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{"sheet":"調査票一覧","index":0,"n_rows":25,"n_cols":4,"rows_kept":25,"cut":false,"hidden":false,"merged":[[6,2,6,3],[7,2,13,2],[15,2,21,2]]}
["調査票一覧"]
[]
["様式番号は市で定めているものとなるため、県の調査票番号と異なります。"]
["市町村独自の様式でも可とされているため、他市に提出する場合でも使用することは可能です。"]
["記入要領については、県調査票番号に該当する様式をご確認ください。"]
[]
["県調査票番号","市様式","内容"]
["様式１号","第２号様式の５","軽減対象者調書","介護老人福祉施設サービス"]
["様式２号","第２号様式の６",null,"地域密着型介護老人福祉施設入所者生活介護"]
["様式３号","第２号様式の１",null,"訪問介護、通所介護、短期入所生活介護"]
["様式４号","第２号様式の２",null,"夜間対応型訪問介護、地域密着型通所介護、認知症対応型通所介護、小規模多機能型居宅介護"]
["様式５号","第２号様式の３",null,"第1号訪問介護事業、第1号通所介護事業、介護予防短期入所介護"]
["様式６号","第２号様式の４",null,"介護予防認知症対応型通所介護、介護予防小規模多機能型居宅介護"]
["様式７号","第２号様式の７",null,"定期巡回・随時対応型訪問介護看護、看護小規模多機能型居宅介護"]
[]
["様式８号","第３号様式の５","軽減市町村別調書","介護老人福祉施設サービス"]
["様式９号","第３号様式の６",null,"地域密着型介護老人福祉施設入所者生活介護"]
["様式１０号","第３号様式の１",null,"訪問介護、通所介護、短期入所生活介護"]
["様式１１号","第３号様式の２",null,"夜間対応型訪問介護、地域密着型通所介護、認知症対応型通所介護、小規模多機能型居宅介護"]
["様式１２号","第３号様式の３",null,"第1号訪問介護事業、第1号通所介護事業、介護予防短期入所介護"]
["様式１３号","第３号様式の４",null,"介護予防認知症対応型通所介護、介護予防小規模多機能型居宅介護"]
["様式１４号","第３号様式の７",null,"定期巡回・随時対応型訪問介護看護、看護小規模多機能型居宅介護"]
[]
["◎以下の調査票は全サービス作成してください。"]
["様式１５号","総括表",null,"総括表"]

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["第２号様式の１（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定居宅サービス関係軽減対象者票）"]
["市町村名",null,null,null,null,"法人名"]
["対象期間",null,null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,null,null,null,"（単位：円）"]
["Ａ通番","Ｂ         確認\n番号","Ｃ１ 　　　　氏　　名","軽　減　額"]
[null,null,null,"訪問介護","通所介護",null,null,"短期入所生活介護"]
[null,null,"（カタカナで記入）","Ｄ１","Ｅ１","Ｆ１","G１","H１","I１","J１","K１"]
[null,null,null,"サービス費","サービス費","食　費","計","サービス費","食　費","滞在費","計"]
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[null,null,"Ｃ２","Ｄ２","Ｅ２","Ｆ２","G２","H２","I２","J２","K２"]
[null,null,null,"人",null,null," 人",null,null,null," 人"]
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["第２号様式の２（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定地域密着型サービス関係軽減対象者票）"]
["市町村名",null,null,null,null,null,null,null,"法人名"]
["対象期間",null,null,null,null,null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"（単位：円）"]
["Ａ通番","Ｂ         確認\n番号","Ｃ１ 　　　　氏　　名","軽　減　額"]
[null,null,null,"夜間対応型訪問介護","地域密着型通所介護",null,null,"認知症対応型通所介護",null,null,"小規模多機能型居宅介護"]
[null,null,"（カタカナで記入）","Ｄ１","Ｅ１","Ｆ１","G１","H１","I１","J１","K１","L１","M１","N１"]
[null,null,null,"サービス費","サービス費","食　費","計","サービス費","食　費","計","サービス費","食　費","宿泊費","計"]
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["第２号様式の３（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定介護予防サービス等関係軽減対象者票）"]
["市町村名",null,null,null,null,null,null,"法人名"]
["対象期間",null,null,null,null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（単位：円）"]
["Ａ通番","Ｂ         確認\n番号","Ｃ１ 　　　　氏　　名","軽　減　額"]
[null,null,null,"第１号訪問事業",null,"第1号通所事業",null,null,null,null,null,"介護予防短期入所生活介護"]
[]
[null,null,null,"現行相当","緩和基準","現行相当","緩和基準","現行相当","緩和基準","現行相当合計","緩和基準合計"]
[null,null,"（カタカナで記入）","Ｄ１",null,"Ｅ１",null,"Ｆ１",null,"G１",null,"H１","I１","J１","K１"]
[null,null,null,"サービス費","サービス費","サービス費","サービス費","食　費","食　費","計","計","サービス費","食　費","滞在費","計"]
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["第２号様式の４（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定地域密着型介護予防サービス関係軽減対象者票）"]
["市町村名",null,null,null,null,"法人名"]
["対象期間",null,null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,null,null,"（単位：円）"]
