Spreadsheet: 1980e4d8-751f-4ee0-9723-1f8dd93ebef7
Sheet: Sheet1

Unnamed: 0 | Colorado Department of Health and Environment (CDPHE) | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6
 | How to use the Budget with Justification Form
 | General Instructions:
 | This Budget Worksheet Template is used to explain how your agency plans to use CDPHE funds consistent with the proposed work plan. The Budget Template includes three worksheets: Instructions, sample budget and blank template. Budget requests and their associated deliverables need to be in alignment and provide a consistent, logical picture of what is to be accomplished, by whom, and the associated costs.  In the event that this alignment does not occur, applicants will be contacted with requests for clarifications and/or modifications.
 | The information contained in each expenditure category helps the Program understand your request.  Please provide narrative for each category in the "Description of Work" or the "Description of Item" section.
 | The form is an Excel worksheet that includes instructions in various cells that can be viewed by hovering the computer mouse over the cells.  The instructions below give additional guidance.
 | Contact Information
 | Complete the top portion of the form by providing your Agency Name, Budget Period, Project Name, and Contact Information for both Program and Fiscal contacts.
 | [NAME]: Enter your agency name |  |  |  |  | Program Contact Name, Title, Phone and [NAME]
 | Budget Period:  Enter budget/ project period dates |  |  |  |  | Enter your agency's program contact information here
 | Project Name:  Enter the  project name |  |  |  |  | Fiscal Contact Name, Title, Phone and [NAME]
 |  |  |  |  |  | Enter your agency's fiscal contact information here
 | Personal Services
 | When filling out the Personal Services expenditure category, information in all 8 columns should appear:
 | Column B:  Position Title
 | Examples:  Executive Director, Nurse Practitioner, Finance Director
 | Column C:  Description of Work
 | Use the Description of Work column of the budget template to address the role and expected contribution of budgeted personnel. The time commitment of each individual should be justified as a reasonable estimate for the work to be performed.  A description of how fringe benefits are projected and what components are included in the calculation (insurance, paid time off, pension, etc.) must be included.  For hourly employees, please include hourly rate, hourly fringe and the number of hours budgeted.
 | Column D:  List SOW deliverable/primary task(s) this budget item supports
 | For this column, list all scope of work deliverables or primary tasks that this budget item supports.
 | For example, if the Principal Investigator will help accomplish deliverables 1, 4, 6, and 8, you would list:
 | ENTER ON FORM:
 | 1, 4, 6, 8 (in column 3)
 | Columns E-H (salaried employees):  [NAME] or Annual Salary / Fringe / Percent Time on Project
 | Enter the gross or annual salary, fringe, and the percent of time spent on project for each person.
 | For example: A full-time salaried employee is paid $42,000 a year;  their fringe benefits rate is 22%; they plan to spend   approximately 40% of their time on the project. Their total contribution to the Work Plan is calculated as follows:
 | $42,000 = annual salary
 | $42,000 x .22 = $9,240 fringe
 | $42,000 + $9,240 = $51,240.00
 | $51,240 x .40 = $20,496.00 amount you are requesting from CDPHE.
 | ENTER ON FORM:
 | Gross Annual Salary:  $42,000
 | Fringe:  $9,240
 | Percent FTE:  40%
 | Total:  $20,496.00 (this automatically calculates)
 | Columns E-H (hourly employees):  Hourly Wage / Hourly Fringe / Number of Hours on Project
 | Your calculation should be based on the number of hours they plan to work on the Work Plan with [NAME] listed as an amount per hour.
