User Guide for the Cost Data Collection Instrument

%  attributable  to ground  ambulance 

Did your  agency  receive  revenue? 

Amount 

Source 

Facility contracts, e.g. nursing homes, prisons, businesses  Subcontracted ambulance services  Standby events  Membership fees  Charitable foundations & individual donors (excluding vehicles  or any cost offsets reported elsewhere)  Executive loan programs, e.g. CEO, business dev., etc.  Program‐related investments, e.g. public‐private investments  Local taxes earmarked for EMS  Contract revenue from local governments in return for services   Enterprise funds and utility rates  Sales of assets and services  Bond or debt financing  State/local donation of surplus vehicles & durable equipment  Other donations (includes market value for donation);  excludes labor, facilities, vehicles, equipment, supplies,  medication, and other items reported elsewhere  Special purpose grants (generally state)  Matching grants (generally state)  Technical assistance, e.g. subsidized training  Demonstration grants (federal)  Congressional earmarks  Other (specify)

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