Attachment J.22 - Business Proposal Format Updated.xlsx

XLSX spreadsheet 225 KB Posted Jun 7, 2022

Attached to: World Trade Center Health Program Clinical Centers of Excellence (CCE)
Solicitation number: 75D301-22-R-72142
Issued by: Department of Health and Human Services Centers for Disease Control and Prevention

About this file

Written by GovTribe AI · Dec 28, 2023

This file contains templates for a Clinical Centers of Excellence contractor to submit budget and expense information to the National Institute for Occupational Safety and Health for the World Trade Center Health Program. The templates include forms for contractors to provide line item details for direct labor costs, subcontractor labor costs, other direct costs, rent and lease amounts, overhead costs, and travel expenditures for each option period. Contractors must also submit activity reports aligning labor categories with activity codes and descriptions of expenses. Supporting documentation is required for rent/lease amounts and indirect overhead rates. Contractors will use these templates to invoice NIOSH on a cost-reimbursement basis for providing services such as care coordination, case management, quality assurance controls, and administering healthcare services to 9/11 responders and survivors through the World Trade Center Health Program Clinical Centers of Excellence.

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Other files

File	Type	Posted
75D301-22-R-72142 Revision 06-28-2022.doc	DOC document	Jun 28, 2022
Questions and Answers 75D301-22-R-72142 complete corrected 06-10-2022.xlsx	XLSX spreadsheet	Jun 13, 2022
Attachment J.16 - Invoice Format Updated.xlsx	XLSX spreadsheet	Jun 7, 2022
75D301-22-R-72142 Revision 06-07-2022.doc	DOC document	Jun 7, 2022
Attachment J.28 - Lifestyle Medicine SOP (Draft).pdf	PDF	Jun 7, 2022
Questions and Answers 75D301-22-R-72142 complete.xlsx	XLSX spreadsheet	Jun 7, 2022
75D301-22-R-72142 Revision 05-25-2022.doc	DOC document	May 25, 2022
Attachment J.13 - HHS Subcontracting Plan Template.doc	DOC document	May 24, 2022
Attachment J.25 - NYMA Member Volumes and Acuity.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.12 - PastPresent Performance Questionnaire.docx	DOCX document	May 24, 2022
Attachment J.9 - TGD 009 (Monthly Report).pdf	PDF	May 24, 2022
Attachment J.14 - CUI-SSP (System Security Plan).docx	DOCX document	May 24, 2022
Attachment J.18 - Change Request Control Log.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.4 - TGD 003 (Semiannual Report).pdf	PDF	May 24, 2022
Attachment J.20 - Activity_Codes.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.24 - Case Management & Utilization Management SOP.pdf	PDF	May 24, 2022
Attachment J.26 - Pharmacy Prior Authorizations SOP (Draft).pdf	PDF	May 24, 2022
Attachment J.27 - Provider Blocks SOP (Draft).pdf	PDF	May 24, 2022
Attachment J.19 - Quarterly Staffing Report Template.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.11 - Partner and Sub Template.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.15 - Question and Answer Template.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.8 - TGD 007 (Timely Filing).pdf	PDF	May 24, 2022
Attachment J.7 - BEAST for Responders.pdf	PDF	May 24, 2022
Attachment J.17 - Change_Request_form.docx	DOCX document	May 24, 2022
Attachment J.21 - Billing Labor Categories.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.23 - Facilities Capital Cost of Money Factors Computation Template.pdf	PDF	May 24, 2022
75D301-22-R-72142.doc	DOC document	May 24, 2022
Attachment J.6 - BEAST for Survivors (Draft).pdf	PDF	May 24, 2022
Attachment J.10 - Translation Guide.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.2 - QASP Template.docx	DOCX document	May 24, 2022
Attachment J.16 - Invoice Format May 2022.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.5 - Transfer Policy.pdf	PDF	May 24, 2022
Attachment J.22 - Business Proposal Format.xlsx	XLSX spreadsheet	May 24, 2022
Attachment J.1 - Acronym List.docx	DOCX document	May 24, 2022
Attachment J.3 - Business Associate Agreement Template.docx	DOCX document	May 24, 2022

