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PROGRAM BUDGET SUMMARY
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View at 100% or Larger MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
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Use WHOLE DOLLARS Only
ATTACHMENT B.1
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PROGRAMDATE PREPARED Page Of
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GRANTEE NAME BUDGET PERIOD
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 From:To:
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MAILING ADDRESS (Number and Street) BUDGET AGREEMENTAMENDMENT #
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CITYSTATEZIP CODEFEDERAL ID NUMBER
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TOTAL BUDGET
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EXPENDITURE CATEGORY(Use Whole Dollars)
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 1.SALARY & WAGES$0
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2.FRINGE BENEFITS$0
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3.TRAVEL$0
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4.SUPPLIES & MATERIALS$0
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5.CONTRACTUAL (Subcontracts/Subrecipients)$0
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6.EQUIPMENT$0
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7.OTHER EXPENSES
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$0
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8.TOTAL DIRECT EXPENDITURES (Sum of Lines 1-7)$0$0$0$0
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 9.INDIRECT COSTS: Rate #1 %$0
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INDIRECT COSTS: Rate #2 %$0
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10. TOTAL EXPENDITURES$0$0$0$0
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 SOURCE OF FUNDS:
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11.FEES & COLLECTIONS
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12.STATE AGREEMENT
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13.LOCAL
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14.FEDERAL
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15.OTHER(S)
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16.TOTAL FUNDING$0$0$0$0
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 AUTHORITY: P.A. 368 of 1978 The Department of Health and Human Services is an equal opportunity
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COMPLETION: Is Voluntary, but is required as a condition of funding. employer, services and programs provider.
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 DCH-0385(E) (Rev. 08/15) (Excel) Previous Edition Obsolete.
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