Part E
3. The following form must be attached if there was a transfer of funds:
AAS 205, Request for Approval of Transfer
4. UV Evaluation of Targeting in CY 2000 AND Comparative Analysis.
5. Ern If applicable, attach a summary of and documentation for any proposed
equipment requests.
6. Advisory Council review of CY 2001 plan and budget was held on: '-/- /z-O/ .
Date
Comments (or attach minutes):
7. Reviewed (Signatures required):
!/a 7'Y) S= //- O/
Director, Area A nc on Aging Date
S// - 6/
Ex iv rector, Grantee Agency Date
I:\Winwrd\OAAFORMS\PLANS\area annual plan and budget\Signature Sheet for Annual Plan&Budget including
state funds.doc
Executive Summary
The 2001 Weld County Annual Budget is basically unchanged from the Four Year
Plan. We continue to support the congregate meals program, senior legal services,
the ombudsman program, dental and food supplement programs as in-house
services. We will also continue to support the community's effort to maintain the
Wellspring Club, which is focused on health promotion and education and the
annual Senior Health Fair. We will establish a medication program that will
address the requirements under Title III Part D. Contracts with local agencies
continue to be for home delivered meals, Hispanic outreach, home health care,
attorney supervision, food services through University of Northern Colorado,
adult day care and peer counseling services.
If the State General funds remain the same, we plan to continue our South County
in-home services, our enhanced dental program , the ombudsman program and
support our loneliness and isolation outreach efforts.
ADVISORY COUNCIL REVIEW
The Area Agency on Aging Advisory Council has had the opportunity to
review and comment on the following items in the annual plan.
(Comments are attached.)
1. Statement of intent and justification for transfers budgeted
between Parts B, C-1, and C-2;
2. Statement of intent and justification for use of Part B funds
for Advocacy, Coordination, and/or Program Development;
3. Application for waiver for the Area Agency on Aging to
provide direct services; and
4. Request for waiver of the requirement to award minimum
percentage of funds for required support services (25% for
access, 15% for in-home and 3% for legal services).
5. Use of state funds (Long Bill and House Bill 1079) to increase
Program Services for the elderly.
6. The Area Agency on Aging Advisory Council has had the
opportunity to review and comment on the 2001 annual plan and
budget.
s= io of (Signed) Oenn,~� �
(Date) (Chairperson, Area Agency
on Aging Advisory Council)
(3/01)
I:\Winwrd\OAAFORMS\PLANS\area annual plan and budget\ADVISORY COUNCIL REVIEW
including state funds.doc
Area Agency on Aging Advisory Board Minutes-April 12,2001
Members Present: John Cruz, Don Feldhaus, Ruth Gartrell, Pat Graham, James Holman, Betty
Jones, Mary Jones, John Lee, Dave Long, Josie Sanchez and Marlene Sieber
Members Absent: Don Beirerbach, Mary Eastwood, and Shirely lanelli
1. Approval of the minutes: Minutes were approved as written
2. State General Funds Budget Status: Eva reviewed the Budget Progress Report with the board.
She stated that as of March 31, 2001 approximately 101,225.77 have been expended. She
indicated that in order to spend all the general funds by the end of June dollars may need to
moved from programs that are having difficulty spending all of the designated funds. The dental
program has been very successful and could use additional dollars to meet the clients' needs that
have contacted the Area Agency on Aging. She will continue working closely with the agency's
fiscal officer and the state office to make sure the funds are expended timely.
3. Annual Plan OAA 2001: Eva reviewed the proposed 2001 Older American's Act budget. Each
service category was reviewed and discussed. Clarification was given regarding the renaming of
Title III Part D(In- home services). Eva stated that in the reauthorization of the Older
American's Act Title III Part F (Disease Prevention and Health Promotion Services) has been
renamed and is now Title III Part D. The original Part D (In-home services for the frail elderly)
was absorbed In Title III B, support services. New Part D also requires that each Area Agency
on Aging must use a certain amount of dollars from the Part D allocations for medication
(education, actual assistance with medication, etc) issues. Eva also recommended that the funds
available in Part E(National Family Caregiving Program)be designated as "to be determined"
until the staff and the advisory board have had an opportunity to explore program options. Ruth
Gartrell moved to accept the proposed budget. John Holman seconded the motion. A vote was
taken and the motion carried.
