Att D - HFO Budget Template 2025-2027 - FINAL.xlsx

XLSX spreadsheet 144 KB Posted May 27, 2026

Attached to: RFA for HFO Baker and Malheur Counties
Solicitation number: S-58800-00017054
Issued by: Oregon

About this file

Written by GovTribe AI · Jun 2, 2026

This is a Healthy Families Oregon (HFO) budget template for the 2025-2027 biennium (July 1, 2025 - June 30, 2027) applicable to lead agencies and subcontractors serving Baker and Malheur counties. The budget template accommodates three program agreement structures: lead agencies providing all program oversight and direct services, lead agencies providing oversight and some direct services with subcontractors, or lead agencies providing oversight only with subcontractors delivering all direct services. The template requires agencies to complete revenue sections identifying General & ELA Fund allocations, Medicaid, Title IV-B2, and other funding sources, and to detail personnel expenditures including core positions such as Program Manager (minimum 0.5 FTE), Supervisors (1:5 ratio recommended for Home Visitors), Eligibility Screeners, Home Visitors, and Data Entry support staff. The budget period covers 21 months, with salary calculations based on annual figures automatically adjusted for this timeframe.

Administrative and indirect costs cannot exceed 15% of the General Fund allocation, and HFO General Funds cannot support non-CORE positions or HUB personnel. The template provides guidance on non-personnel costs including Advisory Board meetings, cell phones and service, computers, curriculum materials (with Growing Great Kids identified as aligned with the HFA model), professional development, required training costs for FROG Scale and HFA Supervisor Resources and Reflections, HFA National Conference attendance, and mileage reimbursement at $0.66 per mile. Central Administration covers Core FFS Training, HFA Annual Affiliation and Accreditation fees, and Statewide Evaluation costs including ASQ materials. Lead agencies must identify funding sources for each expenditure category and complete separate subcontractor budget tabs for each contracted partner, with subcontractors similarly limited to 15% administrative costs as part of total program allocation.

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Other files

File	Type	Posted
Att E - HFO Fiscal Guidelines 2025-2027_Final.pdf	PDF	May 27, 2026
Addendum 1- RFA HFO - Baker Malheur Counties_S-58800-00017054.pdf	PDF	May 27, 2026
Att F - HFA Best Practice Standards_version-8.4 Jul 2025.pdf	PDF	May 27, 2026
Att H - Staffing_Plan.xlsx	XLSX spreadsheet	May 27, 2026
Att B - Disclosure.docx	DOCX document	May 27, 2026
RFA HFO - Draft Baker Malheur Counties.pdf	PDF	May 27, 2026
Att G - FINAL.HFO_PPPM_8th_Edition_HFO_PPPM.42723.pdf	PDF	May 27, 2026
Att A - Sample Grant.pdf	PDF	May 27, 2026
Att C - Cover Sheet - Baker Malheur County.pdf	PDF	May 27, 2026

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INSTRUCTIONS

Healthy Families Oregon - Budget Instructions
Please note: Healthy Families Oregon's fiscal guidelines can be found in our Program Policy and Procedure Manual
Within the HFO System, there are 3 types of program agreement structures:
1	Grantee provides all program oversite and employs staff for all direct services, within the service delivery area.
2	Grantee provides all program oversite, employs staff for SOME direct services, and has subcontract(s) with 1 or more agencies for additional direct services, all within the service delivery area
3	Grantee provides program oversite, but no direct service. Grantee has 1 or more subcontracts for ALL direct services, within the service delivery area.

Read through the contract structures above to determine where your program fits.

1	If you are #1, then you will complete the Lead Agency Budget and only that budget tab (blue)
2	If you are #2, then you will complete the Lead Agency Budget to capture your Administration, indirect costs and direct service costs AND complete additional "Subcontractor Budgets", one for each subcontractor.
3	If you are #3, then you will complete the Lead Agency Budget to capture your Administration and indirect costs and the "Subcontractor Budgets", one for each subcontractors.

HFO Budget Guidance Tab:

Review the HFO Budget Guidance tab, for guidance on HFO CORE services costs, and typical costs needed to support an HFO program.

