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476 <br />TEXAS DEPARTMENT OF HEALTH <br />RECEIVING AGENCY PROGRAM: ASSOCIATE COMMISSIONER FOR FAMILY HEALTH <br />PERFORMING AGENCY: PARIS -LAMAR COUNTY HEALTH DEPARTMENT <br />CONTRACT TERM: 09/01/03 THRU: 08/31/04 BUDGET PERIOD: 09/01/03 THRU 08/31/04 <br />TDH DOC. NO. 7560022067 200401 A CHG. 03 <br />REVISED CONTRACT BUDGET <br />Financial status reports are due the 30th of December, 31st of March, 30th of June, and the 30th of November. <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 />$41,625.00 <br />$41,625.00 <br />$83,250.00 <br />11,655.00 <br />11,655.00 <br />23,310.00 <br />630.00 <br />630.00 <br />1,260.00 <br />0.00 <br />0.00 <br />0.00 <br />3,210.00 <br />3,210.00 <br />6,420.00 <br />15,299.00 <br />15,299.00 <br />30,598.00 <br />3,360.00 <br />3,360.00 <br />6,720.00 <br />$75,779.00 <br />$75,779.00 <br />$151,558.00 <br />0.00 <br />0.00 <br />0.00 <br />$75,779.00 <br />$75,779.00 <br />$151,558.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />$75,779.00 <br />$75,779.00 <br />$151,558.00 <br />$0.00 <br />$0.00 <br />$0.00 <br />Detail on Indirect Cost Rate Type: <br />D Rate 0.00 Base $0.00 Total $0.00 <br />Budget Justification: Increase due to extension of term from 2/29/04 to 8/31/04 and increased number to be served. <br />Revised Number to be Served/Units of Service: 1,200 <br />Form No. GC -9 <br />Financial status reports are due the 30th of December, 31st of March, 30th of June, and the 30th of November. <br />