HomeMy WebLinkAbout2006-320 Dov 6 -3�v
CONTRACT BETWEEN
INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS
AND
STATE OF FLORIDA DEPARTMENT OF HEALTH
FOR OPERATION OF
INDIAN RIVER COUNTY HEALTH DEPARTMENT
CONTRACT YEAR 2006-2007
This agreement ("Agreement' ) is made and entered into between the State of Florida ,
Department of Health ("State' ) and the Indian River County Board of County
Commissioners ("County' ) , through their undersigned authorities , effective October 1 ,
2006 .
RECITALS
A. Pursuant to Chapter 154 , F . S . , the intent of the legislature is to "promote ,
protect, maintain , and improve the health and safety of all citizens and visitors of this state
through a system of coordinated county health department services . "
B . County Health Departments were created throughout Florida to satisfy this
legislative intent through "promotion of the public's health , the control and eradication of
preventable diseases , and the provision of primary health care for special populations . "
C . Indian River County Health Department ("CHD" ) is one of the County Health
Departments created throughout Florida . It is necessary for the parties hereto to enter into
this Agreement in order to assure coordination between the State and the County in the
operation of the CHID .
NOW THEREFORE , in consideration of the mutual promises set forth herein , the
sufficiency of which are hereby acknowledged , the parties hereto agree as follows :
1 . RECITALS . The parties mutually agree that the forgoing recitals are true and
correct and incorporated herein by reference .
2 . TERM . The parties mutually agree that this Agreement shall be effective from
October 1 , 2006 , through September 30 , 2007 , or until a written agreement replacing this
Agreement is entered into between the parties, whichever is later, unless this Agreement
is otherwise terminated pursuant to the termination provisions set forth in paragraph 8 ,
below.
3 . SERVICES MAINTAINED BY THE CHID . The parties mutually agree that the CHD
shall provide those services as set forth on Part III of Attachment II hereof, in order to
maintain the following three levels of service pursuant to Section 154 . 01 (2 ), Florida
Statutes , as defined below:
a . " Environmental health services" are those services which are organized and
operated to protect the health of the general public by monitoring and regulating activities
in the environment which may contribute to the occurrence or transmission of disease .
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Environmental health services shall be supported by available federal , state and local
funds and shall include those services mandated on a state or federal level . Examples of
environmental health services include , but are not limited to , food hygiene , safe drinking
water supply, sewage and solid waste disposal , swimming pools , group care facilities ,
migrant labor camps , toxic material control , radiological health , occupational health .
b . "Communicable disease control services" are those services which protect the
health of the general public through the detection , control , and eradication of diseases
which are transmitted primarily by human beings . Communicable disease services shall
be supported by available federal , state , and local funds and shall include those services
mandated on a state or federal level . Such services include , but are not limited to ,
epidemiology, sexually transmissible disease detection and control , HIV/AIDS ,
immunization , tuberculosis control and maintenance of vital statistics .
c. " Primary care services" are acute care and preventive services that are made
available to well and sick persons who are unable to obtain such services due to lack of
income or other barriers beyond their control . These services are provided to benefit
individuals , improve the collective health of the public, and prevent and control the spread
of disease . Primary health care services are provided at home , in group settings , or in
clinics . These services shall be supported by available federal , state , and local funds and
shall include services mandated on a state or federal level . Examples of primary health
care services include , but are not limited to : first contact acute care services ; chronic
disease detection and treatment; maternal and child health services ; family planning ;
nutrition ; school health ; supplemental food assistance for women , infants , and children ;
home health ; and dental services .
4 . FUNDING . The parties further agree that funding for the CHD will be handled as
follows :
a . The funding to be provided by the parties and any other sources are set forth in Part
II of Attachment II hereof. This funding will be used as shown in Part I of Attachment II .
i. The State's appropriated responsibility (direct contribution excluding any state fees,
Medicaid contributions or any other funds not listed on the Schedule C) as provided in
Attachment II , Part II is an amount not to exceed $ 3 , 679 , 114 . 00 (State General
Revenue, Other State Funds and Federal Funds listed on the Schedule c) . The State's
obligation to pay under this contract is contingent upon an annual appropriation
by the Legislature .
ii. The County's appropriated responsibility (direct contribution excluding any fees,
other cash orlocal contributions) as provided in Attachment Il , Part II is an amount not
to exceed $863 , 623 . 00 (amount listed under the "Board of County Commissioners Annual
Appropriations section of the revenue attachment) .
b . Overall expenditures will not exceed available funding or budget authority ,
whichever is less , (either current year or from surplus trust funds) in any service category .
Unless requested otherwise , any surplus at the end of the term of this Agreement in the
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County Health Department Trust Fund that is attributed to the CHD shall be carried
forward to the next contract period .
c . Either party may establish service fees as allowed by law to fund activities of the
CHD . Where applicable, such fees shall be automatically adjusted to at least the
Medicaid fee schedule .
d . Either party may increase or decrease funding of this Agreement during the term
hereof by notifying the other party in writing of the amount and purpose for the change in
funding . If the State initiates the increase/decrease , the CHD will revise the Attachment II
and send a copy of the revised pages to the County and the Department of Health ,
Bureau of Budget Management. If the County initiates the increase/decrease, the County
shall notify the CHD . The CHD will then revise the Attachment II and send a copy of the
revised pages to the Department of Health , Bureau of Budget Management .
e . The name and address of the official payee to who payments shall be made is :
County Health Department Trust Fund
Indian River County
Accounts Receivable
190027 th Street
Vero Beach , FL 32960-3383
5 . CHD DIRECTOR/ADMINISTRATOR . Both parties agree the director/administrator
of the CHD shall be a State employee or under contract with the State and will be under
the day-to-day direction of the Deputy State Health Officer. The director/administrator
shall be selected by the State with the concurrence of the County. The
director/administrator of the CHID shall insure that non-categorical sources of funding are
used to fulfill public health priorities in the community and the Long Range Program Plan .
A report detailing the status of public health as measured by outcome measures and
similar indicators will be sent by the CHD director/administrator to the parties no later than
October 1 of each year (This is the standard quality assurance "County Health Profile" report located on
the Office of Planning, Evaluation & Data Analysis Intranet site).
6 . ADMINISTRATIVE POLICIES AND PROCEDURES . The parties hereto agree that
the following standards should apply in the operation of the CHD :
a . The CHD and its personnel shall follow all State policies and procedures, except to
the extent permitted for the use of county purchasing procedures as set forth in
subparagraph b . , below. All CHD employees shall be State or State-contract personnel
subject to State personnel rules and procedures. Employees will report time in the Client
Information System/Health Management Component compatible format by program
component as specified by the State .
b . The CHD shall comply with all applicable provisions of federal and state laws and
regulations relating to its operation with the exception that the use of county purchasing
procedures shall be allowed when it will result in a better price or service and no statewide
Department of Health purchasing contract has been implemented for those goods or
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services . In such cases , the CHD director/administrator must sign a justification therefore ,
and all county-purchasing procedures must be followed in their entirety, and such
compliance shall be documented . Such justification and compliance documentation shall
be maintained by the CHD in accordance with the terms of this Agreement . State
procedures must be followed for all leases on facilities not enumerated in Attachment IV.
c . The CHD shall maintain books , records and documents in accordance with those
promulgated by the Generally Accepted Accounting Principles (GAAP) and Governmental
Accounting Standards Board (GASB ) , and the requirements of federal or state law. These
records shall be maintained as required by the Department of Health Policies and
Procedures for Records Management and shall be open for inspection at any time by the
parties and the public, except for those records that are not otherwise subject to disclosure
as provided by law which are subject to the confidentiality provisions of paragraph 6 . i . ,
below. Books , records and documents must be adequate to allow the CHD to comply with
the following reporting requirements :
i. The revenue and expenditure requirements in the Florida Accounting
System Information Resource (FLAIR).
ii. The client registration and services reporting requirements of the
minimum data set as specified in the most current version of the Client
Information System/Health Management Component Pamphlet;
iii. Financial procedures specified in the Department of Health 's Accounting
Procedures Manuals , Accounting memoranda , and Comptroller's
memoranda ;
iv. The CHD is responsible for assuring that all contracts with service
providers include provisions that all subcontracted services be reported
to the CHD in a manner consistent with the client registration and
service reporting requirements of the minimum data set as specified in
the Client Information System/Health Management Component
Pamphlet.
d . All funds for the CHD shall be deposited in the County Health Department Trust
Fund maintained by the state treasurer. These funds shall be accounted for separately
from funds deposited for other CHDs and shall be used only for public health purposes in
Indian River County.
e . That any surplus/deficit funds , including fees or accrued interest, remaining in the
County Health Department Trust Fund account at the end of the contract year shall be
credited/debited to the state or county, as appropriate , based on the funds contributed by
each and the expenditures incurred by each . Expenditures will be charged to the program
accounts by state and county based on the ratio of planned expenditures in the core
contract and funding from all sources is credited to the program accounts by state and
county. The equity share of any surplus/deficit funds accruing to the state and county is
determined each month and at contract year-end . Surplus funds may be applied toward
the funding requirements of each participating governmental entity in the following year.
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However, in each such case, all surplus funds , including fees and accrued interest, shall
remain in the trust fund until accounted for in a manner which clearly illustrates the amount
which has been credited to each participating governmental entity. The planned use of
surplus funds shall be reflected in Attachment ll , Part I of this contract, with special capital
projects explained in Attachment V .
f. There shall be no transfer of funds between the three levels of services without a
contract amendment unless the CHD director/administrator determines that an emergency
exists wherein a time delay would endanger the public's health and the Deputy State
Health Officer has approved the transfer. The Deputy State Health Officer shall forward
written evidence of this approval to the CHD within 30 days after an emergency transfer.
g . The CHD may execute subcontracts for services necessary to enable the CHID to
carry out the programs specified in this Agreement. Any such subcontract shall include all
aforementioned audit and record keeping requirements .
h . At the request of either party, an audit may be conducted by an independent CPA
on the financial records of the CHD and the results made available to the parties within
180 days after the close of the CHID fiscal year. This audit will follow requirements
contained in OMB Circular A- 133 and may be in conjunction with audits performed by
county government. If audit exceptions are found , then the director/administrator of the
CHD will prepare a corrective action plan and a copy of that plan and monthly status
reports will be furnished to the contract managers for the parties .
i . The CHD shall not use or disclose any information concerning a recipient of
services except as allowed by federal or state law or policy .
j . The CHD shall retain all client records , financial records, supporting documents ,
statistical records , and any other documents (including electronic storage media ) pertinent
to this Agreement for a period of five (5) years after termination of this Agreement. If an
audit has been initiated and audit findings have not been resolved at the end of five (5)
years , the records shall be retained until resolution of the audit findings .
k . The CHD shall maintain confidentiality of all data , files , and records that are
confidential under the law or are otherwise exempted from disclosure as a public record
under Florida law . The CHD shall implement procedures to ensure the protection and
confidentiality of all such records and shall comply with sections 384 . 29 , 381 . 004 , 392 . 65
and 456 . 057 , Florida Statutes , and all other state and federal laws regarding
confidentiality. All confidentiality procedures implemented by the CHD shall be consistent
with the Department of Health Information Security Policies, Protocols , and Procedures ,
dated September 1997 , as amended , the terms of which are incorporated herein by
reference . The CHD shall further adhere to any amendments to the State's security
requirements and shall comply with any applicable professional standards of practice with
respect to client confidentiality.
I . The CHD shall abide by all State policies and procedures , which by this reference
are incorporated herein as standards to be followed by the CHD , except as otherwise
permitted for some purchases using county procedures pursuant to paragraph 6 . b . hereof.
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m . The CHD shall establish a system through which applicants for services and current
clients may present grievances over denial , modification or termination of services . The
CHD will advise applicants of the right to appeal a denial or exclusion from services , of
failure to take account of a client' s choice of service , and of his/her right to a fair hearing to
the final governing authority of the agency. Specific references to existing laws , rules or
program manuals are included in Attachment I of this Agreement .
n . The CHD shall comply with the provisions contained in the Civil Rights Certificate ,
hereby incorporated into this contract as Attachment III .
o . The CHD shall submit quarterly reports to the county that shall include at least the
following :
i. The DE3851- 1 Contract Management Variance Report and the DE580L1
Analysis of Fund Equities Report ;
ii. A written explanation to the county of service variances reflected in the
DE3851- 1 report if the variance exceeds or falls below 25 percent of the planned
expenditure amount. However, if the amount of the service specific variance
between actual and planned expenditures does not exceed three percent of the
total planned expenditures for the level of service in which the type of service is
included , a variance explanation is not required . A copy of the written
explanation shall be sent to the Department of Health , Bureau of Budget
Management.