["Ａ通番","Ｂ         確認\n番号","Ｃ１ 　　　　氏　　名","軽　減　額"]
[null,null,null,"介護予防認知症対応型通所介護",null,null,"介護予防小規模多機能型居宅介護"]
[null,null,"（カタカナで記入）","Ｄ１","Ｅ１","Ｆ１","G１","H１","I１","J１"]
[null,null,null,"サービス費","食　費","計","サービス費","食　費","宿泊費","計"]
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["第２号様式の５（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定介護福祉施設サービス関係軽減対象者票）"]
["市町村名",null,null,null,"法人名"]
["対象期間",null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,"（単位：円）"]
["Ａ通番","Ｂ 確認番号","Ｃ１ 氏　　　名　　　(カタカナで記入）","軽 減 額",null,null,"G１  計"]
[]
[null,null,null,"D１","E１　　　　","F１　　　　　"]
[null,null,null,"サービス費","食　費","居住費"]
[null,null,null,null,null,null,{"$f":"SUM(D13:F13)","v":0}]
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["第２号様式の６（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定地域密着型介護老人福祉施設入所者生活介護関係軽減対象者票）"]
["市町村名",null,null,null,"法人名"]
["対象期間",null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,"（単位：円）"]
["Ａ通番","Ｂ 確認番号","Ｃ１ 氏　　　名　　　(カタカナで記入）","軽 減 額",null,null,"G１  計"]
[]
[null,null,null,"D１","E１　　　　","F１　　　　　"]
[null,null,null,"サービス費","食　費","居住費"]
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[null,null,"Ｃ２","D２","E２","F２","G２"]
[null,"合 計","人",{"$f":"SUM(D13:D35)","v":0},{"$f":"SUM(E13:E35)","v":0},{"$f":"SUM(F13:F35)","v":0},{"$f":"SUM(G13:G35)","v":0}]

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["第２号様式の７（第３条関係）"]
[]
[null,"軽減実施見込額調書兼実績報告書"]
["（指定定期巡回・随時対応型訪問介護看護等関係軽減対象者票）"]
[null,"市町村名",null,null,null,"法人名"]
[null,"対象期間",null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,null,"（単位：円）"]
[null,"Ａ通番","Ｂ 確認番号","Ｃ１ 氏　　　名　　　(カタカナで記入）","軽 減 額"]
[null,null,null,null,"定期巡回・随時対\n応型訪問介護看護","看護小規模多機能型居宅介護"]
[null,null,null,null,"D１　介護サービス費","Ｅ１　介護サービス費","Ｆ１　　　　食費負担","Ｇ１　　　　宿泊費","Ｈ１　　  計"]
[]
[null,null,null,null,null,null,null,null,{"$f":"SUM(F13:H13)","v":0}]
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[null,null,null,null,"人",null,null,null,"人"]
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["第３号様式の１（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定居宅サービス関係補助額市町村別配分票）"]
["市町村名",null,null,null,"法人名"]
["対象期間",null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,"（単位：円）"]
["圏域","助成申請先\n市町村名","利用者負担軽減額",null,null,"各市町村補助額"]
[null,null,null,null,null,"Ａ１～Ｃ１／総括表B４～B６×総括表Ｇ４～Ｇ６"]
[null,null,"Ａ１ 訪問","Ｂ１ 通所","Ｃ１ 短期","Ｄ１ 訪問","Ｅ１ 通所","Ｆ１ 短期"]
["政令・中核市","横浜市",null,null,null,"","",""]
[null,"川崎市",null,null,null,"","",""]
[null,"横須賀市",null,null,null,"","",""]
[null,"相模原市",null,null,null,"","",""]
["横須賀・\n三浦\n保健福祉\n圏域","鎌倉市",null,null,null,"","",""]
[null,"逗子市",null,null,null,"","",""]
[null,"三浦市",null,null,null,"","",""]
[null,"葉山町",null,null,null,"","",""]
["県央\n保健福祉\n圏域","厚木市",null,null,null,"","",""]
[null,"大和市",null,null,null,"","",""]
[null,"海老名市",null,null,null,"","",""]
[null,"座間市",null,null,null,"","",""]
[null,"綾瀬市",null,null,null,"","",""]
[null,"愛川町",null,null,null,"","",""]
[null,"清川村",null,null,null,"","",""]
["湘南西部\n保健福祉\n圏域","平塚市",null,null,null,"","",""]
[null,"秦野市",null,null,null,"","",""]
[null,"伊勢原市",null,null,null,"","",""]
[null,"大磯町",null,null,null,"","",""]
[null,"二宮町",null,null,null,"","",""]
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[null,"茅ヶ崎市",null,null,null,"","",""]
[null,"寒川町",null,null,null,"","",""]
["県西\n保健福祉\n圏域","南足柄市",null,null,null,"","",""]
[null,"中井町",null,null,null,"","",""]