4. Legislative Update: Betty reviewed the six bills that could directly effect seniors. The board
was very interested in the outcome of HB 1079 and was in strong support of the bill. Betty
suggested that the board write a letter of support regarding the bill and send the letter to the key
legislators. Pat Graham made a motion to that effect and Mary Jones seconded the motion. A
vote was taken and the motion was carried.
5. Board Outreach Participation Reports: Moved to next month
6. Committee Reports: Moved to next month
7. General Announcements: Bev Reid announce that the annual Greeley/Weld Senior Foundation
banquet will be on May 6th and that tickets were available.
Meeting was adjourned at 11:05
WELD COUNTY AREA AGENCY ON AGIII .
(Name of Agency)
Area Agency on Aging Plan Amendments
For
Older Americans Act Amendments of 2000
I, the undersigned, affirm, certify and give the assurances required by sections
305, 306, and 307 of the Older Americans Act, as amended in 2000 (P.L. 106-
501).
Signature of Area A cy ng Official
Fy M Iawal
Typed Name o Area Agency on Aging Official
5= //—v/
Date
I:\Winwrd\OAAFORMS\PLANS\area annual plan and budget\signature state plan amendments.doc
•
(Name gency) G
Certification
Of
Maintenance of Effort
Title Ill, Part E
National Family Caregiver Support Program
I, the undersigned, affirm, certify and give the assurance that funds made available under Title III, Part E
shall supplement, and not supplant, any Federal, State, or local funds expended by the State or unit of
general purpose local government(including area agencies on aging)to provide services described in
section 373 of the Older Americans Act, as amended in 2000(P.L. 106-501)(-74 -"Yr?Signature of re ency on Aging Director
W(
vV
Si rt ture of Council of Government Director
Title of Authorized Official
Date
I:\Winwrd\OAAFORMS\PLANS\area annual plan and budget\MOE.doc
Region 2B
Revision #
Date 10-May-01
REQUEST FOR APPROVAL OF TRANSFER
Statement/Justification for the Transfer:
Weld County Area on Aging requests the transfer of C-2 monies to B services for the 2001
Fiscal Year. We are asking that$42,697 be transferred from C-2 to B services. Weld County
can maintain its C-2 home delivered program at the same level using its program income, USDA
and $23,409 of Federal/State. Therefore, we can enhance B services by the transfer without
hindering C-2 services.
Weld County Area on Aging requests the transfer of C-2 monies to C-1 services for the 2001
Fiscal Year, in the amount of$5,958. Weld County can maintain its C-2 home delivered meal
program at the same level, and can enhance the C-1 program. Therefore, we can enhance
C-1 services without hindering our C-2 services.
A summary of public meeting comments with regard to the transfer of funds is included
in Attachment Number 1. If there were no comments regarding the transfer of funds, the
public meeting minutes should still mention that the transfer of funds was discussed at
the meeting.
NOTE: The maximum allowable amount that can be transferred statewide is:
Not more than 30% between Part C-1 and Part C-2
Not more than 20% between Part B and Part C
AAS 205 (9/99)
