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0 -1 7 <br />North Carolina Department of Health and Human Services <br />Division of Public Health <br />DPH Budget Contract Unit <br />REVISED <br />WIC PROGRAM <br />Agency Name Lee County Health Department <br />Original <br />Amount <br />5403 Client Services 231 , 699 <br />5404 Nutrition Education 7 7, 3 4 2 <br />(Minimum Amount $ 71,342) <br />5405 General Administration 35 , 67 1 <br />(Maximum Amount $35,671) <br />®409 Breastfeeding Promotion <br />(Minimum Amount $ 9,901) <br />Total <br />12,000 <br />$ 356,712 <br />Instructions for completing the original budget: <br />Revision # <br />Revision applies to: <br />SFY allocation (June - Sept.) <br />FFY allocation (Oct.-May) <br />STATE USE ONLY <br />FRC FRC <br />Using the funds listed under total above, allocate your funds among the four WIC activities. Note the minimum <br />level of funds that must be budgeted for Nutrition Education and Breastfeeding Promotion, and the maximum <br />amount of funds to be budgeted in General Administration Your total for the four activities should match the total <br />on the Budgetary Estimate. This form is to be signed and returned with the WIC Agreement Addenda to the <br />Division's Contract Unit. <br />Instructions for completing budget revisions: <br />This form may be reproduced and used to submit budget revisions. When submitting budget revisions, show the <br />amount of funds being increased/decreased in the amount column for the respective activity (ex. +1000 or -1000). <br />Line through the total amount and put a zero. Indicate the Revision Budget revisions are due in the program <br />office by May 1st for close-out of the state fiscal year and September 1st for close-out of the federal fiscal year. <br />This form should be mailed to the WIC Operations Manager, 1914 Mail Service Center, Raleigh, NC 27699-1914_ <br />Signature f Local Agency Director Date <br />Signatur of Local Finance fhcer Date <br />Signature of WIC Operations Manager Date <br />