SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 1 of 19 Release date: 01/2022

Feb 4, 2022

Applicant/Recipient Application/Award Number

Substance Abuse and Mental Health Organization Inc. TI12345-01

Project Title: Treatment of Substance Abuse and Mental Illnesses in our Community

Start Date End Date Budget Year

Budget Period: 09/30/2022 09/29/2023 1

For Multi-Year Funded (MYF) awards only 

Check the box to select the Incremental Period 

COST SHARING AND MATCHING

Matching Required: YES NO

Match Ratio stated in the NOFO:

The matching funds must not be less than $ 15 for each $ 85 of federal funds provided.

A. Personnel

Line 

Item 

#

Position Name

Key 

Position 

per the 

NOFO

Check 

if 

Hourly 

Rate

Calculation

Hourly 

Rate Hours # of Staff

Annual 

Salary

% Level 

of Effort 

(LOE)

Personnel 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Project Director Alice Doe 1 $64,890 17.00% $11,031 $11,031

2 Program Coodinator

Vacant, to be hired 

within 60 days of 

anticipated award date

1 $46,276 100.00% $46,276 $46,276

3 Prevention Specialist Sarah Smith 1 $26,000 25.00% $6,500 $0 $6,500

4 Peer Recovery Support 

Specialist Ron Jones 1 $23,000 40.00% $9,200 $0 $9,200

5 Outreach Assistant Susan Johnson $13.38 100 1 4.81% $1,338 $0 $1,338

TOTAL $74,345 $57,307 $17,038

Line 

Item 

# Personnel Narrative:

1

Project Director Alice Doe Key Personnel Salary $64,890 # of Staff 1 LOE 17.00% Personnel Cost $11,031

The Project Director will provide daily oversight of the project. This position is responsible for overseeing the implementation 

of the project activities, internal and external coordination, developing materials, and conducting meetings.

2

Program Coodinator Vacant, to be hired 

within 60 days of Salary $46,276 # of Staff 1 LOE 100.00% Personnel Cost $46,276

The Program Coordinator will coordinate project services and activities, including training, communication, and information 

dissemination.

3

Prevention Specialist Sarah Smith Salary $26,000 # of Staff 1 LOE 25.00% Personnel Cost $6,500

The Prevention Specialist will be responsible for conducting educational/training programs. Our organization will fund all of 

the Prevention Specialist's personnel cost.

4

Peer Recovery Support 

Specialist Ron Jones Salary $23,000 # of Staff 1 LOE 40.00% Personnel Cost $9,200

The Peer Recovery Support Staff will be responsible for peer recruitment, coordination, and support. Our organization will 

fund all of the Peer Recovery Support Staff's personnel cost.

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 2 of 19 Release date: 01/2022

Feb 4, 2022

Line 

Item 

# Personnel Narrative:

5

Outreach Assistant Susan Johnson Hourly Rate $13.38 # of Staff 1 Hours 100 Personnel Cost $1,338

The Outreach Assistant will ensure clients are contacted, referred to the services provider for treatment, and follow up done. 

Our organization will fund all of the Outreach Assistant's personnel cost.

B. Fringe Benefits

 Our organization's fringe benefits consist of the components shown below:

Fringe Component Rate (%)

Retirement 7.50%

FICA 7.65%

Health Insurance 10.00%

Unemployment Insurance 1.50%

Total Fringe Rate 26.65%

 Fringe Benefits Cost

Line 

Item 

#

Position Name

Calculation

Personnel 

Cost

Total 

Fringe 

Rate (%)

Fixed / Lump 

Sum Fringe 

(if any) 

Fringe 

Benefits 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Project Director Alice Doe $11,031 26.65% $2,940 $2,940

2 Program Coodinator

Vacant, to be hired 

within 60 days of 

anticipated award date

$46,276 26.65% $12,333 $12,333

3 Prevention Specialist Sarah Smith $6,500 26.65% $1,732 $0 $1,732

4 Peer Recovery Support 

Specialist Ron Jones $9,200 26.65% $2,452 $0 $2,452

5 Outreach Assistant Susan Johnson $1,338 26.65% $357 $0 $357

TOTAL $19,814 $15,273 $4,541

Fringe Benefits Narrative: 

There are no differences in the Total Fringe Rate for the staff proposed. No Fixed/Lump Sum Fringe is requested. Our 

organization will cover all of the fringe benefit costs for the Prevention Specialist, Peer Recovery Support Staff, and Outreach 

Assistant.

