| A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | AA | AB | AC | AD | AE | |
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3 | Example Only | ||||||||||||||||||||||||||||||
4 | Please download this budget as an Excel file to complete it. Upload the completed budget to the Application Google Form. | ||||||||||||||||||||||||||||||
5 | Google Form upload link: https://docs.google.com/forms/d/e/1FAIpQLScuHEvXCVxkBYVW-R8FAtTY6JWqamAGjK9h4keO_J_d3QAMqA/viewform | ||||||||||||||||||||||||||||||
6 | Details, explanations and definitions entered as comments in the cells. | ||||||||||||||||||||||||||||||
7 | Local Planning and Support OPHP Budget Template -12 Month Budget | ||||||||||||||||||||||||||||||
8 | Contractor Name | ABC Health Department | Program Contact Name, Title, Phone and Email | ||||||||||||||||||||||||||||
9 | Budget Period | July 1, 2024 - June 30, 2025 | Fiscal Contact Name, Title, Phone and Email | ||||||||||||||||||||||||||||
10 | Project Name | Local Planning and Support | |||||||||||||||||||||||||||||
11 | FY 25 Local Planning and Support | ||||||||||||||||||||||||||||||
12 | ABC Health Department | $567,335 | |||||||||||||||||||||||||||||
13 | |||||||||||||||||||||||||||||||
14 | |||||||||||||||||||||||||||||||
15 | |||||||||||||||||||||||||||||||
16 | Expenditure Categories | ||||||||||||||||||||||||||||||
17 | Personal Services -Salaried Employees | Enter salaried personnel (individuals do not have to be listed, rather groups or job titles are acceptable) to perform work for the Core Public Health Service/Capability. Include the total amount of the salaries including total fringe. Enter the actual or estimated FTE. In the Description of Work, include the roles. staff categories, and/or staff that relate to the core public health service or capability. | |||||||||||||||||||||||||||||
18 | Core Service or Capability (one line per Core Public Health Service/Capability as needed) | Description of Work | Estimated FTE through this funding | Total Amount Requested from CDPHE | AND/OR % of funding | Calculation Only for Percent to $ Amount Reference | |||||||||||||||||||||||||
19 | All | Director and Deputy Director are involved in all of these roles. | 1.25 | $92,855.00 | 5.00% | $28,367 | |||||||||||||||||||||||||
20 | Assessment and Planning | Community Health Workers | 2.00 | 1.00% | $5,673 | ||||||||||||||||||||||||||
21 | Communications | Communications team. This consists of 6 employes and this funding is used for approximately 25% of their time. This includes the communications director, 2 staff, and 1 intern. Plus 30% fringe. | 2.50 | $130,000.00 | $0 | ||||||||||||||||||||||||||
22 | Policy Development and Support | $0 | |||||||||||||||||||||||||||||
23 | Partnerships | 0.45% | $2,553 | ||||||||||||||||||||||||||||
24 | Organizational Competencies | Administrative support team for scheduling and fiscal support | $0 | ||||||||||||||||||||||||||||
25 | Emergency Preparedness and Response | $0 | |||||||||||||||||||||||||||||
26 | Health Equity and the Social Determinants of Health | $0 | |||||||||||||||||||||||||||||
27 | Communicable Disease Prevention, Investigation and Control | staff costs | 2.00 | 5.00% | $28,367 | ||||||||||||||||||||||||||
28 | Environmental Public Health | $0 | |||||||||||||||||||||||||||||
29 | Maternal, Child, Adolescent, and Family Health | $0 | |||||||||||||||||||||||||||||
30 | Chronic Disease, Injury Prevention, and Behavioral Health Promotion | 0.25% | $1,418 | ||||||||||||||||||||||||||||
31 | Access to and Linkage with Healthcare | BH staff time to link clients to care | 0.50% | $2,837 | |||||||||||||||||||||||||||
32 | All Foundational Capabilities | <--Note you can add a row if needed! There are two options that are not pre-populated. One is an option for "All Core Public Health Services" and one is an option for "All Foundational Capabilities"). This just provides more nuance to the "All" category. You may also select a different value in the existing dropdowns if there are some that you are not using. | $0 | ||||||||||||||||||||||||||||
