TEMPLATE FOR CONTRACT BUDGET JUSTIFICATION PREPARATION Agency Name: Budget Term: Program: All individual line items must show actual amounts. Rounded amounts are carried to the Grant Budget page. INTRODUCTION: Guidance is offered for the preparation of a budget request. Following this guidance will facilitate the review and approval of a requested budget by insuring that the required or needed information is provided. Note: Each Line item category below that has a Superscript 2 must be on the Grant Budget Line-Item Detail page For each requested position, provide the following information: name of staff member occupying the position, if available; monthly salary; percentage of time budgeted for this program; total months of salary budgeted; and total salary requested. Also, provide a justification and describe the scope of responsibility for each position, relating it to the accomplishment of program objectives. Name Position & Title Monthly % of Time # of Months Longevity Amount $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Actual Total for Salaries listed above (amount total) $ - Rounded Total for Salaries listed above (nearest 100) $ - B.Fringe Benefits Fringe benefits are usually applicable to direct salaries and wages. Provide information on the rate of fringe benefits used and the basis for their calculation. If a fringe benefit rate is not used, itemize how the fringe benefit amount is computed. Note: If fringe benefits are not computed by using a percentage of salaries, itemize how the amount is determined. Amount of total x percentage Fringe Benefits Rate 20% X Salaries $ ‐ Actual Total Fringe Benefits $ ‐ Rounded Total Fringe Benefits $ ‐ C.Professional Fees/Grant Awards 2 Detail the organization’s fees to outside professionals, consultants, and personal-service contractors. Include legal, accounting, and auditing fees. Provide complete justification for the use of an outside professional, consultant, and personal-service contractor. Include the consultant name, and a description of the servic Professional Fees/Grant Awards 20% X Salaries $ ‐ $ ‐ Actual Total Fringe Benefits $ ‐ Rounded Total Fringe Benefits $ ‐ D.Supplies Detail the organization’s expenses for office supplies, housekeeping supplies, food and beverages, and other supplies. Individually list each item requested. Provide justification for each item and relate it to specific program objectives. General Office Supplies may be shown by an estimated amount per month times the number of months. Note: Add additional rows if $ x of months Actual Amount $ $ x of months Actual Amount $ Actual Total For Supplies Fees $ ‐ Rounded Total For Supplies Fees $ ‐ E.Telephone Detail the organization’s expenses for telephone, cellular phones, beepers, telegram, FAX, E-mail, telephone equipment maintenance, and other related expenses. $ per month x of months Actual Amount $ $ per month x of months Actual Amount $ Salaries $ ‐ $ ‐ Actual Total for Telephone Fees $ ‐ Rounded total for Telephone Fees ‐$ F. Postage and Shipping Detail the organization’s expenses for postage, messenger services, overnight delivery, outside mailing service fees. $X months Actual Amount $ $X months Actual Amount $ Actual Total for Postage & Shipping $ $ ‐ Rounded total for Postage & Shipping $ $ ‐ G. Occupancy Detail the organization’s expenses for the use of office space and other facilities, heat, light, power, other utilities, and outside janitorial services. Also detail the allocation method used. $X months # of staff Actual Amount $ $X months # of staff Actual Amount $ Actual Total for O $ ‐ Rounded total fo $ ‐ H. Equipment Rental and Maintenance Detail the organization’s expense for renting and maintaining computers, copiers, and other office equipment. $X months Actual Amount $ $X months Actual Amount $ Actual Total for Equipment Rental & Mainte $ ‐ Rounded total for Equipment Rental & Ma $ ‐ I. Printing and Publications Detail the organization’s expenses for producing printed material, purchasing books and publications, and buying subscriptions to publications. $X months Actual Amount $ $X months Actual Amount $ Actual Total for Printing and Publications $ $ ‐ Rounded total for Printing and Publication $ ‐ J. Travel 2 Dollars requested in the travel category should be for staff travel only. Travel for consultants should be shown in the professional fees/grant awards category. In-State Travel—Provide a narrative justification describing the travel staff members will perform. List where travel will be undertaken, number of trips planned, who will be making the trip, and approximate dates. If mileage is to be paid, provide the number of miles and the cost per mile. If travel is by air, provide the estimated cost of airfare. If per diem/lodging is to be paid, indicate the number of days and amount of daily per diem as well as the number of nights and estimated cost of lodging. Include the cost of ground transportation when applicable. Out-of-State Travel—Provide a narrative justification describing the same information requested above Include CDC HRSA or In‐ State Travel: Actual Amount $ Rounded Amounts $ Out‐of‐State Travel: K. Insurance Detail the organization’s expenses for liability insurance, fidelity bonds, and other insurance. Actual Amount $ Rounded Amounts $ L. Specific Assistance To Individuals 2 Detail the the description, quantity and cost per item. Actual Amount $ Rounded Amounts $ M. Total Direct Costs Show total direct costs by listing totals of each category Actual Amount $ Rounded Amounts $ $ ‐ Rounded Total $ N. Indirect Costs To claim indirect costs, the applicant organization must have a current approved indirect cost rate agreement established with the cognizant Federal agency. A copy of the most recent Federal indirect cost rate agreement must be provided to the State. The rate is % and is computed on the following direct cost or Salary & Benefits base of $ . Personnel $ Fringe $ Travel $ Supplies $ Total x 0.00% $ ‐ Approved cost allocation plans must be sent to the State. This Budget Justification Form must be submitted for all new and continuation contract requests. All Expense Object Line-item Categories above must be rounded to the neartes $100 when completing the Grant Budget TOTAL OF BUDGET ACTUAL_____________________ ROUNDED_____________________.