Page_2
A I B I C I D
1 TITLE III AWARD REQUEST
2 Grant Application Period: from January 1.2001 to December 31.2001
3 Region 2B
4 Grant Award#
5 Revision#
6 Date 10-May-01
7
8
9 NOGA Award
10 Potential Award Transfer Request Request
11 ADMIN
12 Admin Carryover
13 Admin New Alloc 39,891 39,891
i$ TOTAL ADMIN 39,891 39,891
16 SERVICES
17 Part B Carryover
18 Part B New Alloc 150,307 42,697 193,004
19 TOTAL PART B 193,004
20 Part C1 Carryover 425 425
21 Part C1 New Alloc 157,766 5,958 163,724
22 TOTAL PART C1 158,191 164,149
23 Part C2 Carryover
24 Part C2 New Alloc 72,064 (48,655) 23,409
25 TOTAL PART C2 72,064 23,409
26 OLD Part D Carryover
27
28 TOTAL OLD PART D 0 0
29 Part F Carryover 7,201 7,201
30 Part D New Alloc 11,309 11,309
31 TOTAL PART D&F 18,510 18,510
32 Total Svc Carryover 7,626 7,626
33 Total Svc New Alloc 391,446 391,446
34 TOTAL SERVICES 399,072 399,072
35
36 Administration,Part D,and Part F are excluded from all transfers.
37 OLD PART D IS THE FORMER IN-HOME SERVICES
38 PART F CARRY OVER AND NEW PART D IS HEALTH PROMOTION
39
40
41
42 Page 1
43 AAS 200(2/01)
44
MS 200&400 forms without PART E:xls
Region 2B
Revision#
Date 10-May-01
AREA AGENCY ADMINISTRATION BUDGET
Line Item Budget Federal Budget Local Cash Budget In-Kind Budget Total Budget
Personnel 33,626 10,045 43,671
Travel 1,756 524 2,280
Equipment 0
Other Direct 4,509 2,731 7,240
Indirect 0
Total 39,891 13,300 0 53,191
Total Mmin from AM 200
* Match must be 25%of total budget:
(Match = Local Cash Budget+ In-Kind budget)
Federal Funds = 39,891 / 3 = 13,297 This is the minimum
match required.
Actual Match = 13,300
Over/(Under)Match (3)
MS 220 (9/99)
Page 3
APPLICATION FORM-FFY 2001 OAA TITLE VII
LONG TERM CARE OMBUDSMAN &
ELDER ABUSE PREVENTION FUNDS
2001. FUNDS ELDER ABUSE • LTC OMBUDSMAN
PREVENTION
FFY 2001 New Allocation Orig.EAP Amt $1,568 Orig.LTCO Amt $2,290
(Federal Only funds)
-Amt to LTCO -$0 + Amt from EAP +$0
Final EAP Amt $2,091 Final LTCO Amt $3,053
Local Match Amount CASH IN-KIND CASH IN-KIND
(25%for FFY 2001 funds) $0 $523 $00 $763
Name&address of Weld Area Agency on Aging Weld Area Agency on Aging
subgrantee(s)if applicable.
Put"AAA"if Area Agency
is directly providing this
service.
Describe Activities to be funded
(see Vol. 10 for authorized activities). Community education presentations to Weld Ongoing training for Volunteer Ombudsman
county community members(continuation (continuation from 2000).
For example,local APS Task Force from 2000).
Coordination,Development of Public Recruitment of University of Northern
Education Materials,etc. AAA participation in the Adult Protection Colorado interns for the Ombudsman
Networking Group(continuation from Program(continuation from 2000).
2000).
Appropriate training opportunities for
AAA participation in the Long Term Care current Ombudsman staff(continuation
Bio-Ethics Committees(continuation from from 2000).
2000)
Increase Assistant Ombudsman hours from
16 hours per week to 20 hours per week
Describe Products/Outcomes expected as a Supervision of the Volunteer Ombudsman
result of funding expenditures. Increased community awareness of elder Program.
abuse issues.
For example,provide support(covering Increased number of Volunteer
copying and mailing costs)for 6 local APS Elder Abuse materials(materials and Ombudsman.
Task Force meetings annually in each of the mailing costs)
3 counties. Ongoing training to existing volunteers and
staff.
Increased hours of direct Ombudsman
assistance for residents and family
members.
Describe Coordination Activities between The Ombudsman program is involved in Many community providers are involved in
AAA,APS,and other local agencies as the CNA Training Center as a trainer the SEP Advisory Committee. One of the
required by Vol. 10. (including elder abuse issues)and attends goals of this committee is to monitor the
their advisory board meeting as needed. spending of the Title VII funds.
