Form Sfy 01 - Home And Community Based Care - Alaska Commission On Aging Page 7

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Alaska Commission on Aging
Home Community Based Care
Project:
Agency Name:
How expenses will be paid
ACoA funds by Allotment
Total
(600) Other
Total ACoA
Local
Fees for
Other
Other
ACoA
MHTA
Requested
Match
Service
Sources
Costs
Contracts:
Food Service
Transportation
Printing
Other
Sub-total
$
$
$
Insurance/Bonding:
$
$
HCB Audit:
$
$
Other (Specify)
$
$
$
$
$
$
Totals $
$
$
$
$
$
$
G:\ACOA\SFY01 NEW FORMS\FY01 HCB Cost Proposals
CP 7
8/3/00

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