Form Sfy 01 - Home And Community Based Care - Alaska Commission On Aging Page 5
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10Alaska Commission on Aging
Home Community Based Care
Project:
Agency Name:
ACoA funds by Allotment
How expenses will be paid
Total
(400) Supplies
Local
Fees for
Other
Total ACoA
Supply
ACoA
MHTA
Match
Service
Sources
Request
Cost
Food/snack supplies:
# of Meals
Cost per meal
# of snacks
Cost per snack
Subtotal $
$
$
Office supplies
$
$
Household supplies
$
$
Other (specify)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Totals $
$
$
$
$
$
$
G:\ACOA\SFY01 NEW FORMS\ FY01 HCB Cost Proposals
CP 5
8/3/00
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Parent category: Financial