[null,"大井町",null,null,null,"","",""]
[null,"松田町",null,null,null,"","",""]
[null,"山北町",null,null,null,"","",""]
[null,"開成町",null,null,null,"","",""]
[null,"小田原市",null,null,null,"","",""]
[null,"箱根町",null,null,null,"","",""]
[null,"真鶴町",null,null,null,"","",""]
[null,"湯河原町",null,null,null,"","",""]
["その他\n（県外）",null,null,null,null,"","",""]
[null,null,"Ａ２","Ｂ２","Ｃ２ ","Ｄ２ ","Ｅ２","Ｆ２"]
["合","計",{"$f":"SUM(C12:C45)","v":0},{"$f":"SUM(D12:D45)","v":0},{"$f":"SUM(E12:E45)","v":0},{"$f":"SUM(F12:F45)","v":{"$error":"#DIV/0!"}},{"$f":"SUM(G12:G45)","v":{"$error":"#DIV/0!"}},{"$f":"SUM(H12:H46)","v":{"$error":"#DIV/0!"}}]
["※総括票のＧ４～６(補助額)が０円の時は各市町村補助額も０円となります。"]

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["第３号様式の２（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定地域密着型サービス関係補助額市町村別配分票）"]
["市町村名",null,null,null,null,"法人名"]
["対象期間",null,null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,null,null,"（単位：円）"]
["圏域","助成申請先\n市町村名","利用者負担軽減額",null,null,null,"各市町村補助額"]
[null,null,null,null,null,null,"A1～D1／総括表B7～B10×総括表G7～G10"]
[null,null,"Ａ１ 　　　　　夜間対応型　　訪問介護","Ｂ１　　　　地域密着型通所介護","C１ 　　　　認知症対応型通所介護","D１ 　　　　　　　　小規模多機能型居宅介護","E１ 　　　　　夜間対応型　　訪問介護","F１　　　　地域密着型通所介護","G１ 　　　　認知症対応型通所介護","H１ 　　　　小規模多機能型居宅介護"]
["政令・中核市","横浜市",null,null,null,null,"",null,"",""]
[null,"川崎市",null,null,null,null,"",null,"",""]
[null,"横須賀市",null,null,null,null,"",null,"",""]
[null,"相模原市",null,null,null,null,"",null,"",""]
["横須賀・\n三浦\n保健福祉\n圏域","鎌倉市",null,null,null,null,"",null,"",""]
[null,"逗子市",null,null,null,null,"",null,"",""]
[null,"三浦市",null,null,null,null,"",null,"",""]
[null,"葉山町",null,null,null,null,"",null,"",""]
["県央\n保健福祉\n圏域","厚木市",null,null,null,null,"",null,"",""]
[null,"大和市",null,null,null,null,"",null,"",""]
[null,"海老名市",null,null,null,null,"",null,"",""]
[null,"座間市",null,null,null,null,"",null,"",""]
[null,"綾瀬市",null,null,null,null,"",null,"",""]
[null,"愛川町",null,null,null,null,"",null,"",""]
[null,"清川村",null,null,null,null,"",null,"",""]
["湘南西部\n保健福祉\n圏域","平塚市",null,null,null,null,"",null,"",""]
[null,"秦野市",null,null,null,null,"",null,"",""]
[null,"伊勢原市",null,null,null,null,"",null,"",""]
[null,"大磯町",null,null,null,null,"",null,"",""]
[null,"二宮町",null,null,null,null,"",null,"",""]
["湘南東部\n保健福祉\n圏域","藤沢市",{"$f":"第２号様式の２!D36","v":0},{"$f":"第２号様式の２!G36","v":0},{"$f":"第２号様式の２!J36","v":0},{"$f":"第２号様式の２!N36","v":0},{"$f":"C32/総括表!E24*総括表!O24","v":{"$error":"#DIV/0!"}},{"$f":"D32/総括表!E26*総括表!O26","v":{"$error":"#DIV/0!"}},{"$f":"E32/総括表!E28*総括表!O28","v":{"$error":"#DIV/0!"}},{"$f":"F32/総括表!E30*総括表!O30","v":{"$error":"#DIV/0!"}}]
[null,"茅ヶ崎市",null,null,null,null,"",null,"",""]
[null,"寒川町",null,null,null,null,"",null,"",""]
["県西\n保健福祉\n圏域","南足柄市",null,null,null,null,"",null,"",""]
[null,"中井町",null,null,null,null,"",null,"",""]
[null,"大井町",null,null,null,null,"",null,"",""]
[null,"松田町",null,null,null,null,"",null,"",""]
[null,"山北町",null,null,null,null,"",null,"",""]
[null,"開成町",null,null,null,null,"",null,"",""]
[null,"小田原市",null,null,null,null,"",null,"",""]
[null,"箱根町",null,null,null,null,"",null,"",""]
[null,"真鶴町",null,null,null,null,"",null,"",""]
[null,"湯河原町",null,null,null,null,"",null,"",""]
["その他\n（県外）",null,null,null,null,null,"",null,"",""]
[null,null,"Ａ２","Ｂ２","Ｃ２ ","D２ ","E２ ","F２ ","G２","H２"]