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p . The dates for the submission of quarterly reports to the county shall be as follows
unless the generation and distribution of reports is delayed due to circumstances beyond
the CHD 's control :
i. March 1 , 2007 for the report period October 1 , 2006 through
December 31 , 2006 ;
ii. June 1 , 2007 for the report period October 1 , 2006 through
March 31 , 2007 ;
iii. September 1 , 2007 for the report period October 1 , 2006
through June 30 , 2007 ; and
iv. December 1 , 2007 for the report period October 1 , 2006
through September 30 , 2007 .
7 . FACILITIES AND EQUIPMENT . The parties mutually agree that:
a . CHD facilities shall be provided as specified in Attachment IV to this contract and
the county shall own the facilities used by the CHD unless otherwise provided in
Attachment IV.
b . The county shall assure adequate fire and casualty insurance coverage for County-
owned CHD offices and buildings and for all furnishings and equipment in CHD offices
through either a self-insurance program or insurance purchased by the County.
c. All vehicles will be transferred to the ownership of the County and registered as
county vehicles . The county shall assure insurance coverage for these vehicles is
available through either a self-insurance program or insurance purchased by the County.
All vehicles will be used solely for CHD operations . Vehicles purchased through the
County Health Department Trust Fund shall be sold at fair market value when they are no
longer needed by the CHD and the proceeds returned to the County Health Department
Trust Fund .
8 . TERMINATION .
a . Termination at Will . This Agreement may be terminated by either party without
cause upon no less than one-hundred eighty ( 180) calendar days notice in writing to the
other party unless a lesser time is mutually agreed upon in writing by both parties . Said
notice shall be delivered by certified mail , return receipt requested , or in person to the
other party's contract manager with proof of delivery.
b . Termination Because of Lack of Funds . In the event funds to finance this
Agreement become unavailable , either party may terminate this Agreement upon no less
than twenty-four (24 ) hours notice . Said notice shall be delivered by certified mail , return
receipt requested , or in person to the other party's contract manager with proof of delivery .
c. Termination for Breach . This Agreement may be terminated by one party, upon no
less than thirty (30 ) days notice, because of the other party's failure to perform an
obligation hereunder. Said notice shall be delivered by certified mail , return receipt
requested , or in person to the other party's contract manager with proof of delivery.
Waiver of breach of any provisions of this Agreement shall not be deemed to be a waiver
of any other breach and shall not be construed to be a modification of the terms of this
Agreement.
9 . MISCELLANEOUS . The parties further agree :
a . Availability of Funds . If this Agreement, any renewal hereof, or any term ,
performance or payment hereunder, extends beyond the fiscal year beginning July 1 ,
2006 , it is agreed that the performance and payment under this Agreement are contingent
upon an annual appropriation by the Legislature , in accordance with section 287 . 0582 ,
Florida Statutes .
b . Contract Managers . The name and address of the contract managers for
the parties under this Agreement are as follows :
For the State : For the County:
Ernesto Rubio Jason Brown
Name Name
Business Manager Budget Manager
Title Title
190027 1h Street 1840 25`h Street
Vero Beach , FL 32960-3383 Vero Beach , FL 32960-3365
Address Address
772-794-7464 772-567-8000 , ext . 1214
Telephone Telephone
If different contract managers are designated after execution of this Agreement, the name ,
address and telephone number of the new representative shall be furnished in writing to
the other parties and attached to originals of this Agreement.
C . Captions . The captions and headings contained in this Agreement are for
the convenience of the parties only and do not in any way modify, amplify , or give
additional notice of the provisions hereof.
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In WITNESS THEREOF , the parties hereto have caused this 37 page agreement to be
executed by their undersigned officials as duly authorized effective the 1S` day of October, 2006 .
BOARD OF COUNTY COMMISSIONERS STATE OF FLORIDA
FOR INDIAN RIVER COUNTY
DEPARTMENT OF HEALTH
SIGNED B SIGNED BY: �
NAME : Arthur R . Neuberger NAME& Rony Francois, M . D. , M .S . P. H . , Ph . D.
TITLE : Chairman TITLE : Secretary
DATE : September 19 , 2006 DATE : 10 . L . o (1
ATTESTED TO :
SIGNED BY:)44j,�t SIGNED BY :
NAME : �T /k /3.9/PrgA1 NAME : Je L. Kline . R. N . , M . P. H .
TITLE : G'W,0' TITLE : C1HD Administrator
DATE : DATE :
PPROVED
C my Adm istrato
APPROVED AS TO FORM
AND E AL SUFFICILNCC
MARIAN ff. FELL
ASSISTANT COUNTY ATTORNEY
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ATTACHMENT
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PROGRAM SPECIFIC REPORTING REQUIREMENTS AND PROGRAMS REQUIRING
COMPLIANCE WITH THE PROVISIONS OF SPECIFIC MANUALS
Some health services must comply with specific program and reporting requirements in addition to the Personal Health
Coding Pamphlet (DHP 50-20), Environmental Health Coding Pamphlet (DHP 50-21 ) and FLAIR requirements because
of federal or state law, regulation or rule. If a county health department is funded to provide one of these services , it
must comply with the special reporting requirements for that service. The services and the reporting requirements are
listed below:
Service Requirement
1 . Sexually Transmitted Disease Requirements as specified in FAC 64D-3, F . S . 381 and
Program F. S . 384 and the CHD Guidebook .
2 . Dental Health Monthly reporting on DH Form 1008* .
3. Special Supplemental Nutrition Service documentation and monthly financial reports as
Program for Women , Infants specified in DHM 150-24* and all federal, state and county
and Children . requirements detailed in program manuals and published
procedures.
4 . Healthy Start/ Requirements as specified in the Healthy Start Standards
Improved Pregnancy Outcome and Guidelines 1998 and as specified by the Health Start
Coalitions in contract with each county health department.
5 . Family Planning Periodic financial and programmatic reports as specified
by the program office and in the CHD Guidebook, Internal
Operating Policy FAMPLAN 14*
6 . Immunization Periodic reports as specified by the department regarding
the surveillance/investigation of reportable vaccine
preventable diseases, vaccine usage accountability, the
assessment of various immunization levels and forms
reporting adverse events following immunization and
Immunization Module quarterly quality audits and duplicate
data reports .
7. Chronic Disease Program Requirements as specified in the Community Intervention
Program (CIP) and the CHD Guidebook.
8 . Environmental Health Requirements as specified in DHP 50-4* and 50-21 *
9 . HIV/AIDS Program Requirements as specified in Florida Statue 384.25 and
64D-3.016 and 3 .017 F.A.C . and the CHD Guidebook. Case
reporting on CDC Forms 50 .428 (Adult/ Adolescent) and
50 .42A (Pediatric). Socio-demographic data on persons
tested for HIV in CHD clinics should be reported on Lab
Request Form 1628 or Post-Test Counseling Form 1633 .
These reports are to be sent to the Headquarters HIV/AIDS
office within 5 days of the initial post-test counseling
appointment or within 90 days of the missed post-test
counseling appointment.
ATTACHMENT I (Continued )
10 . School Health Services HRSM 150-25', including the requirement for an annual plan
as a condition for funding .
'or the subsequent replacement if adopted during the contract period .
ATTACHMENT II
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PART I. PLANNED USE OF COUNTY HEALTH DEPARTMENT TRUST FUND BALANCES
Estimated State Share Estimated County Share
of CHD Trust Fund of CHID Trust Fund
Balance as of 09/30/06 Balance as of 09/30/06 Total
1 . CHID Trust Fund Ending Balance 09/30/06 497,344 5189664 12016,008
2. Drawdown for Contract Year ( 132,894) ( 104,907) (237,801 )
October 1 , 2006 to September 30 , 2007
3 . Special Capital Project use for Contract Year
October 1 , 2006 to September 30, 2007
4 . Balance Reserved for Contingency Fund
October 1 , 2006 to September 30, 2007 364 ,450 413,757 778,207
Note: The total of items 2 , 3 and 4 must equal the ending balance in item 1 .
Special Capital Projects are new construction or renovation projects and new furniture or equipment associated with these projects, and mobile health vans
.
Pursuant to 154 .02, F.S . , At a minimum , the trust fund shall consist of: an operating reserve, consisting of 7 .5 percent of the annual operating
budget,
maintained to ensure adequate cash flow from nonstate revenue sources .
Working Copy ATTACHMENT H
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part IL Sources of Contributions to County Health Department
October 1, 2006. to September 30, 2007
State CHD County Total CHD
Trost Fond :.CED Tru tFund ..r . Other
(cash) Trust Fund (cash) Contribution Total
1. GENERAL REVENUE - STATE
015040 ALG/CESSPOOL IDENTIFICATION AND ELIMINATION 0 0 0 0 0
015040 ALG/CONTR TO CHDS-AIDS PATIENT CARE 100,000 0 100,000 0 100,000
015040 ALG/CONTR TO CHDS-AIDS PREV & SURV & FIELD STAFF 0 0 0 0 0
015040 ALG/CONTR TO CHDS-DENTAL PROGRAM 0 0 0 0 0
015040 ALG/CONTR TO CHDS-MIGRANT LABOR CAMP SANITATION 2,759 0 2,759 0 2,759
015040 ALG/CONTR. TO CHDS-IMMU RATION OUTREACH TEAMS 11 ,375 0 11 ,375 0 11 ,375
015040 ALG/CONTR. TO CHDS-INDOOR AIR ASSIST PROG 9,939 0 91939 0 9,939
015040 ALG/CONTR, TO CHDS-MCH HEALTH - FIELD STAFF COST 0 0 0 0 0
015040 ALG/CONTR. TO CHDS-SOVEREIGN IMMUNITY 0 0 0 0 0
015040 ALG/CONTRIBUTION TO CHDS-PRIMARY CARE 15,789 0 15,789 0 15,789
015040 ALG/FAMILY PLANNING 36,022 0 36,022 0 36,022
015040 ALG/IPO - OUTREACH SOCIAL WORKERS CAT. 050707 0 0 0 0 0
015040 ALG/IPO HEALTHY START 0 0 0 0 0
015040 ALG/IPO HEALTHY START/IPO CAT 050707 0 0 0 0 0
015040 ALG/IPO-INFANT MORTALITY PROJECT CAT. 050707 0 0 0 0 0
015040 ALG/MCH HEALTHY START/PO CAT 050870 0 0 0 0 0
015040 ALGIMCH-INFANT MORTALITY PROJECT CAT. 050870 0 0 0 0 0
015040 ALG/MCH-OUTREACH SOCIAL WORKERS CAT 050870 24,000 0 24,000 0 24,000
015040 ALG/PRIMARY CARE 204,314 0 204,314 0 204,314
015040 ALG/SCHOOL HEALTH/SLRPLEMENTAL 50,548 0 50,548 0 50,548
015040 CATE ESCAMBIA 0 0 0 0 0
015040 CHD SUPPORT SERVICES 0 0 0 0 0
015040 CLOSING THE GAP PROGRAM 0 0 0 0 0
015040 COMMUNITY SMILES - DADE 0 0 0 0 0
015040 COMMUNITY TB PROGRAM 73,220 0 73,220 0 73,220
015040 DENTAL SPECIAL INITIATIVE PROJECTS 0 0 0 0 0
015040 DUVAL TEEN PREGNANCY PREVENTION 0 0 0 0 0
015040 ENHANCED DENTAL SERVICES 25,267 0 25,267 0 25,267
015040 FL HEPATITIS & LIVER FAILURE PREVENTION/CONTROL 0 0 0 0 0
015040 HEALTH PROMOTION & EDUCATION INITIATIVES 0 0 0 0 0
015040 HEALTHY BEACHES MONITORING 10,328 0 10,328 0 10,328
015040 HEALTHY START - DATA COLLECTION PROJECT STAFF 0 0 0 0 0
015040 LA LIGA CONTRA EL CANCER 0 0 0 0 0
015040 MEDIVAN PROJECT 0 0 0 0 0
015040 METRO ORLANDO URBAN LEAGUE TEENAGE PREG PREV 0 0 0 0 0
015040 PRIMARY CARE SPECIAL DENTAL PROJECTS 65,549 0 65,549 0 65,549
015040 PRIMARY CARE SPECIAL PROJECTS 0 0 0 0 0
015040 SCHOOL HEALTH-SUPPLEMENT-TANF 14,050 0 14,050 0 14,050
015040 SPECIAL NEEDS SHELTER PROGRAM 0 0 0 0 0
015040 STD GENERAL REVENUE 0 0 0 0 0
015040 VOLUNTEER SCHOOL HEALTH NURSE GRANT 0 0 0 0 0
015050 ALG/CONTR TO CHDS 1 ,958,867 0 1,958,867 0 1 ,958,867
GENERAL REVENUE TOTAL 2,602,027 0 21602,027 0 2,602,027
2. NON GENERAL REVENUE - STATE
015010 ALG/CONTR TO CHDS-REBASING TOBACCO TF 27,287 0 27,287 0 27,287
015010 BASIC SCHOOL HEALTH - TOBACCO TF 70,001 0 70,001 0 70,001
015010 CHD SUPPORT SERVICES 0 0 0 0 0
11000011 -
Working Copy ATTACIRVIRNT H.
