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<br />DEPARTMENT OF STATE HEALTH SERVICES <br /> <br />RECEIVING AGENCY PROGRAM: IMMUNIZATION BRANCH <br />PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT <br />CONTRACT TERM: 01/01/04 THRU: 08/31/05 BUDGET PERIOD: 01/01/04 THRU 08/31/05 <br />DSHS DOC. NO. 7560022067 200501C CHG.06 <br /> <br />REVISED CONTRACT BUDGET <br /> <br /> FINANCIAL ASSISTANCE <br />OBJECT CLASS CATEGORIES CURRENT APPROVED CHANGE NEW OR REVISED <br /> BUDGET (A) REQUESTED (B) BUDGET (C) <br />Personnel $29,309.00 $19,499.00 $48,808.00 <br />Fringe Benefits 10,275.00 6,850.00 17,125.00 <br />Travel 1,000.00 667.00 1,667.00 <br />Equipment 0.00 0.00 0.00 <br />Supplies 6,000.00 4,000.00 10,000.00 <br />Contractual 500.00 333.00 833.00 <br />Other 3,000.00 2,000.00 5,000.00 <br />Total Direct Charges $50,084.00 $33,349.00 $83,433.00 <br />Indirect Charges 0.00 0.00 0.00 <br />TOTAL $50,084.00 $33,349.00 $83,433.00 <br />PERFORMING AGENCY SHARE: <br />Program Income 0.00 0.00 0.00 <br />Other Match 0.00 0.00 0.00 <br />RECEIVING AGENCY SHARE $50,084.00 $33,349.00 $83,433.00 <br />PERFORMING AGENCY SHARE $0.00 $0.00 $0.00 <br />Detail on Indirect Cost Rate Type: <br />Rate 0.00 Base $0.00 Total $0.00 <br />Budget Justification: Amendment to extend contract term and increase contract amount with 8 months of funding in order to return <br />contract term to the State Fiscal Year. No revision to number served. <br /> <br />Form No. GC-9 ECPS - Rev. 10/04 <br /> <br />Financial status reports are due the 30th of April, 30th of July, 30th of October, 30th of January, 30th of April, 30th of July, and the <br />30th of November. <br />