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SAMPLE BUDGET
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BUDGET WITH JUSTIFICATION FORM
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Contract Routing #
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Contractor NameABC Health CenterProgram Contact Name, Title, Phone and EmailJane Smith, Executive Director, 303-888-5555, jane.smith@abchealthctr.org
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Budget Period5/1/2022 - 6/30/2024Fiscal Contact Name, Title, Phone and EmailJohn Williams, Finance Director, 303-888-5556, john.williams@abchealthctr.org
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Project NameXYZ Project
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Expenditure Categories
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Personal Services
Salaried Employees
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Position TitleDescription of Work Budget Item Supports SOW (Yes/No)Gross or Annual SalaryFringePercent of Time on ProjectTotal Amount Requested from CDPHE
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Principal InvestigatorThe Principal Investigator will provide project oversight to include strategic planning and visioning, project management, ensuring deliverables are met, budget oversight and oversight of future implementation strategies of the XYZ project.Yes$85,000.00 $ 21,250 40%$42,500
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Project ManagerThe project manager will provide overall coordination and oversight of the XYZ program. They will assist with staffing and training and will ensure continuous communication between project stakeholders. Yes$65,000.00 $ 16,250 100%$81,250
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Finance ManagerThis position provides day to day management of funds and contracts by: Preparing budgets and requests for reimbursement, coordinating and approving budget adjustments and revisions as necessary, and by communicating billing concerns with contactors/vendors in order to bring any variances into compliance. Yes$36,000.00 $ 7,920 20%$8,784
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Personal Services
Hourly Employees
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Position TitleDescription of Work Budget Item Supports SOW (Yes/No)Hourly Wage Hourly FringeTotal # of Hours on ProjectTotal Amount Requested from CDPHE
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Student WorkerThe project anticipates hiring a graduate student worker (PhD candidate) at a rate of $22.50 to assist with project operations and evaluation activities as assigned for a period of 12 months and approximately 1000 hours.Yes$22.50 $5.63 1000$28,130
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Administrative AssistantAdministrative project support (copies, answering phone calls, mailing, scheduling trainings, etc) ($15 x 20 hours/week for 40 weeks)Yes$15.00 $3.75 800$15,000
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Total Personal Services
(including fringe benefits)		$175,664
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Supplies & Operating Expenses
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ItemDescription of Item Budget Item Supports SOW (Yes/No)RateQuantityTotal Amount Requested from CDPHE
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Telephone lines/long distance and Internet servicesThe project will need a budget for telephone service, long distance charges, and internet access. Internet/server access services and telephone services cost averages $206.19 per person x 5 staff.Yes $ 206.19 5$1,031
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Public education visual aidsVisual displays will be used to provide education to community members by illustrating the health effects of cardiovascular disease. We anticipate purchasing 10 different displays, each with a different health focus. Approximate unit cost per visual display is $50.Yes $ 50.00 10$500
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PostageMailing of postcards to seniors (500 in database, $.25/postcard) to inform them of health prevention workshops Yes $ 0.25 500$125
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Copying/PrintingPrinting of postcards ($1.50 for color x 500)Yes $ 1.50 500$750
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Office suppliesCopy paper for the project (5 reams @ $22/ream)Yes $ 22.00 5$110
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Total Supplies
& Operating Expenses		$2,516
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Travel
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ItemDescription of ItemBudget Item Supports SOW (Yes/No)RateQuantityTotal Amount Requested from CDPHE
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Mileage Principal investigator will attend two mandatory trainings in Denver. Round trip is approximately 300 miles x 2 trips = 600 miles. Reimbursement at $.56/mile.Yes $ 0.56 600$336
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MealsPrincipal investigator will attend two mandatory trainings in Denver. Meal estimate is based on current government per diem rate for Denver: Travel day per diem reimbursement at $49.50 and full day reimbursement at $66.00. Meals are not being provided during the trainings. (We anticipate two days of travel per diem and two days of full per diem for each training.
(2 x $49.50) + (2 x $66) = $99 + $132 = $231/per training, per person.		Yes $ 231.00 2$462
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LodgingOvernight stay for PI to attend two mandatory meetings in Denver. Estimate is based on current government per diem rate for Denver. $149/night x 3 nights x 2 trainingsYes $ 149.00 6$894
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ParkingParking downtown Denver for two mandatory meetings - $10/day x 6 days.Yes $ 10.00 6$60
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Total Travel$1,752
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Contractual
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Subcontractor NameDescription of ItemBudget Item Supports SOW (Yes/No)RateQuantityTotal Amount Requested from CDPHE
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TBDA contractor will be hired to determine community perceptions and needs related to obesity and chronic disease using participatory research strategies. The contractor will develop and implement a survey, conduct focus groups (minimum of 3), analyze data, and report on the results. This research is critical for achieving the proposed objectives and will guide remaining work in years two and three. Hiring a contractor is necessary (program staff do not possess the specialized research skills necessary to complete this phase of the work plan) and is more cost effective than hiring a full-time employee. A Request for Proposal will be used to select the contractor. Yes $ 7,500.00 1$7,500
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Total Contractual$7,500
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SUB-TOTAL BEFORE INDIRECT$187,432
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Indirect
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ItemDescription of Item Total Amount Requested from CDPHE
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Federally-negotiated indirect cost rateFederally negotiated indirect cost rate of 33.99% of TDC$63,708
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CDPHE-approved indirect cost rate
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De minimis indirect cost rate
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Total Indirect$63,708
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TOTAL $251,140
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SAMPLE BUDGET
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