6-RFP 26-09 Blank Budget Template DD 2026-27.xlsx

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Attached to
Innovated Services to Support Competitive Integrated Employment and Community Inclusion
Solicitation number
26-09
Issued by
Montgomery County, Pennsylvania

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File Summary

This is a blank budget template for the Montgomery County Department of Health and Human Services, Office of Developmental Disabilities (ODD), for the fiscal year 2026/2027. The template is designed for developmental disabilities (DD) program providers to submit comprehensive budget proposals to Montgomery County. The document requests detailed budget submissions organized into eight primary categories: Staff/Habilitation, Room/Board/Maintenance, Property (Furniture & Equipment), Transportation, Residential Adaptation, Agency Administration, Revenue/Anticipated Income, and Expenses Less Income. Supporting schedules are required for wages and salaries, rent (including property leased from unrelated parties, purchased by related parties, and purchased by the agency), purchased treatment services, program equipment, and administrative budget allocations. The template mandates that providers indicate any variance of 3% or greater from prior year budgets and provide supporting documentation for significant line items such as wages and purchased personnel services.

The budget template establishes a framework for calculating provider reimbursement rates on a fee-for-service basis, with separate calculations for gross and net rates specified by unit of service (day, hour, session, etc.). All budgeted expenses must be reconciled against anticipated income sources including Medical Assistance, liability payments, room and board revenue, third-party private insurance, interest income, and other sources, with the final calculation determining the amount requested from Montgomery County. The template requires providers to detail administrative cost allocation methodologies if the agency operates multiple programs and must document the basis for all budgeted amounts through supporting schedules and documentation. No specific deadline date is provided in this blank template document, as it serves as a standardized form for providers to complete and submit during the county's annual budget cycle.

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Other files

File Type Posted
2-Exhibit A - HHS Standard Terms and Condition for Services revised 6-3-24 (2).pdf PDF
7-Appendix A document.docx DOCX document
3-RFP 26-09 Innovated Services to Support Competitive Integrated Employment and Community Inclusion.docx DOCX document
4-Instructions to Bidders Template.docx DOCX document
5-Trade Secret Form.pdf PDF
1-2025-2026 DD Contract SAMPLE.docx DOCX document

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Summary

Montgomery County Department of Health and Human Services - Office of Developmental Disabilities
FY 2026/2027 Budget Submission Summary for ALL DD PROGRAMS

Provider:

25/26
Program NameFacility #Approved26/27RateComments
BudgetBudget

Total Budget: $0 $0

Budget

2026 / 2027 Budget Submission
Montgomery County
Dept of HHS - Office of Developmental Disabilities
Agency Name:0
Billing Address :Facility Address:
Vendor # :Facility # :
Cost Center :Total Clients
Program Name:MONTCO Clients
123456
Audited/ActualActual+ProjectedProjected
DESCRIPTIONA/C24/2525/2626/27COMMENTS
#
A . STAFF / HABILITATION
1) Wages and Salaries*111
2) Employer Match Taxes121
3) Retirement - Provider122
4) Insurance and Other123
5) Staff Development131
6) Purchased Personnel132
7) Habilitation Equipment345
8) Purchased Practitioner Service*361
9) Communications321
10) Accounting Fees132
11) Auditing Fees132
12) Legal Fees132
13) Advertising322
14) Communications321
15) Education Supplies and Equipment346
16) Other
SUB - TOTAL STAFF$0$0$0
Indicate VARIANCE of 3% (+/-)N/A
* include a supporting schedule
B . ROOM , BOARD MAINTENANCE
1) Rent / Mortage Payment *311
2) Utilities (water, gas, electric, sewer, oil)312
3) Insurance - Casuality Loss/ Property313
4) Housekeeping314
5) Library371
6) Office Supplies331
7) Medical Supplies341
8) Drugs342
9) Food343
10) Clothing344
11) Recreational Supplies347
12) Household Goods348
13) Other Expenses*373

SUB -TOTAL ROOM , BOARD $0 $0 $0

Indicate VARIANCE of 3% (+/-) N/A

C . Property (Furniture & Equipment)

1) Program Equipment412
2) Furniture413
3) Office Equipment415
4) Program Equipment Repair422
5) Furniture Repair423
6) Office Equipment Repair425

SUB - TOTAL Property $0 $0 $0

Indicate VARIANCE of 3% (+/-) N/A

D . TRANSPORTATION

1) Client Transportation352
2) Automobile Leased /Purchased*315
3) Automobile Insurance313
4) Automotive Repairs & Maintenance313
5) Staff Travel351
SUB - TOTAL TRANSPORTATION$0$0$0

Indicate VARIANCE of 3% (+/-) N/A

E . RESIDENTIAL ADAPTATION
1) Building Repairs421
2) Furniture & Equipment Repairs422
3) Building Adaptation - Minor421
4) Building Adaptation/Renovations424
5) Building Maintenance425
6) Interest Expense362
Sub-Total Residential$0$0$0

Indicate VARIANCE of 3% (+/-) N/A

F . AGENCY ADMINISTRATION
1) Administration Budget" F "
Admin Rate of Total ExpenseERROR:#DIV/0!ERROR:#DIV/0!ERROR:#DIV/0!

