The file's text, extracted by GovTribe without its formatting.
Revised Option 1
| Agency: | | | | |
| Program: | | | | |
| FY 24-25 | | | | |
| Line Item | Total Program Budget | Funding Request (how will the funds requested via this RFP be used) | HSA Recommendation | Included in MTDC? |
| Revenue | | | | |
| Funding being requested via this RFP | | | | |
| | $ - 0 | | | | |
| Total Revenue | $ - 0 | ERROR:#REF! | | | | |
| Expense | | | | | | |
| Personnel Expense | | | FTE | | MTDC? | Description/Explanation |
| List all staff positions, their salary, and the FTE for this contract | | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| | | | | yes | |
| Benefits | $ - 0 | $ - 0 | | $ - 0 | yes | |
| subtotal personnel | $ - 0 | $ - 0 | | $ - 0 | YES | |
| Operating Expenses | | | | | MTDC? | Description/Explanation |
| Supplies | | | | | | |
| Telephone/Communications | | | | | | |
| Employee-Related Expenses (Recruiting, Conference Fees, Fingeprinting, Health Screen, etc.) | | | | | | |
| Facilities-Related Expenses (Utilities, Maintenance Repair, Real Estate Taxes, etc.) | | | | | | |
| Client-Related Expenses (Food, Transportation, etc.) | | | | | | |
Insert all Other Operating Expenses (list each on its own row) (items included above are just examples, can be edited or removed)
| subtotal operating expenses | $ - 0 | $ - 0 | $ - 0 | |
| Admin Expense | | | | Description/Explanation |
| Administrative expense | $ - 0 | $ - 0 | $ - 0 | |
| subtotal admin expense | $ - 0 | $ - 0 | $ - 0 |
| Total Expenses | $ - 0 | $ - 0 | $ - 0 |
| SUBTOTAL | $ - 0 |
| SUBTOTAL EXCLUDING DIRECT CLIENT PAYMENTS | $ - 0 |
| ICR off total (as historically calculated at 15%) | $0.00 |
| ICR off personnel (at 15%) | $0.00 |
| De Minimus (15%) | $0.00 |
| ICR if treated as client services contract only and personnel and operating costs were covered in indirect costs (at 15%) | $0.00 |
Cost Summary
| Name of agency: | | |
| Program Name | Core Services | |
| Cost Summary | |
| FY25-26 (July 2025–June 2026) | $ - 0 |
| FY26-27 (July 2026–June 2027) | $ - 0 |
| FY27-28 (July 2027–June 2028) | $ - 0 |
| Total Costs | $ - 0 |
FY25-26
| Agency: | | |
| Program: Core Services | | |
| FY25-26 | | |
| Line Item | Total Program Budget | Funding Request (how will the funds requested via this RFP be used) |
| Revenue | | |
| Funding being requested via this RFP | | |
| Other funding sources (foundation funding, individual donations, corporate donations, contracts with public entities or others). List each contract/funding in its own row. Please add in more rows if needed. | | |
In kind (facilities, maintenance, other)
| Total Revenue | $ - 0 | | $ - 0 |
| Expenses | | | |
| Personnel Expenses | | | |
| (List all staff positions that are a part of the Core Service Agency program (the amounts listed in column C should include salaries, benefits and taxes for these positions). | FTE* | | FTE funded by HSA Funding** | Description/Explanation |
| List all staff positions, their salary, and the FTE for this contract | | | |
| Benefits (if not included above) | | | | | |
| Subtotal Personnel | $ - 0 | 0.00 | $ - 0 | 0.00 | |
| Operating Expenses - MTDC | | | | | Description/Explanation |
| Supplies | | | | | |
| Telephone/Communications | | | | | |
| Subtotal Operating Expenses - MTDC | $ - 0 | $ - 0 |
| Operating Expenses - non-MTDC | | |
| Facilities-Related Expenses for Program (Utilities, Maintenance Repair, etc.) | | |
| Client-Related Expenses (Food, Transportation, etc.) | | |
Insert all Other Operating Expenses (list each on its own row) (items included above are just examples, can be edited or removed)
| Subtotal Operating Expenses - non-MTDC | $ - 0 | $ - 0 | | |
| Indirect Costs (up to 15% of MTDC—see RFP) | | | FTE funded by HSA Funding** | Description/Explanation |
| Maximum Indirect Costs | $ - 0 | $ - 0 | | |
| Indirect Costs | | | | |
| Subtotal Indirect Costs | $ - 0 | $ - 0 | 0.00 |
| Total Expenses | $ - 0 | $ - 0 | |
| * List the proportion of each position that will be allocated to the Core Service Agency program |
| ** List the proportion of each position that will be funded by the HSA funding being requested via this RFP |