C. Travel

Trip 

# Purpose Destination

Calculation

Item

Cost / 

Rate per 

Item

Basis

Quantity 

per 

Person

Number 

of 

Persons

Travel 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1

Substance Abuse 

Treatment 

National 

Conference

Chicago, IL to 

Washington, DC

Hotel/Lodging $258.00 Night 2.00 2 $1,032

Per Diems (M&IE only) $79.00 Day 2.00 2 $316

Airfare $200.00 Round Trip 1.00 2 $400

$1,748

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 3 of 19 Release date: 01/2022

Feb 4, 2022

Trip 

# Purpose Destination

Calculation

Item

Cost / 

Rate per 

Item

Basis

Quantity 

per 

Person

Number 

of 

Persons

Travel 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

2

Local Travel various Local Travel (POV Mileage) $0.55 Mile 1,050.00 2 $1,155

$1,155

3

Regional Training 

Workshop on 

Evidence-based 

Approaches to 

Treatment 

Indianapolis, IN Hotel/Lodging $127.00 Night 2.00 2 $508

Per Diems (M&IE only) $69.00 Day 2.00 2 $276

Airfare $160.00 Round Trip 1.00 2 $320

$0 $1,104

TOTAL $4,007 $2,903 $1,104

Trip 

# Travel Narrative:

1

Substance Abuse Treatment 

National Chicago, IL to Washington, DC Travel Cost $1,748

Two staff (Project Director and Program Coordinator) will attend the annual National Conference on Substance Abuse 

Treatment scheduled to be held in Washington, D.C., from June 14-15, 2023.

2

Local Travel various Travel Cost $1,155

Local travel is needed for staff to attend local meetings and training events, and conduct project activities in the geographic 

catchment area. Privately-owned vehicle (POV) mileage reimbursement rate is based on the organization’s policies.

3

Regional Training Workshop on Evidence-based Approaches to 

Treatment Indianapolis, IN Travel Cost $1,104

Our organization will provide the funding for two project staff to attend the annual Regional Training Workshop on Evidencebased Treatment Approaches scheduled for August 2023 (the closest location is Indianapolis, IN).

D. Equipment

Line 

Item 

#

Item

Check 

if Item 

is a 

Vehicle

Calculation

Quantity

Purchase or 

Rental/Lease 

Cost

Percent 

Charged to the 

Project

Equipment 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 N/A $0 $0

TOTAL $0 $0

Line 

Item 

# Equipment Narrative: 

1

N/A Quantity Purchase or Rental/Lease Cost % Charged to the Project Equipment Cost $0

N/A

E. Supplies

Line 

Item 

#

Item

Calculation

Unit Cost Basis Quantity Duration Supplies Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Supplies for various project activities $50.00 per month 12.00 $600 $600

2 Laptop $900.00 per laptop 1.00 $900 $900

3 Printer $300.00 per printer 1.00 $300 $300

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 4 of 19 Release date: 01/2022

Feb 4, 2022

Line 

Item 

#

Item

Calculation

Unit Cost Basis Quantity Duration Supplies Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

4 Printing supplies $37.00 per month 12.00 $444 $444

5 Copies $0.10 per copy 8,000.00 $800 $800

6 Furniture (bookcase) $75.00 per item 1.00 $75 $0 $75

7 Furniture (tables) $100.00 per item 2.00 $200 $0 $200

8 Furniture (chairs) $25.00 per item 10.00 $250 $0 $250

9 Computer $500.00 per computer 1.00 $500 $0 $500

TOTAL $4,069 $3,044 $1,025

Line 

Item 

# Supplies Narrative:

1

Supplies for various project activities Unit Cost $50.00 Basis per month Quantity Duration 12.00 Supplies Cost $600

Supplies including office consumables such as notebooks, folders, binders, pens, highlighters etc. will be used by project 

personnel for the sole direct benefit of the project.

2

Laptop Unit Cost $900.00 Basis per laptop Quantity 1.00 Duration Supplies Cost $900

The Project Director will use the laptop for presentations and other project related communications, documents, and 

activities. This is a one-time expense. Cost was based on retail value at the time the application was written.

3

Printer Unit Cost $300.00 Basis per printer Quantity 1.00 Duration Supplies Cost $300

The printer will be used to print presentations and other documents for the project. This is a one-time expense. Cost was 

based on retail value at the time the application was written.

4

Printing supplies Unit Cost $37.00 Basis per month Quantity Duration 12.00 Supplies Cost $444

Supplies (ink cartridges and paper) are needed for the printer.

5

Copies Unit Cost $0.10 Basis per copy Quantity 8,000.00 Duration Supplies Cost $800

Copies of handouts are needed for various project activities including presentations, workshops, and training events.

6

Furniture (bookcase) Unit Cost $75.00 Basis per item Quantity 1.00 Duration Supplies Cost $75

The local television station will donate furniture (1 bookcase @ $75; 2 tables @100 each; and 10 chairs @$25 each) for 

project activities, and a computer (@ $500) for the Program Coordinator. 

 

Unit costs are the current fair market value for the items. These items are a one-time expense. We will use these items for 

the project and will claim them as our non-federal match contribution only ONCE during the project period.

7

Furniture (tables) Unit Cost $100.00 Basis per item Quantity 2.00 Duration Supplies Cost $200

See the narrative for line item# 6 above.

8

Furniture (chairs) Unit Cost $25.00 Basis per item Quantity 10.00 Duration Supplies Cost $250

See the narrative for line item# 6 above.

9

Computer Unit Cost $500.00 Basis per computer Quantity 1.00 Duration Supplies Cost $500

See the narrative for line item# 6 above.