["合","計",{"$f":"SUM(C12:C45)","v":0},{"$f":"SUM(D12:D45)","v":0},{"$f":"SUM(E12:E45)","v":0},{"$f":"SUM(F12:F45)","v":0},{"$f":"SUM(G12:G45)","v":{"$error":"#DIV/0!"}},{"$f":"SUM(H12:H46)","v":{"$error":"#DIV/0!"}},{"$f":"SUM(I12:I45)","v":{"$error":"#DIV/0!"}},{"$f":"SUM(J12:J45)","v":{"$error":"#DIV/0!"}}]
["※総括票のＧ７～１０(補助額)が０円の時は各市町村補助額も０円となります。"]

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["第３号様式の３（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定介護予防サービス等関係補助額市町村別配分票）"]
["市町村名",null,null,null,null,"法人名"]
["対象期間",null,null,null,null,"事業所名"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"（単位：円）"]
["圏域","助成申請先\n市町村名","利用者負担軽減額",null,null,null,null,"各市町村補助額"]
[null,null,null,null,null,null,null,"Ａ１～Ｃ１／総括表Ｂ１１～Ｂ１３×総括表Ｇ１１～Ｇ１３"]
[null,null,"Ａ１\n第一号訪問事業\n(現行相当）","   　　　　　　　　第一号訪問事業\n（緩和基準）","Ｂ１\n第一号通所事業\n（現行相当）","   　　　　　　　　第一号通所事業\n（緩和基準）","Ｃ１ 　　　　介護予防短期入所生活介護","Ｄ１\n第一号訪問事業\n(現行相当）","第一号訪問事業　　　　　（緩和基準）","Ｅ１\n第一号通所事業\n（現行相当）","   　　　　　　　　第一号通所事業\n（緩和基準）","Ｆ１ 　　　　介護予防短期入所生活介護"]
["政令・中核市","横浜市",null,null,null,null,null,"",null,"",null,""]
[null,"川崎市",null,null,null,null,null,"",null,"",null,""]
[null,"横須賀市",null,null,null,null,null,"",null,"",null,""]
[null,"相模原市",null,null,null,null,null,"",null,"",null,""]
["横須賀・\n三浦\n保健福祉\n圏域","鎌倉市",null,null,null,null,null,"",null,"",null,""]
[null,"逗子市",null,null,null,null,null,"",null,"",null,""]
[null,"三浦市",null,null,null,null,null,"",null,"",null,""]
[null,"葉山町",null,null,null,null,null,"",null,"",null,""]
["県央\n保健福祉\n圏域","厚木市",null,null,null,null,null,"",null,"",null,""]
[null,"大和市",null,null,null,null,null,"",null,"",null,""]
[null,"海老名市",null,null,null,null,null,"",null,"",null,""]
[null,"座間市",null,null,null,null,null,"",null,"",null,""]
[null,"綾瀬市",null,null,null,null,null,"",null,"",null,""]
[null,"愛川町",null,null,null,null,null,"",null,"",null,""]
[null,"清川村",null,null,null,null,null,"",null,"",null,""]
["湘南西部\n保健福祉\n圏域","平塚市",null,null,null,null,null,"",null,"",null,""]
[null,"秦野市",null,null,null,null,null,"",null,"",null,""]
[null,"伊勢原市",null,null,null,null,null,"",null,"",null,""]
[null,"大磯町",null,null,null,null,null,"",null,"",null,""]
[null,"二宮町",null,null,null,null,null,"",null,"",null,""]
["湘南東部\n保健福祉\n圏域","藤沢市",{"$f":"第２号様式の３!D32","v":0},{"$f":"第２号様式の３!E32","v":0},{"$f":"第２号様式の３!J32","v":0},{"$f":"第２号様式の３!K32","v":0},{"$f":"第２号様式の３!O32","v":0},{"$f":"C32/総括表!E32*総括表!O32","v":{"$error":"#DIV/0!"}},null,{"$f":"E32/総括表!E34*総括表!O34","v":{"$error":"#DIV/0!"}},null,{"$f":"G32/総括表!E36*総括表!O36","v":{"$error":"#DIV/0!"}}]
[null,"茅ヶ崎市",null,null,null,null,null,"",null,"",null,""]
[null,"寒川町",null,null,null,null,null,"",null,"",null,""]
["県西\n保健福祉\n圏域","南足柄市",null,null,null,null,null,"",null,"",null,""]
[null,"中井町",null,null,null,null,null,"",null,"",null,""]
[null,"大井町",null,null,null,null,null,"",null,"",null,""]
[null,"松田町",null,null,null,null,null,"",null,"",null,""]
[null,"山北町",null,null,null,null,null,"",null,"",null,""]
[null,"開成町",null,null,null,null,null,"",null,"",null,""]
[null,"小田原市",null,null,null,null,null,"",null,"",null,""]
[null,"箱根町",null,null,null,null,null,"",null,"",null,""]
[null,"真鶴町",null,null,null,null,null,"",null,"",null,""]
[null,"湯河原町",null,null,null,null,null,"",null,"",null,""]
["その他\n（県外）",null,null,null,null,null,null,"",null,"",null,""]
[null,null,"Ａ２",null,"Ｂ２",null,"Ｃ２ ","Ｄ２ ",null,"Ｅ２",null,"Ｆ２"]
["合","計",{"$f":"SUM(C12:C45)","v":0},0,0,0,0,{"$error":"#DIV/0!"},0,{"$error":"#DIV/0!"},0,{"$error":"#DIV/0!"}]
