J.48 CLIN 0015 Cost Proposal Template - Option Year 5 (MPIP).xlsx
XLSX spreadsheet 30 KB Posted
- Solicitation number
- 75FCMC19R0041
About this file
This document contains cost templates and travel templates for a federal contract solicitation. The solicitation is for Durable Medical Equipment Medicare Administrative Contractor services to process and pay Medicare claims for Jurisdiction C, which includes Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, Puerto Rico, and the U.S. Virgin Islands. The templates require the contractor to provide detailed cost breakdowns for direct labor, fringe benefits, travel, subcontractors, other direct costs, indirect costs, fees, and the total cost for each contract line item number. Travel templates must include information on the purpose of each trip, originating and destination locations, number of travelers, number of trips, estimated lodging and per diem costs, airfare expenses, rental car costs, and other miscellaneous trip expenses.
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Text version
CLIN 0015
| COST TEMPLATE - Attachment J.48 | |||
| (Provide a cost spreadsheet for each CLIN proposed) | |||
| CLIN 0015 | T.8 | ||
| Total FTEs | Medicare Healthcare Provider Intervention Program (MPIP) | ||
| Hours | Total | ||
| COST ELEMENTS |
| Direct Labor | |||
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| Add Other Appropriate Labor Categories (note: labor categories should match WBS) | 0 | $0.00 | $0.00 |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| 0 | $0.00 | $0.00 | |
| Subtotal Direct Labor | 0 | $0.00 | $0.00 |
Fringe Benefits (at ____%) $0
Total Direct Labor $0
| Travel (See separate schedule. Total should match) | $0 | |
| SUBCONTRACTORS | ||
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Subcontractor Name | 0 | $0.00 |
| Total Subcontractor | 0 | $0.00 |
Other Direct Costs (See separate schedule. Total should match.) $0
TOTAL ALL DIRECT COSTS $0
Indirect Costs (at ______ %) $0
TOTAL OTHER BEFORE FEE $0
| Base Fee (at ____%) | $0 |
| Award Fee (at ______%) | $0 |
| Fixed Fee (at ______%) | $0 |
TOTAL OTHER AFTER FEE $0
| GRAND TOTAL | $0 |
| V2 04242012 |
| 20180524 |
| 20180829 |
| 8/29/19 |
&"Arial,Bold"&12 75FCMC19R0041 DME Medicare Administrative Contractor (MAC)
Confidential, Procurement Sensitive
TRAVEL
| COST TEMPLATE - Attachment J.48 |
| TRAVEL SUMMARY |
| CLIN 0015 |
| Purpose of Trip | SOW WBS | |||
| Crosswalk | Labor Category Taking Trip | Trip Origin | Destination | # People |
| (A) | # Trips | |||
| (B) | # Days | |||
| (C) | # Nights | |||
| (D) | Lodging Rate | |||
| (E) | Lodging | |||
| (F=E*D*A) | M&IE | |||
| (G) | Total Lodging |
and M&IE
| (H=F+G) | Airfare |
| (I) | Car Rental |
| (J) | Misc. |
| (K) | Local |
Mileage
| (L) | Total Per Trip |
| (M=H+I+J+K+L) | Total For All Trips |
(N=M*B )
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| $ - | $ - | $ - | $ - | ||
| TOTAL TRAVEL | $ - | ||||
| Travel Assumptions: |
Confidential, Procurement Sensitive
ODC
COST TEMPLATE - Attachment J.48
| CLIN 0015 DME SERVICES | GRAND | |
| Cost Element | Amount | TOTAL |
| $0.00 | ||
| Add costs by category | $0.00 | |
| $0.00 | ||
| $0.00 | ||
| $0.00 | ||
| $0.00 | ||
| $0.00 | ||
| $0.00 | ||
| TOTAL ODCs | $0.00 | $0.00 |
Confidential, Procurement Sensitive
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