F. Contractual

Summary of Contractual Costs

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 5 of 19 Release date: 01/2022

Feb 4, 2022

Agreement # Name of Organization or Consultant Type of Agreement Contractual 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Certified Trainers, Inc. Contract $3,000 $3,000 $0

2 Client Treatment Services, Inc. Subaward $25,000 $25,000 $0

3 John Smith (Case Manager) Consultant $57,550 $57,550 $0

4 Jane Johnson (Evaluator) Consultant $9,772 $9,772 $0

5 TBD (Community Education and Engagement Specialist) Consultant $5,300 $5,300 $0

6 Jane Doe (Outreach Facilitator) Consultant $6,750 $0 $6,750

7 County School District Consultant $7,500 $0 $7,500

TOTAL $114,872 $100,622 $14,250

Contractual Details for Certified Trainers, Inc.

Agreement # Services and Deliverables Provided

1

Certified trainers will provide three (3) organization staff with recovery and wellness training so they will be equipped with 

current approaches and evidence-based practices on mental health recovery and wellness. The contract with Certified 

Trainers Inc. will be procured as a micro-purchase with a period of performance identical to the budget period 9/30/2022 to 

09/29/2023. 

 

The Program Coordinator will oversee the contract with Certified Trainers Inc. The Program Coordinator will review the daily 

training curriculum, schedule, and materials to ensure they are in line with the statement of work and will ensure staff 

feedback is provided to assess the effectiveness of the training provided.

Personnel

Fringe Benefits

Supplies

Other

Travel

Equipment

Indirect Charges

 Contractual Other Costs for Certified Trainers, Inc.

Line 

Item 

#

Item

Check 

for 

Minor 

A&R

Calculation

Unit Cost / 

Rate Basis Quantity Duration Contractual Other Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Five-Day Training Session for 3 

organization staff $750.00 per individual 4.00 $3,000 $3,000

TOTAL $3,000 $3,000

Line 

Item 

#

Contractual Other Narrative:

1

Five-Day Training Session for 3 organization staff Unit Cost/Rate $750.00 Basis per individual Quantity 4.00 Duration Other Cost $3,000

Certified trainers will train staff on the latest recovery and wellness approaches and evidence-based practices so they can 

effectively serve the population of focus and implement the project activities.

 Contractual Total Direct Charges for Certified Trainers, Inc.

TOTAL DIRECT 

CHARGES FOR THIS 

AGREEMENT

TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$3,000

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 6 of 19 Release date: 01/2022

Feb 4, 2022

 Contractual Total Cost for Certified Trainers, Inc.

TOTAL COST TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$3,000 $3,000

Contractual Details for Client Treatment Services, Inc.

Agreement # Services and Deliverables Provided

2

We intend to issue a subaward to Client Treatment Services, Inc. for comprehensive client-centered treatment services to 

200 clients each year. We plan to procure the services via a small purchase with a period of performance identical to the 

budget period 9/30/2022 to 09/29/2023. We obtained competitive prices from an adequate number of qualified sources to 

ensure competition. Refer to the attached summary of services and deliverables for Client Treatment Services, Inc. 

 

The Program Coordinator is primarily responsible for overseeing the contract with Client Treatment Services, Inc. This 

individual will be supported by the Case Manager. They will conduct weekly site visits to monitor and review effectiveness 

of the services provided, identify problems/issues, and implement necessary changes. They will review reports, records, 

and data to ensure treatment services are provided to the population of focus, the services or practices that are 

implemented have a demonstrated evidence base, and are effective per the agreed upon statement of work.

Personnel

Fringe Benefits

Supplies

Other

Travel

Equipment

Indirect Charges

 Contractual Other Costs for Client Treatment Services, Inc.

Line 

Item 

#

Item

Check 

for 

Minor 

A&R

Calculation

Unit Cost / 

Rate Basis Quantity Duration Contractual Other Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Client Treatment Services $125.00 /client per year 200.00 $25,000 $25,000

TOTAL $25,000 $25,000

Line 

Item 

#

Contractual Other Narrative:

1

Client Treatment Services Unit Cost/Rate $125.00 Basis /client per 

year Quantity 200.00 Duration Other Cost $25,000

The unit cost/rate of $125/client per year for client treatment services is based on the organization's history of expenses.

 Contractual Total Direct Charges for Client Treatment Services, Inc.

TOTAL DIRECT 

CHARGES FOR THIS 

AGREEMENT

TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$25,000

 Contractual Total Cost for Client Treatment Services, Inc.

TOTAL COST TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$25,000 $25,000

Contractual Details for John Smith (Case Manager)

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 7 of 19 Release date: 01/2022

Feb 4, 2022

Agreement # Services and Deliverables Provided

3

The Case Manager, John Smith, is vital to coordinating and organizing comprehensive client treatment services and 

planning related to the program and leading to successful outcomes. He will be responsible for working closely with Client 

Treatment Services, Inc. to coordinate and organize client treatment services and planning. 

 

The Case Manager is a consultant whose services will be obtained via small purchase procurement with a period of 

performance identical to the budget period 9/30/2022 to 09/29/2023. Refer to the attached summary of services and 

deliverables for the Case Manager. 

 

The Program Coordinator will oversee the agreement with the Case Manager, John Smith. The Program Coordinator will 

review the Case Manager's weekly reports and feedback from Client Treatment Services, Inc. to ensure he is providing the 

required support and services per the agreement. The Program Coordinator will meet with the Case Manager weekly to 

monitor and review progress, identify problems/issues, and implement corrective actions.