Budget Summary Tab:

** You will not put any information into the BUDGET SUMMARY. This tab will auto calculate based on your other budgets.

Lead Agency Budget Tab:
AGENCY & REVENUE:
1	Fill out your AGENCY INFORMATION at the top, A3:A10
2	You cannot fill in your DELC Contract Amount in D9, this will autofill from the General Fund
3	Enter your agency fringe percentage in D10, this will then auto-calculate for all staff
4	If the staff within your agency have different benefits (therefore their fringe percentange is different than most within the agency) enter their fringe percentage in the white cell below their FTE, in the Salary & Benefits section. If a % is entered here, it will override the % in D10 for this staff person.
5	Next, complete the REVENUE section, under the green heading. All funding under your DELC grant for HFO Services should be entered here, for the time period July 1, 2025 - June 30, 2027
6	Please enter in your 7/1/2025 - 6/30/2027 GENERAL & ELA FUND ALLOCATION, and any additional funding you may receive

PERSONAL SERVICES EXPENDITURES:
7	Enter each annual base salary in column A (do not try to enter each individual FTE in column C, this will autocalculate for 21 months later)
8	In columns E through I - indicate what % of each staff person's fte is paid for be each funding stream. 1 = 100%, .85 = 85%, .5 = 50%, ect. This will autocalculate Column C
9	If you have staff to enter in "Other Staff", you need to enter their Fringe % directly into C87 and C89
PROGRAM MATERIALS & EXPENDITURES:
10	Enter in your cost (column CD) and quantity (column F) Use colum E to inform what you need to ender into the Column F (quantity) - Your estimated cost will calculate in column J. Column C, D and F have instructions/clarifications in each box, just click in the box
11	Next, move over to columns M through P and allocate where the funding will come from for each of these program expenditures. Your column L expenditures should not exceed your column J costs.
ADMINISTRATIVE/INDIRECT EXPENDITURES
12	You can add (just type over "other?") or change any of the typical Administrative and Indirect positions listed here
13	Indicate how much of each person's fte is spent on HFO
14	Indicate how much funding comes from each funding stream for those Administrative/Indirect costs.
15	Your total program Administrative and Indirect costs should not exceed 15% of your 7/1/2025 - 6/30/2027 General Fund program allocation

Subcontractor Budget Tabs (#1 - #4)
1	Fill in your Subcontractor Agency Name at B6
2	Fill in your your agencies fringe benefit % (costs are not calculated in the budget)
3	Next, fill in the REVENUE section with the subcontracted amounts from your contractor
4	Follow instructions #7 - #15 above

HFO Budget Guidance

		BUDGET GUIDANCE WHEN DEVELOPING AN HFO PROGRAM BUDGET
	Definitions and helpful information:
	Personnel Costs
	Program Manager
(must be a mimimum of .5fte)	The Program Manager responsibilites including overall program accountability and supervision of the Supervisor(s) and sometimes the screeners. PM and Supervisor can also be combined into 1 position when feasible. The PM position is NOT an administrative cost, this is a CORE position for HFA programs.
	Supervisor
1:5 Supervisor to Home Visitor ratio is recommended and best practice	Supervisor to Home Visitor ration: 1FTE Sup:5 full time FTE home visitors. A 1:6 ratio is allowable, but not encouraged. (Review Best Practice Standards (#12) for supervision requirements/ratios of part time home visitors).
	Eligibility Screener (ES)	A full-time ES will conducts multiple NBQ screens each week, along with community outreach and referral activities. Be sure to consider potential costs of an ES driving to and from hosptials and community agencies such as WIC for screens, as well as community presentations. This position may also include data entry.
	Home Visitors	A Home Visitor provides parent coaching, education and guidance through 1:1 in-home services. HFA/HFO uses a weighted caseload point system to help programs effectively manage caseload capacity at any given time. While maximum max caseload points for a full time Home Visitor is 30 points, Best Practice is a maximum of 24 points, and HFO encourages this. Details for this can be found in BPS # 8. A 1.0 fte home visitor, who has been employed for HFO for at least 12 months, must maintain a minimum caseload of 18 points. Caseload points will slowly increase through a new home visitor's first year of employment. See the PPPM, Standard 8, for details on this.
	Data Entry/Support	This optional position will provide support to the program and assistance with data entry into the statewide data system.
	Administrative and Indirect Costs	The cost for administrative and indirect support from the agency will vary. Some organizations provide a portion of these services as in-kind contribution to the program. These costs should not equal more than 15% of the HFO General Fund Allocation. If the lead contracting agency has subcontracts with other agencies for this HFO work, the total administrative and indirect costs, between all agencies, cannot exceed 15% of the HFO allocation from DELC. Please note, the HFO Program Manager position is not administrative. Any other higher management fte should be charged to administration if being paid for by HFO General Funds.