["※総括票のＧ１1～１３(補助額)が０円の時は各市町村補助額も０円となります。"]

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["第３号様式の４（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定地域密着型介護予防サービス関係補助額市町村別配分票）"]
["市町村名",null,null,"法人名"]
["対象期間",null,null,"事業所名"]
[]
[null,null,null,null,null,"（単位：円）"]
["圏域","助成申請先\n市町村名","利用者負担軽減額",null,"各市町村補助額"]
[null,null,null,null,"A1～B1／総括表B14～15×総括表G14～G15"]
[null,null,"Ａ１ 　　　　　　　　介護予防認知症　　　対応型通所介護","Ｂ１ 　　　　　　　　介護予防小規模　　　多機能型居宅介護","C１ 　　　　　　　　介護予防認知症　　　対応型通所介護","D１ 　　　　　　　　介護予防小規模　　　多機能型居宅介護"]
["政令・中核市","横浜市",null,null,"",""]
[null,"川崎市",null,null,"",""]
[null,"横須賀市",null,null,"",""]
[null,"相模原市",null,null,"",""]
["横須賀・\n三浦\n保健福祉\n圏域","鎌倉市",null,null,"",""]
[null,"逗子市",null,null,"",""]
[null,"三浦市",null,null,"",""]
[null,"葉山町",null,null,"",""]
["県央\n保健福祉\n圏域","厚木市",null,null,"",""]
[null,"大和市",null,null,"",""]
[null,"海老名市",null,null,"",""]
[null,"座間市",null,null,"",""]
[null,"綾瀬市",null,null,"",""]
[null,"愛川町",null,null,"",""]
[null,"清川村",null,null,"",""]
["湘南西部\n保健福祉\n圏域","平塚市",null,null,"",""]
[null,"秦野市",null,null,"",""]
[null,"伊勢原市",null,null,"",""]
[null,"大磯町",null,null,"",""]
[null,"二宮町",null,null,"",""]
["湘南東部\n保健福祉\n圏域","藤沢市",{"$f":"第２号様式の４!F34","v":0},{"$f":"第２号様式の４!J34","v":0},{"$f":"C32/総括表!E38*総括表!O38","v":{"$error":"#DIV/0!"}},{"$f":"D32/総括表!E40*総括表!O40","v":{"$error":"#DIV/0!"}}]
[null,"茅ヶ崎市",null,null,"",""]
[null,"寒川町",null,null,"",""]
["県西\n保健福祉\n圏域","南足柄市",null,null,"",""]
[null,"中井町",null,null,"",""]
[null,"大井町",null,null,"",""]
[null,"松田町",null,null,"",""]
[null,"山北町",null,null,"",""]
[null,"開成町",null,null,"",""]
[null,"小田原市",null,null,"",""]
[null,"箱根町",null,null,"",""]
[null,"真鶴町",null,null,"",""]
[null,"湯河原町",null,null,"",""]
["その他\n（県外）",null,null,null,"",""]
[null,null,"Ａ２","Ｂ２","Ｄ２ ","Ｅ２"]
["合","計",{"$f":"SUM(C12:C45)","v":0},{"$f":"SUM(D12:D45)","v":0},{"$f":"SUM(E12:E45)","v":{"$error":"#DIV/0!"}},{"$f":"SUM(F12:F45)","v":{"$error":"#DIV/0!"}}]
["※総括票のＧ１４～１５(補助額)が０円の時は各市町村補助額も０円となります。"]

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["第３号様式の５（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定介護福祉施設サービス関係補助額市町村別配分票）"]
["市町村名",null,null,"法人名"]
["対象期間",null,null,"事業所名"]
[]
[null,null,null,null,"（単位：円）"]
["圏域","助成申請先　　　市町村名","利用者負担軽減額",null,"各 市 町 村 補 助 額　　　　　   　　　　　　           "]
[null,null,null,null,"（Ａ１／総括表B１×総括表Ｇ１）"]
[null,null,"Ａ1　介護福祉施設サービス",null,"Ｂ１　介護福祉施設サービス"]
["政令・中核市","横浜市",null,null,""]
[null,"川崎市",null,null,""]
[null,"横須賀市",null,null,""]
[null,"相模原市",null,null,""]
["横須賀・\n三浦\n保健福祉\n圏域","鎌倉市",null,null,""]
[null,"逗子市",null,null,""]
[null,"三浦市",null,null,""]
[null,"葉山町",null,null,""]
["県央\n保健福祉\n圏域","厚木市",null,null,""]
[null,"大和市",null,null,""]
[null,"海老名市",null,null,""]
[null,"座間市",null,null,""]
[null,"綾瀬市",null,null,""]
[null,"愛川町",null,null,""]
[null,"清川村",null,null,""]
["湘南西部\n保健福祉\n圏域","平塚市",null,null,""]
[null,"秦野市",null,null,""]
[null,"伊勢原市",null,null,""]
[null,"大磯町",null,null,""]
[null,"二宮町",null,null,""]
["湘南東部\n保健福祉\n圏域","藤沢市",{"$f":"第２号様式の５!G29","v":0},null,{"$f":"C32/総括表!E9/総括表!入所補助額","v":{"$error":"#DIV/0!"}}]
[null,"茅ヶ崎市",null,null,""]
[null,"寒川町",null,null,""]
["県西\n保健福祉\n圏域","南足柄市",null,null,""]
[null,"中井町",null,null,""]
[null,"大井町",null,null,""]
[null,"松田町",null,null,""]
[null,"山北町",null,null,""]
[null,"開成町",null,null,""]
[null,"小田原市",null,null,""]
[null,"箱根町",null,null,""]