Personnel

Fringe Benefits

Supplies

Other

Travel

Equipment

Indirect Charges

 Contractual Personnel Costs for John Smith (Case Manager)

Line 

Item 

#

Position Name

Key 

Position 

per the 

NOFO

Check 

if 

Annual 

Salary

Calculation

Hourly 

Rate Hours # of Persons

Annual 

Salary

% Level 

of Effort 

(LOE)

Contractual 

Personnel 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Case Manager John Smith 1 $53,750 100.00% $53,750 $53,750

TOTAL $53,750 $53,750

Line 

Item 

#

Contractual Personnel Narrative:

1

Case Manager John Smith Salary $53,750 # of Persons 1 LOE 100.00% Personnel Cost $53,750

The Case Manager is vital to organizing and coordinating client treatment and related treatment planning services 

necessary for the success of the program

 Contractual Travel Costs for John Smith (Case Manager)

Trip 

# Purpose Destination

Calculation

Item

Cost / 

Rate per 

Item

Basis

Quantity 

per 

Person

Number 

of 

Persons

Contract 

Travel Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1

Substance Abuse 

Treatment 

National 

Conference

Chicago, IL to 

Washington, DC

Hotel/Lodging $258.00 Night 2.00 1 $516

Per Diems (M&IE only) $79.00 Day 2.00 1 $158

Airfare $200.00 Round Trip 1.00 1 $200

$874

2

Local Travel various Local Travel (POV Mileage) $0.585 Mile 2,492.00 1 $1,458

$1,458

TOTAL $2,332 $2,332

Trip 

# Contractual Travel Narrative:

Substance Abuse Treatment 

National Chicago, IL to Washington, DC Travel Cost $874

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 8 of 19 Release date: 01/2022

Feb 4, 2022

Trip 

# Contractual Travel Narrative:

1 The Case Manager is required to attend the National Conference on Substance Abuse Treatment scheduled to be 

held in Washington, D.C., from June 14-15, 2023.

2

Local Travel various Travel Cost $1,458

Travel will be required to coordinate with the Client Services Treatment provider and follow up with clients throughout the 

geographic catchment area. Local travel rate is based on GSA's privately-owned vehicle (POV) mileage reimbursement rate 

effective January 1, 2022.

 Contractual Supplies Costs for John Smith (Case Manager)

Line 

Item 

#

Item

Calculation

Unit Cost Basis Quantity Duration Contractual 

Supplies Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Project supplies $47.75 per month 12.00 $573 $573

TOTAL $573 $573

Line 

Item 

#

Contractual Supplies Narrative: 

1

Project supplies Unit Cost $47.75 Basis per month Quantity Duration 12.00 Supplies Cost $573

The Case Manager will need various supplies to coordinate and organize client treatment services.

 Contractual Other Costs for John Smith (Case Manager)

Line 

Item 

#

Item

Check 

for 

Minor 

A&R

Calculation

Unit Cost / 

Rate Basis Quantity Duration Contractual Other Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Training Course $175.00 per course 1.00 $175 $175

2 Cell phone service $60.00 per month 12.00 $720 $720

TOTAL $895 $895

Line 

Item 

#

Contractual Other Narrative:

1

Training Course Unit Cost/Rate $175.00 Basis per course Quantity 1.00 Duration Other Cost $175

The Case Manager is required to attend one training session annually for treatment providers.

2

Cell phone service Unit Cost/Rate $60.00 Basis per month Quantity Duration 12.00 Other Cost $720

Cell phone service is needed for communication and collaboration with the treatment service provider and clients.

 Contractual Total Direct Charges for John Smith (Case Manager)

TOTAL DIRECT 

CHARGES FOR THIS 

AGREEMENT

TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$57,550

 Contractual Total Cost for John Smith (Case Manager)

TOTAL COST TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$57,550 $57,550

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 9 of 19 Release date: 01/2022

Feb 4, 2022

Contractual Details for Jane Johnson (Evaluator)

Agreement # Services and Deliverables Provided

4

The Evaluator, Jane Johnson, will be responsible for all data collection and reporting required under the NOFO. The 

Evaluator is an experienced individual (Ph.D. level) with expertise in substance abuse, research and evaluation, is 

knowledgeable about the population of focus, and will be responsible for all data collection and reporting as required by the 

NOFO. 

 

The Evaluator is a consultant whose services will be obtained via micro-purchase procurement with a period of 

performance identical to the budget period 9/30/2022 to 09/29/2023. Refer to the attached summary of services and 

deliverables for the Evaluator. 

 

The Project Director will oversee the agreement with the Evaluator. The Project Director will review the Evaluator's monthly 

reports to ensure she is providing the required support and services per the agreement. The Project Director will meet with 

the Evaluator bi-weekly to monitor and review progress, identify problems/issues, and implement corrective actions.

Personnel

Fringe Benefits

Supplies

Other

Travel

Equipment

Indirect Charges

 Contractual Personnel Costs for Jane Johnson (Evaluator)

Line 

Item 

#

Position Name

Key 

Position 

per the 

NOFO

Check 

if 

Annual 

Salary

Calculation

Hourly 

Rate Hours # of Persons

Annual 

Salary

% Level 

of Effort 

(LOE)

Contractual 

Personnel 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Evaluator Jane Smith $40.00 200 1 9.62% $8,000 $8,000

TOTAL $8,000 $8,000

Line 

Item 

#

Contractual Personnel Narrative:

1

Evaluator Jane Smith Key Personnel Hourly Rate $40 # of Persons 1 Hours 200 Personnel Cost $8,000

The Evaluator is needed to implement data collection and reporting activities required by the NOFO.