Non-Personnel Costs
Advisory Board Meetings	HFA requires programs to utilize a governance structure inclusive of an advisory committee or board that meets regularly to review and strategize program planning, implementation, and evaluation. To accommodate professionals and families with busy day schedules, it is appropriate to host these meetings in the evening. Providing dinner (or lunch in the afternoon) is an exceptable expenditure and can make attendance by members more consistant. Food and material for meetings are typical expenses for Advisory meetings.
Cell Phones	Cell phones are not required, however they allow for enhanced communications and safety protocols within programs. For both of these reasons, cell phones are highly encourage. Staff using personal cell phones is discouraged to help maintain professional boundaries with program participants, allowing staff to keep their personal cell phones personal. Work cell phones can also help with navigation when going to visit a new family, as well as another safety procaution.
Cell Service & Land-line phones	Programs may choose to reimburse each staff's personal cell phone bill for business related charges or to establish a business account with a cellular provider to provide all phones and service (preferred). Additionally, many programs also have "desk" land-line phone for staff. Some programs are finding that if their staff have a cell phone, they don't need the land-line phones.
Computers	Laptops, while not required, increase staff efficiency and provide a mechanism for expedited completion of participant documentation and provide a mechanism to view educational videos with parents who do not have a DVD player.
Copies	The program will make numerous copies of program forms and tools. Programs may purchase or lease the necessary equipment to do so.
Family Support Materials	Most HFO programs utilize Growing Great Kids curriculm, as it aligns very well with the HFA model. However, HFA does not prescribe a particular curriculum. Programs will choose participant curriculum that is evidence informed, strength-based, family centered and meets the needs of the population being served. This line is also where home visit supply costs can be budgeted.
Family Support Meetings	Opportunities to bring families together is not a required program component, however programs are encouraged to do so as a mechanism to help families develop a healthy informal social support system.
HFA Conference	The PCAA/HFA national conference is held once every other year with numerous sessions geared toward managers, supervisors, and direct service staff. On inbetween years, HFA offers a Leadership Conference. These conferences are typically in late summer to early fall time of year, and are often hosted in the mid-west (recent conferences have been in Chicago, Cincinnati, New Orleans)
Internet Fees	Internet service allows staff to access the HFA Learning Center for no-cost training, along with email communication, and resource gathering for families etc.
Mileage	Adjust miles per month to reflect your geographic area. There are 3 mileage lines: 1) Home Visitor 2) Eligibility Screeners 3) Program Managers and Supervisors. Adjust mileage reimbursement rate if needed
Office Supplies	Adjust unit cost assumptions to reflect your local costs
Professional Development	HFA requires that all staff have opportunities for ongoing professional development to advance skills and reduce burnout.

HFA Services to Insure Model Fidelity

Core FFS Training	(UPDATE) CENTRAL ADMINISTRATION (DELC) WILL PAY FOR FSS CORE TRAINING. PROGAM SITES WILL BE RESPONSIBLE FOR COVERING ADDITIONAL TRAINING COSTS
Core FROG Survey Training	FROG Core training is provided by HFA national office. Program sites are responsible for registering staff with HFA national office.
Core Supervisor Training	FROG Supervisor and HFA Supervisor Resources and Reflections is provided by HFA national office. Program sites are responsible for registering staff with HFA national office for these trainings.
HFA Annual Fee Affiliation Application Accreditation Application Peer Reveiwer Travel Expenses	CENTRAL ADMINISTRATION (CA) WILL ALSO COVER THESE HFA NATIONAL COSTS FOR EACH SITE

Measurement Tools/Database/Evaluation
General Guidance	HFO Central Administration pays for the cost of our Statewide Evaluation
ASQ Materials	The Ages and Stages Questionnaire (ASQ3) and Ages and Stages Social-Emotional Questionnaire (ASQ-SE) are both child development screening tool, both of which are required by HFO.