33 | Personal Services - Hourly Employees | Enter hourly personnel to perform work for the for the Core Public Health Service/Capability. Include the total amount of the wages including total fringe. Enter the actual or estimated FTE. In the Description of Work, include the roles and/or staff that relate to the core public health service or capability. Individuals do not have to be listed, rather groups or job titles are acceptable. | |||||||||||||||||||||||||||||
34 | Core Service or Capability (one line per Core Public Health Service/Capability as needed) | Description of Work | Estimated FTE through this funding | Total Amount Requested from CDPHE | AND/OR % of funding | ||||||||||||||||||||||||||
35 | All | $0 | |||||||||||||||||||||||||||||
36 | Assessment and Planning | Intern program -2 interns and supervisor | 1.50 | 10.00% | $56,734 | ||||||||||||||||||||||||||
37 | Communications | $0 | |||||||||||||||||||||||||||||
38 | Policy Development and Support | $0 | |||||||||||||||||||||||||||||
39 | Partnerships | $0 | |||||||||||||||||||||||||||||
40 | Organizational Competencies | $0 | |||||||||||||||||||||||||||||
41 | Emergency Preparedness and Response | $0 | |||||||||||||||||||||||||||||
42 | Health Equity and the Social Determinants of Health | $0 | |||||||||||||||||||||||||||||
43 | Communicable Disease Prevention, Investigation and Control | Intern program -5 interns | 1.00 | 2.00% | $11,347 | ||||||||||||||||||||||||||
44 | Environmental Public Health | $0 | |||||||||||||||||||||||||||||
45 | Maternal, Child, Adolescent, and Family Health | $0 | |||||||||||||||||||||||||||||
46 | Chronic Disease, Injury Prevention, and Behavioral Health Promotion | $0 | |||||||||||||||||||||||||||||
47 | Access to and Linkage with Healthcare | $0 | |||||||||||||||||||||||||||||
48 | Total Personal Services (including fringe benefits) | $222,855.00 | 24.20% | $137,295 | |||||||||||||||||||||||||||
49 | Supplies & Operating Expenses | Include list of all allowable operating expenses. The justification should describe the rationale, necessity and reasonableness of the operation costs budgeted. If rent is claimed as direct cost, provide a narrative justification which describes the prescribed policy including the effective date of the policy. These can be aggregated by Core PH Services, Capability, All services & capabilities, all services, or all capabilities. | |||||||||||||||||||||||||||||
50 | Core Service or Capability (one line per Core Public Health Service/Capability as needed) | Description of Item(s) | Total Amount Requested from CDPHE | AND/OR % of funding | |||||||||||||||||||||||||||
51 | All | New computers based on replacement schedule. 10 computers at $1,200 each and 5% of our funding is dedicated to supplies; 9.5% of our budget to county costs | $12,000.00 | 9.50% | $53,897 | ||||||||||||||||||||||||||
52 | Assessment and Planning | $0 | |||||||||||||||||||||||||||||
53 | Communications | $0 | |||||||||||||||||||||||||||||
54 | Policy Development and Support | $0 | |||||||||||||||||||||||||||||
55 | Partnerships | $0 | |||||||||||||||||||||||||||||
56 | Organizational Competencies | $0 | |||||||||||||||||||||||||||||
57 | Emergency Preparedness and Response | $0 | |||||||||||||||||||||||||||||
58 | Health Equity and the Social Determinants of Health | $0 | |||||||||||||||||||||||||||||
59 | Communicable Disease Prevention, Investigation and Control | $0 | |||||||||||||||||||||||||||||
60 | Environmental Public Health | $0 | |||||||||||||||||||||||||||||
61 | Maternal, Child, Adolescent, and Family Health | $0 | |||||||||||||||||||||||||||||
62 | Chronic Disease, Injury Prevention, and Behavioral Health Promotion | $0 | |||||||||||||||||||||||||||||
63 | Access to and Linkage with Healthcare | $0 | |||||||||||||||||||||||||||||
64 | All Core Public Health Services | <--Note you can add a row if needed! There are two options that are not pre-populated. One is an option for "All Core Public Health Services" and one is an option for "All Foundational Capabilities"). This just provides more nuance to the "All" category. You may also select a different value in the existing dropdowns if there are some that you are not using. | $0 | ||||||||||||||||||||||||||||
65 | Total Supplies & Operating Expenses | $12,000.00 | 9.50% | $53,897 | |||||||||||||||||||||||||||