INDIAN RIVER COUNTY HEALTH DFYARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2006 to September 30,2007
State CHD County Total CUD
Trust Fund CHD Trust Fund .Other
(ash) _ .Trust Fund (cub). Contribution Total
2. NON GENERAL REVENUE - STATE
015010 FL HEPATITIS & LIVER FAILURE PREVENTION/CONTROL 0 0 0 0 0
015010 FULL SERVICE SCHOOLS - TOBACCO IF 74,304 0 74,304 0 74,304
015010 ONSFFE SEWAGE RESEARCH PROGRAM 0 0 0 0 0
015010 PACE EH 15,000 0 15,000 0 15 ,000
015010 PUBLIC SWIMMING POOL PROGRAM 0 0 0 0 0
015010 SUPER ACT PROGRAM ADM TF 10,000 0 10,000 0 10,000
015010 SUPPLEMENTAL/COMPREHENSIVE SCHOOL HEALTH - TOB TF 0 0 0 0 0
015010 VARICELLA IMMUNIZATION REQUIREMENT TOBACCO TF 6,088 0 6,088 0 6,088
015020 BIOMEDICAL WASTE/DEP ADM IF 9,948 0 9,948 0 9.948
015020 SAFE DRINKING WATER PRG/DEP ADM 0 0 0 0 0
015020 FOOD AND WATERBORNE DISEASE PROGRAM ADM TF/DACS 0 0 0 0 0
NON GENERAL REVENUE TOTAL 212,628 0 212,628 0 212,628
3. FEDERAL FUNDS - State
007000 AIDS PREVENTION 56,585 0 56,585 0 56,585
007000 AIDS SEROPREVALENCE 0 0 0 0 0
007000 AIDS SURVEILLANCE 0 0 0 0 0
007000 BIOTERR SURVEILLANCE & EPIDEMIOLOGY 86,407 0 86,407 0 86,407
007000 BIOTERRORISM PLANNING & READINESS 87,983 0 87,983 0 87,983
007000 CDHPE PROGRAM 69, 117 0 69,117 0 69, 117
007000 CHD SUPPORT SERVICES 89,316 0 89,316 0 89,316
007000 CHILDHOOD LEAD POISONING PREVENTION 0 0 0 0 0
007000 COASTAL BEACH MONITORING PROGRAM 91090 0 9,090 0 9,090
007000 COMPREHENSIVE CARDIOVASCULAR PROGRAM 0 0 0 0 0
007000 FGTF/AIDS MORBIDITY 0 0 0 0 0
007000 FGTFBREAST & CERVICAL CANCER-ADMIN/CASE MAN 0 0 0 0 0
007000 FGTF/FAMILY PLANNING TITLE X SPECIAL INITIATIVES 0 0 0 0 0
007000 FGTF/FAMB.Y PLANNING-TITLE X 54,921 0 54,921 0 54,921
007000 FGTF/IMMUNIZATION ACTION PLAN 17,252 0 17,252 0 17,252
007000 FGTF/WIC ADMINISTRATION 345, 127 0 345, 127 0 345, 127
007000 FLORIDA PANDEMIC INFLUENZA 19,839 0 19,839 0 19,839
007000 HEALTH PROGRAM FOR REFUGEES 0 0 0 0 0
007000 HOUSING OPPORTUNITIES FOR PEOPLE WITH AIDS (HOPWA) 0 0 0 0 0
007000 IMMUNIZATION SUPPLEMENTAL 0 0 0 0 0
007000 IMMUNIZATION-WIC LINKAGES 0 0 0 0 0
007000 MCH BGTF-GADSDEN SCHOOL CLINIC 0 0 0 0 0
007000 MCH BGTF-HEALTHY START B'O 0 0 0 0 0
007000 MCH BGTF-INFANT MORTALITY PROJECT 0 0 0 0 0
007000 MCH BGTF-MCH/CHB-D HEALTH 10,535 0 10,535 0 10,535
007000 MCH BGTF-MCH/DENTAL PROJECTS 47,500 0 47,500 0 47,500
007000 MCH BGTF-OUTREACH SOCIAL WORKERS 0 0 0 0 0
007000 PHP-CITIES RESPONSE INITIATIVE 0 0 0 0 0
007000 RAPE PREVENTION & EDUCATION GRANT 0 0 0 0 0
007000 RISK COMMUNICATIONS 0 0 0 0 0
007000 RYAN WHITE 0 0 0 0 0
007000 RYAN WHITE - EMERGING COMMUNITIES 0 0 0 0 0
007000 RYAN WHITE-AIDS DRUG ASSIST PROG-ADMIN 35 ,000 0 35,000 0 35,000
007000 RYAN WHITE-CONSORTIA 0 0 0 0 0
Working Copy ATTACHMENT IL
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2006 to September 30, 2007
State CHD County Total CHD
Trust Fund CIID Trust Fund .Other
(cash) 'frust Fund: (eash) Contribution, Total
3. FEDERAL FUNDS - State
007000 STD FEDERAL GRANT - CSPS 0 0 0 0 0
007000 STD PROGRAM - PHYSICIAN TRAINING CENTER 0 0 0 0 0
007000 STD PROGRAM INFERTILITY PREVENTION PROSECT (IPP) 0 0 0 0 0
007000 SYPHILIS ELIMINATION 0 0 0 0 0
007000 TESTING HN SERONEGATIVE HEADQUARTERS 0 0 0 0 0
007000 TRAINING AND EDUCATION 0 0 0 0 0
007000 TUBERCULOSIS CONTROL - FEDERAL GRANT 0 0 0 0 0
007000 WEST NILE VIRUS & EPIDEMIOLOGY PROJECTS 2006 0 0 0 0 0
007000 WIC BREASTFEEDING PEER COUNSELING 0 0 0 0 0
007000 WIC BREASTFEEDING PEER COUNSELING PROG FFY 2005 0 0 0 0 0
007000 WIC INFRASTRUCTURE 0 0 0 0 0
015009 MEDIPASS WAVER-HLTHY STRT CLIENT SERVICES 0 0 0 0 0
015009 MEDIPASS WAVER-SOBRA 0 0 0 0 0
015075 TITLEXXUSCHOOL HEALTH/SUPPLEMENTAL 98,347 0 98,347 0 98,347
015075 NEW LINE 0 0 0 0 0
015075 NEW LINE 0 0 0 0 0
015075 NEW LINE 0 0 0 0 0
FEDERAL FUNDS TOTAL 1 ,027,019 0 1 ,027,019 0 1 ,027,019
4. FEES ASSESSED BY STATE OR FEDERAL RULES - STATE
001020 MIGRANT HOUSING PERMIT 5,000 0 5,000 0 5,000
001020 MOBILE HOME AND PARKS 12,354 0 12,354 0 12,354
001020 FOOD HYGIENE PERMIT 12,400 0 12,400 0 12,400
001020 BIOHAZARD WASTE PERMIT 10,098 0 10,098 0 10,098
001020 SWIMMING POOLS 36,720 0 36,720 0 36,720
001020 PRIVATE WATER CONSTR PERMIT 0 0 0 0 0
001020 PUBLIC WATER ANNUAL OPER PERMIT 2,430 0 2,430 0 2,430
001020 PUBLIC WATER CONSTR PERMIT 0 0 0 0 0
001020 NON-SDWA SYSTEM PERMIT 0 0 0 0 0
001020 SAFE DRINKING WATER 0 0 0 0 0
001020 TANNING FACILITIES 2,662 0 2,662 0 2,662
001020 BODY PIERCING 300 0 300 0 300
001092 NON SDWA LAB SAMPLE 0 0 0 0 0
001092 OSDS VARIANCE FEE 0 0 0 0 0
001092 ENVIRONMENTAL HEALTH FEES 1 ,690 0 1 ,690 0 1 ,690
001092 OSDS REPAIR PERMIT 25, 171 0 25, 171 0 25, 171
001092 OSDS PERMIT FEE 228,743 0 228,743 0 228,743
001092 I & M ZONED OPERATING PERMIT 10,350 0 10,350 0 10,350
001092 AEROBIC OPERATING PERMIT 0 0 0 0 0
001092 SEPTIC TANK SITE EVALUATION 125,736 0 125,736 0 125,736
001170 LAB FEE CHEMICAL ANALYSIS 0 0 0 0 0
001170 NONPOTABLE WATER ANALYSIS 0 0 0 0 0
001170 WATER ANALYSIS-POTABLE 0 0 0 0 0
010304 MQA INSPECTION FEE 6,700 0 6,700 0 6,700
FEES ASSESSED BY STATE OR FEDERAL RULES TOTAL 480,354 0 480,354 0 480,354
5. OTHER CASH CONTRIBUTIONS - STATE
Working Copy ATTACHMENT II.