Budget Summary

Healthy Families Oregon - Budget Summary
Contracting Agency:	0	# of Subcontracts
Counties served:	Baker Malheur
Budget Period:	July 1, 2025 - June 30, 2027

REVENUE
	Quarter 1-8

GENERAL FUNDS

(must be spent before Jun 30, 2027)		Allocations		Budget	General & ELA Funds- Grant award	Medicaid	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
	This amount will go into your AMS account for
7/1/25 - 6/30/27	Lead Agency		0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
			Subcontractor #1		0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	ERROR:#REF!			TOTAL REVENUE		ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!	ERROR:#REF!

PERSONAL SERVICES EXPENDITURES
		Expenditures		Budget	General & ELA Funds- Grant award	Medicaid	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
	Lead Agency		0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	Subcontractor #1		0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
			TOTAL PERSONAL SERVICES EXPENDITURES	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

MATERIALS & SUPPLIES EXPENDITURES
		Expenditures		Budget	General & ELA Funds- Grant award	Medicaid	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
	Lead Agency		0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	Subcontractor #1		0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
			TOTAL MATERIALS & SUPPLIES EXPENDITURES	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

ADMINISTRATIVE/INDIRECT EXPENDITURES
	General Fund allowable for administation is limited to 15% of the General Fund award		Expenditures		Revenue Budget	General & ELA Funds- Grant award	Medicaid	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
		Lead Agency		0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	You may claim up to	Subcontractor #1		0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
				TOTAL ADMINISTRATIVE/INDIRECT EXPENDITURES	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0

Lead Agency Budget Healthy Families Oregon - Program Budget Detail

Prime Contractor - Agency Name:
Counties Served:	Baker Malheur
Do you subcontract HFO program services to other agencies?

Budget Period:	July 1, 2025 - June 30, 2027	REVENUE
NTE Estimated Amount to Lead Agency:		Total Program Funding Summary

	Personal Services Fringe Benefits %		Revenue Budget	General & ELA Funds	Medicaid
(amount planned to allocate this biennium)	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
			$ - 0

	PERSONAL SERVICES EXPENDITURES
	SALARIES & BENEFITS		Position FTE	Base Salary
(21 Months)	General Fund & ELA
FTE %	Medicaid
FTE %	Title IV-B2
FTE %	MIECHV
FTE %	County GF, Fundraising, Foundation, Grants, Other %	Fringe Benefits %		Expenditure Budget	General & ELA Funds	Medicaid
(amount planned to allocate this biennium)	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
	Enter Annual Salary
		Program Manager	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Program Manager Assistant	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	- 0	Supervisor 1	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Supervisor 2	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Supervisor 3	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Supervisor 4	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Supervisor 5	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Community Outreach	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Eligibility Screener 1	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Eligibility Screener 2	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Eligibility Screener 3	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Eligibility Screener 4	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Data Entry & Admin Support	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 1	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 2	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 3	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 4	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 5	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 6	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 7	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 8	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 9	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 10	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 11	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 12	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 13	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 14	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 15	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 16	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 17	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 18	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 19	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 20	0.00	$ - 0				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		TOTAL FTE	Position FTE	Base Salary
(21 Months)	Total # FTE GF Funded Home Visitors	Total # FTE Medicaid Home Visitors	Total # FTE Title IV-B2 Home Visitors	Total # FTE MIECHV Home Visitors	Total # FTE

Other Home Visitors

0.00 $ - 0 0.00 0.00 0.00 0.00 0.00

	Other Staff
Optional. Cannot be paid for by GFs	Mental Health Consultant	0.00	Cannot use this $ for non HFO CORE positions	Cannot use this $ for non HFO CORE positions		$ - 0	Cannot use this $ for non HFO CORE positions	$ - 0	Cannot use this $ for non HFO CORE positions	$ - 0
	Fringe				$ - 0	$ - 0		$ - 0		$ - 0
	OTHER Non HFO CORE position?	0.00				$ - 0		$ - 0		$ - 0
	Fringe				$ - 0	$ - 0		$ - 0		$ - 0
	TOTAL SALARIES AND BENEFITS					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