 | For example:  An hourly employee is paid $15/hour with 25% fringe; their time on the project will be for 20 hours/week for 39 weeks (9 months).   Their total contribution to the Work Plan is calculated as follows:
 | 20 hours/week x 39 weeks = 780 Hours
 | $15/hour x 25% fringe = $3.75/hour fringe
 | $15/hour + $3.75/hour = $18.75/hr
 | $18.75/hour x 780 hours = $14,625
 | ENTER ON FORM:
 | [NAME]:  $15
 | Hourly Fringe:  $3.75
 | # of Hours:  780
 | Total:  $14,625.00 (this automatically calculates)
 | Column I:  Match or In-Kind
 | Reporting match and in-kind allows us to understand the total cost of completing the work proposed in the Work Plan.  For example, cost may include the contribution of program administrator's time (i.e., an Executive Director, Nursing Director, or Program Manager’s time).  Provide this information only if requested to do so by RFA.
 | Column J: Total Amount Requested from CDPHE
 | This column should reflect the amounts you are requesting from CDPHE.
 | Total Personal Services (including fringe benefits)
 | This row should show the totals for each columns and reflect the total amount of Personal Services costs you are requesting from CDPHE.
 | Supplies & Operating Expenses
 | Supplies and operating expenses may include, but are not limited to, postage, office supplies, paid media, educational materials, and copying.
 | Column B:  Item
 | This column should list the item to be used in support of the Work Plan.
 | Example 1:  Telephone
 | Example 2:  Public education visual aids
 | Column C:  Description of Item
 | This is a description of the item(s) listed in the first column (Item).  Use the Item Description Column to describe the rationale for the costs budgeted (how it will be used to advance the Work Plan) and how cost estimates are calculated.
 | Example 1:  Visual aids that will be used when providing education to community members.  This will include displays illustrating the health effects of cardiovascular disease.   We anticipate purchasing 10 different displays, each with a different health focus.  Approximate unit cost per visual aid is $50.
 | Column F:  List SOW deliverable/primary task activity number(s) this budget item supports
 | For this column, list all scope of work deliverables or primary tasks that this budget item supports.
 | ENTER ON FORM:
 | For example 1:  All
 | Column G:  [NAME] and Column H:  Quantity
 | [NAME] in column 4 and Quantity in column 5, if appropriate.
 | Example 1:  Monthly cost for local and long distance phone service will be charged at $25/month for 12 months.
 | Rate = $25.00
 | Quantity = 12 months
 | Total = $300 ($25 x 12)
 | Example 2:  Cost of 10 visual aids at $50 each
 | Rate = $50.00
 | Quantity = 10 aids
 | Total = $500 ($50x10)
 | Column I:  Match or in kind
 | This column should reflect all match and in-kind contributions for each item related to supplies and operating expenses to successfully complete the Work Plan.   Provide this information only if requested to do so by RFA.
 | Column J: Total Amount Requested from CDPHE
 | This column should reflect the amounts for Supplies and Operating Expenses you are requesting from CDPHE.
 | Total Supplies & Operating Expenses
 | This row should total the amounts for Match or In-Kind and the total of the Supplies & Operating Expenses you are requesting from CDPHE.
 | Travel
 | This expenditure category should include all in-state and out-of-state travel expenses.  Please separate lodging, meals, mileage, airfare, and other travel costs, and indicate how they support the Work Plan.  Use the Description of Item column to describe the necessity and reasonableness of all estimated travel costs. Indicate which project personnel will be traveling and describe their anticipated contributions to the Work Plan. [NAME] how cost estimates for airfare, mileage, ground transportation, lodging, etc. were determined.  Include any mandatory meetings. Agencies should have established policies for reimbursement of travel expenses and should treat all funds from CDPHE in accordance with those policies. CDPHE may require submission of an agency's travel policy during the contract period.
 | Lodging - Budgeting with the current government rates published on the U.S. General Services Administration (GSA) website is strongly recommended.  Lodging costs should be reasonable and follow the travel policies established by your agency/organization.
 | Meals -  Budgeting with the current government per diem rates published on the U.S. General Services Administration (GSA) website is strongly recommended.  Current per diem rates can be found at: http://www.gsa.gov    Per Diem costs should be reasonable and follow the travel reimbursement policies established by your agency/organization but can not exceed the current U.S. government rate.
 | Mileage - Mileage may be reimbursed per the agency’s policy but not to exceed the current U.S. government rate.