The AAA and APS are members of the
Weld County Adult Protection Networking
Group and the Bio-Ethics Committee
(AAS 270)
COMPARATIVE ANALYSIS OF MINORITIES AND LOW INCOME PERSONS SERVED IN CY2000 REGION 2 16
REVISION
DATE S7i//O/
%OF 60+
POPULATION
#OF PERSONS IN REGION
#OF 60+IN PSA 20450 100.00%
#OF 60+MINORITY IN PSA 2243 10.97%
#OF 60+LOW INCOME IN PSA 2131 10.42%
#OF 60+LOW INCOME MINORITY IN
PSA 1682 8.22%
HOME-
ACCESS IN-HOME LEGAL CONGREGATE DELIVERED PART D PART F
SERVICES SERVICES SERVICES MEALS MEALS SERVICES SERVICES
PERSONS SERVED IN CY 2000 102 19 118 1665 187 19 300
PROJECTED TO BE SERVED 160 55 150 1700 117 24 508
#MINORITIES PROJECTED TO BE
SERVED IN CY 2000 160 5 28 175 18 8 68
#MINORITIES ACTUALLY SERVED
IN CY 2000 97 1 17 209 24 0 Aggregate
%OF MINORITY GOAL 60.63% 20.00% 60.71% 119.43% 133.33% 0.00% #VALUEI
%OF MINORITY SERVED IN CY
2000 TO%OF TOTAL POPULATION 0.47% 0.00% 0.08% 1.02% 0.12% 0.00% #VALUE!
#LOW INCOME PROJECTED TO
BE SERVED IN CY 2000 160 55 175 1050 117 20 8
#LOW INCOME ACTUALLY
SERVED IN CY 2000 84 13 94 933 165 19 Aggregate
% LOW INCOME GOAL 52.50% 23.64% 53.71% 88.86% 141.03% 95.00% #VALUE!
%OF LOW INCOME SERVED IN CY
2000 TO%OF TOTAL POPULATION 0.41% 0.06% 0.46% 4.56% 0.81% 0.09% #VALUE!
2/01
Region 2-8
Revision#
Date 57ii/o/
A B I C I D I E [_ F ( G I H I I J J I K L M
1 SERVICE DELIVERY OBJECTIVES AND COST PROJECTIONS Fiscal Year
2 1 I 1 1 I I
3 TITLE Ill-B SUPPORT SERVICES
4 I 1 _I
r
5 Section 1: UNITS UNDUPLICATED PERSONS COST BY FUNDING SOURCE
6 SERVICE CATEGORY TOTAL TOTAL UNDUP. UNDUP. ALL OTHER
7 UNITS OF UNDUP. RURAL LOW UNDUP. FED/STATE PROGRAM LOCAL LOCAL TOTAL FUNDS(NON UNIT
8 SERVICE PERSONS PERSONS INCOME MINORITY III B INCOME CASH IN-KIND BUDGET TITLE III) COST
9 a. ACCESS: B C D E F G H I . J K L M
_
10 Assessment/Screen 0 #DIV/0!
11 Case Management _ 0 #DIV/0!
12 Client Representation _ 0 #DIV/0!
13 Escort 0 #DIV/0!
14 Info/Referral 0 #DIV/0!
15 Outreach 3,600 160 40 160 160 22,400 22,00O 44,400 12.33
16 Shopping Assistance 0 #DIV/0!
17 Transportation 0 #DIV/0!
18 ACCESS SUBTOTAL: 3,600 160 40 160 160 $ 22,400 $ - $ 22,000 $ - $ 44,400 $ - -
19 b. IN-HOME SERVICES: _ 0 #DIV/0!