INDIAN RIVERCOUNTY HEALTH DEPARTMENT
Part IL Sources of Contributions to County Heaitb Department
October 1, 2006 to September 30, 2007
Sate CHD County Total CHD
Trust Fund CHO Trust Fund -Other
(cash)-" ' " Trust Fund. (cash) Contribution Total
5. OTHER CASH CONTRIBUTIONS - STATE
010304 STATIONARY POLLUTANT STORAGE TANKS 0 0 0 0 0
090001 DRAW DOWN FROM PUBLIC HEALTH UNIT 132,894 0 132,894 0 132,894
OTHER CASH CONTRIBUTIONS TOTAL 132,894 0 132,894 0 132,894
6. MEDICAID - STATE/COUNTY
001056 MEDICAID PHARMACY 0 0 0 0 0
001076 MEDICAID TB 0 0 0 0 0
001078 MEDICAID ADMINISTRATION OF VACCINE 15,311 15,311 30,622 0 30,622
001079 MEDICAID CASE MANAGEMENT 0 0 0 0 0
001080 MEDICAID OTHER 0 0 0 0 0
001081 MEDICAID CHILD HEALTH CHECK UP 161 ,720 230,423 392, 143 0 392, 143
001082 MEDICAID DENTAL 94,764 135,023 229,787 0 229,787
001087 MEDICAID STD 2,362 3,365 5,727 0 5,727
001089 MEDICAID AIDS 0 0 0 0 0
001147 MEDICAID HMO RATE 0 0 0 0 0
001191 MEDICAID MATERNITY 45,522 64,862 110,384 0 110,384
001192 MEDICAID COMPREHENSIVE CHILD 173,528 247,249 420,777 0 420,777
001193 MEDICAID COMPREHENSIVE ADULT 125,641 179,017 304,658 0 304,658
001194 MEDICAID LABORATORY 0 0 0 0 0
001083 MEDICAID FAMILY PLANNING 6, 128 55, 149 61 ,277 0 61 ,277
001208 MEDEPASS $3.00 ADM. FEE 67,608 67,608 135,216 0 135,216
MEDICAID TOTAL 692,584 998,007 1 ,690,591 0 1 ,690,591
7. ALLOCABLE REVENUE - STATE
018000 REFUNDS 500 0 500 0 500
037000 PRIOR YEAR WARRANT 0 0 0 0 0
038000 12 MONTH OLD WARRANT 0 0 0 0 0
ALLOCABLE REVENUE TOTAL 500 0 500 0 500
8. OTHER STATE CONTRIBUTIONS NOT IN CHD TRUST FUND - STATE
PHARMACY SERVICES 0 0 0 151 ,831 151 ,831
LABORATORY SERVICES 0 0 0 102, 193 102, 193
TB SERVICES 0 0 0 0 0
IMMUNIZATION SERVICES 0 0 0 300, 163 300, 163
STD SERVICES 0 0 0 0 0
CONSTRUCTION/RENOVATION 0 0 0 0 0
WIC FOOD 0 0 0 1 ,612,083 1 ,612,083
ADAP 0 0 0 0 0
DENTAL SERVICES 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
OTHER STATE CONTRIBUTIONS TOTAL 0 0 0 2, 166,270 2, 166,270
9. DIRECT COUNTY CONTRIBUTIONS - COUNTY
008030 GRANTS-COUNTY TAX DIRECT 0 1 ,742,802 1 ,742,802 0 11742,802
008034 GRANTS CNTY COMMSN OTHER 0 863,623 863 ,623 0 863,623
Working copy ATTACHMENT, EL
INDIAN RIVER COUNTY-HEALTH DEPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 2006 to September 30,2007
State CHD . . County Total CHD
.Trust Fund 'CUD . Trust Fund Other
. (cash) " Trust Fund l (cash). Contribution , Total
BOARD OF COUNTY COMMISSIONERS TOTAL 0 2,606,425 2,606,425 0 2,606,425
10. FEES AUTHORIZED BY COUNTY ORDINANCE OR RESOLUTION - COUNTY
001060 VITAL STATISTICS FEES OTHER 0 11200 11200 0 11200
001077 RABIES VACCINE 0 0 0 0 0
001077 COMMUNICABLE DISEASE FEES 0 146,632 146,632 0 146,632
001077 PRIMARY CARE FEES 0 232,983 232,983 0 232,983
001077 AIDS CO-PAYS 0 0 0 0 0
001094 LOCAL ORDINANCE FEES 0 137,485 137,485 0 137,485
001094 ADULT ENTER. PERMIT FEES 0 0 0 0 0
001114 NEW BIRTH CERTIFICATES 0 36, 128 36, 128 0 36, 128
001115 DEATH CERTIFICATES 0 134,730 134,730 0 134,730
001117 VOCAL STATS-ADM. FEE 50 CENTS 0 2,258 21258 0 21258
FEES AUTHORIZED BY COUNTY TOTAL 0 691,416 6913416 0 691 ,416
11. OTHER CASH AND LOCAL CONTRIBUTIONS - COUNTY
001009 RETURNED CHECK ITEM 0 0 0 0 0
001029 THIRD PARTY REIMBURSEMENT 0 33,839 33,839 0 33,839
001029 HEALTH MAINTENANCE ORGAN. (HMO) 0 0 0 0 0
001054 MEDICARE PART D 0 0 0 0 0
001077 RYAN WHITE TITLE H 0 0 0 0 0
001090 MEDICARE PART 0 176, 112 176, 112 0 176, 112
005040 INTEREST EARNED 0 0 0 0 0
005041 INTEREST EARNED-STATE INVESTMENT ACCOUNT 0 12,000 12,000 0 12,000
007010 U.S. GRANTS DIRECT 0 0 0 0 0
010300 SALE OF GOODS AND SERVICES TO STATE AGENCIES 0 2,580 2,580 0 2,580
010301 EXP WITNESS FEE CONSULTNT CHARGES 0 0 0 0 0
010405 SALE OF PHARMACEUTICALS 0 0 0 0 0
010409 SALE OF GOODS OUTSIDE STATE GOVERNMENT 0 0 0 0 0
010500 SALES OF SERVICES OUTSIDE STATE GOVERNMNENT 0 0 0 0 0
011000 OTHER GRANTS & DONATIONS 0 9, 155 9, 155 0 91155
011000 GRANT-TLC 0 65, 148 65, 148 0 65, 148
011000 GRANT-UNITED WAY 0 54,285 54,285 0 54,285
011000 GRANT-SJWDM 0 24,656 24,656 0 24,656
011000 GRANT-ECB 0 20,820 20,820 0 20,820
011000 GRANT-DIRECT 0 0 0 0 0
011000 GRANT-DIRECT 0 0 0 0 0
011000 GRANT-DIRECT 0 0 0 0 0
011001 HEALTHY START COALITION CONTRIBUTIONS 0 3577028 357,028 0 357,028
011007 CASH DONATIONS PRIVATE 0 0 0 0 0
012020 FINES AND FORFEITURES 0 0 0 0 0
012021 RETURN CHECK CHARGE 0 0 0 0 0
028020 INSURANCE RECOVERIES-OTHER 0 0 0 0 0
090002 DRAW DOWN FROM PUBLIC HEALTH UNIT 0 179,307 179,307 0 179.307
OTHER CASH AND LOCAL CONTRIBUTIONS TOTAL 0 934,930 934,930 0 9349930
12. ALLOCABLE REVENUE - COUNTY
018000 REFUNDS 0 0 0 0 0
037000 PRIOR YEAR WARRANT 0 0 0 0 0
Working Copy ATTACHMENT II.
INDIAN RIVER COUNTY#IEALTKI)EPARTMENT
Part II. Sources of Contributions to County Health Department
October 1, 20H to September 30;2007
State CBD County Total CAD
Trust Fund - CBD Trost Fund Othar.
(cash) Trust Feud (cash) Goutn=zbinion Total. :
12. ALLOCABLE REVENUE - COUNTY
038000 12 MONTH OLD WARRANT 0 0 0 0 0
COUNTY ALLOCABLE REVENUE TOTAL 0 0 0 0 0
13. BUILDINGS - COUNTY
ANNUAL RENTAL EQUIVALENT VALUE 0 0 0 436,712 436,712
BUILDING MAINTENANCE 0 0 0 147,529 147,529
INSURANCE 0 0 0 0 0
UTILITIES 0 0 0 0 0
GROUNDS MAINTENANCE 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
OTHER (SPECIFY) 0 0 0 0 0
BUILDINGS TOTAL 0 0 0 584,241 584,241
14. OTHER COUNTY CONTRIBUTIONS NOT IN CHD TRUST FUND - COUNTY
EQUIPMENT/VEHICLE PURCHASES 0 0 0 0 0
VEHICLE INSURANCE 0 0 0 0 0
VEHICLE MAINTENANCE 0 0 0 0 0
OTHER COUNTY CONTRIBUTION - HUMAN SERVICES 0 0 0 74,400 74,400
OTHER COUNTY CONTRIBUTION (SPECIFY) 0 0 0 0 0
OTHER COUNTY CONTRIBUTIONS TOTAL 0 0 0 74,400 74,400
GRAND TOTAL CHD PROGRAM 5, 148,006 5,230,778 10,378,784 2,824,911 13,203,695
Working Copying ATTACHMENT`H
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part III. Planned Staffing, Clients, Services, And Expenditures By Program Service Area.Within Each Level Of Service
October 1, 2006 to September 30,1007
Quarterly Expenditure Plan
FTVs Clients 1st. 2ptl., 3rd : 4th _ Grand :
(0.00) Unite . Services ('!V}.elsdollarsanly):. ' State 'County Total•.. -
A. COMMUNICABLE DISEASE CONTROL:
VITAL STATISTICS ( 180) 2. 18 0 0 17,229 24,715 32,028 21 ,426 0 95,398 95,398
IMMUNIZATION ( 101 ) 5 .62 4,059 19,800 150,013 96,842 69,804 87,028 137,254 266,433 403 ,687
STD (102) 5 .56 728 3, 185 69,350 79, 115 69,932 65,251 215,572 68,076 283,648
A.I.D.S. ( 103) 3 .94 590 8,000 40,012 49,040 47,954 49,662 158,668 28,000 186,668
TB CONTROL SERVICES ( 104) 2.92 470 2, 149 30,367 34,514 29,573 40, 124 115,737 18,841 134,578
COMM. DISEASE SURV. (106) 2.09 0 500 31 ,904 38,989 35,088 30,417 136,398 0 136,398
HEPATITIS PREVENTION (109) 0.00 0 0 0 0 0 0 0 0 0
PUBLIC HEALTH PREP AND RESP (116) 2.52 0 0 88,549 45,460 61 , 178 59,845 255,032 0 255,032
COMMUNICABLE DISEASE SUBTOTAL 24.83 5,847 33,634 427,424 368,675 345,557 353 ,753 1 ,018,661 476,748 1 ,495,409
B. PRIMARY CARE:
CHRONIC DISEASE SERVICES (2 10) 2.85 2,300 3,200 24,497 19,030 46,095 17,387 86,677 20,332 107,009
TOBACCO PREVENTION (212) 0.00 0 0 0 0 0 0 0 0 0
HOME HEALTH (215) 0.00 0 0 0 0 0 0 0 0 0
W.I.C. (22 1 ) 8.84 4,914 30,958 117,963 91,722 100,877 103,260 413,822 0 413,822
FAMILY PLANNING (223) 10.05 3 , 160 14,000 162,882 191 ,049 145,779 169,696 314,621 354,785 669,406
IMPROVED PREGNANCY OUTCOME (225) 0.00 0 0 0 0 0 0 0 0 0
HEALTHY START PRENATAL (227) 3.98 657 14, 100 40,270 44,303 43,366 39,687 0 167,626 167,626
COMPREHENSIVE CHILD HEALTH (229) 24.68 4,380 21 ,420 375,951 428,953 419, 172 395,359 490,307 1 , 129, 128 1 ,619,435
HEALTHY START INFANT (23 1 ) 3.23 155 9,400 55,312 65,825 54,800 58,616 0 234,553 234,553
SCHOOL HEALTH (234) 7.00 0 120,000 104,830 117,728 106,406 102,288 427,252 4,000 431 ,252
COMPREHENSIVE ADULT HEALTH (237) 40.66 6,900 47,300 726,420 817,983 786,083 788,848 1 ,216,540 1 ,902,794 3, 119,334
DENTAL HEALTH (240) 12.04 4,038 22,520 215,045 243,946 231 ,724 265, 102 334,536 621 ,281 955,817
PRIMARY CARE SUBTOTAL 113.33 26,504 282,898 1,823, 170 2,020,539 1 ,934,302 1 ,940,243 3,283,755 4,434,499 7,718,254
C. ENVIRONMENTAL HEALTH:
Water and Onsite Sewage Programs
COASTAL BEACH MONITORING (347) 0.25 585 640 6,669 5,075 11 ,225 8,277 31 ,246 0 31 ,246
LIMITED USE PUBLIC WATER SYSTEMS (357) 0.31 70 315 4,547 3,870 1 ,792 5,630 9,503 6,336 15,839
PUBLIC WATER SYSTEM (358) 0.04 2 45 548 204 483 1,228 2,463 0 21463
PRIVATE WATER SYSTEM (359) 1 .24 635 898 12,421 15,236 14,705 20,009 6,237 56, 134 62,371
INDIVIDUAL SEWAGE DISP. (361 ) 10.44 4,584 10,970 112,631 175,312 169,299 139,223 512,960 83,505 596,465
Group Total 12.28 5,876 12,868 136,816 1997697 197,504 174,367 562,409 145,975 708,384
Facility Programs
FOOD HYGIENE (348) 0.71 Ito 520 14,409 12,662 11,275 13,388 0 51 ,734 51 ,734
BODY ART (349) 0.01 3 5 337 320 291 376 1 ,324 0 17324
GROUP CARE FACILITY (35 1 ) 0.38 130 249 117234 8,338 71456 7,388 34,416 0 34,416
MIGRANT LABOR CAMP (352) 0.01 1 7 99 730 262 61 1 , 152 0 1, 152
HOUSING,PUBLIC BLDG SAFETY,SANITATION (35a)27 168 200 2,660 4,033 2,700 5, 151 0 14,544 14,544
MOBILE HOME AND PARKS SERVICES (354) 0.22 57 180 3,834 9,378 1 ,678 3,786 18,676 0 18,676
SWIMMING POOLSBATHING (360) 0.70 255 785 7,334 10,004 12,967 14, 174 40,031 41448 44,479
BIOMEDICAL WASTE SERVICES (364) 0.61 197 265 4,925 6,875 8,558 5,289 18,209 71438 25,647
TANNING FACILITY SERVICES (369) 0.07 10 35 1 ,248 1 , 155 11422 1 ,860 5,685 0 5,685
Working Copying ATTACHMENT 11,
INDIAN RIVER COUNTY HEALTH DEPARTMENT
Part IH. Planned.Staffing, Clients, Services, And Expenditures_By Program Service Area Within Each Level Of Service
October 1,2006 to September 30, 2007
Quarterly Expenditure Plan
FPE's Clients- 1st 2nd : 3rd. 4th Grand .