 | Airfare - Airfare may be budgeted for travel only at the coach rate.
 | Column B:  Item
 | List the item in this column:  i.e., mileage, lodging, meals, airfare, etc.
 | Column C:  Description of Item
 | Use the Description of Item column to describe the necessity and reasonableness of all estimated travel costs.  Indicate the project personnel who will be traveling and describe their anticipated contributions to the work plan.  [NAME] how cost estimates were determined.
 | Example 1:  Mileage
 | Description:  Principal Investigator and project manager will make two site visits to XYZ Health Center to review contract   compliance (tie purpose back to SOW).  Round trip = 25 miles.  Agency reimbursement rate is $.50 per mile.
 | 2 trips x 25 miles = 50 miles
 | 50 miles x $.50 = $25
 | Example 2: Meals for training
 | Description of Item: Principal 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 are anticipating two days of travel per diem and two days of full per diem for each training. ($231/trip x 2= $462)
 | Rate:  $231/per trip/ person
 | Quantity:  1 staff
 | Number of trips:  2
 | Total: $231
 | Column F:  List SOW deliverable/primary task activity number(s) this budget item supports
 | For this column, list all scope of work deliverables or primary tasks that this budget item supports.
 | For example, item will support deliverable 1 and 2.
 | Enter on form:  1, 2
 | Column G:  [NAME] and Column H:  Quantity
 | [NAME] in  column 4 and Quantity in column 5, if appropriate.
 | See examples in previous section.
 | Column I:  Match or in kind
 | This column should reflect all match and in-kind contributions to the project needed to successfully complete the Work Plan. Provide this information only if requested to do so by RFA.
 | Column J: Total Amount Requested from CDPHE
 | This column should reflect the total amount for travel expenses you are requesting from CDPHE.
 | Total Travel Expenses
 | This row should total the amounts for Match or In-Kind and the total of the Travel Expenses you are requesting from CDPHE.
 | Contractual (payments to third parties or entities)
 | The Contractual expenditure category should describe costs for subcontractors (persons not employed by your agency) needed to complete work on the Work Plan.  This includes consulting and personal services subcontracts.  The Description of Item should specify the need for the subcontractor, the selection process, the work to be performed, how costs were calculated and the expected deliverables. CDPHE may request copies of contractual and grant agreements or MOU/MOA's during the contract period.  Subcontractors may not be pre-paid for services.
 | Column B:  Item
 | List the name of subcontractor
 | Column C:  Description of Item
 | Example 1:  Participatory Research Contractor
 | A contractor will be hired to determine community perceptions and needs related to obesity and chronic disease using participatory research strategies. Contractor will be responsible for development and implementation of survey, focus groups (minimum of 3), analysis of data, determining trends, and reporting of results.  A Request for [NAME] will be developed to elicit contractors. Applications will be scored and selected based on reasonableness of cost and ability to meet stated criteria. The program staff members do not have the necessary skills to carry out the proposed work required as research skills are very specialized.  The results of the research will be critical for achieving the proposed objectives and will guide remaining work in years two and three. Hiring a contractor is more feasible and cost effective than hiring a full-time employee for the first project year.
 | Column F:  List SOW deliverable/primary task(s) this budget item supports
 | For this column, list the SOW deliverable/primary task(s) this budget item supports.
 | For example, item will support [NAME] and 2.
 | Enter on form:  1, 2
 | Column G:  [NAME] and Column H:  Quantity
 | [NAME] in column 4 and Quantity in column 5, if appropriate.
 | Describe rate in this column if appropriate.
 | For example, research contractor expenses will be $7500/year.
 | Rate:  $7500
 | For example, ONE contractor required for research components of the project.
 | Quantity:  1
 | Total = $7,500 ($7,500 x 1)
 | Column I:  Match or in kind
 | This column should reflect all match and in-kind contributions to the project related to contractual services to successfully complete the Work Plan.  Provide this information only if requested to do so by RFA.