20 Chore Service 0 #DIV/0!
21 Homemaker 650 16 0 16 3 9,175 500 11,000 20,675 31.81
22 Personal Care 1,137 33 5 13 2 12,000 700 15,000 27,700 24.36
23 Repairs/Maint/Renovation 0 #DIV/0!
24 Telephone Reassurance 0 #DIV/0!
25 Treatment _ 0 #DIV/0!
26 Visiting 0 #DIV/0!
27 IN-HOME SVCS SUBTOTAL: 1,787 49 5 29 5 $ 21,175 $ 1,200 $ - $ 26,000 $ 48,375 $ -
_ _
28 I
29 I E Ii AAS 230(9/99)
30 _ I
31 Page 1 of 6
32
Region 2a
Revision#
Date r/#/DI
A I B I C I D I E I F I G I H I I I J 1 K I L I M
33 TITLE III-B SUPPORT SERVICES
34 1
35 Section 1 (cont.): UNITS UNDUPLICATED PERSONS COST BY FUNDING SOURCE
36 SERVICE CATEGORY • TOTAL TOTAL UNDUP. UNDUP. ALL OTHER
37 UNITS OF UNDUP. RURAL LOW UNDUP. FED/STATE PROGRAM LOCAL LOCAL TOTAL FUNDS(NON UNIT
38 c. COMMUNITY SERVICE PERSONS PERSONS INCOME MINORITY III B INCOME CASH IN-KIND BUDGET TITLE III) COST
39 SERVICES: B C D E F G H I J K L M
40 Adult Day Care , 20,000 75 18 75 18 25,000 64,000 3,000 92,000 4.60
41 Counseling 1,800 90 NA NA NA 33,000 33,000 18.33
42 Discount 0 #DIV/0!
43 Education _ 0 #DIV/0!
44 Employment Services 0 #DIV/0!
45 Health Screening _ 0 #DIV/0!
46 Interpreting - 0 #DIV/0!
47 Legal Services-Individual 950 150 NA NA NA 24,850 800 9,800 35,450 37.32
48 Legal Services-Education 20 400 NA NA NA 4,526 4,526 226.30
49 Material Aid 0 #DIV/0!
50 Ombudsman-Complaints 350 250 NA NA NA 31,187 31,187 89.11
51 Ombudsman-Education 100 750 NA NA NA 7,796 7,796 77.96
52 Recreation 0 #DIV/0!
53 Senior Center Operation 0 #DIV/0!
54 Senior Center Acqu/Cons 0 #DIV/0I
55 COMM SVCS SUBTOTAL: 23,220 1,715 18 75 18 $ 126,359 $ 64,800 $ - $ 12,800 $ 203,959 $
56 Coordination 23,070 23,070
57 Program Development 0
58 COORD/PROG DEV SUBTOTAL: 0 0_ 0 0 0 $ 23,070 $ - $ - $ - $ 23,070 $
59 To Be Determined _
60 PART B GRAND TOTAL 28,607 1,924 63 264 183 $ 193,004 $ 66,000 $ 22,000 $ 38,800 $ 319,804 $
61 l I Total Part B from AAS 200
62
63 AAS 230 (2/01)
64 Page 2 of 6
Region 2 6
Revision#
Date 57,3/41/
A I B _I C J D I E I F I G I H I I I J I K J L I M
1 TITLE III-C NUTRITION SERVICES
2
3 Section 2: UNITS UNDUPLICATED PERSONS COST BY FUNDING SOURCE
4 TOTAL
5 UNITS OF TOTAL UNDUP. UNDUP. ALL OTHER
_ _
6 SERVICE UNDUP. RURAL LOW UNDUP. FED/STATE PROGRAM LOCAL LOCAL TOTAL FUNDS(NON
7 #OF MEALS- PERSONS PERSONS INCOME MINORITY III B INCOME CASH IN-KIND USDA BUDGET' TITLE III)
8 SERVICE CATEGORY B C D E F G H I J K L M
_ _
9 C-1 CONGREGATE MEALS 0
10 Congregate Meals" 71,500- 1,800 750 1,050 154,325 158,907 39,384 352,616
11 Nutrition Counseling 5 5 2 5 2 3,274 3,274
12 Nutrition Education 69 1,800_ 750 1,050 175 3,274 3,274