[null,"真鶴町",null,null,""]
[null,"湯河原町",null,null,""]
["その他\n（県外）",null,null,null,""]
["合","計","Ａ２",null,"Ｂ２"]
[null,null,{"$f":"SUM(C12:D45)","v":0},null,{"$f":"SUM(E12:E45)","v":{"$error":"#DIV/0!"}}]
["※総括票のＧ１(補助額)が０円の時は各市町村補助額も０円となります。"]

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["第３号様式の６（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定地域密着型介護老人福祉施設入所者生活介護関係補助額市町村別配分票）"]
["市町村名",null,null,"法人名"]
["対象期間",null,null,"事業所名"]
[]
[null,null,null,null,"（単位：円）"]
["圏域","助成申請先　　　市町村名","利用者負担軽減額",null,"各 市 町 村 補 助 額　　　　　   　　　　　　           "]
[null,null,null,null,"（Ａ１／総括表B２×総括表Ｇ２）"]
[null,null,"Ａ1　地域密着型介護老人福祉施設入所者生活介護",null,"Ｂ１　地域密着型介護老人福祉施設入所者生活介護"]
["政令・中核市","横浜市",null,null,""]
[null,"川崎市",null,null,""]
[null,"横須賀市",null,null,""]
[null,"相模原市",null,null,""]
["横須賀・\n三浦\n保健福祉\n圏域","鎌倉市",null,null,""]
[null,"逗子市",null,null,""]
[null,"三浦市",null,null,""]
[null,"葉山町",null,null,""]
["県央\n保健福祉\n圏域","厚木市",null,null,""]
[null,"大和市",null,null,""]
[null,"海老名市",null,null,""]
[null,"座間市",null,null,""]
[null,"綾瀬市",null,null,""]
[null,"愛川町",null,null,""]
[null,"清川村",null,null,""]
["湘南西部\n保健福祉\n圏域","平塚市",null,null,""]
[null,"秦野市",null,null,""]
[null,"伊勢原市",null,null,""]
[null,"大磯町",null,null,""]
[null,"二宮町",null,null,""]
["湘南東部\n保健福祉\n圏域","藤沢市",{"$f":"第２号様式の６!G37","v":0},null,{"$f":"C32/総括表!E11*総括表!O11","v":{"$error":"#DIV/0!"}}]
[null,"茅ヶ崎市",null,null,""]
[null,"寒川町",null,null,""]
["県西\n保健福祉\n圏域","南足柄市",null,null,""]
[null,"中井町",null,null,""]
[null,"大井町",null,null,""]
[null,"松田町",null,null,""]
[null,"山北町",null,null,""]
[null,"開成町",null,null,""]
[null,"小田原市",null,null,""]
[null,"箱根町",null,null,""]
[null,"真鶴町",null,null,""]
[null,"湯河原町",null,null,""]
["その他\n（県外）",null,null,null,""]
["合","計","Ａ２",null,"Ｂ２"]
[null,null,{"$f":"SUM(C12:D45)","v":0},null,{"$f":"SUM(E12:E45)","v":{"$error":"#DIV/0!"}}]
["※総括票のＧ２(補助額)が０円の時は各市町村補助額も０円となります。"]

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["第３号様式の７（第３条関係）"]
[]
["軽減実施見込額調書兼実績報告書"]
["（指定定期巡回・随時対応型訪問介護看護等関係補助額市町村別配分票）"]
["市町村名",null,null,"法人名"]
["対象期間",null,null,"事業所名"]
[]
[null,null,null,null,null,"（単位：円）"]
["圏域","助成申請先\n市町村名","利用者負担軽減額",null,"各市町村補助額"]
[null,null,null,null,"A1～B1／総括表B16～B17×総括表G16～G17"]
[null,null,"Ａ１\n定期巡回・随時対応型訪問介護看護","Ｂ１ \n看護小規模多機能型居宅介護","C１\n定期巡回・随時対応型訪問介護看護","D１\n看護小規模多機能型\n居宅介護"]
["政令・中核市","横浜市",null,null,"",""]
[null,"川崎市",null,null,"",""]
[null,"横須賀市",null,null,"",""]
[null,"相模原市",null,null,"",""]
["横須賀・\n三浦\n保健福祉\n圏域","鎌倉市",null,null,"",""]
[null,"逗子市",null,null,"",""]
[null,"三浦市",null,null,"",""]
[null,"葉山町",null,null,"",""]
["県央\n保健福祉\n圏域","厚木市",null,null,"",""]
[null,"大和市",null,null,"",""]
[null,"海老名市",null,null,"",""]
[null,"座間市",null,null,"",""]
[null,"綾瀬市",null,null,"",""]
[null,"愛川町",null,null,"",""]
[null,"清川村",null,null,"",""]
["湘南西部\n保健福祉\n圏域","平塚市",null,null,"",""]
[null,"秦野市",null,null,"",""]
[null,"伊勢原市",null,null,"",""]
[null,"大磯町",null,null,"",""]
[null,"二宮町",null,null,"",""]
["湘南東部\n保健福祉\n圏域","藤沢市"]
[null,"茅ヶ崎市",null,null,"",""]
[null,"寒川町",null,null,"",""]
["県西\n保健福祉\n圏域","南足柄市",null,null,"",""]
[null,"中井町",null,null,"",""]
[null,"大井町",null,null,"",""]
[null,"松田町",null,null,"",""]
[null,"山北町",null,null,"",""]
[null,"開成町",null,null,"",""]
[null,"小田原市",null,null,"",""]
[null,"箱根町",null,null,"",""]
[null,"真鶴町",null,null,"",""]
[null,"湯河原町",null,null,"",""]
["その他\n（県外）",null,null,null,"",""]
