FY11/12 Supplemental Schedule of Fees and Charges for Services Prepared by: Office of Management & Budget

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1 FY11/12 Supplemental Schedule of s and Charges for Services Prepared by: Office of Management & Budget V:\ FY12 Supplemental Schedule of s and Charges for Services

2 FOR These fees are either beyond the approval authority of the Board or were approved by the Board through ordinance or other legal means and are provided for informational purposes (352) DENTAL: Charged in accordance with current medicaid rate. WATER PROGRAM FEES: Sample Collection $50.00 IMMUNIZATIONS: CHILDHOOD IMMUNIZATIONS: No charge for required immunizations of children through 12th grade. All children receiving foreign travel inoculations must be charged according to the fee schedule. Medicaid does not pay for ADULT immunizations, or any immunizations for children that are not required. Private Well Clearance: Bacteriological Analysis $40.00 Plan Review/Permit $40.00 TOTAL $80.00 On Site Sewage Treatment and Disposal System OSTDS PROGRAM FEES: (for new & Modification and holding Tank permits only) Site Evaluation only (no permit): Application / Plan Review $ Site Evaluation $ TOTAL $ New System Without Well OSTDS Construction Application and Plan Review, New $ OSTDS Construction Site Evaluation $ OSTDS Construction System Inspection Research $5.00 TOTAL $ New System With Well OSTDS Construction Application and Plan Review, New $ OSTDS Construction Site Evaluation $ OSTDS Construction System Inspection Research $5.00 Bacteriological Analysis $40.00 Plan Review/Permit $40.00 Timed Inspection (Local PHU Surcharge) $45.00 TOTAL $ FY 12 Supplemental Schedule of s and Charges for Services Effective: October 1, 2011

3 FOR On Site Sewage Treatment and Disposal System OSTDS PROGRAM FEES: (for new & Modification and holding Tank permits only) Repair Permit OSTDS Construction Repair or Mod Site Evaluation $ OSTDS Construction System Inspection Research $5.00 OSTDS Construction Permit (Repair) $55.00 OSTDS Construction Application & Existing System $50.00 TOTAL $ OSTDS Construction Reinspection $50.00 OSTDS Construction Abandonment Permit and Inspect. $50.00 TOTAL $ Holding Tank Permit Holding Tank Application $ OSTDS Construction System Inspection Research $5.00 TOTAL $ Modification Permit (straight modification permit without existing system denial) OSTDS Construction Repair or Mod Site Evaluation $ OSTDS Construction Application & Existing System $50.00 Timed Inspection (Local PHU Surcharge) $45.00 TOTAL $ Existing System (less than 3 years) $35.00 FY 12 Supplemental Schedule of s and Charges for Services Effective: October 1, 2011

4 FOR (352) PRIMARY CARE CLIENT FEES BY PROCEDURE AND FEE GROUP: For laboratory and radiological services, clients will pay based on their income according to Federal Guidelines using current provider fee schedule. Example: CLIENT NET INCOME CHARGE 100% of federal poverty level Zero charge 101% - 119% of federal poverty level 17% of the current charge 120% - 139% of federal poverty level 33% of the current charge 140% - 159% of federal poverty level 50% of the current charge 160% - 179% of federal poverty level 67% of the current charge 180% - 199% of federal poverty level 83% of the current charge Above 200% of federal poverty level 100% of the current charge SEXUALLY TRANSMITTED DISEASE: s are based on sliding fee scale (as shown above) except stand alone lab screening which are fee for service. VITAL STATISTICS: Birth Certificates $15.00 Birth Certificates: Additional copies $7.00 Death Certificates $10.00 Notary Services $5.00 FY 12 Supplemental Schedule of s and Charges for Services Effective: October 1, 2011

5 SHERIFF (352) FLEET: Vehicle Safety Violation Ticket Inspection RECORDS: Copies - one-sided Copies - double-sided Concealed Weapon Permit Fingerprinting CIVIL: Non-Enforceable Process Out of State Non Enforceable Process Enforceable Process: Docket Writ of Execution Sheriff's Levy for Demand Preparation of newspaper Ad Conducting Sheriff's Sale Bill of Sale of Sheriff's Deed Satisfaction of Judgment $4.00 each $0.15 / page $0.20 / page $5.00 each $80.00 each $50.00 each Filing/ Recording (First Page) $10.00 each Filing/ Recording (each additional page) $8.50 each Arrest Orders - In / County Arrest Orders - Out of County Writs of Replevin/Attachment FALSE ALARM REDUCTION UNIT: PERMITS: Fire Alarm Permits: City $15.75 each County Burglar Alarm Permits: City County FALSE ALARMS: City Fire: Second, Third & Fourth Alarm Fifth, Sixth & Seventh Alarm Eighth and Above Alarm No Keyholder Response City Burglar: Second, Third & Fourth Alarm Fifth and Sixth Alarm Seventh and Eighth Alarm Ninth and Above Alarm County Fire & Burglar: Second Alarm Third and Fourth Alarm Fifth and Sixth Alarm Seventh & Eighth Alarm Ninth & Tenth Alarm $15.00 each $18.50 each $15.00 each $ / each $ / each $ / each $52.50 / each $60.00 / each $ / each $ / each $ / each $25.00 / each $50.00 / each $ / each $ / each $ / each NOTE: Sheriff s Office fees as submitted in the Sheriff s Certified Budget. FY 12 Supplemental Schedule of s and Charges for Services Effective Date: October 1, 2011