(0.00) 'Units Services (Whokdollan only) State i ' Coaoty Total
C. ENVIRONMENTAL HEALTH:
Group Total 2.98 931 21246 46,080 53,495 46,609 51 ,473 119,493 78, 164 197,657
Groundwater Contamination
STORAGE TANK COMPLIANCE (3 55) 1 .06 110 510 16,056 27,639 51 ,368 13 ,901 108,964 0 t08,964
SUPER ACT SERVICE (356) 0.39 12 135 2,299 3, 158 2,516 5, 163 13,136 0 13, 136
Group Total 1 .45 122 645 18,355 30,797 53,884 19,064 122, 100 0 122, 100
Community Hygiene
RADIOLOGICAL HEALTH (372) 0.00 0 1 35 44 40 36 155 0 155
TOXIC SUBSTANCES (373) 0. 15 75 57 1 ,525 1,464 2,928 3,461 0 9,378 9,378
OCCUPATIONAL HEALTH (344) 0. 10 0 0 867 833 1 ,335 867 31200 702 3,902
CONSUMER PRODUCT SAFETY (345) 0.00 0 0 0 62 0 0 62 0 62
INJURY PREVENTION (346) 0.00 0 0 0 0 0 0 0 0 0
LEAD MONITORING SERVICES (350) 0.00 0 0 159 285 103 87 0 634 634
PUBLIC SEWAGE (362) 0. 13 0 400 2,873 41466 3,798 2,614 8,938 4,813 13,751
SOLD) WASTE DISPOSAL (363) 0.21 0 50 2,802 3 ,304 3,625 3,877 13 ,608 0 13,608
SANITARY NUISANCE (365) 0.05 27 48 149 1 ,600 11408 1 ,271 0 4,428 41428
RABIES SURVEILLANCE/CONTROL SERVICES (360 10 20 100 1 ,456 977 11132 1 ,599 0 5, 164 5, 164
ARBOVIRUS SURVEILLANCE (367) 0.00 0 10 244 61 285 297 0 887 887
RODENT/ARTHROPOD CONTROL (368) 0.01 0 12 358 58 73 53 542 0 542
WATER POLLUTION (370) 0.38 0 920 4,659 5,319 1 ,762 5,307 4,091 12,956 17,047
AIR POLLUTION (371 ) 0. 19 0 80 5, 172 1 , 141 3,036 1 ,643 10,992 0 10,992
Group Total 1 .32 122 1 ,678 20,299 19,614 19,525 21 ,112 41 ,588 38,962 80,550
ENVIRONMENTAL HEALTH SUBTOTAL 18.03 7,051 17,437 221 ,550 303,603 317,522 266,016 845,590 263, 101 1 , 108,691
D. SPECIAL CONTRACTS:
SPECIAL CONTRACTS (599) 1 .00 0 0 15, 190 13,020 15, 190 13,030 0 56,430 56,430
SPECIAL CONTRACTS SUBTOTAL 1 .00 0 0 15, 190 13,020 15, 190 13,030 0 56,430 56,430
TOTAL CONTRACT 157. 19 39,402 333,969 2,487,334 2,705,837 2,612,571 2,573,042 5, 148,006 5,230,778 10,378,784
ATTACHMENT III
INDIAN RIVER COUNTY HEALTH DEPARTMENT
CIVIL RIGHTS CERTIFICATE
The applicant provides this assurance in consideration of and for the purpose of obtaining federal grants, loans,
contracts (except contracts of insurance or guaranty), property, discounts, or other federal financial assistance to
programs or activities receiving or benefiting from federal financial assistance. The provider agrees to complete
the Civil Rights Compliance Questionnaire, DH Forms 946 A and B (or the subsequent replacement if adopted
during the contract period ), if so requested by the department.
The applicant assures that it will comply with:
1 . Title VI of the Civil Rights Act of 1964, as amended , 42 U .S .C. , 2000 Et seq . , which prohibits
discrimination on the basis of race , color or national origin in programs and activities receiving or
benefiting from federal financial assistance.
2 . Section 504 of the Rehabilitation Act of 1973, as amended , 29 U . S. C . 794, which prohibits discrimination
on the basis of handicap in programs and activities receiving or benefiting from federal financial
assistance.
3 . Title IX of the Education Amendments of 1972, as amended , 20 U .S. C . 1681 et seq . , which prohibits
discrimination on the basis of sex in education programs and activities receiving or benefiting from
federal financial assistance.
4 . The Age Discrimination Act of 1975, as amended , 42 U .S .C . 6101 et seq . , which prohibits discrimination
on the basis of age in programs or activities receiving or benefiting from federal financial assistance.
5. The Omnibus Budget Reconciliation Act of 1981 , P. L. 97-35, which prohibits discrimination on the basis
of sex and religion in programs and activities receiving or benefiting from federal financial assistance.
6. All regulations, guidelines and standards lawfully adopted under the above statutes. The applicant agrees
that compliance with this assurance constitutes a condition of continued receipt of or benefit from federal
financial assistance, and that it is binding upon the applicant, its successors, transferees, and assignees
for the period during which such assistance is provided . The applicant further assures that all contracts,
subcontractors, subgrantees or others with whom it arranges to provide services or benefits to
participants or employees in connection with any of its programs and activities are not discriminating
against those participants or employees in connection with any of its programs and activities are not
discriminating against those participants or employees in violation of the above statutes, regulations,
guidelines , and standards. In the event of failure to comply, the applicant understands that the grantor
may, at its discretion , seek a court order requiring compliance with the terms of this assurance or seek
other appropriate judicial or administrative relief, to include assistance being terminated and further
assistance being denied .
ATTACHMENT IV
INDIAN RIVER COUNTY HEALTH DEPARTMENT
FACILITIES UTILIZED BY THE COUNTY HEALTH DEPARTMENT
Facility
Description Location Owned By
Clinic, Dental , Vital Statistics , 1900 27"' Street County of
Environmental Health , WIC , Vero Beach , FL 32960-3383 Indian River
Administrative Headquarters
39 ,200 sq . ft.
Gifford Health Center 4675 28" Court Indian River County
10 , 642 sq ft Vero Beach , FL 32967- 1330 Hospital District
Co-Located Site :
WIC 12196 County Road 512 Treasure Coast
Fellsmere , FL 32948-5463 Community Health
ATTACHMENT V
INDIAN RIVER COUNTY HEALTH DEPARTMENT
SPECIAL PROJECTS SAVINGS PLAN
IDENTIFY THE AMOUNT OF CASH THAT IS ANTICIPATED TO BE SET ASIDE ANNUALLY FOR THE PROJECT.
CONTRACTYEAR STATE COUNTY TOTAL
2004-2005 $ $ $
2005-2006 $ $ $
2006-2007 $ $ $
2007-2008 $ $ $
2008-2009 $ $ $
PROJECT TOTAL $ $ $
SPECIAL PROJECT CONSTRUCTIONlRENOVATION PLAN
PROJECT NAME: NONE
LOCATION/ ADDRESS:
PROJECT TYPE: NEW BUILDING _ ROOFING _
RENOVATION PLANNING STUDY _
NEW ADDITION OTHER
SQUARE FOOTAGE:
PROJECT SUMMARY: Describe scope of work in reasonable detail.
ESTIMATED PROJECT INFORMATION :
START DATE (initial expenditure of funds) :
COMPLETION DATE :
DESIGN FEES: $
CONSTRUCTION COSTS : $
FURNITUREIEQUIPMENT $
TOTAL PROJECT COST: $
COST PER SQ FOOT: $ #DIV/01
Special Capital Projects are new contruction or renovation projects and new furniture or equipment
associated with these projects and mobile health vans.
ATTACHMENT VI
INDIAN RIVER COUNTY HEALTH DEPARTMENT
PRIMARY CARE
"Primary Care" as conceptualized for the county health departments and for the use of categorical
Primary Care funds ( revenue object code 015040 ) is defined as:
"Health care services for the prevention or treatment of acute or chronic medical conditions or minor
injuries of individuals which is provided in a clinic setting and may include family planning and
maternity care. "
Indicate below the county health department programs that will be supported at least in part with
categorical Primary Care funds this contract year:
X Comprehensive Child Health (229/29)
X Comprehensive Adult Health (237/37)
X Family Planning (223/23)
Maternal Health/IPO (225/25)
X Laboratory (242/42 )
Pharmacy (241 /93)
Other Medical Treatment Program ( please identify)
Describe the target population to be served with categorical Primary Care funds .
The target population served with categorical Primary Care funds are the residents of Indian River
County, who fall at or below 200% of Federal Poverty
Does the health department intend to contract with other providers for the delivery of primary health
care services using categorical (015040 ) Primary Care funds? If so, please identify the provider(s) ,
describe the services to be delivered , and list the anticipated contractual amount by provider. In
addition , contract providers are required to provide data on patients served and the services provided
so that the patients may be registered and the service data entered into HCMS .
No .
ENVIRONMENTAL HEALTH FEE SCHEDULE
FISCAL YEAR 2006-2007
EFFECTIVE 07/01 /2006
DESCRIPTION FEE DEPOSIT ORG ED OBJECT REVENUE St OCA FUND BUDGET let PROGRAM
AMOUNT AMOUNT 14I15 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
PUBLIC SWIMMING POOLS AND BATHING PLACES
1 . Annual Permit - Up to (and including) 25,000 gallons 100.00 90,00 XX-360 DK 001020 000121 CD 8K000 20.2-141001
64200700 1306000000
Ia. Transfer to headquarters 10.00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000
2. More than 25,000 gallons 200.00 180.00 XX-360 DK 001020 000121 CD 8K000 20-2-141001 64200700 1306000000
2a. Transfer to headquarters 20.00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000
3. Exempted Cando Pools (over 32 units) 50.00 45.00 XX-360 DK 001020 000121 CD 81(000 20-2-141001 64200700 1306000000
3a. Transfer to headquarters 5.00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000
4. Plan Review Fee (one time only) 350.00 315.00 XX-360 DK 001020 000121 CD 8K000 20-2-141001 64200700 1306000000
4a. Transfer to headquarters 35.00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000
5. Initial Operating Permit one 8me only) 150.00 135.00 XXJ60 DK001020 000121 CD 81(000 20-2-141001 6420071X1
1306000000
5a. Transfer to headquarters 15.00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000
OTHER FEES
Collected by the 13 delegated counties
Broward, Dade, Duval. Hillsborough, Lee, Manatee,
Collier, Palm Beach, Pinellas, Polk, Sarasota. Volusia, Escambia.
Permits and variances for Okaloosa, Santa Rosa, Walton, Bay,
Homes, and Washington Counties are processed by Escambia
County and variances and permits for Pasco County are processed
-
by Pinellas County as follows.
1 . Plan review new construction) 350.00 350.00 XX-360 I DK 1 001092 000121 CD 8K000 20-2-141001 64200700
1306000000
2. Modillcation to a contsnuction permit (permit issued and pool not finished 100.00 100.00 XX-360 DK 001092 000121 CD 81(000
20-2-141001 64200700 1306000000
Min contruclion)
3. Modification to a completed pool, one that has been in operation 150.00 150.00 XX-360 DK 001092 000121 CD 8K000 20-2.141001
64200700 1306000000
4. Plan/application review for bathing place development 275.00 275.00 XX-360 DK 001092 000121 CD I 8K000 20-2-141001 64200700
1306000000
5. Initial operating permit 150.00 150.00 XX-360 DK 001092 000121 CD 81(000 20-2-141001 64200700 1306000000
6. Variance applications 240.00 216.00 )(X-360 DK 001092 000121 CD 8K000 20-2-141001 64200700 1306000000
6a. Transfer to Headquarters 24.00 XX-910 SM 001206 000100 RV K3000 10-2-021042 64200600 00 1302000000
All other counties are to send the fee to Bureau of Water
Programs in Tallahassee or the Environmental Engineering
section in Orlando as follows.
