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387 <br />DEPARTMENT OF STATE HEALTH SERVICES <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: 01/01104 THRU 08/31/05 <br />DSHS DOC. NO. 7560022067 200501C CHG..06, <br />REVISED CONTRACT BUDGET ° <br />FINANCIAL ASSISTANCE <br />OBJECT CLASS CATEGORIES <br />CURRENT APPROVED <br />BUDGET (A) <br />CHANGE <br />REQUESTED (B) <br />NEW OR REVISED <br />BUDGET (C) <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 />RECEIVING AGENCY SHARE <br />PERFORMING AGENCY SHARE <br />$29,309.00 <br />$19,499.00 <br />$48,808.00 <br />10,275.00 <br />6,850.00 <br />17,125.00 <br />1,000.00 <br />667.00. <br />. , 1,667.00 <br />. 9.00 <br />-- - 0.00 <br />0.00 <br />6,000.00 <br />4,000.00 <br />10,000.00 <br />500.00 <br />333.00 <br />833.00 <br />3,000.00 <br />2,000.00 <br />5,000.00 <br />$50,084.00 <br />$33,349.00 <br />$83,433.00 <br />0.00 <br />0.00 <br />0.00 <br />$50,084.00 <br />$33,349.00 <br />$83,433.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />$50,084.00 <br />$33,349.00 <br />$83,433.00 <br />$0.00 <br />$0.00 <br />$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 />roan NO. UU -N bUFb — Kev. IUN4 <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 />