13 Nutrition Screening 1,800 1,800 750 1,050 175 3,276 3,276
14 Outreach _ 0
15 To Be Determined 0
16 TOTAL C-1 73,374_▪ 5,405 2,252 3,155 352 1$ 164,149 $ 158,907 $ - $ - $ 39,384 $ 362,440 $
17 j Total Part C-1 from AAS 200 r Total Budget minus USDA? 323,056
18 C-2 HOME-DELIVERED MEALS 0
19 Home-Delivered Meals" 8,707 117 48 117 18 23,409 55,000 4,352 12,521 95,282
20 Nutrition Counseling 0 0 0 0 0 0
21 Nutrition Education 234 117 48 117 18 0
22 Nutrition Screening 117 117 48 117 18 0
23 Outreach _ 0
24 To Be Determined 0
25 TOTAL C-2 9,058 351 144 351 54 $ 23,409 $ 55,000 $ - $ 4,352 $ 12,521 $ 95,282 $ -
26 I I Total Part C-2 from AAS 200E Total Budget minus USDA 82,761
27 1 I 1 I
28 TOTAL BUDGE- T'DIVIDED BY(#OF MEALS"+ESTIMATED#OF GUEST MEALS"')=UNIT COST
29 C-1 362,440 * DIVIDED BY 71,500 + ** = 5.07
30 l C-2i 95,282 i' DIVIDED BY _, 9,058 ** + "' = 10.52
31 ""The number Guest Meals(should NOT be included in total teals above;is optional numtie'r`ttlat may be included in the Uni�ostca!g4atmn;,
32 ? AAS 230(2/01)
33 Page 3 of 6
34 I _I I 1 I I
Region-it
Revision#-------
DATE-VA-VP/
A I B I C 1 D 1 E I F I G I H I I I J 1 K I L I M
1 OLD TITLE III-D IN-HOME SERVICES FOR THE FRAIL ELDERLY
2
3 Section 3: UNITS UNDUPLICATED PERSONS COST BY FUNDING SOURCE
4 SERVICE CATEGORY TOTAL TOTAL UNDUP. UNDUP. ALL OTHER
5 UNITS OF UNDUP. RURAL LOW UNDUP. FEDISTATE PROGRAM LOCAL LOCAL TOTAL FUNDS(NON UNIT
6 SERVICE PERSONS PERSONS INCOME MINORITY III B INCOME CASH IN-KIND BUDGET TITLE III) COST
7 IN-HOME SERVICES: B C D E F G H I J K L M
8 Case Management 0 #DIV/0!
9 Chore Service
0 #DIV/0!
10 Homemaker
0 #DIV/0!
11 Personal Care
0 #DIV/0!
12 Repairs/Maint/Renovation
0 #DIV/0!
13 Telephone Reassurance
0 #DIV/0!
14 Treatment
0 #DIV/0!
15 Visiting
0 #DIV/0!
16 To Be Determined
#DIV/0!
17 PART D TOTAL: 0 0 0 0 0 $ - $ - $ - $ - $ - $
-
18 Total Part D from AAS 200 0
19 ! Page of
Region-) b
Revision#-
DATE-14°1
A I B I C 1 D 1 E l F I G I H i I l J 1 K I L I M
20 NEW PART D AND OLD TITLE III-F DISEASE PREVENTION AND HEALTH PROMOTION SERVICES
21
22 Section 4: UNITS UNDUPLICATED PERSONS COST BY FUNDING SOURCE
23 SERVICE CATEGORY TOTAL TOTAL UNDUP. UNDUP. ALL OTHER
24 UNITS OF UNDUP. RURAL LOW UNDUP. FED/STATE PROGRAM LOCAL LOCAL TOTAL FUNDS(NON UNIT
25 SERVICE PERSONS PERSONS INCOME MINORITY III B INCOME CASH IN-KIND BUDGET TITLE III) COST
26 PART NEW D AND OLDF SERVICES: B C D E F G H I J K L M
27 wellspring&Educational Promotions 100 500 120 0 50 5,260 5,260 52.60
28 Weld County Health Fair 6 500 150 100 75 10,562 10,562 1,760.33
29 0 #DIV/0!
