Form Sfy 01 - Home And Community Based Care - Alaska Commission On Aging Page 6
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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
(500) Equipment
Total ACoA
Local
Fees for
Other
Equipment
ACOA
MHTA
Request
Match
Service
Sources
Costs
Items to be purchased:
$
$
$
Sub-total
$
$
Items to be rented:
$
$
$
Sub-total
$
$
Maintenance/repair:
$
$
-
Other (specify):
$
$
$
Sub-total
$
$
Totals
$
$
$
$
$
$
$
G:\ACOA\SFY 01 NEW FORMS\ FY01 HCB Cost Proposals
CP 6
8/3/00
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