Cal. Code Regs. Tit. 17, div. 2, ch. 3, subch. 18, Appendix
Current through Register 2024 Notice Reg. No. 50, December 13, 2024
Transportation Cost Statement - Page 1 Instructions
Instructions
| Line | Reference | |
| 1. | Enter the vendor name and telephone number. | 58551 (a)(1)(a)(2) |
| 2. | Enter vendor identification number, service code ad subcode. | 58551 (a)(1)(a)(4) |
| 3. | Enter the address where the service is located. | 58551 (a)(5) |
| 4. | Enter the mailing address of the service. | 58551 (a)(5) |
| 5. | Enter the management organization name if the service is affiliated with a management organization. | 58551 (a)(6) |
| 6. | Enter the name and telephone number of the contact person. | 58551 (a)(7) |
| 7. | Enter the name of the vendoring regional center. | 58551 (a)(8) |
| 8. | Enter the names of the contracting regional centers for which you provide service. | 58551 (a)(8) |
| 9. | Enter the effective date of service. | 58551 (a)(9) |
| 10-16. | On Lines 10-16, enter the projected costs for these items | 58552 (a)(1) through (a)(7) |
| 17. | To determine the subtotal, add all projected costs for line items 10-16, and enter on this line. | 58554 (a)(1) |
| 18. | Enter the total vendor income from page 2, Section A, on this line. | 58554 (a)(2) |
| 19. | To determine the annual net cost, subtract the vendor income, if any (line 18) from the subtotal of the projected costs (line 17). Enter this amount on line 19 and on page 2, Section B, under annual net cost. | 58554 (a)(3) |
Instructions
| Section | Reference | |
| A | Enter information on vendor income received, including name of each source, duration of income, and amount of income received from each source. Add these amounts, and enter the total on page 1, line 18. | 58533 |
| B | To establish the proposed rate of payment, divide the annual net cost by the projected number of annual route miles anticipated to be driven. The quotient shall be the proposed rate of payment. | 58554 (a)(4) |
| C | To determine the hourly rate of pay for Transportation Aides, add the hourly salaries and wages, hourly fringe benefits and hourly training cost. | 58555 (a) through (b) |
Cal. Code Regs. Tit. 17, div. 2, ch. 3, subch. 18, Appendix