1 . Plan review (new construction) 350.00 350.00 XX-360 DK 001092 000100 CO 8K000 20-2-141001 64200700 1306000000
2. Modification to a contsrtuction permit (permit issued and pool not finished 100.00 100.00 XX-360 DK 001092 000100 CD 8K000
20-2-141001 64200700 1306000000
with contruction)
3. Modification to a completed pool, one that has been in operation 150.00 150.00 XX-360 DK 001092 000100 CD 8K000 20-2-141001
64200700 1306000000
4. PlaNapplication review for bathingplace development 275.00 275.00 XX-360 DK 001092 000100 CD 81(000 20-2.141001 64200700
1306000000
5. Initial pperatin permit 150.00 150.00 XX-360 DK 001092 000100 CD 8K000 20-2-141001 64200700 1306000000
6. Variance applications 240.00 216.00 XX-360 DK 001092 000100 CD 8K000 20-2-141001 64200700 1306000000
"Must use County Health Department IBI (01 -67) Page 1 9/11 /2006
DESCRIPTION FEE DEPOSIT I ORG EO OBJECT REVENUE SI OCA FUND BUDGET 1B1 PROGRAM
AMOUNT I AMOUNT LAILS CODE CATEGORY I GF-SF-FID ENTITY COMPONENT
MOBILE HOME 8 RECREATIONAL VEHICLE PARKS
(FEES ARE PRORATED ON A QUARTERLY BASIS)
1 . Annual permit for 5 to 14 spaces 50.00 45.00 XX-354 DK 001020 000121 CD 81(000 20-2-141001 64200700
1306000000
la. Transfer to headquarters 5.00 )(X-910 MP 001206 000100 RV 00000 10-2-021042 64200500 00 1302000000
3.50 Per
2. Annual Permit for 15 to 171 spaces space XX-354 DK 001020 000121 CD BK000 20-2-141001 64200700 1306000000
2a. Transfer to headquarters 10% XX-910 MP 001206 000100 RV 00000 10-2-021042 64200600 00 1302000000
3. Annual Permit for 172 and above spaces 600.00 540.00 XX-354 DK 001020 000121 CD 8K000 20-2-141001 54200700 1306000000
3a. Transfer to headquarters 60.00 XX-910 MP 001206 000100 RV 00000 10-2-021042 64200600 00 1302000000
MIGRANT LABOR CAMPS
1 . Annual permit for facilities with 5-50 occupants 125.00 125.00 XX-352 DK 001020 000121 CD 8K000 20-2-141001 64200700
1306000000
2. Annual Permit for facilities with 51-100 occupants 225.00 225.00 XX-352 DK 001020 000121 CD 8K000 20-2-141001 64200700
1306000000
3. Annual Permit for facilities with over 100 occupants 500.00 500.00 XX-352 DK 001020 000121 CD 8K000 20-2-141001 54200700
1306000000
BIOMEDICAL WASTE GENERATORS
1 . Initial permit (prorated after 3/31 for generator, storage and treatment) 55.00 55.00 XX-364 DK 001020 000121 CD 81(000
20-2-141001 64200700 1306000000
2. Renewal of annual permit except generator Producing 000121
less than 25lbs/30 days) postmarked by October 1 55.00 55.00 XX-364 DK 001020 000121 CD 8K000 20-2-141001 64200700
1306000000
3. Renewal of annual permit except generator producing 000121
less than 25lbs/30 days) postmarked after October 1 75.00 75.00 XX-364 DK 001020 000121 CD 81(000 20-2-141001 64200700
1306000000
4. Initial Transporter Registration (prorated after 3131 , includes 1 truck) 55.00 55.00 XX-364 DK 001020 000121 CD 8K000 20-2-141001
64200700 1306000000
5. Initail Registration of Each Additional Truck 10.00 10.00 XX-364 DK 001020 000121 CD 81(000 20-2-141001 64200700
1306000000
6. Annual Registration Renewal (Postmarked by 10/01 , includes 1 truck) 55.0055.00 XX-364 DK 001020 000121 CD 8K000 20-2-141001
64200700 1306000000
7. Annual Registration Renewal (postmarked after 10/01 , includes i track) 75.00 75.00 XX-364 DK 001020000121 CD 81(000 20-2-141001
64200700 1306000000
8. Annual Registration of Each Additional Truck 10.00 10.00 XX-364 DK 001020 000121 CD 8K000 20-2-141001 64200700
1306000000
TANNING FACILITIES
1 . Annual license fee 150.00 135.00 XX-369 DK 001020 000121 CD 8K000 20-2-141001 64200700 1306000000
1a. Transfer to headquarters 15.00 XX-910 TN 001206 000100 RV R9000 10-2-021042 84200600 00 1302000000
2. Fee for each additional device 55.00 49.50 XX-369 DK 001020 000121 CD 8K000 20-2-141001 64200700 1306000000
2.a. Transfer to headquarters 5.50 XX-910 TN 001206 000100 RV R9000 10-2-021042 54200500 00 1302000000
3. Late fee 25.00 25.00 XX-369 DK 001020 000121 CD 81(000 20-2-141001 64200700 1306000000
BODY PIERCING
1 . Initial License prorated quarterly) 150.00 135.00 XX-349 DK 001020 000121 CD 81(000 20-2-141001 64200700
1306000000
1a. Transfer to headquarters 15.00 XX-910 IF 001206 000100 RV PIERS 10-2-021042 64200600 00 1302000000
2. Temporary Establishment 75.00 67.50 XX-349 DK 001020 000121 CD 8Ko00 20-2-141001 64200700 1306000000
2a. Transfer to headquarters 7.50 XX-910 IE 001206 000100 RV PIERS 10-2-021042 64200600 00 1302000000
3. Annual Renewal License Fee 150.00 135.00 XX-349 DK 001020 000121 CD 8K000 20-2-141001 64200700 1306000000
3a. Transfer to headquarters 1500 XX-910 iE 001206 000100 RV PIERS 10-2-021042 64200600 00 1302000000
4. Late fee 100.00 100.00 XX-349 DK 001020 000121 CD 81(000 20-2-741007 64200700 1306000000
"Must use County Health Department IBI (01 .67) Page 2 9/11/2006
DESCRIPTION FEE DEPOSIT ORG ED OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT 14115 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
FOOD ESTABLISHMENTS
1 . Annual Permit for Fratemal/Civic 160.00 144.00 XX-348 DK 001020 000121 CD 81(000 20-2-141001 64200700 1306000000
1a. Transfer to headquarters 16.00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
2. Annual Permit School Cafeteria Operating for
9 months or less 130.00 117.00 XX-348 DK 001020 000121 CD 81(000 20-2-141001 64200700 1306000000
2a. Transfer to headquarters 13.00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
3. Annual Permit School Cafeteria Operating for more
than months 160.00 144.00 XX-348 DK 001020 000121 CD 8K000 20-2-141001 64200700 1306000000
3a. Transfer to headquarters 16.00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
4. Annual Permit for Hosphal/Nursing Food Service 210.00 189.00 XX-368 OK 001020 000121 CD 81(000 20-2-141001 64200700
1306000000
4a. Transfer to headquarters 21 .00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
5. Annual Penult for Movie Theaters 160.00 144.00 XX-348 DK 001020 000121 CD 8K000 20-2-141001 64200700 1306000000
5a. Transfer to headquarters 16.00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
6. Annual Permit for Jails/Prisons 210.00 189.00 XX-348 OK 001020 000121 CD 81(000 20-2-141001 64200700 1306000000
6a. Transfer to headquarters 21 .00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
7. Annual Parmit for Bars/Lounges Drink Service Only) 160.00 144.00 XX-348 DK 001020 000121 CD 8K000 20-2-141001
64200700 1306000000
7a. Transfer to headquarters 16.00 XX-910 FP 001206 000100 RV 10000 10-2-021042 1 64200600 00 1302000000
8. Annual Permit for Residential Facilities 110.00 99.00 XX-348 DK 001020 000121 CD 81(000 20-2-141001 64200700
1. 1306000000
8a. Transfer to headquarters 11 .00 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
9. Annual Permit for Child Care Centers without C&F license 85.00 76.50 XX-348 DK 001020 000121 CD 8K000 20-2-141001
64200700 1306000000
9a. Transfer to headquarters 8.50 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
10. Annual Permit for Limited Food Service 85.00 76.50 XX-348 DK 001020 000121 CD 81(000 20-2-141001 64200700
1306000000
10a. Transfer to headquarters 8.50 XX-910 FP 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
11 . Annual Permit Other Food Service 160.00 144.00 XX-348 DK 001020 000121 CD 8K000 20-2-141001 64200700 1306000000
Ila. Transfer to headquarters 16.00 XX-910 FP 1 001206 000100 RV 10000 10-2-021042 64200600 00 1302000000
12. Plan Ravi" $358wur $35/hour XX-348 DK 001092 000121 CD 6K000 20-2-141001 64200700 1306000000
13, Food Worker Training (per person) 10.00 10.00 XX-348 DK 001092 000121 CD 8K000 20-2-141001 64200700 1306000000
14. Request for Inspection 40.00 40.00 XX-348 DK 001092 000121 CD 81(000 20-2-141001 64200700 1306000000
15. Re-inspection after the first reinspection) 30.00 30.00 XX-348 DK 001092 000121 CD 81(000 20-2-141001 64200700
1306000000
i6. Late Renewal 25.00 25.00 XX-348 DK 001092 000121 CD 81(000 20-2-141001 84200700 1306000000
17. Alcoholic Beverage Inspection Approval 30.00 30.00 XX-348 DK 001092 000121 CD 8K000 20-2-141001 64200700
1306000000
"Must use County Health Department IBI (01 -67) Page 3 9/11 /2006
DESCRIPTION FEE DEPOSIT ORG EO OBJECT I REVENUE SI OCA FUND BUDGET 161 PROGRAM
AMOUNT AMOUNT 1-411.5 CODE CATEGORY GFSF-FID ENTITY COMPONENT
ONSITE SEWAGE DISPOSAL PROGRAM (OSTDS)
1 . Application for parimming of an onsite sewage 50.00 46.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001 64200700
1306000000
treatment and disposal system which includes
application and plan review for new and repair permits
la. Transfer to headquarters 4.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
2. Application and approval for existing system, does not includes stem 35.00 32.20 XX-361 DK 001092 000121 CD 81(000 20-2-141001
64200700 1306000000
inspection
2a. Transfer to headquarters 2.80 XX-910 ST 001206 000100 RV IE000 10-2-021042 64200600 00 1302000000
3. Application for permitting of a new Performance-based treatment system 125.00 1 115.00 XX-361 DK 001092 000121 CD 81(000 20-2-141001
64200700 1306000000
3a. Transfer to headquarters 10.00 XX-910 ST 001206 000100 RV 111000 10-2-021042 64200600 00 1302000000
4. Site evaluation for a new system 115.00 105.80 XX-361 OK 001092 000121 CD SK000 20-2-141001 64200700 1306000000
4a. Transfer to headquarters 9.20 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
S. Site evaluation for a system repair or modfcation of system 75.00 69.00 XX-361 DK 001092 000121 CD 81(000 20-2-141001
64200700 1306000000
5a. Transfer to headquarters 6.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
6. Site re-evaluation, new or repair or modification 75.00 69.00 XX-361 DK 001092 000121 CD 81(000 20-2-141001 64200700
1306000000
6a. Transfer to headquarters 6.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
7. Permit for new systems, or modification to system 55.00 50.60 XX-361 DK 001092 000121 CD 81(000 20-2-141001 64200700
1306000000
7a. Transfer to headquarters 4.40 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 130200000D
8. New system ors tem modification installation inspection 80.00 73.60 XX-361 DK 001092 000121 CD 81(000 20-2-141001
64200700 1306000000
8a. Transfer to headquarters 6.40 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
Bb. Research fee to be collected in addition, and concurrent with 5.00 5.00 XX-910 RF 001206 000100 RV 89000 10-2-021042 64200600
00 1302000000
the permit for a new system installation fee.
9. Repair permit issuance which includes inspection 50.00 41 .40 XX-361 DK 001092 000121 CD 8K000 20-2-141001 64200700
1306000000
9a. Transfer to headquarters 3.60 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
91h. Transfer to headquarters for training center 5.00 XX-910 TC 001206 000100 RV SEWTN 10-2-021042 1 64200600 00 1302000000
10. Inspection of system previously in use 50.00 46.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001 64200700 1306000000
10a. Transfer to headquarters 4.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
11 . Reinspection fee per visit for site inspections after system 50.00 46.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001
64200700 1306000000
consVuction approval
11 a. Transfer to headquarters 4.00 XX-910 ST 001206 000100 1 RV IE000 10-2-021042 64200600 00 1302000000
12. Installation reinspection of non-compliant system per 50.00 46.00 XX-361 DK 001092 000121 CD 81(000 20-2-141001
64200700 1 1306000000
each site visit
12a. Transfer to headquarters 4.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
13. S tem abandonment permit, includes permit 40.00 36.80 XX-361 DK 001092 000121 CD 8K000 20.2-141001 64200700
1306000000
issuance and inspection
13a. Transfer to headquarters 3.20 XX-910 ST 001206 000100 RV 1E000 10-2-021042 64200600 00 1302000000
14. Annual operating permit fee for systems in IM and 150.00 138.00 XX-361 DK 001092 000121 CD 81(000 20-2-141001 64200700
1306000000
equivalent areas, and for systems receiving commercial waste
14a. Transfer to headquarters 12.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
15. Amendments or changes to the operating permit during 50.00 46.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001 64200700
1308000000
the permit period par change or amendment
15a. Transfer to headquarters 4.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
16. Aerobic treatment unit operating permit (biennial) 100.00 92.00 XX-361 DK 001092 000121 CD 81(000 20-2-141001 64200700
1306000000
16a. Transfer to headquarters 8.00 0-910 ST 001206 000100 RV 1E000 10-2.021042 64200600 00 1302000000
**Must use County Health Department IBI (01 -67) Page 4 9/11 /2006
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L41LS CODE CATEGORY GF-SF-FID ENTITY COMPONENT
17. Biennial operating permit fee for performance-based treatment systems. 100.00 92.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001
64200700 1306000000
prorated fee is to be charged beginning with second year of operation.
