5814 Attachment#2 Budget Template Form.xlsx
XLSX spreadsheet 29 KB Posted
- Attached to
- Hospital Based Violence Intervention HB4045
- Solicitation number
- S-44300-00011096
- Issued by
- Multnomah County, Oregon
About this file
This document is an attachment titled "5814 Attachment#2 Budget Template Form.xlsx" related to a state and local contract opportunity for the Hospital Based Violence Intervention Program Learning Community. The opportunity is funded by the state of Oregon and allows applicants to apply for up to $50,000 in funding to defray the expense of participation in the learning community between July 1, 2023 and June 30, 2024. Applicants must submit a proposed budget and narrative justification detailing how the requested funds will support their participation in the learning community and development of partnerships to establish hospital-based violence intervention services in their community.
The budget template includes line items for salaries, fringe benefits, equipment, office supplies, travel, and other costs. Applicants must provide a detailed breakdown of each budget category and a narrative justification. The total direct costs and indirect costs will determine the total funding request. Successful applicants will be required to submit an invoice using a template provided by the Oregon Health Authority to receive the funding as a lump sum payment.
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Other files
| File | Type | Posted |
|---|---|---|
| 5814 Attachment#3 Grant Agreement Form.pdf | ||
| 5814 final.pdf | ||
| 5814 Attachment#2 Budget Template Form~1.xlsx | XLSX spreadsheet | |
| 5814 final~1.pdf | ||
| 5889 - Attchment H - Sample Grant Agreement.pdf | ||
| 5814 final~2.pdf |
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Text version
02.01.2022-06.30.2023 Line Item Budget and Narrative Worksheet
INSTRUCTIONS: Please fill out the following proposed budget for your organization using the spreadsheet below. Please also provide a brief justification of this budget in the space below the spreadsheet. Applicants may apply for up to $50,000 of funding to defray the expense of participation in the HHP Learning Community between July 1, 2023-June 30, 2024. Because this round of funding is intended as seed money, successful applicants will submit an invoice using a template provided by OHA to receive funding as a lump sum.
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Comment:
@Yakis Paul does this wording sound OK? We're wanting to set the expectation that they'll need to submit an invoice on our template and get the funding up front.
Reply:
Yes, sounds good, I will save this into the file thank you!
Hospital Based Violence Intervention Program Learning Community tc={8727C418-6878-4A7E-91BA-12FFA1361011}: [Threaded comment]
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Comment:
| Adjust the title here based on POIC's response as to whether we can use the HHP name. | Formula (do not enter) | ||||||||
| Organization Name: | |||||||||
| Fiscal Contact: | |||||||||
| E-mail address: | |||||||||
| Phone Number: | Fax Number: | ||||||||
| Budget Categories | Description | Total | |||||||
| (1) Salary - | Position # | Title of Position | Salary (Full, annual base salary amount without fringe benefits) | % of time (FTE) | # of months requested | Total Salary | $0 | ||
| 1 | 12 | 0.00 | |||||||
| 2 | 12 | 0.00 | |||||||
| 3 | 12 | 0.00 | |||||||
| 4 | 12 | 0.00 |
| TOTAL SALARY | $0.00 |
| Narrative* : |
| (2) Fringe Benefits (including health insurance, retirement costs, etc. Use either 'base' or '%' depending on how your organization calculates.) | Position # | Total Salary (autopopulated from lines I10-I13 above) | Base If Applicable | % | = | Total Fringe | $0 |
| 1 | 0.00 | = | 0.00 | ||||
| 2 | 0.00 | = | 0.00 | ||||
| 3 | 0.00 | = | 0.00 | ||||
| 4 | 0.00 | = | 0.00 |
| TOTAL FRINGE | $0.00 | ||
| (3) Equipment | List equipment. Include all equipment necessary for program (i.e. computer, printer, telephone, etc.). | $0 | $0 |
| Narrative description of equipment |
| (4) Office Supplies | Do not list. These items include supplies for meetings, general office supplies ie. paper, pens, software, highlighters, binders, folders, etc. | $0 | $0 | ||
| (5) Travel | This covers in-state, out-of-state, and travel to all required trainings. | $0 | |||
| In state | Out Of State | Subtotal | |||
| Narrative* : |
| Per Diem: | $0 | ||||
| Hotel: | $0 | ||||
| Air fare: | $0 | ||||
| Reg. fees: | $0 | ||||
| Other: | $0 | ||||
| Mileage: | Miles: | 0 | X | .56 |
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Comment:
We need to make sure this is the correct mileage reimbursement rate
| per mile | $0 | |||||
| (6) Other (food, gift cards for participants, etc.) | Please list. | $0 | ||||
| $0 | ||||||
| $0 | ||||||
| $0 | ||||||
| $0 | ||||||
| $0 | ||||||
| (7) Contracts: | List all sub-contracts and all contractual costs, if applicable. | $0 | ||||
| $0 | ||||||
| $0 | ||||||
| (8) Total Direct Costs | (Sum of 1 through 7) | $0 | ||||
| (9)Cost Allocation and Indirect Rate | Indirect @ | 0.00% | $0 | $0 |
(10) TOTALS (Sum of 8 & 9). $0
| Narrative Justification |
| Instructions: Please use the space below to describe how the funds requested will support participation in the Learning Community and development of partnerships to establish hospital-based violence intervention services in your community. While clear and concise answers are welcome, there is no maximum or minimum word count; use the amount of space you need. |
| Please write your narrative justification here. |
@Yakis Paul does this wording sound OK? We're wanting to set the expectation that they'll need to submit an invoice on our template and get the funding up front.
Yes, sounds good, I will save this into the file thank you!
Adjust the title here based on POIC's response as to whether we can use the HHP name.
We need to make sure this is the correct mileage reimbursement rate
File details come from the government source that posted it. Updated .