CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 16 16.00 0.00 0.00
Subtotal (Total Children Is Unduplicated) 16 16.00 0.00 0.00
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 73 3554.00 88850.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 40 1167.00 29175.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 41.00 2050.00 50.00
Subtotal (Total Children Is Unduplicated) 114 4762.00 120075.00 25.22
----------------------------------------------------------------------------------------------------------------
Total 4778.00 120075.00 25.13
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 119
----------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
417 4778.00 120075.00 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 417 4778.00 120075.00 0.00