17a. Transfer to headquarters 8.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
18. Review of application due to proposed amendments or changes after 75.00 69.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001
84200700 1306000000
initial operating permit Issuance for a performance-based treatment system
Ida. Transfer to headquarters 6.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
19. Tank manufacturer's inspection per annum 100.00 50.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001 64200700
1306000000
19a. Transfer to headquarters 50.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
20. Septage disposal service permit per annum 75.00 69.00 XX-361 DK 001092 000121 CO 8K000 20-2-141001 64200700
1306000000
20a. Transfer to headquarters 6.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
21 . Additional charge per pump out vehicle 35.00 32.20 X0(-361 DK 001092 000121 CD 8K000 20-2-141001 84200700
1306000000
21a. Transfer to headquarters 2.80 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
22. Portable or temporary toilet service permit par annum 75.00 69.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001 64200700
1306000000
22a. Transfer to headquarters 1 6.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 1 64200600 1 00 1302000000
23. Additional charge Per pump out vehicle 35.00 32.20 XX-361 DK 001092 000121 CD 8KOD0 20-2-141001 64200700 1308000000
23a. Transfer to headquarters 2.80 XX-910 ST 001206 000100 RV 1E000 10-2-021042 64200600 00 1302000000
24. Septa a stabilization facility inspection fee per annum 150.00 138.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001
64200700 1306000000
24a. Transfer to headquarters 1200. XX-910 ST 001206 000100 RV lE000 10-2.021042 64200600 00 1302000000
24. Seplage disposal site evaluation fee per annum 200.00 184.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001 64200700
1306000000
24a. Transfer to headquarters 16.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 64200600 00 1302000000
24. Aerobic treatment unit maintenance entity permit per annum 25.00 23.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001
64200700 1306000000
24a. Transfer to headquarters 2.00 XX-910 ST 001206 000100 RV lE000 10-2-021042 1 64200600 00 1302000000
25. Variance application for a single family residence per 150.00 75.00 XX-361 OK 001092 000121 CD 8K000 20-2-141001
64200700 1306000000
each lot or building site
25a. Transfer to headquarters 75.00 XX-910 CR 001206 000100 RV BY000 10-2-021042 64200600 00 1302000000
26. Variance application for a multi-family " commercial 200.00 100.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001 64200700
1306000000
building per each bullding site
26a. Transfer to headquarters 100.00 XX-910 CR 001206 000100 RV BY000 10.2-021042 64200600 00 1302000000
27. Inspection for construction of an injection wall (FL Keys) 125.00 125.00 XX-361 DK 001092 000121 CD 8K000 20-2-141001
64200700 1306000000
FEE COLLECTED AT HEADQUARTERS - Onsite Sewage Program
1 . Application for Innovative product approval 500.00 For headquarters use only
2. Application for registration including initial examination 75.00 For headquarters use only
3. Initial registration 100.00 For headquarters use only
4. Renewal registration 100.00 For headquarters use only
5. Certificate of authorization each two year period 250.00 For headquarters use only
"Must use County Health Department IBI (01 -67) Page 5 9/11 /2006
DESCRIPTION FEE DEPOSIT I ORG EO OBJECT I REVENUE I SI OCA FUND I BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GFSF-FID ENTITY COMPONENT
DRINKING WATER
1 . First Year Public Water Annual Operation Permit and 75.00 67.50 XX-357 DK 001020 000121 CD 8K000 20-2-141001
64200700 1306000000
Construction Permit - Limited Use
Ia. Transfer to headquarters 7.50 XX-910 64 001206 000100 RV M5000 10-2-021042 64200600 00 1302000000
2. Second Year Public Water Annual Operation Permit -
Limited Use 70.00 63.00 XX-357 DK 001020 000121 CO 8K000 20-2-141001 64200700 1306000000
2a. Transfer to headquarters 7.00 XX-910 64 001206 000100 RV M5000 10-2-021042 64200600 00 1302000000
3. Multi-Family Water Construction Permit - serving 3 or 4 40.00 36.00 XX-357 DK 001020 000121 CD 81<000 20.2-141001
64200700 1306000000
non-rental residences
3a. Transfer to headquarters 1 4.00 XX-910 64 001206 000100 RV M5000 10-2-021042 64200600 00 1302000000
4. Initial Operating Permit Fee After March 31 of Any Year 35.00 31 .50 XX-357 DK 001020 000121 CD 8K000 20-2-141001
64200700 1306000000
4a. Transfer to headquarters 3.50 XX-910 64 001206 000100 RV M5000 10-2-021042 64200600 00 1302000000
5. Non-SDWA Lab Sample (Sample Collection/Review
of Analytical Results/Health Risk Interpretation):
Bacterial Sample Collection 40.00 40.00 XX-357 DK 001020 000121 CD 8K000 20-2-141001 64200700 1306000000
Chemical Sample Collection 50.00 50.00 XX-357 OK 001020 000121 CD 111 20-2-141001 64200700 1306000000
Combined Chemical microbiological 55.00 55.00 XX-357 DK 001020 000121 CD 81<000 20-2441001 64200700 1306000000
6. Reinspection of Mufti-family Water System 25.00 25.00 XX-357 I DK 1 001092 000121 CD 8K000 20-2-141001 64200700
1306000000
7. Reinspection of Public Water System 40.00 40.00 XX-357 DK 001092 000121 CD 8K000 20-2-141001 64200700 1306000000
8. Delineated Area Clearance Fee 50.00 50.00 XX-357 DK 001092 000121 CD 8K000 20-2-141001 64200700 1306000000
9. Limited Use Commercial Registered System 15.00 15.00 XX-357 DK 001092 000121 CD 81<000 20-2-141001 64200700
1306000000
10. Limited Use Commercial Public Water System 25.00 25.00 XX-357 DK 001092 000121 CO 8KD00 20-2-141001 64200700
1306000000
Operating Permit Family Day Care Establishment
11 . Limited Use Commercial Public Water System Operating Permit 15.00 15.00 XX-357 DK 001092 000121 CD 8K000 20-2-141001
64200700 1306000000
Family Day Care Establishment After March 31 of Any Year.
Safe Drinking Water Act (Delegated Counties)
1 . Construction permit for each Category I through III treatment
)ant, as defined! in Rule 62-699.310, F.A.C.., with treatment
other than disinfection only.
a. Treatment plant - 5 MGD and above 7,500.00 7,500.00 XX-358 WC 001020 000121 CD SDWCH 2O-2.141001 64200700 1306000000
b. Treatment plant - 1 MGD up to 5 MGD 6,000.00 6,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
c. Treatment plant - 0.25 MGD up tot MGD 4,000.00 4,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700
1306000000
d. Treatment plant - 0, 1 MGD up to .25 MGD 2,000.00 2,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700
1306000000
e. Treatmentplant - upto0.1 MGD 1 ,000.00 1 ,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
2. Construction permit for each Category IV treatment plant, as
defined in Rule 62-699.310, F.A.C.., vdth treatment other than
disinfection only.
"Must use County Health Department 1131 (01 -67) Page 6 9/11/2006
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT LML5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
a. Treatment plant - 5 MGD and above 7,500.00 7,500.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
b. Treatment plant - 1 MGD up to 5 Moo 6,000.00 6,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700
1306000000
c. Treatment plant - 0.25 MGD up lot MGD 4,000.00 4,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700
1306000000
d. Treatment plant - 0. 1 MGD up Io .025 MGD 2,000.00 2,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
e. Treatment plant - 0.01 up to 0. 1 MGD 1 ,000.00 1 ,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700
1306000000
f. Treatment plant - up to 0.01 MGD 400.00 400.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
3. Construction permit for each Category V treatment plant, as
defined in Rule 62-699.310, F.A.C.., - Disinfection Only
a. treatment plant - 5 MGD and above 5,000.00 5,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
b. Treatment plant - 1 MGD up to 5 MGD 3,000.00 3,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
c. Treatment plant - 0.25 MGD up tot MGD 1 ,000.00 1 ,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
d. Treatment plant - 0.1 MGD up to .025 MGD 500.00 500.00 XX-358 WC 001020 0D0121 CD SDWCH 2O-2-141001 64200700 1306000000
e. Treatment plant - up to 0.1 MGD 300.00 300.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
4. Distribution and transmission systems, including raw water
lines into the plan, except those under general permit
a. Serving a community public wader system 500.00 500.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
b. Serving a non-transient noncommunity public water systems 350.00 350.00 XX-358 WCI 001020 000121 CD SDWCH 2O-2-141001
64200700 1306000000
c. Sawing anoncommun public water system 250.00 250.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
5. Construction peril for each public water supply well.
a. Well located in a delineated area pursuant to Chapter 62-524,
F.A.C.. 500.00 500.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
b. Any other public water supply well. 250.00 250.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
6. Major modifications to systems that alter the existing treatment
without expanding the capacity of the system and are not
considered substantial changes pursuant to
Rule 624.050(7) below.
a. 1MGD and above 2,000.00 2,000.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
b. .1 MGD up tot MGD 1 ,000.00 1 ,000.00 M-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
c. 0.01 up to .1 MGD 500.00 500.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
d. Up to 0.01 MGD 100.00 100.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
e. Lead and Copper Corrosion Fee 100.00 100.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 60200700 1306000000
7. Minor modifications to systems that result in no change in the
treatment or ceacit .
a. . 1 MGDandabove 300.00 300.00 XX-358 EWC , 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
b. Up to 0.1 MGD 100.00 100.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
8. Fines and Forfeitures Variable Variable XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700 1306000000
9. General Permit Fee for any General Permit not specilically listed: 100.00 100.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001
64200700 1306000000
a. General Permits requiring Professional Engineer or Professional 250.00 250.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001
64200700 1306000000
Geologist certification
a. General Permits not requiring Professional Engineer or 100.00 100.00 XX-358 WC 001020 000121 CD SDWCH 2O-2-141001 64200700
1306000000
Professional Geologist certification
Radioactive Materials Licenses - General
1 . Annual fee: static elimination devices $25.00 For headquarters use only
2. Annual fee: measuring, gauging and control devices $25.00 For headquarters use only
"Must use County Health Department IBI (01 -67) Page 7 9/11 /2006
DESCRIPTION FEE DEPOSIT I ORD EO OBJECT I REVENUE SI I OCA I FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L4/L5 CODE CATEGORY GFSF-FID ENTITY COMPONENT
3. Annual fee: in vivo testing license $125.00 For headquarters use only
4. Annual fee: in vitro testinglicense $125.00 For headquarters use only
5. Annual fee: depleted uranium license $125.00 For headquarters use only
Radioactive Materials Licenses - Specific
Application Fees
1 . Source Material.