 Contractual Travel Costs for Jane Johnson (Evaluator)

Trip 

# Purpose Destination

Calculation

Item

Cost / 

Rate per 

Item

Basis

Quantity 

per 

Person

Number 

of 

Persons

Contract 

Travel Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1

Substance Abuse 

Treatment 

National 

Conference

Chicago, IL to 

Washington, DC

Hotel/Lodging $258.00 Night 2.00 1 $516

Per Diems (M&IE only) $79.00 Day 2.00 1 $158

Airfare $200.00 Round Trip 1.00 1 $200

$874

2

Local Travel various Local Travel (POV Mileage) $0.585 Mile 1,535.00 1 $898

$898

TOTAL $1,772 $1,772

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 10 of 19 Release date: 01/2022

Feb 4, 2022

Trip 

# Contractual Travel Narrative:

1

Substance Abuse Treatment 

National Conference Chicago, IL to Washington, DC Travel Cost $874

The Evaluator is required to attend the National Conference on Substance Abuse Treatment cheduled to be held in 

Washington, D.C., from June 14-15, 2023.

2

Local Travel various Travel Cost $898

Local travel is needed for data collection activities in the geographic catchment area. Local travel rate is based on GSA's 

privately-owned vehicle (POV) mileage reimbursement rate effective January 1, 2022.

 Contractual Total Direct Charges for Jane Johnson (Evaluator)

TOTAL DIRECT 

CHARGES FOR THIS 

AGREEMENT

TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$9,772

 Contractual Total Cost for Jane Johnson (Evaluator)

TOTAL COST TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$9,772 $9,772

Contractual Details for TBD (Community Education and Engagement Specialist)

Agreement # Services and Deliverables Provided

5

The Community Outreach and Engagement Specialist is key to our meeting the goal of enrolling 200 clients into the 

program each year. This individual will develop a plan for community education and outreach efforts to engage clients in the 

community about activities and services; and provide presentations at community meetings and events to stakeholders, 

community civic organizations, local and other agencies, family groups, schools etc. 

 

The Community Outreach and Engagement Specialist will be a consultant whose services will be obtained via micropurchase procurement with a period of performance to end 09/29/2023. Refer to the attached summary of services and 

deliverables for the Community Outreach and Engagement Specialist. 

 

The Program Coordinator will oversee the agreement with the Community Outreach and Engagement Specialist. The 

Program Coordinator will review the Specialist's monthly reports to ensure the required services are provided and the 

performance goals are met per the agreement. The Program Coordinator will meet with the Specialist bi-weekly to monitor 

and review progress, identify problems/issues, and implement corrective actions.

Personnel

Fringe Benefits

Supplies

Other

Travel

Equipment

Indirect Charges

 Contractual Personnel Costs for TBD (Community Education and Engagement Specialist)

Line 

Item 

#

Position Name

Key 

Position 

per the 

NOFO

Check 

if 

Annual 

Salary

Calculation

Hourly 

Rate Hours # of Persons

Annual 

Salary

% Level 

of Effort 

(LOE)

Contractual 

Personnel 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1

Community Outreach 

and Engagement 

Specialist

TBD $26.50 200 1 9.62% $5,300 $5,300

TOTAL $5,300 $5,300

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 11 of 19 Release date: 01/2022

Feb 4, 2022

Line 

Item 

#

Contractual Personnel Narrative:

1

Community Outreach and 

Engagement Specialist TBD Hourly Rate $26.5 # of Persons 1 Hours 200 Personnel Cost $5,300

The Specialist is needed to develop and implement a plan for community education and outreach efforts to 

engage clients and help us achieve the annual client enrollment goal for the project.

 Contractual Total Direct Charges for TBD (Community Education and Engagement Specialist)

TOTAL DIRECT 

CHARGES FOR THIS 

AGREEMENT

TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$5,300

 Contractual Total Cost for TBD (Community Education and Engagement Specialist)

TOTAL COST TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$5,300 $5,300

Contractual Details for Jane Doe (Outreach Facilitator)

Agreement # Services and Deliverables Provided

6

The Outreach Facilitator, Jane Doe, will volunteer her services to facilitate the youth prevention and outreach sessions 

outlined in the strategic plan. She will work closely with the Case Manager to coordinate and organize the outreach 

sessions. 

 

The Program Coordinator will coordinate the volunteer support provided by the Outreach Facilitator. The Program 

Coordinator will meet with the Outreach Facilitator bi-weekly to review progress and identify and resolve issues.

