New York State Education Department Office of Management Services State Aid Unit (518) 474-2977 District Code: 200901 WELLS CSD Vendor ID: 1000002058 2013-14 Certificate of Excess Cost Aid for Students with Disabilities 1. TOTAL EXCESS COST AID (less Estimated or calc) $0.00 2. Total Aug-Nov State Share Medicaid Paid By DOH $318.50 3. Total Overpayments Deducted $0.00 4. December Net Payment $0.00 (Line 1 X .25 minus St Sh Med & Overpayments) 5. Check Date 6. TOTAL EXCESS COST AID (less Estimated or calc) $111,029.00 7. Total Dec-Feb State Share Medicaid Paid by DOH $1,001.05 8. Total Overpayments Deducted $0.00 9. March Net Payment $76,400.75 (Line 6 X .70 less previous EC, St Sh Med & O/P's ) 10. Check Date 03/14/2014 11. TOTAL EXCESS COST AID (less Estimated or calc) $111,029.00 12. Total Mar-May State Share Medicaid Paid by DOH $1,435.22 13. Total Foster Care Deducted $0.00 14. Total Overpayments Deducted $0.00 15. June Net Payment $15,219.13 (Line 11 X .85 less previous EC,St Sh Med,FC, & O/P's) 16. Check Date 06/13/2014 17. Est** Accrued Aug Excess Cost $16,654.35 (Line 11 X 100% minus total of previous deducts & Net EC paid) 18. Est Accrued Sept Ex Cost (Actual - Estimated) $0.00 Check will be mailed under separate cover from the Division of the Treasury. (ST-3 Code A3101 Basic Formula Aid - Excess Cost Only) **The estimated Aug payment will be reduced by June & July State Share Medicaid.
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