[null,null,"Ａ２","Ｂ２","Ｄ２ ","Ｅ２"]
["合","計",{"$f":"SUM(C12:C45)","v":0},{"$f":"SUM(D12:D45)","v":0},{"$f":"SUM(E12:E45)","v":0},{"$f":"SUM(F12:F45)","v":0}]
["※総括票のＧ１６～１７(補助額)が０円の時は各市町村補助額も０円となります。"]

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[null,null,null,null,"総括表"]
[]
[null,null,null,null,null,null,null,null,"法人名及び施設名"]
[]
[]
["項目","Ａ","本来受領すべき\n利用者負担総額\n（全入所者）","Ｂ","軽減総額","Ｃ","１０％相当額","Ｄ","全額公費分","Ｅ","控除額　　　　　１％相当額","Ｆ","１／２\n公費分","Ｇ","助成額（円）　　　　　　　","Ｈ","助成請求額（円）　　　　　　　"]
[null,null,null,null,null,null,null,null,null,null,null,"※３(Ｂ-Ｅ)×0.5\n※４(Ｃ-Ｅ)×0.5\n※５(Ｂ<Ｅ)＝0"]
[null,null,null,null,"(実人員数)人","（Ａ×0.１）",null,"※１（Ｂ＜Ｃ）＝0\n※２(Ｂ－Ｃ)",null,"（Ａ×0.01）",null,null,null,"（Ｄ＋Ｆ）",null,"（Ｄ＋Ｆ）"]
["介護福祉施設サービス","Ａ１",null,"Ｂ１",null,"Ｃ１",{"$f":"ROUNDDOWN(C9*10%,0)","v":0},"Ｄ１",{"$f":"IF(E9<G9,0,E9-G9)","v":0},"Ｅ１",{"$f":"ROUNDDOWN(C9*1%,0)","v":0},"Ｆ１",{"$f":"ROUNDDOWN(IF(E9<K9,0,IF(E9<G9,(E9-K9),(G9-K9))/2),0)","v":0},"Ｇ１",{"$f":"I9+M9","v":0},"Ｈ１",{"$f":"ROUNDDOWN(I9+M9,-3)","v":0}]
["（人数）",null,null,null,0]
["地域密着型介護老人福祉施設入所者生活介護","Ａ２",null,"Ｂ２",null,"Ｃ２",{"$f":"ROUNDDOWN(C11*10%,0)","v":0},"Ｄ２",{"$f":"IF(E11<G11,0,E11-G11)","v":0},"Ｅ２",{"$f":"ROUNDDOWN(C11*1%,0)","v":0},"Ｆ２",{"$f":"ROUNDDOWN(IF(E11<K11,0,IF(E11<G11,(E11-K11),(G11-K11))/2),0)","v":0},"Ｇ２",{"$f":"I11+M11","v":0},"Ｈ２",{"$f":"ROUNDDOWN(I11+M11,-3)","v":0}]
["（人数）",null,null,null,0]
["計","Ａ３",{"$f":"C9+C11","v":0},"Ｂ３",{"$f":"E9+E11","v":0},"Ｃ３",null,"Ｄ３",null,"Ｅ３",{"$f":"K9+K11","v":0},"Ｆ３",{"$f":"M9+M11","v":0},"Ｇ３",{"$f":"O9+O11","v":0},"Ｈ３",{"$f":"SUM(Q9,Q11)","v":0}]
[null,null,null,null,{"$f":"SUM(E10,E12)","v":0}]
[]
["項目","Ａ","本来受領すべき\n利用者負担総額\n（全利用者）","Ｂ","軽減総額","Ｃ","10％相当額","Ｄ","全額公費分","Ｅ","控除額　　　　　１％相当額","Ｆ","１／２\n公費分","Ｇ","助成請求額　　　　　　　","Ｈ","助成請求額（円）"]
[null,null,null,null,"(実人員数)人",null,"（Ａ×0.1）",null,"（Ｂ-Ｃ）",null,"（Ａ×0.01）","※６(B4～17-E4～17)×0.5\n※７(B4～17<E4～17）＝0",null,"（Ｄ＋Ｆ）",null,"（Ｄ＋Ｆ）"]
["訪問介護","Ａ４",null,"Ｂ４",null,"Ｃ４",null,"Ｄ４",null,"Ｅ４",{"$f":"ROUNDDOWN(C18*1%,0)","v":0},"Ｆ４",{"$f":"IF(E18<K18,0,ROUNDDOWN((E18-K18)/2,0))","v":0},"Ｇ４",{"$f":"M18","v":0},"Ｈ４",{"$f":"ROUNDDOWN(I18+M18,-3)","v":0}]
["（人数）",null,null,null,0]
["通所介護","Ａ５",null,"Ｂ５",null,"Ｃ５",null,"Ｄ５",null,"Ｅ５",{"$f":"ROUNDDOWN(C20*1%,0)","v":0},"Ｆ５",{"$f":"IF(E20<K20,0,ROUNDDOWN((E20-K20)/2,0))","v":0},"Ｇ５",{"$f":"M20","v":0},"Ｈ５",{"$f":"ROUNDDOWN(I20+M20,-3)","v":0}]
["（人数）",null,null,null,0]
["短期入所生活介護","Ａ６",null,"Ｂ６",null,"Ｃ６",null,"Ｄ６",null,"Ｅ６",{"$f":"ROUNDDOWN(C22*1%,0)","v":0},"Ｆ６",{"$f":"IF(E22<K22,0,ROUNDDOWN((E22-K22)/2,0))","v":0},"Ｇ６",{"$f":"M22","v":0},"Ｈ６",{"$f":"ROUNDDOWN(I22+M22,-3)","v":0}]
["（人数）",null,null,null,0]
["夜間対応型訪問介護","Ａ７",null,"Ｂ７",null,"Ｃ７",null,"Ｄ７",null,"Ｅ７",{"$f":"ROUNDDOWN(C24*1%,0)","v":0},"Ｆ７",{"$f":"IF(E24<K24,0,ROUNDDOWN((E24-K24)/2,0))","v":0},"Ｇ７",{"$f":"M24","v":0},"Ｈ７",{"$f":"ROUNDDOWN(I24+M24,-3)","v":0}]
["（人数）",null,null,null,0]
["地域密着型通所介護","Ａ８",null,"Ｂ８",null,"Ｃ８",null,"Ｄ８",null,"Ｅ８",{"$f":"ROUNDDOWN(C26*1%,0)","v":0},"Ｆ８",{"$f":"IF(E26<K26,0,ROUNDDOWN((E26-K26)/2,0))","v":0},"Ｇ８",{"$f":"M26","v":0},"Ｈ８",{"$f":"ROUNDDOWN(I26+M26,-3)","v":0}]
["（人数）",null,null,null,0]
["認知症対応型通所介護","Ａ９",null,"Ｂ９",null,"Ｃ９",null,"Ｄ９",null,"Ｅ９",{"$f":"ROUNDDOWN(C28*1%,0)","v":0},"Ｆ９",{"$f":"IF(E28<K28,0,ROUNDDOWN((E28-K28)/2,0))","v":0},"Ｇ９",{"$f":"M28","v":0},"Ｈ９",{"$f":"ROUNDDOWN(I28+M28,-3)","v":0}]