		MATERIALS & SUPPLIES EXPENDITURES
	Special notes or instructions:	Program	Cost	Time Frame	Quantity	Description	Cost	Expenditure Budget	General & ELA Funds	Medicaid
(amount planned to allocate this biennium)	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
		Advisory Board meetings	$ 250.00	monthly? Quarterly?		# of Advisory Committee meetings during the 21 month budget period	$ - 0	$ - 0
		Cell Phones Purchase	$ 500.00	per staff		# of phones you anticipate needing to purchase. Do you need to replace any phones? Anticipate any additional staff positions?	$ - 0	$ - 0
		Cell Phone Service	$ 45.00	per staff/month		# of staff who use cell phones	$ - 0	$ - 0
		Copies of Forms/Tools	$ 25.00	per family/per month		# of families typically receiving services at any one time	$ - 0	$ - 0
	This should not be an ongoing cost, only if new computers need to be purchased. Computer maintenance should be captured in Administration costs	Computers (purchase of new)	$ 1,100.00	per staff		# of staff that will need new computers	$ - 0	$ - 0
		Family Support Materials (ie - curriculum materials and home visit supplies)	$ 100.00	per family/month		# of families	$ - 0	$ - 0
		Family Support Meetings	$ 50.00	per month		# of meetings	$ - 0	$ - 0
		Land Line phone and/or Internet Service		per month	24	months	$ - 0	$ - 0
	If your agency pays a different rate per mile, then change the amount in cells C116, C118 & C120	Mileage (Home visitors)	$ 0.66

DEAHN Erin - ELD: DEAHN Erin - ELD:

Change this mileage reimbursement rate if needed	per mile	0			$ - 0	$ - 0
	Enter estimated # of miles here:		# miles/month/hvor	$ - 0			cost/mo/hv
	Mileage (Elig. Scrnrs & Outreach)	$ 0.66

DEAHN Erin - ELD: DEAHN Erin - ELD:

Change this mileage reimbursement rate if needed	per mile	0			$ - 0	$ - 0
	Enter estimated # of miles here:		#miles/month/elig screeners & outreach	$ - 0			cost/mo/hv
	Mileage (PM & Supervisors)	$ 0.66

DEAHN Erin - ELD: DEAHN Erin - ELD:

Change this mileage reimbursement rate if needed BAKER Dawn * DELC: BAKER Dawn * DELC:

Enter the ANNUAL SALARY			#miles/month/PM & sups	0			$ - 0		$ - 0
		Enter estimated # of miles here:		# miles/month/hvor	$ - 0			cost/mo/hv
		Office Supplies		per staff/month	0			$ - 0		$ - 0
		Postage		per month	24			$ - 0		$ - 0
		Professional Development		per staff/year	0	Many programs choose to allocate a specific amount of funding per staff person, for trainings they are interested in.		$ - 0		$ - 0
	Each site is responsible for registration of staff for FROG scale, FROG Scale for Supervisors, and HFA Supervisor Resources and Reflections training offered by HFA national office.	FROG Scale Core		costs per anticipated staff person		Anticipated # of new staff, including staff turn over		$ - 0		$ - 0
		FROG Scale Supervisor		costs per anticipated staff person		Anticipated # of new staff, including staff turn over		$ - 0		$ - 0
		HFA Supervisor Resources and Reflections		costs per anticipated staff person		Anticipated # of new staff, including staff turn over		$ - 0		$ - 0
	Each site is responsible for training their staff in the primary curriculum that they have chosen to use.	Primary Curriculum Training		Cost per curriculum training		Anticipated # of staff that will need to be trained in primary curriculum		$ - 0		$ - 0
		Curriculum training travel costs		flight, hotel & car rental, and mileage reimbursement		# of trainings		$ - 0		$ - 0
	Attendance NOT required but a great opportunity for Program Managers and/or Supervisors	HFA Nat'l Conference Travel/registration		1x year				$ - 0		$ - 0
	This is not required, but highly encourages to build positive team relationships. If you'd like to make this part of your training plan you can.	Staff Training Retreat		1x/year				$ - 0		$ - 0
	Cannot be paid for with HFO general fund $$	Ancillary supplies (diapers, books, safety supplies, gas cards, bus tickets)		Cannot be paid for with HFO general fund $$				$ - 0		$ - 0
		"Welcome Baby" Packets (often provided during eligibility screening) or other eligibility screen materials/supplies		per month	24	months		$ - 0		$ - 0
		Office Space & Maintenance (utilities, insurance, etc.)		per month	24	months		$ - 0		$ - 0
				per month				$ - 0		$ - 0
				per month				$ - 0		$ - 0
				per month				$ - 0		$ - 0
		TOTAL MATERIALS AND SUPPLIES COSTS								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