Personnel

Fringe Benefits

Supplies

Other

Travel

Equipment

Indirect Charges

 Contractual Personnel Costs for Jane Doe (Outreach Facilitator)

Line 

Item 

#

Position Name

Key 

Position 

per the 

NOFO

Check 

if 

Annual 

Salary

Calculation

Hourly 

Rate Hours # of Persons

Annual 

Salary

% Level 

of Effort 

(LOE)

Contractual 

Personnel 

Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Outreach Facilitator 

(Consultant) Jane Doe $25.00 240 1 11.54% $6,000 $0 $6,000

TOTAL $6,000 $0 $6,000

Line 

Item 

#

Contractual Personnel Narrative:

1

Outreach Facilitator 

(Consultant) Jane Doe Hourly Rate $25 # of Persons 1 Hours 240 Personnel Cost $6,000

The consultant, Jane Doe, will volunteer her time to provide outreach facilitation services (20 hours per month). The hourly 

rate is based on the average salary for an outreach facilitator in the geographic catchment area.

 Contractual Travel Costs for Jane Doe (Outreach Facilitator)

Trip 

# Purpose Destination

Calculation

Item

Cost / 

Rate per 

Item

Basis

Quantity 

per 

Person

Number 

of 

Persons

Contract 

Travel Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 12 of 19 Release date: 01/2022

Feb 4, 2022

Trip 

# Purpose Destination

Calculation

Item

Cost / 

Rate per 

Item

Basis

Quantity 

per 

Person

Number 

of 

Persons

Contract 

Travel Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1

Local Travel various Local Travel (POV Mileage) $0.50 Mile 1,500.00 1 $750

$0 $750

TOTAL $750 $0 $750

Trip 

# Contractual Travel Narrative:

1

Local Travel various Travel Cost $750

Jane Doe will fund her local travel expenses. Local travel is based on average distance between the outreach 

facilitator’s location and the meeting site (125 miles per month x 12 months = 1,500 miles). Privately-owned vehicle (POV) 

mileage reimbursement rate is based on the organization’s policies.

 Contractual Total Direct Charges for Jane Doe (Outreach Facilitator)

TOTAL DIRECT 

CHARGES FOR THIS 

AGREEMENT

TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$0 $6,750

 Contractual Total Cost for Jane Doe (Outreach Facilitator)

TOTAL COST TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$6,750 $0 $6,750

Contractual Details for County School District

Agreement # Services and Deliverables Provided

7

The County School District will donate services to educate, screen, provide care coordination, and risk reduction 

interventions for infectious diseases for up to 50 youths with drug use disorders who are receiving treatment. The Program 

Coordinator will oversee the donated services provided by the County School District. The Program Coordinator will meet 

with the County School District manager each month to review progress and identify and resolve issues.

Personnel

Fringe Benefits

Supplies

Other

Travel

Equipment

Indirect Charges

 Contractual Other Costs for County School District

Line 

Item 

#

Item

Check 

for 

Minor 

A&R

Calculation

Unit Cost / 

Rate Basis Quantity Duration Contractual Other Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Drug testing, referral, and case 

management $150.00 per youth per pear

50.00 $7,500 $0 $7,500

TOTAL $7,500 $0 $7,500

Line 

Item 

#

Contractual Other Narrative:

Drug testing, referral, and case management Unit Cost/Rate $150.00 Basis per youth per 

pear Quantity 50.00 Duration Other Cost $7,500

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 13 of 19 Release date: 01/2022

Feb 4, 2022

Line 

Item 

#

Contractual Other Narrative:

1 The County School District will donate their services to educate, screen, and treat up to 50 youths. The estimated average 

cost is $150/person.

 Contractual Total Direct Charges for County School District

TOTAL DIRECT 

CHARGES FOR THIS 

AGREEMENT

TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$0 $7,500

 Contractual Total Cost for County School District

TOTAL COST TOTAL FEDERAL 

REQUEST

TOTAL NON-FEDERAL 

MATCH

$7,500 $0 $7,500

G. Construction: Not Applicable

H. Other

Line 

Item 

#

Item

Check 

if 

Minor 

A&R

Calculation

Unit Cost / 

Rate Basis Quantity Duration Other Cost

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

1 Rent for project site $5.75 per sq. ft. per 

month 750.00 12.00 $51,750 $51,750

2 Cell phone service $100.00 per month 12.00 $1,200 $1,200

3 Incentives $10.00 per client follow 

up

200.00 $2,000 $2,000

4 Brochures $0.90 per brochure 1,500.00 $1,350 $1,350

5 Space rental for activities $175.00 per event 24.00 $4,200 $0 $4,200

6 Student surveys $5.00 per survey 500.00 $2,500 $0 $2,500

7 Brichures $1.00 per brochure 500.00 $500 $0 $500

TOTAL $63,500 $56,300 $7,200

Line 

Item 

# Other Narrative:

1

Rent for project site Unit Cost/Rate $5.75 Basis per sq. ft. per 

month Quantity 750.00 Duration 12.00 Other Cost $51,750

We are requesting rental costs as a direct charge because the 750 sq ft service site is necessary for the project. The service 

site will be used for staff and consultants to coordinate and implement project activities such as Advisory Working Group 

meetings, vocational and educational counseling sessions with clients, meetings with local authorities and organizations to 

plan and coordinate activities for client supports. The rent was calculated by square footage and reflects SAMHSA’s fair 

share of the space. Refer to attached signed copy of the rental lease agreement and floor plan and the completed Rent 

Questionnaire for more details to support the rental cost.