a. Concentration of uranium from phosphate ores for the
production of uranium as *yellow cake' or powdered solid; $6,907 For headquarters use only
b. Concentration of uranium from phosphate ores for the
production of 'green cake' or equivalent, moist or solid; $3,768 For headquarters use only
a All other speck source material licenses excluding depleted
uranium used as shielding and counterweights. $544 For headquarters use only
2. Special Nuclear Material (SNM).
a. SNM in sealed sources contained in devices in measuring systems; $653 For headquarters use only
In. SNM not sufficient to form a critical mass, except as in 2.a.,
2.c. and 5.e. $1 ,340 For headquarters use only
c. SNM to be used as calibration and reference sources. $205 For headquarters use only
3. Byproduct, naturally occurring or accelerator produced material.
a. Processing or manufacturing for commercial distribution or
industrial uses; $2,923 For headquarters use only
b. Processing or manufacturing and distribution of
radiopharmaceuticals. This category includes radiopharmacies. $2,560 For headquarters use only
G. Industrial radiography performed only in an approved shielded
radiography installation, $1 ,558 For headquarters use only
d. Industrial radiography performed only at the address indicated
in the license, or at temporary job sites of the licensee; $1 ,643 For headquarters use only
e. Radioactive materials in sealed sources for irradiation of
materials where the source is not removed from the shield and is
less than 10,000 curies; $605 For headquarters use only
f.(I) Radioactive materiels In sealed sources for irradiation of
materials when the source is not removed from the shield and is
greater than 10,000 curies and less than 100,000 curies, or where
the source is less than 100,000 curies and is removed from the
shield; $1 ,414 For headquarters use only
(II) Radioactive materials In sealed sources for irradiation of
materials when the source is equal to or greater than 100,000
curies and less than 1 ,000,000 curies; $3,659 For headquarters use only
(III) Radioactive materials in sealed sources for irradiation of
materials when the source Is greater than 1 ,000,000 curies; $9,780 For headquarters use only
. Distribution of items containing radioactive materials to
persons under a general license; $1 ,643 For headquarters use only
h. Distribution of exempt quantities or items containing natural)
occurring or accelerator produced malarial to persons exempt
from licensing; $1 ,643 For headquarters use only
"Must use County Health Department 1131 (01 -67) Page 8 9/11 /2006
DESCRIPTION FEE DEPOSIT ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT L41L$ CODE CATEGORY GFSFFID ENTITY COMPONENT
Well logging
(I) Sealed sources or sub-surface tracer studies $1 ,135 For headquarters use only
II Subsurface tracer studies and sealed sources $1 ,436 For headquarters use only
'. Nuclear Laundry; $3,200 For headquarters use only
k. Industrial or medical research and development; $1 , 184 For headquarters use only
I.(0 Fixed and portalble gauging devices $605 For headquarters use only
(II) In Vitra and clinical laboratory $725 For headquarters use only
III) Academic $978 For headquarters use only
IV Possession of uranium or thorium, or their decay products, as
a result of mining or processing $978 For headquarters use only
(V) All other speck licenses except as otherwise noted $725 For headquarters use only
m. Licenses of broad scope
I) Academic $3,200 For headquarters use only
II Medical $3,200 For headquarters use only
111 Industrial or Research and Development $3,200 For headquarters use only
n. Gas chromatography devices; 5434 I For headquarters use only
o. Reference or calibration sources equal to or less than one
millicurie total; $314 For headquarters use only
. Nuclear service licenses, such as leak testing, Instrument
calibration, etc.; $518 For headquarters use only
4. Waste disposal or Processing
a. Commercial waste disposal or treatment facilities, including
burial or Incineration; $275,842 For headquarters use only
b. All other commercial facilities involving compaction,
repackaging, storage or transfer; $27,084 For headquarters use only
c. Commercial treatment of radioactive materials for release to
unrestricted areas. $5,760 For headquarters use only
5. Medical use.
a. Teletherapy or high dose rate remote after loading devices; $1 ,414 For headquarters use only
b. Medical institutions including hospitals, except 5.a. and Se.; $1 ,643 For headquarters use only
c. Private pnictice physicians except 5.a. and SAL; $1 ,184 For headquarters use only
d. Private practice physicians using only strontium 90 eye
applicators, materials authorized by Rule 64E-5.631 , F.A.C., and
materials authorized by Rule 64E-5.630; F.A.C. $605 For headquarters use only
e. Nuclear powered pacemakers; $434 For headquarters use only
f. Mobile nuclear medicine services. $1 ,414 For headquarters use only
6. Civil defense. $544 For headquarters use only
7. Device, product, or sealed source safety evaluation.
a. Device evaluation, per device; $1 ,208 For headquarters use only
b. Sealed source design, per source. $528 For headquarters use only
Radioactive Materials Licenses - Specific
Annual Fees
1 . Source Material.
Ia. Concentration of uranium from phosphate ores for the
"Must use County Health Department 161 (01 -67) Page 9 9/11 /2006
DESCRIPTION FEE DEPOSIT I ORG EO OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT LI/L5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
production of uranium as ' Ilow cake' or powdered solid; $11 ,942 For headquarters use only
b. Concentration of uranium from phosphate was for the
production of 'green cake" or equivalent, moist or solid; $7,439 For headquarters use only
c. All other specific source material licenses excluding depleted
uranium used as shielding and counterweights. $229 For headquarters use only
2. Special Nuclear Material (SNM).
a. SNM in sealed sources contained in devices used in
measuring systems, $518 For headquarters use only
b. SNM not sufficient to form a critical mass, except as In 2.a.,
above, and 2.c. and 5.e., below; $1 ,944 For headquarters use only
c. SNM to be used as calibration and reference sources. $109 For headquarters use only
3. Byproduct, naturally occurring or accelerator produced material.
a. Processing or manufacturing for commercial distribution or
industrial uses; $2,802 For headquarters use only
b. Processing or manufacturing and distribution of
radiopharmaceuticals. This category includes radiopharmacies. $3,840 For headquarters; use only
c. Industrial radiography performed only in an approved shielded
radiography installation, $2,161 For headquarters use only
d. Industrial radiography performed only at the address indicated
in the license, or at temporary job sites of the licensee; $2,657 For headquarters use only
e. Radioactive materials in sealed sources for irradiation of
materials where the source is not removed from the shield and is
less than 10,000 curies; $605 For headquarters use only
L(0 Radioactive materials in sealed sources for irradiation of
materials when the source Is not removed from the shield and is
realer than 10,000 curies and less than 100,000 curies, or where
the source is less than 100,000 curies and is removetl from
the shield; $1 ,630 For headquarters use only
(II) Radioactive materials in sealed sources for irradiation of
materials when the source is equal to or greater than 100,000
curies and less than 1 ,000,000 curies; $3,961 For headquarters use only
(III) Radioactive materials in sealed sources for Irradiation of
materials when the source is greater than 1 ,000,000 curies; $4,398 For headquarters use only
g. Distribution of items containing radioactive materials to persons
under a general license; $2, 150 For headquarters use only
h. Distribution of exempt quantities or items containing natural)
occurring or accelerator produced material to persons exempt
from licensing; $2,150 For headquarters use only
I. Well logging
I Sealed sources or sub-surface tracer studies $1 ,498 For headquarters use only
II Sub-surface tracer studies and sealed sources $1 ,594 For headquarter use only
I. Nuclear Laundry; $5,651 For headquarters use only
k. Industrial or medical research and development; $1 ,474 For headquarters use only
I.(I) Fixed and portable gauging devices $966 For headquarters use only
"Must use County Health Department 1131 (01 -67) Page 10 9/11/2006
DESCRIPTION FEE DEPOSIT ORG ED OBJECT REVENUE SI OCA FUND BUDGET IBI PROGRAM
AMOUNT AMOUNT 1-411.5 CODE CATEGORY GFSFFID ENTITY COMPONENT
(11) In Vitro and clinical laboratory $918 For headquarters use only
(III) Academic $1 ,171 For headquarters use only
IV) Possession of uranium or Ihodum, or their decay products, as a
resuh of mining or processing $870 For headquarters use only
V All other specific licenses except as otherwise noted $1 ,002 For headquarters use only
m. Licenses of broad scope
I Academic $7,346 For headquarters use only
(11) Medical $5,474 For headquarters use only
(III) Industrial or Research and Development $4,568 For headquarters use only
in. Gas chromatography devices; $314 For headquarters use only
o. Reference or calibration sources equal to or less than one
millicurie total; $132 For headquarters use only
p. Nuclear service licenses, such as, leak testing, Instrument
calibration, etc.; $410 For headquarters use only
4. Waste disposal or processing
a. Commercial waste disposal or treatment facilities, including
burial or incineration; $250,555 1 For headquarters use only
b. All other commercial facilities Involving compaction,
repackaging, storage or transfer; $24,971 For headquarters use only
c. Commercial treatment of radioactive materials for release to
unrestricted areas. $5,735 For headquarters use only
5. Medical use.
a. Teletherapy or high dose rate remote after loading devices; $1 ,378 For headquarters use only
b. Medical institutions including hospitals, except category 5.a.
and 5.e.; $1 ,908 1 For headquarters use only
c. Private practice physicians except category 5.a. and 5.d.; $1 ,340 For headquarters use only
d. Private practice physicians using only strontium 90 eye
applicators, materials authorized by Rule 64E-5.631 , F.A.C., and
materials authorized by Rule 64E-5.630; F.A.C. $748 For headquarters use only
e. Nuclear powered pacemakers; $266 For headquarters use only
I. Mobile nuclear medicine services. $1 ,625 For headquarters use only
6. Civil defense. $821 For headquarters use only
7. Device, product, or sealed source safety evaluation.
a. Device evaluation, per device; NONE
b. Sealed source design, par source. ONE
Reclamation Fee5% of annual For headquarters use only
licensing fee
X-Ray Machine Annual Registration Fees
1 . Medical, chiropractic, osteopathic, or naturopathic machines
- First tube $145 For headquarters use only
Each additional lube $85 For headquarters use only
2. Veterinary machines - First tube $50 For headquarters use only
Each additional tube $34 For headquarters use only
3. Educational or industrial machines - First tube $47 For headquarters use only
`*Must use County Health Department IBI (01 -67) Page 11 9/11 /2006
DESCRIPTION FEE DEPOSIT ORG EO ORJECT REVENUE SI OCA FUND BUDGET 181 PROGRAM
AMOUNT AMOUNT L41L5 CODE CATEGORY FUND
ENTITY COMPONENT
Each additional tube $23 For headquarters use only
4. Dental or podiatry machines - First tube $31 For headquarters use only
Each additional lube $11 For headquarters use only
5. Medical accelerators $258 For headquarters use only
Each additional tube $148 For headquarters use only
L Non-medical accelerators $81 For headquarters use only
Each additional tuba $48 For headquarters use only
Radiologic Technologist Certifications
"Must use County Health Department IBI (01 -67) Page 12 9/11 /2006
DESCRIPTION FEE DEPOSIT ORG ED OBJECT REVENUE $t OCA FUND BUDGET 181 PROGRAM
AMOUNT AMOUNT 1,4/1-5 CODE CATEGORY GF-SF-FID ENTITY COMPONENT
1 . Application and study guide applicant also pays whatever fee
the testing service charges) $75 For headquarters use only
2. Application without study guide (applicant also pays whatever
fee the testing service charges) $50 For headquarters use only
3. Application through endorsement no test neetled) $45 For headquarters use only
4. Repeat examinations (applicant also pays whatever fee the
testing service charges) $35 For headquarters use only
5. Renewal - first category $55 For headquarters use only
Each additional category $40 For headquarters use only
6. Chane in status from active to inactive $40 For headquarters use only
7. Late renewal fee $100 For headquarters use only
S. Duplicate certificate $10 For headquarters use only
9. Listings and mailing labels, per name $0.05 For headquarters use only
Setup charge $55 For headquarters use only
10. Sludyguide $25 L For headquarters use only
Pre and Post Mining Fees
1 . Gamma radiation exposure measurement (1 per acre) $7.50 For headquarters use only
2. Soil characterisation measurement (1 per 20 acres $320 For headquarters use only
3. Air monitoring measurements $165 For headquarters use only
4. Surface and ground water measurements $300 For headquarters use only
Low-Level Radioactive Waste Inspection Fee
Cubic foot of waste shipped (minimum fee = $50 per shipment) $1 .95 For headquarters use only
Low-Level Radioactive Waste Transport Fee
Annual transport permit $100 For headquarters use only
Water Analysis Fees
1 . Gross alpha $28 For headquarters use only
2. Gross beta $28 For headquarters use only
3. Radium 226 $110 For headquarters use only
4. Radium 228 $110 For headquarters use only
5. Uranium $110 For headquarters use only
6. Tritium $40 For headquarters use only
7. Strontium 89, strontium 90 $95 For headquarters use only
8. Iodine 131 $170 For headquarters use only
9. Photon emitters $126 For headquarters use only
Laboratory Certification Fees
1 . Safe drinking water certification $500 For headquarters use only
2. Clean water certification $500 For headquarteuse only
3. Resource conservation recove $500 For head uarters use only
4. Field of testing application $200 For headquarters use only
"Must use County Health Department 161 (01 -67) Page 13 9/11 /2006