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Budget
| Rockland County Department of Mental Health- Budget Template | |
| Agency Name: |
| Program Name: |
| Contract Period |
Proposed Budget Amount- Year 1: $ Proposed Budget Amount- Year 2: $ Proposed Budget Amount- Year 3: $
| Program Budget Template |
| Instructions: Budget must be fully completed based on projected program expenses broken out by year, for the entire contract period. Description of the expense, calculation and justification must be provided. |
| Personnel Costs | | | |
| Year 1 | Year 2 | Year 3 |
| Position Title | | | |
Full Time Employees
| Annual Salary | Full-Time Equivalent | | |
| (Indicate standard work week of 35, 37.5, 40) | Expense for Program | | Annual Salary | Full-Time Equivalent |
| (Indicate standard work week of 35, 37.5, 40) | Expense for Program | | Annual Salary | Full-Time Equivalent |
| (Indicate standard work week of 35, 37.5, 40) | Expense for Program | | | |
Full-Time Personnel Costs $0 $0 $0
| | Position Title | | | | | | | |
| Part-time/Per-Diem Employees | Hourly Rate | Hours per week | Program Expense | Hourly Rate | Hours per week | Program Expense | Hourly Rate | Hours per week | Program Expense |
Part-Time Personnel Costs $0 $0 $0
| Year 1- Personnel Costs | Year 2- Personnel Costs | Year 3- Personnel Costs |
| Full-Time + Part-Time Personnel Costs | Full-Time + Part-Time Personnel Costs | Full-Time + Part-Time Personnel Costs |
| Fringe % | Fringe % | Fringe % |
| Personnel Costs Sub-total | Personnel Costs Sub-total | Personnel Costs Sub-total |
| Comments: | Comments: | Comments |
| Operational Budget | | | | | | |
| Year 1 | | Year 2 | | Year 3 | |
| Ongoing Operational Expenses | Expense Amount | Description, justification and calculation/allocation | Expense Amount | Description, justification and calculation/allocation | Expense Amount | Description, justification and calculation/allocation |
| Rent | | | | | | |
| Utilities | | | | | | |
| Staff Training | | | | | | |
| Insurance | | | | | | |
| Training materials | | | | | | |
| Program Supplies and Materials | | | | | | |
| Office Supplies | | | | | | |
| Communications: Telephone, Cable, Internet | | | | | | |
| Staff Travel | | | | | | |
| Add lines as needed | | | | | | |
| Ongoing Operational Costs | $ | | $ | | $ | |
| Year 1 | | Year 2 | | Year 3 | |
| One-Time Start up costs (if applicable) | Expense Amount | Description, justification and calculation/allocation | Expense Amount | Description, justification and calculation/allocation | Expense Amount | Description, justification and calculation/allocation |
| Installation costs | | | | | | |
| Vending Machine (provide brand, model, etc) | | | | | | |
| Naloxboxes (provide brand, model, etc) | | | | | | |
One-Time Start up Costs $ $ $
| Year 1- Operational Costs | Year 2- Operational Costs | Year 3- Operational Costs |
| Add: Ongoing Operational Costs | | |
| Add: One Time Start up Costs | | |
| Operational Budget Sub-total | Operational Budget Sub-total | Operational Budget Sub-total |
| Comments: | Comments: | Comments: |
| Total Expenses | | |
| Total Budget Expenses- Year 1 | Total Budget Expenses- Year 2 | Total Budget Expenses- Year 3 |
| Add: Personnel Budget Sub-total | Add: Personnel Budget Sub-total | Add: Personnel Budget Sub-total |
| Add: Operational Budget Sub-total | Add: Operational Budget Sub-total | Add: Operational Budget Sub-total |
| Budget Sub-total | Budget Sub-total | Budget Sub-total |
| Add: Agency Admin*: Use CFR percentage if applicable | Add: Agency Admin*: Use CFR percentage if applicable | Add: Agency Admin*: Use CFR percentage if applicable |
| Total Budget Expenses | Total Budget Expenses | Total Budget Expenses |
| * Agency Admin Costs % may not exceed 15% and include general administrative costs, such as accounting and legal fees, and overhead costs specific to this program or contract only. If your agency submits a CFR, use the CFR % not to exceed 15%. | | |
| Total Revenue | |
| Budget Revenue- Year 1 | |