2

Cell phone service Unit Cost/Rate $100.00 Basis per month Quantity Duration 12.00 Other Cost $1,200

The monthly cell phone service costs reflect the percent of effort for the program coordinator supporting this project only. 

Cell phone service is needed for communication and coordination while conducting project activities in the geographic 

catchment area.

Incentives Unit Cost/Rate $10.00 Basis per client 

follow up Quantity 200.00 Duration Other Cost $2,000

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 14 of 19 Release date: 01/2022

Feb 4, 2022

Line 

Item 

# Other Narrative:

3

$10 non-cash incentives (such as gift cards and bus passes) will be awarded to 200 clients for data collection follow up.

4

Brochures Unit Cost/Rate $0.90 Basis per brochure Quantity 1,500.00 Duration Other Cost $1,350

Brochures will be needed for program outreach at various community and other sponsored events such as health fairs, 

workshops, and seminars.

5

Space rental for activities Unit Cost/Rate $175.00 Basis per event Quantity 24.00 Duration Other Cost $4,200

The ABC Company will donate space for the various activities outlined in the scope of work, such as teen night out, after 

school programs, and parent education classes (2 events per month).

6

Student surveys Unit Cost/Rate $5.00 Basis per survey Quantity 500.00 Duration Other Cost $2,500

The ABC Company will cover the cost of the student surveys.

7

Brichures Unit Cost/Rate $1.00 Basis per brochure Quantity 500.00 Duration Other Cost $500

The ABC Company will cover the printing costs for the brochures to be handed out with the student surveys.

I. Total Direct Charges

TOTAL DIRECT CHARGES

TOTAL FEDERAL REQUEST TOTAL NON-FEDERAL MATCH

$235,449 $45,158

J. Indirect Charges

Type of IDC Rate / Cost Allocation Plan

We will apply the rate in our approved federally negotiated IDC rate agreement

 Indirect Charges

End Date of Effective Period of 

Approved IDC Rate Agreement

Calculation

Approved IDC Rate 

(%) Approved Base IDC

FEDERAL 

REQUEST

NONFEDERAL 

MATCH

06/30/2024 12.00% $72,580 $8,710 $8,710

TOTAL $8,710 $8,710

Indirect Charges Narrative:

1. Our organization's approved IDC rate is 12.00% of personnel and fringe costs effective through 06/30/2024. 

2. We applied our IDC rate to personnel and fringe costs only, which is the approved base stated in our IDC rate agreement. 

3. Our approved IDC rate is in effect at the beginning of the budget period. 

4. We have attached a copy of our approved federally negotiated IDC rate agreement.

REVIEW OF COST SHARING AND MATCHING

The table below compares the amount of matching funds (NON-FEDERAL MATCH) entered in the budget with the minimum 

required match calculated based on the match ratio entered on page 1.

Sample Budget - Data Shown is for Illustration Purposes Only
SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 15 of 19 Release date: 01/2022

Feb 4, 2022

FEDERAL REQUEST (amount of federal 

funds requested in the budget)

NON-FEDERAL MATCH (your matching 

funds entered in the budget)

REQUIRED NON-FEDERAL MATCH 

(minimum match required per the match 

ratio on page 1)

$244,159 $45,158 $43,087

BUDGET SUMMARY: YEAR 1

BUDGET 

CATEGORY

FEDERAL 

REQUEST

NON-FEDERAL 

MATCH

A. Personnel $57,307 $17,038

B. Fringe Benefits $15,273 $4,541

C. Travel $2,903 $1,104

D. Equipment $0 $0

E. Supplies $3,044 $1,025

F. Contractual $100,622 $14,250

G. Construction (N/A) $0 $0

H. Other $56,300 $7,200

I. Total Direct Charges

(sum of A to H) $235,449 $45,158

J. Indirect Charges $8,710 $0

Total Projects Costs 

(sum of I and J) $244,159 $45,158

BUDGET SUMMARY FOR REQUESTED FUTURE YEARS

Year 2 Year 3 Year 4 Year 5

Budget Category FEDERAL 

REQUEST

NON-FEDERAL 

MATCH

FEDERAL 

REQUEST

NON-FEDERAL 

MATCH

FEDERAL 

REQUEST

NON-FEDERAL 

MATCH

FEDERAL 

REQUEST

NON-FEDERAL 

MATCH

A. Personnel $59,026 $17,549 $60,797 $18,075 $62,621 $18,617 $64,500 $19,176

B. Fringe Benefits $15,730 $4,677 $16,689 $4,962 $17,189 $5,110 $17,705 $5,264

C. Travel $2,904 $1,104 $2,904 $1,104 $2,904 $1,104 $2,904 $1,104

D. Equipment

E. Supplies $1,844 $0 $1,844 $0 $1,844 $0 $1,844 $0

F. Contractual $100,622 $14,250 $100,622 $14,250 $100,622 $14,250 $100,622 $14,250

G. Construction $0 $0 $0 $0 $0 $0 $0 $0

H. Other $57,853 $7,200 $57,853 $7,200 $57,853 $7,200 $57,853 $7,200

I. Total Direct

Charges (sum A to H) $237,979 $44,780 $240,709 $45,591 $243,033 $46,281 $245,428 $46,994

J. Indirect Charges $8,971 $0 $9,298 $0 $9,577 $0 $9,865 $0

Total Project Costs 

(sum of I and J) $246,950 $44,780 $250,007 $45,591 $252,610 $46,281 $255,293 $46,994

Sample Budget - Data Shown is for Illustration Purposes Only
 SAMHSA Detailed Budget and Narrative Justification 

v3.0 Page 16 of 19 Release date: 01/2022

Feb 4, 2022

Budget Summary Narrative:

1. Personnel costs for future years include an annual 3% cost of living adjustment (COLA). See attached org. policy onCOLA. 

