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DEPARTMENT OF STATE HEALTH SERVICES <br />E <br />w ~ i cn <br />x <br />C~ <br />1100 WEST 49TH STREET <br />AUSTIN, TEXAS 78756-3199 <br />CATEGORICAL BUDGET CHANGE REQUEST <br />DSHS PROGRAM: CHS - PRIMARY HEALTH CARE <br />CONTRATOR: PARIS-LAMAR COUNTY HERLTH DEPARTMENT <br />CONTRACT NO: 2008-024359 <br />CONTRACT TERM: 09/01/2007 THRU: 08/31/2008 <br />BUDGET PERIOD: 09/01/2007 THRU: 08j31/2008 CHG: OQlA <br />DIRECT COST (OBJECT CLASS CATEGORIES) <br />Current Approved Budget (A) <br />Revised Budget (B) <br />Change Requested <br />Personnel <br />$53,300.00 <br />$69,290.00 <br />$15,990.00 <br />Fringe Benefits <br />Travel <br />$13,325.00 <br />$0.00 <br />$17,322.00 <br />$1,000.00 <br />$3,997.00 <br />$1,000.00 <br />Equipment <br />Supplies <br />Contractual <br />Other <br />Total Direct Charges <br />$0.00 <br />$3,600.00 <br />$25,695.00 <br />$4,080.00 <br />$100,000.00 <br />$0.00 <br />$10,933.00 <br />$30,000.00 <br />$6,600.00 <br />$135,145.00 <br />$0.00 <br />$7,333.00 <br />$4,305.00 <br />$2,520.00 <br />$35,145.00 <br />INDIRECT COST <br />Base <br />$0.00 <br />$0.00 <br />$0.00 <br />Rate <br />Indirect Total <br />0.00% <br />$0.00 <br />0.00% <br />$0.00 <br />0.00% <br />$0.00 <br />PROGRAM INCOME <br />Program Income <br />Other Match <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />Income Total <br />$0.00 <br />$0.00 <br />$0.00 <br />LIMITS/RESTRICTIONS <br />Advance Limit <br />$0.00 <br />$0.00 <br />$0.00 <br />Restricted Budget <br />$0.00 <br />$0.00 <br />$0.00 <br />'SUMMARY <br />CostTotal <br />$100,000.00 <br />$135,145.00 <br />$35,145.00 <br />Performing Agency Share <br />Receiving Agency Share <br />Total Reimbursements Limit <br />$0.00 <br />$100,000.00 <br />$100,000.00 <br />$0.00 <br />$135,145.00 <br />$135,145.00 <br />$0.00 <br />$35,145.00 <br />$35,145.00 <br />JUSTIFICATION <br />' <br />Financial status reports are due: 12/31/2007, 03/31/2008, 06/30/2008, 10/31/2008 <br />- 000088 <br />