	ADMINISTRATIVE/INDIRECT EXPENDITURES
						Expenditure Budget	General & ELA Funds	Medicaid
(amount planned to allocate this biennium)	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
					FTE spent on HFO
				Executive Director		$ - 0
			If you have additional administration/indirect costs line items, you can add them here. You are not restricted to only these items. You may also delete positions if they do not apply to HFO. HFO General Funds cannot pay for any HUB personnel, indirect or not.	IT Manager		$ - 0
				IT Marketing/Internet/Web support		$ - 0
				Tech Support (computers)		$ - 0
				ACCTG Payroll MTG		$ - 0
				Finance Director		$ - 0
				HR Specialist		$ - 0
				HR Director		$ - 0
				Admin Audit/Accounting Fees		$ - 0
				Indirect		$ - 0
				IT		$ - 0
				Other?		$ - 0
				TOTAL ADMINISTRATIVE/INDIRECT COSTS		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

TOTAL EXPENDITURES	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
REVENUE LESS EXPENDITURES	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

&P of &N

Subcontractor #1 Budget Healthy Families Oregon - Program Budget Detail

Prime Contractor - Agency Name:	0
Counties Served:	0

Subcontractor - Agency Name:
Budget Period:	July 1, 2025 - June 30, 2027	REVENUE
Total Biennium Allocation from Lead Agency to Subcontractor #1:		Total Funding Summary

Personal Services Fringe Benefits % "DeahnE": "DeahnE":

See Instructions Tab B35 Of the funds indicated in I10 and of your anticipated earnings this biennium (H12), how much Medicaid funding are you investing into this HFO program, for this biennium?

Revenue Budget	General & ELA Funds	Medicaid	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
					$ - 0

	PERSONAL SERVICES EXPENDITURES
	SALARIES & BENEFITS		Position FTE	Base Salary
(21 Months)	General Fund
FTE %	Medicaid
FTE %	Title IV-B2
FTE %	MIECHV
FTE %	County GF, Fundraising, Foundation, Grants, Other %	Fringe Benefits %		Expenditure Budget	General & ELA Funds	Medicaid	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
	Enter Annual Salary
		Program Manager	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Program Manager Assistant	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Supervisor 1	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Supervisor 2	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Supervisor 3	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Supervisor 4	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Supervisor 5	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Community Outreach	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Eligibility Screener 1	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Eligibility Screener 2	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Eligibility Screener 3	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Eligibility Screener 4	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Data Entry & Admin Support	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 1	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 2	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 3	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 4	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 5	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 6	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 7	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 8	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 9	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 10	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 11	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 12	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 13	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 14	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 15	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 16	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 17	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 18	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 19	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Home Visitor 20	0.00	$ - 0							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe								$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		TOTAL FTE	Position FTE	Base Salary	Total # FTE GF Funded Home Visitors	Total # FTE Medicaid Home Visitors	Total # FTE Title IV-B2 Home Visitors	Total # FTE MIECHV Home Visitors	Total # FTE

Other Home Visitors

0.00 0.00 0.00 0.00 0.00 0.00

	Other Staff
Optional. Cannot be paid for by GFs	Mental Health Consultant	0.00	Cannot use this $ for non HFO CORE positions	Cannot use this $ for non HFO CORE positions	Cannot use this $ for non HFO CORE positions	$ - 0	Cannot use this $ for non HFO CORE positions	$ - 0	Cannot use this $ for non HFO CORE positions	$ - 0
	Fringe					$ - 0		$ - 0		$ - 0
	OTHER Non HFO CORE position?	0.00				$ - 0		$ - 0		$ - 0
	Fringe					$ - 0		$ - 0		$ - 0
	TOTAL SALARIES AND BENEFITS					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