2. The fringe benefit rate for full-time employees for years 01 and 02 is calculated at 26.65%. We project a 3% increase (from 

26.65% to 27.45%) in fringe benefit costs for years 03, 04, and 05. 

3. Supplies costs for future years exclude costs for the laptop, printer, and projector, which are one-time expenses. The donated 

furniture and computer have also been excluded from the Non-Federal Match for future years. 

4. Rental costs - we project an increase of 3% for years 02 through 05.

FUNDING LIMITATIONS / RESTRICTIONS

Funding Limitation/Restriction 

No more than 10 percent of the total grant award for each budget period may be used for data collection, performance 

measurement, and performance assessment, including incentives for participating in the required data collection follow-up.

 

Year 1 Year 2 Year 3 Year 4 Year 5 Total for Budget 

Category

A. Personnel $5,731 $5,435 $5,598 $5,766 $5,939 $28,469

B. Fringe Benefits $1,527 $1,406 $1,448 $1,448 $1,448 $7,277

C. Travel $116 $116 $116 $116 $116 $580

D. Equipment

E. Supplies $400 $400 $400 $400 $400 $2,000

F. Contractual $9,772 $9,772 $9,772 $9,772 $9,772 $48,860

H. Other $2,000 $2,000 $2,000 $2,000 $2,000 $10,000

I. Total Direct 

Charges (sum A to H) $19,546 $19,129 $19,334 $19,502 $19,675 $97,186

J. Indirect Charges $871 $821 $846 $866 $886 $4,290

TOTAL for the 

Budget Year $20,417 $19,950 $20,180 $20,368 $20,561 $101,476

Percentage of the 

Budget 8.362% 8.079% 8.072% 8.063% 8.054%

Funding Limitation/Restriction Narrative:

The percentage of the budget that will be spent on data collection and performance measurement does not exceed 10% for any 

budget period. Maximum percentage for any budget period is 8.4% ($20,417 / $244,159– Year 1). 

 

The following expenses in our budget make up the costs shown for data collection and performance measurement activities: 

Personnel and Fringe - approximately 10% of the Project Director and Program Coordinator's time will be spent overseeing data 

collection and performance measurement activities. 

Travel - approximately 10% of staff's local travel costs. 

Supplies - approximately 50% of the cost for copies. 

Other - $2,000 is the cost for client incentives for data collection follow-up (200 clients @$10 each). 

Contractual - $9,772 is the total cost for the Evaluator who will be implementing data collection and reporting activities. 

Indirect Char

Sample 

ges - portion of IDC on the Personnel and Fringe costs. 

Budget - Data Shown is for Illustration Purposes Only
BUDGET INFORMATION - Non-Construction Programs 

SECTION A - BUDGET SUMMARY

Grant Program Function 

or Activity 

(a) 

Catalog of Federal 

Domestic Assistance 

Number 

(b)

Estimated Unobligated Funds

Federal 

(c)

Non-Federal 

(d)

New or Revise

Federal 

(e)

Non-Fede

(f)

1. $244,159 2.3.4.5. Totals $244,159 

Pres

Sample Budget - Data Shown is for Illustration Purpose
SECTION B - BUDGET CATEGORIES

6. Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY

(1) (2) (3) (4)

a. Personnel $57,307 $17,038 b. Fringe Benefits $15,273 $4,541 c. Travel $2,903 $1,104 d. Equipment $0 $0 e. Supplies $3,044 $1,025 f. Contractual $100,622 $14,250 g. Construction $0 $0 $0 h. Other $56,300 $7,200 i. Total Direct Charges (sum of 6a-6h) $235,449 $45,158 j. Indirect Charges $8,710 $0 k. TOTALS (sum of 6i and 6j) $244,159 $45,158 

7. Program Income

Presc

Authorized for Local Reproduction

Sample Budget - Data Shown is for Illustration Purpose
SECTION C - NON-FEDERAL RESOURCES

(a) Grant Program (b) Applicant (c) State (d) Other So

8.9.

10.11.12. TOTAL (sum of lines 8-11)

SECTION D - FORECASTED CASH NEEDS

Total for 1st Year 1st Quarter 2nd Quarter 3rd Quar

13. Federal14. Non-Federal15. TOTAL (sum of lines 13 and 14)

SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJ

(a) Grant Program FUTURE FUNDING PERIODS (YEA

(b) First (c) Second (d) Thir

16. $246,950 $250,007 $17.18.19.20. TOTAL (sum of lines 16 - 19) $246,950 $250,007 $

SECTION F - OTHER BUDGET INFORMATION

21. Direct Charges: 22. Indirect Charges:

23. Remarks:

Pres

Authorized for Local Reproduction

Sample Budget - Data Shown is for Illustration Purpose