TOTAL EXPENSES $0 $0 $0

Indicate VARIANCE of 3% (+/-) N/A

G . REVENUE/ ANTICIPATED INCOME
1) Medical Assistance530
2) Liability Payments570
3) Room & Board571
4) Third Party/ Private Insurance580
5) Interest Income
6) Other Income- Specify

TOTAL ANTICIPATED INCOME $0 $0 $0

Indicate VARIANCE of 3% (+/-) N/A

H . EXPENSES LESS INCOME $0 $0 $0

I . REQUESTED FROM Montgomery County $0 $0 $0

Fee For Service RateGross Rate :ERROR:#DIV/0!Per
Specify Unit : ( i. e. )
Day / Hour / Session / Etc.Net Rate :ERROR:#DIV/0!Per

Wages

2026 / 2027 Budget Submission
Montgomery County
Office of MH/DD/EI
Agency Name:0
Billing Address :0Facility Address:
000
000
Vendor # :0Facility # :
Cost Center :Total Clients
Program Name:MONTCO Clients

1 1 1 WAGES AND SALARIES

Agency Total SalaryEligible for Participation
Pos.TitleHoursFull TimeSalaryFull TimeSalary
#(Please use civilPerAnnualto beAnnualto be
Nameservice title)WeekRatePaidRatePaid

Total

RENT A

2026 / 2027 Budget Submission
Montgomery County
Office of MH/DD/EI
Agency Name:0
Billing Address :0Facility Address:
000
000
Vendor # :0Facility # :
Cost Center :Total Clients
Program Name:MONTCO Clients
311 RENT Schedule A
Listing of Property Leased From An Unrelated Party
AmountFair
SiteLessorType OfFacilityAnnualCharged toRental
AddressName and AddressProgram#RentMH/MRAppraisal

RENT B

2026 / 2027 Budget Submission
Montgomery County
Office of MH/DD/EI
Agency Name:0
Billing Address :0Facility Address:
000
000
Vendor # :0Facility # :
Cost Center :Total Clients
Program Name:MONTCO Clients
311 RENT Schedule B
Listing of Property Purchased By A Related Party
SiteRelated PartyAnnualAmountFair
AddressName and AddressType ofFacilityDate ofPurchaseDownLength ofPrincipalCharged toRental
Program#PurchasePricePaymentMortgageInterestMH/MRAppraisal

RENT C

2026 / 2027 Budget Submission
Montgomery County
Office of MH/DD/EI
Agency Name:0
Billing Address :0Facility Address:
000
000
Vendor # :0Facility # :
Cost Center :Total Clients
Program Name:MONTCO Clients
311 RENT Schedule C
Listing of Property Purchased By Agency
SiteAgencyAnnualAmountFair
AddressName and AddressType ofFacilityDate ofPurchaseDownLength ofPrincipalCharged toRental
Program#PurchasePricePaymentMortgageInterestMH/MRAppraisal

Rents

2026 / 2027 Budget Submission
Montgomery County
Office of MH/DD/EI
Agency Name:0
Billing Address :0Facility Address:
000
000
Vendor # :0Facility # :
Cost Center :Total Clients
Program Name:MONTCO Clients
311 RENT Schedule A
Listing of Property Leased From An Unrelated Party
AmountFair
SiteLessorType OfFacilityAnnualCharged toRental
AddressName and AddressProgram#RentalMH/MRAppraisal

Treatment

2026 / 2027 Budget Submission
Montgomery County
Office of MH/DD/EI
Agency Name:0
Billing Address :0Facility Address:
000
000
Vendor # :0Facility # :
Cost Center :Total Clients
Program Name:MONTCO Clients

361 PURCHASED TREATMENT SERVICES

DefinitionNumberAmt. Eligible
TypeProvidersof Unitof Unitsfor DPW
(List Individually)Ratefor RateProvidedTotal CostParticipation

Total

Assets

2026 / 2027 Budget Submission
Montgomery County
Office of MH/DD/EI
Agency Name:0
Billing Address :0Facility Address:
000
000
Vendor # :0Facility # :
Cost Center :Total Clients
Program Name:MONTCO Clients

4 1 2 PROGRAM EQUIPMENT

CostAmountAmount NotAmount
CenterQuantityDescription of ItemExpendedEligibleEligible
DPW Part.for DPW

TOTAL

Admin

2026 / 2027 Budget Submission
Montgomery County
Office of MH/DD/EI
Agency Name:0
Billing Address :0Facility Address:
000
000
Vendor # :0Facility # :
Cost Center :Total Clients
Program Name:MONTCO Clients

" F " ADMINISTRATIVE BUDGET

ACCOUNTACCOUNT DESCRIPTIONAMOUNTREMARKS
#
A. PERSONNNEL COSTS
111ASalaries
121ASocial Security Contribution
122ARetirement
123AInsurance and Other Benefits
131AStaff Development
132APurchased Personnel Services
133AOther Personnel Expenses

SUBTOTAL

B. OPERATING COSTS
311ARent
312AUtilities
313AInsurance
314AHousekeeping
321ACommunications
331AOffice Supplies
351AStaff Travel
371ALibrary
372ADebt Service
373AOther Admin. Operating Expenses

SUBTOTAL

C. EQUIPMENT
411ABuilding and Land
412AOffice Equipment
415AMotor Vehicles
421ABuilding Repairs
422AEquipment Repairs
423AMotor Vehicle Repairs

SUBTOTAL

TOTALS

COST ALLOCATION PLAN :

If your agency provides more than one program , to which you allocate these administrative costs , please
provide an explanation of the method used to distribute these costs among the various programs.

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