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[]
[]
["Home and Community Care Block Grant"]
["Allocation & Questions Form"]
[]
[]
["Agency:                                                         ",{"$nulls":7},"Date:",null,"Date:"]
[]
["Current HCCBG Allocation:"]
[]
[]
[]
[]
["Unit Definitions"]
[]
["1. Adult Day Care - A unit of service equals one scheduled day of attendance"]
[]
["2. Congregate Nutrition - A unit of service equals one meal served to an eligible individual"]
[]
["3. Home Delivered Meals - A unit of service equals one meal served to an eligible individual"]
[]
["4. In-Home Aide - A unit of service equals one hour"]
["Level I, Home Management","-","All aides must be competency tested."]
["Level II, Personal Care ","-","All aides must be competency tested."]
["Level III, Personal Care","-","All aides must be competency tested."]
[null,null,"In addition, all aides performing one or more Level III personal care "]
[null,null,"tasks per client must be registered as a Nurse Aide I (CNA)."]
[]
["5. Transportation - A unit of service equals a one way trip provided to an eligible client"]
[]
["6. Housing & Home Improvement is a non-unit service"]
[]
["7. Information & Options Counseling is a non-unit service"]
[]
[]
["Requested HCCBG Allocation:",{"$nulls":3},{"v":0,"d":"$0"}]
["Please see page 1 for unit definitions","2020 Allocation",null,"2021 Amount Requested",null,"2020 Unit Cost",null,"2021 Fixed          Unit Cost",null,"2022 Fixed                Unit Cost"]
[]
["Total Agency Budget","$"]
["Total HCCBG Budget","$",null,"$"]
["HCCBG Services:"]
["1. Adult Day Care","$",null,"$",null,"$",null,"$",null,"$"]
["2. Congregate Nutrition","$",null,"$",null,"$",null,"$",null,"$"]
["3. Home Delivered Meals","$",null,"$",null,"$",null,"$",null,"$"]
["4. In-Home Aide"]
["  Level I - Home Management","$",null,"$",null,"$",null,"$",null,"$"]
["   Level II - Personal Care","$",null,"$",null,"$",null,"$",null,"$"]
["   Level III - Personal Care","$",null,"$",null,"$",null,"$",null,"$"]
["5. Transportation","$",null,"$",null,"$",null,"$",null,"$"]
["6. Housing & Home Imp.","$",null,"$"]
["7. Info & Options Counseling","$",null,"$"]
["TOTAL","$",0,"$",0]
[]
["The total amounts requested for 2021 and 2022 should match the allocation totals on page 1 of the DAAS 732A form."]

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