| | Budget Revenue- Year 2 |
| (total annual revenue must equal total proposed annual budget) | | Budget Revenue- Year 3 |
(total annual revenue must equal total proposed annual budget)
| Revenue Source | Amount | Revenue Source | Amount | Revenue Source | Amount |
| Year 1 Requested Budget Above | | Year 2 Requested Budget Above | | Year 3 Requested Budget Above | |
| Other County Funding | | Other County Funding | | Other County Funding | |
| State Aid | | State Aid | | State Aid | |
| Agency Funding | | Agency Funding | | Agency Funding | |
| + Add lines as needed | | + Add lines as needed | | + Add lines as needed | |
| Total Revenue ** | Total Revenue** | Total Revenue ** |
| ** Total annual revenue must equal total proposed annual budget | | |
RFP-RC-2026-006 Narcan Vending Machine Implementation and Maintenance
Budget Sample
| Rockland County Department of Mental Health |
| Agency Name: |
| Program Name: |
| Contract Period |
Total Proposed Budget Amount:
| Program Budget Template |
| Instructions: Budget must be fully completed based on program expenses for the entire contract period. Description of expense, calculation and justification must be provided. |
| Personnel Budget |
| Position Title |
Full Time Employees
| Annual Salary | Full-Time Equivalent | | | |
| (Indicate standard work week of 35, 37.5, 40) | Total Expense for Program | | | | |
| | Director of Crisis Services | $125,000 | .20 FTE, 40 hour week | $25,000 |
| | Team Leader | $95,000 | 1.0 FTE, 40 hour week | $95,000 |
Full-Time Personnel Budget $120,000
| | Position Title | | | |
| Part-time/Per-Diem Employees | Hourly Rate | Hours per week | Program Expense | | |
| | Per Diem Clinician (covers time off/FMLA) | $39.66 | 32.00 | $66,000 |
Part-Time Personnel Budget $66,000
| Full-Time + Part-Time Personnel Budget | $186,000 |
| Fringe 37.6% | $69,936 |
| Personnel Budget Sub-total | $255,936 |
| Operational Budget | | |
| Line Item Expense | Expense Amount | Description, justification and calculation/allocation |
| Rent | $35,000 | Estimated cost of $2,916.66 per month. Office space estimated at 1,000 sq. fee x $35 per sq. ft. |
| Utilities | $1,763 | Estimated at $146.92 per month ($146.92 x 12) |
| Staff Training | $7,500 | Training on Evidence based practices |
| Insurance | $13,936 | Estimated at $1,161.33 per month for general insurance and malpractice. Expenses are estimated based on our current cost experience |
| Training materials | $0 | |
| Program Supplies and Materials | $1,200 | Estimate $100 x 12 months = $1,200. To cover costs for handout materials in the community. |
| Office Supplies | $1,065 | Estimated cost of general office supplies is $100 annually x 14.2 FTE= $1,065. |
| Communications: Telephone, Cable, Internet | $5,680 | Cell Phones (40 x 6 phones x 12 months = 2,880) Office phone/internet (233.33 per month x 12 =2,800) |
| Staff Travel | $459 | .70 per mile x 655 miles for meetings and community travel |
| One-Time Start up costs (if applicable) |
| Construction costs |
| Furniture |
| Equipment (list each item separately) |
Operational Budget Sub-total $66,603
| Total Budget Expenses | |
| Add: Personnel Budget Sub-total | $255,936 |
| Add: Operational Budget Sub-total | $66,603 |
| Budget Sub-total | $322,539 |
| Add: Agency Admin: 12% Use CFR percentage | $38,705 |
| Total Budget Expenses | $361,244 |
Budget Revenue (total annual revenue must equal total proposed annual budget)
| Revenue Source | Amount |
| Medicaid | $23,108 |
| Medicare | |
| Third Party Health Ins | |
| Other (provide details) - Medicaid Managed Care | $130,945 |
| + Add lines as needed | |
| Rockland County Department of Mental Health Contract | $207,191 |
| State Aid | |
| Total Revenue | $361,244 |
| ** Agency Admin Costs % may not exceed 15% and include general administrative costs, such as accounting and legal fees, and overhead costs specific to this program or contract only. If your agency submits a CFR, use the CFR % not to exceed 15%. | |
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