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F1
| Attachment W | |
| HRSA/Division of Independent Review | Contract No: |
| Task Order No: |
| COST PROPOSAL | | |
| Review Type | Web-Assisted Teleconference | Date: |
| FOA | | |
| Activity Code: | | |
| FOA Name: | | Review Start (If WTC or FTF): |
| | Evaluations Due (If Field): |
| REVIEW SPECIFICATIONS | | |
| Length of Meeting (in days): | 0 | Number of Applications: |
| Number of Panels: | 0 | Number of SSOs: |
| Number of Non-Fed Reviewers: | 0 | On-site Staff (FTF): |
| Number of Chairpersons | 0 | |
| SUMMARY PAGE |
| DIRECT LABOR |
| DIRECT LABOR | Hours | Hourly Rate | | Amount |
| Senior Manager | 0.0 | - 0 | | - 0 |
| Project Manager | 0.0 | - 0 | | - 0 |
| Project Assistant | 0.0 | - 0 | | - 0 |
| SSO (Staff) | 0.0 | - 0 | - 0 | |
| Administrative Assistant | 0.0 | - 0 | | - 0 |
| 0.0 | | | |
| | | TOTAL DIRECT LABOR | - 0 |
| OTHER DIRECT COSTS | | | | |
| 1. Honoraria: | | | - 0 |
| Reviewers | - 0 | |
| Chairperson(s) | - 0 | |
| 2. Subcontractor Costs: | | | - 0 |
| 3. Staff Travel: | | | - 0 |
| 4. Reproduction/Printing Costs: | | | - 0 |
| 5. Supply Costs: | | | - 0 |
| 6. Telephone Costs: | | | - 0 |
| 7. Mailing Delivery Costs: | | | - 0 |
| 8. SSO (If Consultants): | | | - 0 |
| | | | TOTAL OTHER COSTS | - 0 |
| INDIRECT COSTS | | | | | |
| Rate | | Base | | |
| Overhead | 0.00% | X | - 0 | | - 0 |
| G&A | 0.00% | X | - 0 | | - 0 |
| | | | TOTAL INDIRECT COSTS | - 0 |
| | | | Subtotal | - 0 |
| | | | BASE FEE (%) | - 0 |
| | | | Subtotal Before Award Fee | - 0 |
| | | AWARD FEE (%)* | - 0 |
| | | ESTIMATED TOTAL | (0.00) |
| *If Applicable | 121 | | | |
| Web-Assisted Teleconference | | Attachment W | | Page 2 |
OTHER DIRECT COSTS (Detail)
| Honoraria | Reviewers and Chairs | Days | Rate | | Amount |
| 0 | 0 | 0 | | - 0 |
| 0 | 0 | 0 | | - 0 |
| Reimbursable Reviewer Expenses | 0 | 0 | 0 | | - 0 |
| | | | Total : | - 0 |
| Subcontractor Costs | | - 0 |
| Total Subcontractor Costs: | - 0 |
| Staff Travel Costs | Staff | # trip | Rate | |
| 0 | - 0 | - 0 | - 0 |
| | | Total Staff Travel Costs: | - 0 |
| Reproduction/Printing Costs | Units | Rate | | |
| - 0 | - 0 | | - 0 |
| | | Total Reproduction Costs: | - 0 |
| Supply Costs (Itemize) | Units | Rate | | |
| - 0 | - 0 | | - 0 |
| | | Total Supply Costs: | - 0 |
Telephone Costs Units Rate
Total Telephone Costs: - 0
| Mailing/Delivery Costs | Units | Rate | | |
| - 0 | - 0 | | - 0 |
| | | Total Delivery Costs: | - 0 |
| SSO (If Consultants) | # SSO | Hours | Hourly Rate | |
| | - 0 | - 0 | - 0 |
| Other Consultant (Itemize by Purpose) | | - 0 | - 0 | |
| | - 0 | - 0 | |
122 Total Consultant Costs: - 0
Award Fee Award Fee Pool for Announcement
| Task Order Number | | | | | | | |
| Performance | Unsatisfactory | Satisfactory | Excellent | Superior | Award Fee | Award Fee | Amount to be awarded |
| Level | (0%) | (50%) | (75%) | (100%) | Percentage | Amount | |
| | | | | 4.00% | $0.00 | |
| Task 1 Pre-Review | | | | | | | |
| 1a, b, c - Formal Communication | | | | | 0.25% | $0.00 | |
| 1d - Meeting Logistics & Budget | | | | | 0.25% | $0.00 | |
| 1e - Site Logistics | | | | | 0.25% | $0.00 | |
| All Task 1 - Reviewer Correspondence | | | | | 0.25% | $0.00 | |
| 1f, g - Reviewer Selection | | | | | 0.25% | $0.00 | |
| 1g, h - COI Issues | | | | | 0.25% | $0.00 | |
| 1h - Mail Outs | | | | | 0.25% | $0.00 | |
| Task 2, Review | | | | | | | |
| 2a - Logistics & Room Preparation | | | | | 0.25% | $0.00 | |
| Staffing, Performance Evaluation | | | | | 0.25% | $0.00 | |
| Contract RA Performance Evaluation | | | | | 0.25% | $0.00 | |
| SSO Performance Evaluation | | | | | 0.25% | $0.00 | |
| 2d - Data Entry Task | | | | | 0.25% | $0.00 | |
| Task 3, Post Review | | | | | | | |
| 3c - Summary Statements | | | | | 0.25% | $0.00 | |
| 3d - Reviewer Reimbursement | | | | | 0.25% | $0.00 | |
| Final Budget Deliverable Report | | | | | 0.10% | $0.00 | |
| ROL Spreadsheet | | | | | 0.20% | $0.00 | |
| Task 4, Closeout | | | | | | | |
| 4a - DIR Official File Folder | | | | | 0.20% | $0.00 | |
| | | | | TOTAL | $0.00 | |
