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TEXAS DEPARTMENT OF <br />RECEIVING AGENCY PROGRAM: IMMUNIZATION DIVISION <br />PERFORMING AGENCY: PARIS-LAMA3 0O~ BG T PERI DRO10 04 <br />CONTRACT TERM: O 1/0 1/04 THRU. 12 <br />TDH DOC. NO. 7560022067 200501B CHG. OS <br />REVISED CONTRACT BUDGET <br />OBJECT CLASS CATEGORIES <br />Personnel <br />Fringe Benefits <br />Travel <br />Equipment <br />Supplies <br />Contractual <br />Other <br />Total Direct Charges <br />Indirect Charges <br />TOTAL <br />PERFORMING AGENCY SHARE: <br />Program Income <br />Other Match <br />TH <br />.U 12/31/04 <br />F <br />INANCIAL ASSI <br />STA <br />CE <br />CURRENT APPROVED <br />BUDGET (A) <br />RE <br />CHANGE <br />Q_ UESTED (B) <br />00 <br />770 <br />9 <br />$19,539.00 <br />. <br />, <br />$ <br />6,850.00 <br />3,425.00 <br />667.00 <br />333.00 <br />0.00 <br />0.00 <br />4,000.00 <br />2,000.00 <br />333.00 <br />167.00 <br />2,000.00 <br />1,000.00 <br />$33,389.00 <br />0.00 <br />$33,389.00 <br />$16,695.00 <br />0.00 <br />$16,695.00 <br />NEW OR REVISED <br />BUDGET (C) <br />$29,309.00 <br />10,275.00 <br />1,000.00 <br />0.00 <br />6,000.00 <br />500.00 <br />3,000.00 <br />$50,084.00 <br />0.00 <br />$50,084.00 <br />0.00 0.00 0.00 <br />0.00 0.00 0.00 <br />RECEIVING AGENCY SHARE $33,389.00 $16,695.00 $50,084.00 <br />PERFORMING AGENCY SHARE $0'00 ~ 00 <br />Detail on Indirect Cost Rate Type: <br />Rate 0.00 Base $0.04 Total $0.00 <br />Budget Justification: Increase to budget remainder of funds to enable contractor o continue services through the end of the <br />contract term. <br />Form No. GC-9 <br />Financial status reports are due the 30th of April, 30th of July, 30th of October, ~nd the 30th of March. <br />I <br />