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Budget Snapshot

Date:	1/1/22
		Summary of Expenses for Period: XXXX (xx/xx/xx - xx/xx/xx)

CCE:

Budget Category Base Period Option Yr 1 Option Yr 2 Option Yr 3 Option Yr 4 Option Yr 5 Option Yr 6 Option Yr 7 Total

Total Direct Labor	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total Sub Contracts Labor	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Other Direct Costs	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total Direct Costs	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total Overhead Costs	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total CLIN 1	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Travel CLIN 2	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total CLIN 1 &2	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total for Period	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

Direct Labor Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Facility	Employee	WTC Billing Labor Category	Annual Salary	Percentage of Effort	Total for Period	Fringe Rate XX%	Total cost	Comments
					0		0

Total

"Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number) "

Subcontract Labor Subcontract Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number) Facility Employee WTC Billing Labor Category Annual Salary Percentage of Effort Total for Period Fringe Rate XX% Total cost Comments

Totals 0

Activity Report

Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Period: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category.
Activity Codes	WTC Billing Labor Category	FTE	Comments
Total FTE reported		0

Rent - Lease Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Provide how Rent/Lease is calculated by completing Attachment 23 (include supporting documentation on original invoice and if a change in rate occurs.

ODC

Other Direct Costs (ODC) for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

All items must have been on proposal or approved in a change request. All receipts to be attached
Invoice/Receipt #	Category of expenses	Amount	Description
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0

Total Direct Costs $ - 0

Overhead Overhead for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Note: G&A, F&A, Fees, and Indirect Rates are to be defined and calculated here.
Allowable Expense Categories:
Facilities Costs (Attachment 23)
Total Expenses	0
Overhead Rate
Total Overhead	0

Travel

Travel Expenditures Contract #: (enter contract number)

All items must have been on proposal or approved in a change request.

Travel requires pre approval documentation.

All items over $5,000 require a receipt.

All travel requires invoices/receipt.

Direct Labor (1) Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Facility	Employee	WTC Billing Labor Category	Annual Salary	Percentage of Effort	Total for Period	Fringe Rate XX%	Total cost	Comments
					0		0

Total

Subcontract Labor (1) Subcontract Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Facility Employee WTC Billing Labor Category Annual Salary Percentage of Effort Total for Period Fringe Rate XX% Total cost Comments

Totals 0

Activity Report (1)

Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Period: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category.
Activity Codes	WTC Billing Labor Category	FTE	Comments
Total FTE reported		0

ODC (1)

Other Director Costs (ODC) for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

All items must have been on proposal or approved in a change request. All receipts to be attached
Invoice/Receipt #	Category of expenses	Amount	Description
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0

Total Direct Costs $ - 0

Rent - Lease (1) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change

Overhead (1) Overhead for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Note: G&A, F&A, Fees, and Indirect Rates are to be defined and calculated here.
Allowable Expense Categories:
Rent/Lease include Attachment 23
Total Expenses	0
Overhead Rate
Total Overhead	0

Travel (1)

Travel Expenditures Contract #: (enter contract number)

All items must have been on proposal or approved in a change request.

Travel requires pre approval documentation.

Direct Labor (2) Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Facility	Employee	WTC Billing Labor Category	Annual Salary	Percentage of Effort	Total for Period	Fringe Rate XX%	Total cost	Comments
					0		0

Total

Subcontract Labor (2) Subcontract Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Facility Employee WTC Billing Labor Category Annual Salary Percentage of Effort Total for Period Fringe Rate XX% Total cost Comments

Totals 0

Activity Report (2)

Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Period: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category.
Activity Codes	WTC Billing Labor Category	FTE	Comments
Total FTE reported		0

ODC (2)

Other Director Costs (ODC) for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

All items must have been on proposal or approved in a change request. All receipts to be attached
Invoice/Receipt #	Category of expenses	Amount	Description
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0

Total Direct Costs $ - 0

Rent - Lease (2) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change

Overhead (2) Overhead for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Note: G&A, F&A, Fees, and Indirect Rates are to be defined and calculated here.
Allowable Expense Categories:
Rent/Lease include Attachment 23
Total Expenses	0
Overhead Rate
Total Overhead	0

Travel (2)

Travel Expenditures Contract #: (enter contract number)

All items must have been on proposal or approved in a change request.

