Page 184

Official source

Amount of 100 percent Federal Funds (includes ABAWD Pledge Funds) $0.00 Total Amount of 50/50 (or 75/25) Admin Funds (inclusive of federal and non-federal shares) $0.00 Will this contract serve members of Indian Tribal Organizations (ITOs) and be reimbursed at 75%? Yes No 184

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Page 184

Official source

Amount of 100 percent Federal Funds (includes ABAWD Pledge Funds) $0.00 Total Amount of 50/50 (or 75/25) Admin Funds (inclusive of federal and non-federal shares) $0.00 Will this contract serve members of Indian Tribal Organizations (ITOs) and be reimbursed at 75%? Yes No 184