 | Column J: Total Amount Requested from CDPHE
 | This column should reflect the total amount for contractual services you are requesting from CDPHE.
 | Total Contractual Expenses
 | This row should total the amounts for Match or In-Kind and the total of the Contractual Expenses you are requesting from CDPHE.
 | SUB-TOTAL BEFORE INDIRECT
 | This row should total the amount of all Direct Costs you are requesting from CDPHE.
 | Indirect
 | Definition:  Indirect costs are those that have been incurred for common or joint objectives and cannot be readily identified with a particular final cost objective or grant account. Typical indirect costs include depreciation or use allowances on buildings and equipment, the costs of operating and maintaining facilities, and general administration and general expenses, such as the salaries and expenses of executive officers, personnel administration, and accounting. Indirect costs are also called Facilities and Administration costs (F&A) at some agencies. Indirect costs are allocated in a variety of methodologies in order to compute an indirect cost rate and differ from administrative costs in most cases.  A program employee, for example, can be considered administrative and not be included in an agency’s indirect costs.
 | If your agency maintains an indirect or F&A rate and you choose to include this cost on the application budget, be prepared to submit one of the following if you are a successfully awarded applicant: 1. Federally Negotiated Indirect Rate Agreement – An entity that receives funding directly from the Federal government is eligible to recover indirect costs by using a federally negotiated indirect cost rate from their Federal cognizant agency. 2. CDPHE- Official and Approved Negotiated Rate Agreement with CDPHE- – An entity that receives no funding directly from the Federal government is eligible to recover indirect costs by using an indirect cost rate negotiated with the internal audit department at CDPHE.  3. Indirect Cost Allocation Plan – Contractor’s method of allocating indirect costs (overhead to be allocated and the basis of allocation) must comply with generally accepted accounting principles that are consistently applied.
 | NOTE:  Operational expenses that support your specific program and can be identified and are not included in an agency's indirect cost rate agreement, may be directly charged in the "Supply and Operating" category.  The budget applications should: 1. Itemize all allowable costs 2. Explain the methodology used to determine the allocation of all costs to all funding sources for both direct and indirect costs.
 | Column B:  Item
 | In this section, we provide you with three options on how to include Indirect Costs.  Indirect Costs may be requested  (1)  using your agency's State, Federal or CDPHE-negotiated Indirect Cost Rate at the full negotiated rate, or (2) Applicants requesting indirect without a negotiated rate  must provide CDPHE with a copy of their cost allocation plan.  When applicable, indirect cost caps specified in the RFA must be followed regardless of an agency's indirect cost rate agreement or cost allocation plan. In the event that your agency has a tiered indirect cost rate, you may also include (3) tiered indirect costs on the third Indirect Cost line.
 | Submit a copy of the Federal or State negotiated Indirect Cost rate agreement or a cost allocation plan showing distribution of costs across funds to support the option selected.
 | 1.  Negotiated Indirect Cost Rate: In this section, provide your negotiated Indirect Cost rate and the basis (e.g.. total direct costs, salary, salary + fringe, etc.)
 | 2.  Indirect (other)- No Negotiated Rate:  Agencies with an indirect rate that has not been approved by the state or federal government must provide CDPHE with a copy of their indirect cost allocation plan.  When applicable, indirect cost caps specified in the RFA must be followed regardless of an agency's indirect cost rate agreement or indirect cost allocation plan.
 | 3.  Indirect (other) Modified Budget item rate:  If your Indirect Cost rate is modified based on specific budget line items, please include additional rates in this section.
 | Column C:  Description of Item (description is not necessary for the negotiated rate agreement)
 | Example: CDPHE negotiated indirect cost rate is 25% of Total Direct Costs.
 | TOTAL OF MATCH OR IN-KIND
 | This row should total the amounts of Match or In-Kind expenses.  Provide this information only if requested to do so by RFA.
 | TOTAL
 | This row should be the TOTAL of all expenses, including Indirect Costs that you are requesting from CDPHE for your project.