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2021 AFCSP Budget Report F-21343 (10/2020)

Division of Public Health

Alzheimer's Family Caregiver Support Program (AFCSP) 2021 Budget

Please respond to each question, using the previous year's budget as a guide for completing this report. Completion of this form satisfies the requirements under Wis. Admin. Code
§ DHS 68.05 for a distinct program budget for the AFCSP.

You will not be able to start, stop, and then resume data entry into this report. You may want to print this report so that you can gather the necessary information before beginning the data entry.

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Planned distribution of funds by purpose, in dollars ($) and percents (%) (Wis. Admin. Code § 68.06)
  • Please check your math before you submit.
  • County programs are required to spend a minimum of 40% of the agency's AFCSP allocation to provide respite to caregivers of people diagnosed with dementia. Tribes are exempt from the 40% respite requirement.
  • No more than 10% can be claimed for program administration.
  • Estimates are allowed for the categories in question 9, but be aware that actual expenses for each type of respite will be required as part of the 2021 AFCSP Fiscal Report.
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9. AMOUNT planned for each type of respite* This question requires a valid currency format.
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Methods for fund distribution
18. Do you plan to make payments to service providers for direct care as a method of distributing these funds?  (Wis. Admin. Code § DHS 68.09)*
19. Do you plan to make payments to households of persons with Alzheimer's Disease (i.e., cash grant for agreed-upon service/goods)?  (Wis. Admin. Code § DHS 68.09)*
20. Indicate the county's or tribe's maximum amount payable in the calendar year to or on behalf of any participating person*
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