["（人数）",null,null,null,0]
["小規模多機能型居宅介護","Ａ１０",null,"Ｂ１０",null,"Ｃ１０",null,"Ｄ１０",null,"Ｅ１０",{"$f":"ROUNDDOWN(C30*1%,0)","v":0},"Ｆ１０",{"$f":"IF(E30<K30,0,ROUNDDOWN((E30-K30)/2,0))","v":0},"Ｇ１０",{"$f":"M30","v":0},"Ｈ１０",{"$f":"ROUNDDOWN(I30+M30,-3)","v":0}]
["（人数）",null,null,null,0]
["第一号訪問事業\n（現行相当）","Ａ１１",null,"Ｂ１１",null,"Ｂ１１",null,"Ｄ１１",null,"Ｅ１１",{"$f":"ROUNDDOWN(C32*1%,0)","v":0},"Ｆ１１",{"$f":"IF(E32<K32,0,ROUNDDOWN((E32-K32)/2,0))","v":0},"Ｇ１１",{"$f":"M32","v":0},"Ｈ１１",{"$f":"ROUNDDOWN(I32+M32,-3)","v":0}]
["（人数）",null,null,null,0]
["第一号通所事業\n（現行相当）","Ａ１２",null,"Ｂ１２",null,"Ｂ１２",null,"Ｄ１２",null,"Ｅ１２",{"$f":"ROUNDDOWN(C34*1%,0)","v":0},"Ｆ１２",{"$f":"IF(E34<K34,0,ROUNDDOWN((E34-K34)/2,0))","v":0},"Ｇ１２",{"$f":"M34","v":0},"Ｈ１２",{"$f":"ROUNDDOWN(I34+M34,-3)","v":0}]
["（人数）",null,null,null,0]
["介護予防短期入所生活介護","Ａ１３",null,"Ｂ１３",null,"Ｃ１３",null,"Ｄ１３",null,"Ｅ１３",{"$f":"ROUNDDOWN(C36*1%,0)","v":0},"Ｆ１３",{"$f":"IF(E36<K36,0,ROUNDDOWN((E36-K36)/2,0))","v":0},"Ｇ１３",{"$f":"M36","v":0},"Ｈ１３",{"$f":"ROUNDDOWN(I36+M36,-3)","v":0}]
["（人数）",null,null,null,0]
["介護予防認知症対応型通所介護","Ａ１４",null,"Ｂ１４",null,"Ｃ１４",null,"Ｄ１４",null,"Ｅ１４",{"$f":"ROUNDDOWN(C38*1%,0)","v":0},"Ｆ１４",{"$f":"IF(E38<K38,0,ROUNDDOWN((E38-K38)/2,0))","v":0},"Ｇ１４",{"$f":"M38","v":0},"Ｈ１４",{"$f":"ROUNDDOWN(I38+M38,-3)","v":0}]
["（人数）",null,null,null,0]
["介護予防小規模多機能型居宅介護","Ａ１５",null,"Ｂ１５",null,"Ｃ１５",null,"Ｄ１５",null,"Ｅ１５",{"$f":"ROUNDDOWN(C40*1%,0)","v":0},"Ｆ１５",{"$f":"IF(E40<K40,0,ROUNDDOWN((E40-K40)/2,0))","v":0},"Ｇ１５",{"$f":"M40","v":0},"Ｈ１５",{"$f":"ROUNDDOWN(I40+M40,-3)","v":0}]
["（人数）",null,null,null,0]
["定期巡回・随時対応型訪問介護看護","Ａ１６",null,"Ｂ１６",null,"Ｃ１６",null,"Ｄ１６",null,"Ｅ１６",{"$f":"ROUNDDOWN(C42*1%,0)","v":0},"Ｆ１６",{"$f":"IF(E42<K42,0,ROUNDDOWN((E42-K42)/2,0))","v":0},"Ｇ１６",0,"Ｈ１６",{"$f":"ROUNDDOWN(I42+M42,-3)","v":0}]
["（人数）",null,null,null,0]
["看護小規模多機能型居宅介護","Ａ１７",null,"Ｂ１７",null,"Ｃ１７",null,"Ｄ１７",null,"Ｅ１７",{"$f":"ROUNDDOWN(C44*1%,0)","v":0},"Ｆ１７",{"$f":"IF(E44<K44,0,ROUNDDOWN((E44-K44)/2,0))","v":0},"Ｇ１７",{"$f":"M44","v":0},"Ｈ１７",{"$f":"ROUNDDOWN(I44+M44,-3)","v":0}]
["（人数）",null,null,null,0]
["計","Ａ１８",{"$f":"SUM(C18,C20,C22,C24,C26,C28,C30,C32,C34,C36,C38,C40,C42,C44)","v":0},"Ｂ１８",{"$f":"SUM(E18,E20,E22,E24,E26,E28,E30,E32,E34,E36,E38,E40,E42,E44)","v":0},"Ｃ１８",null,"Ｄ１８",null,"Ｅ１８",{"$f":"SUM(K18,K20,K22,K24,K26,K28,K30,K32,K34,K36,K38,K40,K42,K44)","v":0},"Ｆ１８",{"$f":"SUM(M18,M20,M22,M24,M26,M28,M30,M32,M34,M36,M38,M40,M42,M44)","v":0},"Ｇ１８",{"$f":"SUM(O18,O20,O22,O24,O26,O28,O30,O32,O34,O36,O38,O40,O42,O44)","v":0},"Ｈ１８",{"$f":"SUM(Q18,Q20,Q22,Q24,Q26,Q28,Q30,Q32,Q34,Q36,Q38,Q40,Q42,Q44)","v":0}]
[null,null,null,null,{"$f":"SUM(E19,E21,E23,E25,E29,E31,E33,E35,E37,E39,E41,E43,E45)","v":0}]
[]
[null,"I","軽減合計\n（Ｂ３+Ｂ1８）　",{"$f":"E13+E46","v":0},null,"J施設負担額\n※８（Ｉ-（様式3-5、3-6のＢ２＋様式3-1～3-3のＤ２～Ｆ２＋様式3-4、3-7のＣ２、Ｄ２））",null,null,{"$f":"減免総額-(Q13+Q46)","v":0},null,null,"ｋ","補助額合計\n（H３＋H１８）",null,null,null,{"$f":"Q13+Q46","v":0}]
[null,null,null,null,{"$f":"E14+E47","v":0}]
[]
["（表中の※の説明）"]
["※１　軽減総額が10％相当額より小さいときはＤ１～２に「０」を記入する。"]
["※２　軽減総額が10％相当額より大きいときに使用する計算式"]
["※３　軽減総額が10％相当額より小さいときに使用する計算式"]
["※４　軽減総額が10％相当額より大きいときに使用する計算式"]
["※５　軽減総額が控除額１％相当額より小さいときはＦ１～２に「０」を記入する。"]
["※６　軽減総額が１％相当額より大きいときに使用する計算式"]
["※７　軽減総額が控除額１％相当額より小さいときはＦ４～１７に「０」を記入する。"]
["※８　表中Ｉ軽減総額合計から様式3-5,3-6のＢ２と様式3-1～3-3のＤ２～Ｆ２及び様式3-4,3-7のＣ２、Ｄ２の合計を引いた額を記入する。"]
["※この様式は，適宜修正して使用できるものとする。"]