Travel requires pre approval documentation.

Direct Labor (3) Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Facility	Employee	WTC Billing Labor Category	Annual Salary	Percentage of Effort	Total for Period	Fringe Rate XX%	Total cost	Comments
					0		0

Total

Subcontract Labor (3) Subcontract Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Facility Employee WTC Billing Labor Category Annual Salary Percentage of Effort Total for Period Fringe Rate XX% Total cost Comments

Totals 0

Activity Report (3)

Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Period: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category.
Activity Codes	WTC Billing Labor Category	FTE	Comments
Total FTE reported		0

ODC (3)

Other Director Costs (ODC) for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

All items must have been on proposal or approved in a change request. All receipts to be attached
Invoice/Receipt #	Category of expenses	Amount	Description
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0

Total Direct Costs $ - 0

Rent - Lease (3) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change

Overhead (3) Overhead for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Note: G&A, F&A, Fees, and Indirect Rates are to be defined and calculated here.
Allowable Expense Categories:
Rent/Lease include Attachment 23
Total Expenses	0
Overhead Rate
Total Overhead	0

Travel (3)

Travel Expenditures Contract #: (enter contract number)

All items must have been on proposal or approved in a change request.

Travel requires pre approval documentation.

Direct Labor (4) Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Facility	Employee	WTC Billing Labor Category	Annual Salary	Percentage of Effort	Total for Period	Fringe Rate XX%	Total cost	Comments
					0		0

Total

Subcontract Labor (4) Subcontract Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Facility Employee WTC Billing Labor Category Annual Salary Percentage of Effort Total for Period Fringe Rate XX% Total cost Comments

Totals 0

Activity Report (4)

Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Period: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category.
Activity Codes	WTC Billing Labor Category	FTE	Comments
Total FTE reported		0

ODC (4)

Other Director Costs (ODC) for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

All items must have been on proposal or approved in a change request. All receipts to be attached
Invoice/Receipt #	Category of expenses	Amount	Description
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0

Total Direct Costs $ - 0

Rent - Lease (4) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change

Overhead (4) Overhead for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Note: G&A, F&A, Fees, and Indirect Rates are to be defined and calculated here.
Allowable Expense Categories:
Rent/Lease include Attachment 23
Total Expenses	0
Overhead Rate
Total Overhead	0

Travel (4)

Travel Expenditures Contract #: (enter contract number)

All items must have been on proposal or approved in a change request.

Travel requires pre approval documentation.

Direct Labor (5) Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Facility	Employee	WTC Billing Labor Category	Annual Salary	Percentage of Effort	Total for Period	Fringe Rate XX%	Total cost	Comments
					0		0

Total

Subcontract Labor (5) Subcontract Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Facility Employee WTC Billing Labor Category Annual Salary Percentage of Effort Total for Period Fringe Rate XX% Total cost Comments

Totals 0

Activity Report (5)

Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Period: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category.
Activity Codes	WTC Billing Labor Category	FTE	Comments
Total FTE reported		0

ODC (5)

Other Director Costs (ODC) for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

All items must have been on proposal or approved in a change request. All receipts to be attached
Invoice/Receipt #	Category of expenses	Amount	Description
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0

Total Direct Costs $ - 0

Rent - Lease (5) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change

Overhead (5) Overhead for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Note: G&A, F&A, Fees, and Indirect Rates are to be defined and calculated here.
Allowable Expense Categories:
Rent/Lease include Attachment 23
Total Expenses	0
Overhead Rate
Total Overhead	0

Travel (5)

Travel Expenditures Contract #: (enter contract number)

All items must have been on proposal or approved in a change request.

