Forms

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DOA  543 - Monthly Cost Sharing/Non-Unit Reimbursement Data form (MS Word Format)

DOA 730 - Home & Community Care Block Grant for Older Adults, County Funding Plan (MS Word format, 12K)

DOA 731 - County Services Summary; Home & Community Care Block Grant for Older Adults, County Funding Plan (MS Excel format, 105K)

DOA 732 - Provider Services Summary; Home & Community Care Block Grant for Older Adults, County Funding Plan (MS Excel format, 119K)

DOA 732A - Service Cost Computation Worksheet (MS Excel format, 48K)

DOA 732A1 - Cost of Services Attachment, Labor Distribution Schedule (MS Excel format, 31K)

DOA 732 Supplement - Supplement to Provider Service Summary- In-Home Services Detail (MS Excel format, 85K)

DOA 733 - Methodology to Address Service Needs of Low Income Minority Elderly; Home & Community Care Block Grant for Older Adults, County Funding Plan (MS Word format, 12K)

DOA 734 - Community Service Provider Standard Assurances; Home & Community Care Block Grant for Older Adults (MS Word format, 16K)

DOA 735 - Agreement for the Provision of County Based Aging Services; Home & Community Care Block Grant for Older Adults (MS Word format, 33K)

PTCOG Checklist - Checklist for HCCBG Funding (MS Word format, 20K)

PTCOG HCCBG Budget Revision Request - (MS Excel format, 18K)

PTCOG Local Match Form - Certification of Required Minimum Local Match Availability (MS Excel format, 21K)

Standard Assurance to Comply - Standard Assurance to Comply with Older Americans Act Requirements Regarding Clients Rights 

Family Caregiver Support Program Category Listing 

Family Caregiver Support Program Monitoring Tool 

Family Caregiver Budget Proposal -Budget form for Family Caregiver Support Program

Family Caregiver Support Program Request For Proposal-Proposal forms for Family Caregiver Support Program

Family Caregiver RFP Instructions -RFP Instructions for Family Caregiver Support Program

Senior Center Proposal Forms
     Title III-D Disease Prevention / Health Promotion Program Description
     Senior Center General Purpose Funding Program Description
     Senior Center Outreach Program Description