     Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period                                             Statewide

    This report estimates subtotals of units and fees for the number of days of overlap between each included
    FSPSA record and the user-selected report period.  For example, if the FSPSA record authorizes services from
    01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
    authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01).  Note that service authorization periods
    may range from 1 to 12 months and may vary in intensity from child to child.

    FSPSAs overlapping: 07/01/08 and 09/30/08                  Date of Report: 11-18-08                  Page: 1

             Payor Filter: PARH   PAHM   DEI    DEIM
    Eligibility Filter: Program Patients

    Services  Cpt Code                                       Number of   Number of   Total Units    Total Fees        Avg Fee
                                                             Children    Records     Overlapping    Overlapping     Per Unit Auth
                                                                                    Report Period  Report Period

    EI Services, Class # 03
     TRAV  -TRAV      PROVIDER TRAVEL TO NATURAL ENVIRONM          1          1           13.14           $6.57            $0.50
                                                             --------------------------------------------------------------------
    Subtotal (Total Children Is Unduplicated)                      1          1           13.14           $6.57            $0.50

    -----------------------------------------------------------------------------------------------------------------------------
    Total                                                                     1           13.14           $6.57            $0.50
    -----------------------------------------------------------------------------------------------------------------------------

    Number of Children (Unduplicated) With at Least One Authorization  1