Free Form 02AG023E (SUOA-S-56-C) Instructions - Oklahoma

Service Expenditures Profile Purpose of Form

02AG023E (SUOA-S-56-C)

Form 02AG023E is used to annually generate program information from Older Americans Act (OAA) grantees to meet federal requirements. Instructions for Preparation of Form Complete this section for the services listed and each of the other funded services supported by OAA funds. Expenditures by part: III B, III C-1, III C-2, III D, and III E. Allocate the OAA Title III expenditures by part for the core services listed and each of the other funded services supported by OAA funds. Title III B, III C-1, III C-2, III D, and III E. Complete unshaded areas only. *Program income only. If using Title III B vans to transport participants to the nutrition site, thus providing access to congregate nutrition services, Title III C-1 program income may be used. Use of Title III C-2 program income to pay for delivery of home delivered meals may be shown in the Title III C-2 column under home delivered meals. Total Title III expenditure (excludes match). Enter only the total amount of Title III federal funds expended for the service provided, excluding matching funds and Nutrition Services Incentive Program (NSIP) reimbursement. This entry will equal the sum of all entries for the same service category under Titles Ill B, III C-1, III C-2, III D, and III E on Form 02AG023E, page 1. Total all funds expended (includes match). Enter the total amount of all Title III expenditures for the service provided. Include all funds, such as federal, state, local match, NSIP, and everything used to support the OAA service. Percentage total service expenditure. Indicate the percent of total service expenditures represented by or attributable to OAA Title III federal funding. To get this total, divide total Title III expenditures, column 1, by total all funds expended, including match, Column 2, for each service category. EXAMPLE: If total Title III expenditures for personal care = $5,000 and total of all funds expended for personal care = $10,000; then total of service expenditure is $5,000 divided by $10,000 or 50%. Total program income. Enter the estimate of total program income derived as a result of service provision, such as donations and in-kind. Routing of Form Area Agency on Aging (AAA) submits completed form annually to Aging Services Division (ASD). A notice is sent out annually advising the due date, which is close to December 30th.

OKDHS revised 12-15-2003

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