Travel requires pre approval documentation.

Direct Labor (6) Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Facility	Employee	WTC Billing Labor Category	Annual Salary	Percentage of Effort	Total for Period	Fringe Rate XX%	Total cost	Comments
					0		0

Total

Direct Labor (8) Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Facility	WTC Billing Labor Category	Annual Salary	Percentage of Effort	Total for Period	Fringe Rate XX%	Total cost	Comments
				0		0

Total

Subcontract Labor (6) Subcontract Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Facility Employee WTC Billing Labor Category Annual Salary Percentage of Effort Total for Period Fringe Rate XX% Total cost Comments

Totals 0

Activity Report (6)

Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Period: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category.
Activity Codes	WTC Billing Labor Category	FTE	Comments
Total FTE reported		0

Overhead (6) Overhead for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Note: G&A, F&A, Fees, and Indirect Rates are to be defined and calculated here.
Allowable Expense Categories:
Rent/Lease include Attachment 23
Total Expenses	0
Overhead Rate
Total Overhead	0

ODC (6)

Other Director Costs (ODC) for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

All items must have been on proposal or approved in a change request. All receipts to be attached
Invoice/Receipt #	Category of expenses	Amount	Description
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0

Total Direct Costs $ - 0

Rent - Lease (6) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change

Travel (6)

Travel Expenditures Contract #: (enter contract number)

All items must have been on proposal or approved in a change request.

Travel requires pre approval documentation.