FY26-27
| Agency: | | |
| Program: Core Services | | |
| FY25-26 | | |
| Line Item | Total Program Budget | Funding Request (how will the funds requested via this RFP be used) |
| Revenue | | |
| Funding being requested via this RFP | | |
| Other funding sources (foundation funding, individual donations, corporate donations, contracts with public entities or others). List each contract/funding in its own row. Please add in more rows if needed. | | |
In kind (facilities, maintenance, other)
| Total Revenue | $ - 0 | | $ - 0 |
| Expenses | | | |
| Personnel Expenses | | | |
| (List all staff positions that are a part of the Core Service Agency program (the amounts listed in column C should include salaries, benefits and taxes for these positions). | FTE* | | FTE funded by HSA Funding** | Description/Explanation |
| List all staff positions, their salary, and the FTE for this contract | | | |
| Benefits (if not included above) | | | | | |
| Subtotal Personnel | $ - 0 | 0.00 | $ - 0 | 0.00 | |
| Operating Expenses - MTDC | | | | | Description/Explanation |
| Supplies | | | | | |
| Telephone/Communications | | | | | |
| Subtotal Operating Expenses - MTDC | $ - 0 | $ - 0 |
| Operating Expenses - non-MTDC | | |
| Facilities-Related Expenses for Program (Utilities, Maintenance Repair, etc.) | | |
| Client-Related Expenses (Food, Transportation, etc.) | | |
Insert all Other Operating Expenses (list each on its own row) (items included above are just examples, can be edited or removed)
| Subtotal Operating Expenses - non-MTDC | $ - 0 | $ - 0 | | |
| Indirect Costs (up to 15% of MTDC—see RFP) | | | FTE funded by HSA Funding** | Description/Explanation |
| Maximum Indirect Costs | $ - 0 | $ - 0 | | |
| Indirect Costs | | | | |
| Subtotal Indirect Costs | $ - 0 | $ - 0 | 0.00 |
| Total Expenses | $ - 0 | $ - 0 | |
| * List the proportion of each position that will be allocated to the Core Service Agency program |
| ** List the proportion of each position that will be funded by the HSA funding being requested via this RFP |
FY27-28
| Agency: | | |
| Program: Core Services | | |
| FY25-26 | | |
| Line Item | Total Program Budget | Funding Request (how will the funds requested via this RFP be used) |
| Revenue | | |
| Funding being requested via this RFP | | |
| Other funding sources (foundation funding, individual donations, corporate donations, contracts with public entities or others). List each contract/funding in its own row. Please add in more rows if needed. | | |
In kind (facilities, maintenance, other)
| Total Revenue | $ - 0 | | $ - 0 |
| Expenses | | | |
| Personnel Expenses | | | |
| (List all staff positions that are a part of the Core Service Agency program (the amounts listed in column C should include salaries, benefits and taxes for these positions). | FTE* | | FTE funded by HSA Funding** | Description/Explanation |
| List all staff positions, their salary, and the FTE for this contract | | | |
| Benefits (if not included above) | | | | | |
| Subtotal Personnel | $ - 0 | 0.00 | $ - 0 | 0.00 | |
| Operating Expenses - MTDC | | | | | Description/Explanation |
| Supplies | | | | | |
| Telephone/Communications | | | | | |
| Subtotal Operating Expenses - MTDC | $ - 0 | $ - 0 |
| Operating Expenses - non-MTDC | | |
| Facilities-Related Expenses for Program (Utilities, Maintenance Repair, etc.) | | |
| Client-Related Expenses (Food, Transportation, etc.) | | |
Insert all Other Operating Expenses (list each on its own row) (items included above are just examples, can be edited or removed)
| Subtotal Operating Expenses - non-MTDC | $ - 0 | $ - 0 | | |
| Indirect Costs (up to 15% of MTDC—see RFP) | | | FTE funded by HSA Funding** | Description/Explanation |
| Maximum Indirect Costs | $ - 0 | $ - 0 | | |
| Indirect Costs | | | | |
| Subtotal Indirect Costs | $ - 0 | $ - 0 | 0.00 |
| Total Expenses | $ - 0 | $ - 0 | |
| * List the proportion of each position that will be allocated to the Core Service Agency program |
| ** List the proportion of each position that will be funded by the HSA funding being requested via this RFP |