30 * 0 #DIV/0!
31 * 0 #DIV/0!
32 * 0 #DIV/0!
33 0 #DIV/0!
34 0 #DIV/0!
35 0 #DIV/0!
36 To Be Determined 0 #DIV/0!
37 PART F TOTAL: 106 1,000 270 100 125 15,822 0 0 0 15,822 0
38 Medication Management 10 10 5 10 5 2,688 2,688 268.80
39 Program _ 0 #DIV/0!
40 0 #DIV/0!
41 0 #DIV/0!
42 -- 0 #DIV/0!
- -
43 0 #DIV/0!
44 - 0 #DIV/0!
45 0 #DIV/0!
46 0 #DIV/0!
47 Total Medication Management 10 10 5 10 5 $ 2,688 $ - $ - $ - $ 2,688 $
48 TOTAL OF NEW PART D AND OLD F_ $ 116 $ 1,010 $ 275 $ 110 $ 130 $ 18,510 $ - $ - $ - $ 18,510 $
49 �!_ I
50
AAS 230 (9/99)
5
52
51 Page 5 of ,
26
s7///o I
SERVICE DELIVERY OBJECTIVES AND COST PROJECTIONS Region
Fiscal Year /
TITLE HUE CAREGIVER SUPPORT SERVICES Revision#
Section 5: UNITS UNDUPLICATED PERSONS COST BY FUNDING SOURCE I
SERVICE CATEGORY TOTAL TOTAL UNDUP. UNDUP. UNDUP. _ ALL OTHER
UNITS OF UNDUP. RURAL LOW UNDUP. SEVERELY FED/STATE PROGRAM LOCAL LOCAL TOTAL UNDS (NO UNIT
c. COMMUNITY SERVICE PERSONS PERSONS INCOME MINORITY DISABLED III E INCOME CASH IN-KIND COST TITLE III) COST
SERVICES: A B C D E F G H I J K L M
Adult Day Care $ - $ - $ - $ - $ - #DIV/0!
Counseling $ - #DIV/01
Information and Referral $ - #DIV/01
Respite $ - #DIV/0!
Support Groups $ - #DIV/0!
Caregiver Training $ - #DIV/0!
Decision/problem solving $ - #DIV/0I
Supplemental Services $ - #DIV/0!
Needs Assessment $ - #DIV/0!
Outreach $ - #DIV/0!
Material Aid $ - #DIV/01
Clearing House $ - #DIV/0!
$ - #DIV/01
$ - #DIV/0I
UNDETERMINED S00.3 O3 f f,to/ $ - #DIV/0!
Total 0 0 0 0 0 0 $ - $ - $ - $ - $ - $ -
Total Part E from AAS 200
Page 5 of 6 MS 230 (2/01)
MS 200 and 400 forms.xls with part eeE.xlsSSV/400FORMS2001/AAS200 AND 400 FORMS
Region 023
Revision#
Date Slab)
TITLE III SUMMARY OF SERVICES
Section 5: FEDERAL/STATE** PROGRAM INCOME LOCAL CASH LOCAL IN-KIND TOTAL BUDGET
PART B 193,004 66,000 22,000 38,800 319,804
PART C-1 164,149 158,907 0 0 323,056
PART C-2 23,409 55,000 0 4,352 82,761
OLD PART D 0 0 0 0 0
PART F AND NEW PART D 18,510 0 0 0 18,510
TOTAL SERVICES: $ 399,072 $ 279,907 $ 22,000 $ 43,152 $ 744,131
2
*For C-1 and C-2 -do not include USDA here; this is actually a net budget for nutrition.
To calculate the minimum 10% local match:
Federal/State Total Services Funds **divided by 9 = minimum 10% local match.
** divided by 9 = 0
Actual Local Match = 65,152
Over/(Under) Matched 65,152
AAS 230 (2/01)
Page 6 of 6
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