DUE asap Help complete this cost statment form

Due by 11:00pm USA pacific time 07/08/2024

Please use the provided numbers in the attached sample. Also, include the missing information at the bottom of the Cost sample form. Include an estimated cost for gas per day for driving clients. Also, there are no facility fees because this is a Community-based day program. Include the cost of liability Insurance please see the list of important information that needs to be included at the bottom of the cost statement

Sample cost statement for hourly rate 85.15 formula.docx Revised 8.2.12

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Cost Statement Sample Tool

Direct Costs

hourly rate $19.00

Employer taxes $1.45(7.65% of

hourly rate)

Health Insurance $3.00 (Estimated

average cost per

hour per employee

in California)

Subtotal (minimum of 85% of rate) $16.15 (85% of

hourly rate)

Administrative Costs

Managerial personnel hourly rates (prorated) $30.00

Managerial personnel emp. taxes, health insurance (prorated) $4.35 (Employer

taxes and health

insurance prorated

per hour)

Administrative assistant (prorated) $19.00

Administrative assistant emp. Taxes, health insurance (prorated) $2.45 (Employer

taxes and health

insurance prorated

per hour)

Subtotal (maximum of 15% of rate) $6.45 (15% of

combined hourly Staffing Costs (assuming 1:3 ratio): Number of Staff = 12 clients / 3 clients per staff = 4 staff

Rate Per Person/client (Hourly or Daily) Service Code 55 – 1:3 Ratio Service hours 4-5 hours daily per client

$108.21

Total daily Rate for 12 clients $1,298.52

Note: if no administrative costs are part of the rate, show zero expenditures on

appropriate line.

Sample cost statement for hourly rate 85.15 formula.docx Revised 8.2.12

Refer to W&I code on reverse side for information and details about the 15% cap on administrative costs. Refer to current W&I code for information on any payment reductions currently in effect (as of 7/1/12 the payment reduction is 1.25%)

Direct Service Expenditures and Administrative costs

SEC. 8. Section 4629.7 is added to the Welfare and Institutions Code, to read:

4629.7. (a) Notwithstanding any other provision of law, all regional center contracts or agreements

with service providers in which rates are determined through negotiations between the regional center and the

service provider shall expressly require that not more than 15 percent of regional center funds be spent

on administrative costs. For purposes of this subdivision, direct service expenditures are those costs

immediately associated with the services to consumers being offered by the provider. Funds spent on

direct services shall not include any administrative costs. Administrative costs include, but are not limited

to, any of the following:

(1) Salaries, wages, and employee benefits for managerial personnel whose primary purpose is the

administrative management of the entity, including, but not limited to, directors and chief executive

officers.

(2) Salaries, wages, and benefits of employees who perform administrative functions, including, but not limited to, payroll management, personnel functions, accounting, budgeting, and facility management.

(3) Facility and occupancy costs, directly associated with administrative functions. (4) Maintenance and repair. (5) Data processing and computer support services. (6) Contract and procurement activities, except those provided by a direct service employee. (7) Training directly associated with administrative functions. (8) Travel directly associated with administrative functions. (9) Licenses directly associated with administrative functions. ( 1 0 ) T a x e s . ( 1 1 ) I n t e r e s t . ( 1 2 ) Property i nsurance. ( 1 3 ) Personal liability insurance directly associated with administrative functions. ( 1 4 ) Depreciat ion. ( 1 5 ) General expenses, including, but not limited to, communication costs and supplies

directly associated with administrative functions.

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