Salt Lake County Substance Abuse Services

Billing Matrix – FY 2007

Agency Name:

Program Name:

IOM:

Sessions

Roster

Service

Rate

Method

# of Units

Amount

(a)

(b)

(a*b)

Objective

Short Description

Ongoing  or

Client Roster

Direct  or

Billing Rate

Hour          Session

Units

Contract

Number

"One-time" Event

Yes/No

Indirect

Person        Person-Hour

Total

1

2

3

4

5

Contract Total:

$0.00

Signatures:

Agency Director

SL County

Date