66 | Travel | Include all travel and indicate whether in-state or out-of-state. Include costs for attendance of any mandatory meetings. Include appropriate per diem, mileage or airfare rates or include link to current approved rates. Multiple trips should be aggregated by core public health service or capability if possible (i.e if the assessment and planning FTE annual attend a conference, leadership has annual plans to attend NACCHO (this would go in "All"), etc) | |||||||||||||||||||||||||||||
67 | Core Service or Capability (one line per Core Public Health Service/Capability as needed) | Description of Item | Total Amount Requested from CDPHE | AND/OR % of funding | |||||||||||||||||||||||||||
68 | All | NACCHO conference for 2 agency leadership | $2,500.00 | $0 | |||||||||||||||||||||||||||
69 | Assessment and Planning | Mileage to/from community events. Anticipated 8 events per year 50 miles per trip at .65 cents/mile | $260.00 | $0 | |||||||||||||||||||||||||||
70 | Communications | $0 | |||||||||||||||||||||||||||||
71 | Policy Development and Support | $0 | |||||||||||||||||||||||||||||
72 | Partnerships | $0 | |||||||||||||||||||||||||||||
73 | Organizational Competencies | $0 | |||||||||||||||||||||||||||||
74 | Emergency Preparedness and Response | $0 | |||||||||||||||||||||||||||||
75 | Health Equity and the Social Determinants of Health | $0 | |||||||||||||||||||||||||||||
76 | Communicable Disease Prevention, Investigation and Control | Mileage to/from for investigations. Anticipated 50 trips per year 50 miles per trip at .65 cents/mile and 2 staff | $3,250.00 | $0 | |||||||||||||||||||||||||||
77 | Environmental Public Health | $0 | |||||||||||||||||||||||||||||
78 | Maternal, Child, Adolescent, and Family Health | $0 | |||||||||||||||||||||||||||||
79 | Chronic Disease, Injury Prevention, and Behavioral Health Promotion | $0 | |||||||||||||||||||||||||||||
80 | Access to and Linkage with Healthcare | $0 | |||||||||||||||||||||||||||||
81 | Total Travel | $6,010.00 | 0.00% | $0 | |||||||||||||||||||||||||||
82 | Contractual | Include all subcontracts planned to complete the proposed work. This includes, but not limited to, consulting and personal services subcontracts. Restrictions outline in the budget guidelines, including cost reimbursement terms, shall also apply to subcontracts. No subcontractor may be pre-paid for services. Describe how the subcontractor will be selected, the work to be performed, how the costs were calculated and expected deliverables. | |||||||||||||||||||||||||||||
83 | Core Service or Capability (one line per Core Public Health Service/Capability as needed) | Subcontractor Name(s) | Description of Item | Total Amount Requested from CDPHE | OR % of funding | ||||||||||||||||||||||||||
84 | All | $0 | |||||||||||||||||||||||||||||
85 | Assessment and Planning | Great Assessment Company | Assistance with CHA and CHIP for data, writing, and community engagement | 1.00% | $5,673 | ||||||||||||||||||||||||||
86 | Communications | $0 | |||||||||||||||||||||||||||||
87 | Policy Development and Support | $0 | |||||||||||||||||||||||||||||
88 | Partnerships | $0 | |||||||||||||||||||||||||||||
89 | Organizational Competencies | Strategic Planning r Us | Facilitation of programs for strategic planning and creation of 2025 strategic plan. | $6,000.00 | $0 | ||||||||||||||||||||||||||
90 | Emergency Preparedness and Response | $0 | |||||||||||||||||||||||||||||
91 | Health Equity and the Social Determinants of Health | $0 | |||||||||||||||||||||||||||||
92 | Communicable Disease Prevention, Investigation and Control | $0 | |||||||||||||||||||||||||||||
93 | Environmental Public Health | $0 | |||||||||||||||||||||||||||||
94 | Maternal, Child, Adolescent, and Family Health | Neighboring LPHA | Shared community health worker | $17,893.00 | $0 | ||||||||||||||||||||||||||
95 | Chronic Disease, Injury Prevention, and Behavioral Health Promotion | $0 | |||||||||||||||||||||||||||||
96 | Access to and Linkage with Healthcare | $0 | |||||||||||||||||||||||||||||
97 | Total Contractual | $23,893.00 | 1.00% | $5,673 | |||||||||||||||||||||||||||
98 | Direct Totals ($ and %) | $264,758.00 | 34.70% | $196,865 | |||||||||||||||||||||||||||
99 | Direct Total Before Indirect | $461,623.25 | |||||||||||||||||||||||||||||
100 | Indirect | No budget justification is required for the indirect rates. Check with your LPHA's financial officer for negotiated indirect rate. |