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Name of Organization: <br />Name of Program <br />2015 -2016 Funded Personnel <br />Mercy House Living Centers <br />Joseph and Regina House <br />NOTE: Please remember that this is only a budget and that reimbursement should be based on actual service. <br />'" Only direct hours charged to the grant will be reimursable. Timecards must demonstrate direct hours charged <br />to the grant. Benefits (Vacation, sick and holiday) are paid for program staff who work 100% in the ESG program. <br />PROGRAM STAFF <br />Position Title <br />Amoral <br />Salary <br />Annual <br />Benefits <br />Total <br />Compensation <br />ESG Funds <br />Requested <br />Percentage of <br />time in the <br />program serving <br />SA residents <br />Case Manager (I FTE) <br />$ 33,280 <br />$ 5,000 <br />$ 38,280 <br />$ 7,275 <br />20% <br />Case Manager 1 FTE <br />$ 33,280 <br />$ 5,000 <br />$ 38,280 <br />$ 7,275 <br />20% <br />$ <br />Total Amount Requested <br />$ <br />$ <br />Total Amount Requestedl <br />$ 14,550 <br />40% <br />CONTRACTUALlPROFESSIONAL SERVICES <br />Type of Service <br />Annual Contract Amount <br />Total <br />ESG Funds <br />Percentatze of <br />Total Amount Requested <br />$ <br />