Form Sfy 01 - Home And Community Based Care - Alaska Commission On Aging Page 10
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10Alaska Commission on Aging
Home Community Based Care
SFY 01
Project:
Agency Name:
PROJECT RESOURCES SUMMARY
I. REQUIRED LOCAL MATCH
Item
Source
Cash or In-Kind
Value
Total Local Match
$
II. FEES FOR SERVICE
Total Fees for Services
$
III. OTHER SOURCES
Item
Source
Cash or In-Kind
Value
Medicaid (CHOICE) Receipts
State of Alaska
Cash
$______________
Total Other Sources
$
IV. Total ACoA Funds Requested for this project
$
V. Total Project Cost
$
CP 10
G:\ACOA\SFY01 NEW FORMS\FY01 HCB Cost Proposals
8/3/00
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Parent category: Financial