Activity & WTC Billing Title

Activity Code	WTC Billing Labor Category	yes	Categories of expenses
4.1 Contract Management (Directors only for this activity)	Administrative Assistant	no	Cleaning Supplies
4.1.1 Training	Administrative Coordinator		Equipment
4.1.1.1 Training Reporting	Benefits Coordinator		Information Tech software
4.1.2 Staffing Requirements	Case Management		Information Tech Supplies
4.1.2.1 Staffing Report and Wages Report	Claims/Billing Manager		Medical Records
4.1.3 Coordination and Participation	Claims/Billing Specialist		Medical Supplies
4.1.4 Change Request (CR), Documentation, and Control Log	Clinic Manager		Office Supplies
4.1.5 Technical Guidance Document Compliance	Data Analyst		Other
4.1.6 Records Management	Deputy Director		Postage/Mailings
4.1.7 Risk and Issue Management	Director
4.1.8 Fraud Waste and Abuse Compliance	Finance Specialist
4.1.9 Quality Assurance Plan	Information Technology
4.1.9.1 Quality Assurance Internal Audit Report	Medical Assistant
4.2 Systems	Medical Records Coordinator
4.2.1.2 Member Records	Member Services Coordinator
4.2.2 Cost Tracking and Invoicing	Member Services Manager
4.2.3 Operations Manual	Nurse
4.3.1 Member Services	Nurse Manager
4.3.2 Member Enrollment and Initial Contact	Pharmacist
4.3.3 Member Retention	Physician
4.3.4 Transfers	Physician Assistant
4.3.5 Disruptive member and Member in Crisis Protocol	Project Coordinator
4.3.6 Benefits Counseling	Psychiatrist
4.3.6.1 Social Benefits Functions	Psychologist
4.3.6.2 Assistance with Workers Compensation and other Healthcare Benefits	Pulmonologist
4.3.7 Communication	Quality Assurance
4.3.7.1 Translation and Interpretive Services	Revised Title
4.3.7.2 Retention Activities for Current Members	Social Worker
4.3.7.3 Outreach and Education for Prospective Members
4.3.7.4 Establish Formal Mechanism for Consulting with Representative of Eligible Populations
4.3.8 Administering Health Benefits
4.3.8.1 Responsibilities of the Medical Director
4.3.8.1.1 External Providers
4.3.8.2 Responsibilities of the Mental Health Director
4.3.8.3 Monitoring and Initial Health Evaluations
4.3.8.3.1 Initial Health Evaluations
4.3.8.3.2 Annual Monitoring Exam
4.3.8.3.3 General Administration for AME/IHE
4.3.8.4 Diagnostic Services
4.3.8.6 Cancer Screening
4.3.8.7 Certifications
4.3.9 Medical Treatment for Certified Conditions
4.3.9.1 Authorization of Services
4.3.9.3 Prior Authorization]
4.3.9.4 CCE Medical Reviews
4.3.9.5 Medical Appeals
4.3.9.6 Telehealth Services
4.3.9.7 Disaster Preparedness and Public Health Emergencies
4.4 Comprehensive Care Management (do not use, select sub-category)
4.4.1 Case Management and Care Coordination
4.4.1.1 Intensive Case Management
4.4.2 Utilization Management
4.4.3 Inpatient Hospital stays
4.4.4 Lifestyle Medicine
4.5 Claims submission and Payment
4.5.1 Legally allowable fee schedule
4.5.2 Billing for Health Plan Benefits
4.5.3 Claims Appeals
4.5.4 Coordination of Benefits (Survivor Cohort Only)
4.6 Pharmacy Services
4.6.1 Member Education
4.6.2 Covered Medication and Restrictions
4.6.3 Review of Data
4.6.4 Compliance with State and Federal Law
4.6.5 Retrospective Reviews and Reporting
4.6.6 Pharmacy Benefits Quality Assurance and Reporting
4.7.1 Provider Network
4.7.2 Licensing and Insurance
4.8 Transitioning Out
5.1 Data Management Plan
5.2 Data Transfer
6 Performance Metrics
6.1 Quality Assurance Surveillance Plan
9 Deliverables
10 Subcontracting
11 HIPAA COMPLIANCE AND BUSINESS ASSOCIATE AGREEMENT
12 Information Security
12.1 Adequate Security
12.2 Cyber Incident Reporting Requirement
12.3 Cyber Incident Report
12.4 Media Preservation and Protection
12.5 Audit and Accountability (information security)
12.6 Information Security Continuous Monitoring
12.7 Access to Additional Information or Equipment Necessary for Forensic Analysis
12.8 Cyber Incident Damage Assessment Activities
12.9 CDC/NIOSH Safeguarding and Use of Contractor Attributional/Proprietary Information (do not use)
12.1 Use and Release of Contractor Attributional/Proprietary Information Not Created By or For CDC/NIOSH (Do not use)
12.11 Use and Release of Contractor Attributional/Proprietary Information Created By or For CDC/NIOSH (do not use)
12.12 Use and Release of Contractor Attributional/Proprietary Information Created By or For CDC/NIOSH (do not use)
12.13 Other Safeguarding or Reporting Requirements
12.14 Subcontracts

Direct Labor (7) Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Facility	Employee	WTC Billing Labor Category	Annual Salary	Percentage of Effort	Total for Period	Fringe Rate XX%	Total cost	Comments
					0		0

Total

Subcontract Labor (7) Subcontract Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Facility Employee WTC Billing Labor Category Annual Salary Percentage of Effort Total for Period Fringe Rate XX% Total cost Comments

Totals 0

Activity Report (7)

Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Period: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category.
Activity Codes	WTC Billing Labor Category	FTE	Comments
Total FTE reported		0

ODC (7)

Other Director Costs (ODC) for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

All items must have been on proposal or approved in a change request. All receipts to be attached
Invoice/Receipt #	Category of expenses	Amount	Description
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0
		$ - 0

Total Direct Costs $ - 0

Rent - Lease (7) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)

Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change

Overhead (7) Overhead for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number)

Note: G&A, F&A, Fees, and Indirect Rates are to be defined and calculated here.
Allowable Expense Categories:
Rent/Lease include Attachment 23
Total Expenses	0
Overhead Rate
Total Overhead	0

Travel (7)

Travel Expenditures Contract #: (enter contract number)

All items must have been on proposal or approved in a change request.

Travel requires pre approval documentation.

File details come from the government source that posted it. Updated Jun 7, 2022.