	MATERIALS & SUPPLIES EXPENDITURES
Special notes or instructions:	Program	Cost	Time Frame	Quantity	Description	Cost	Expenditure Budget	General & ELA Funds	Medicaid	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
	Advisory Board meetings		monthly? Quarterly?		# of Advisory Committee meetings during the 21 month budget period	$ - 0	$ - 0
	Cell Phones Purchase		per staff		# of phones you anticipate needing to purchase. Do you need to replace any phones? Anticipate any additional staff positions?	$ - 0	$ - 0
	Cell Phone Service		per staff/month		# of staff who use cell phones	$ - 0	$ - 0
	Copies of Forms/Tools		per family/per month		# of families typically receiving services at any one time	$ - 0	$ - 0
This should not be an ongoing cost, only if new computers need to be purchased. Computer maintenance should be captured in Administration costs	Computers (purchase of new)		per staff		# of staff that will need new computers	$ - 0	$ - 0
	Family Support Materials (ie - curriculum materials and home visit supplies)		per family/month		# of families	$ - 0	$ - 0
	Family Support Meetings		per month		# of meetings	$ - 0	$ - 0
	Land Line phone and/or Internet Service		per month	24	months	$ - 0	$ - 0
If your agency pays a different rate per mile, then change the amount in cells C116, C118 & C120	Mileage (Home visitors)	$ 0.66

DEAHN Erin - ELD: DEAHN Erin - ELD:

Change this mileage reimbursement rate if needed	per mile	0			$ - 0	$ - 0
	Enter estimated # of miles here:		# miles/month/hvor	$ - 0			cost/mo/hv
	Mileage (Elig. Scrnrs & Outreach)	$ 0.66

DEAHN Erin - ELD: DEAHN Erin - ELD:

Change this mileage reimbursement rate if needed	per mile	0			$ - 0	$ - 0
	Enter estimated # of miles here:		#miles/month/elig screeners & outreach	$ - 0			cost/mo/hv
	Mileage (PM & Supervisors)	$ 0.66

DEAHN Erin - ELD: DEAHN Erin - ELD:

Change this mileage reimbursement rate if needed BAKER Dawn * DELC: BAKER Dawn * DELC:

Enter the ANNUAL SALARY				#miles/month/PM & sups	0			$ - 0		$ - 0
		Enter estimated # of miles here:			# miles/month/hvor	$ - 0			cost/mo/hv
		Office Supplies			per staff/month	0			$ - 0		$ - 0
		Postage			per month	24			$ - 0		$ - 0
		Professional Development			per staff/year	0	Many programs choose to allocate a specific amount of funding per staff person, for trainings they are interested in.		$ - 0		$ - 0
	Each site is responsible for registration of staff for FROG scale, FROG Scale for Supervisors, and HFA Supervisor Resources and Reflections training offered by HFA national office.	FROG Scale Core	$ 550.00		costs per anticipated staff person		Anticipated # of new staff, including staff turn over		$ - 0		$ - 0
		FROG Scale Supervisor	$ 215.00		costs per anticipated staff person		Anticipated # of new staff, including staff turn over		$ - 0		$ - 0
		HFA Supervisor Resources and Reflections	$ 550.00		costs per anticipated staff person		Anticipated # of new staff, including staff turn over		$ - 0		$ - 0
	Each site is responsible for training their staff in the primary curriculum that they have chosen to use.	Primary Curriculum Training			Cost per curriculum training		Anticipated # of staff that will need to be trained in primary curriculum		$ - 0		$ - 0
		Curriculum training travel costs			flight, hotel & car rental, and mileage reimbursement		# of trainings		$ - 0		$ - 0
	Attendance NOT required but a great opportunity for Program Managers and/or Supervisors	HFA Nat'l Conference Travel/registration			1x year				$ - 0		$ - 0
	This is not required, but highly encourages to build positive team relationships. If you'd like to make this part of your training plan you can.	Staff Training Retreat			1x/year				$ - 0		$ - 0
	Cannot be paid for with HFO general fund $$	Ancillary supplies (diapers, books, safety supplies, gas cards, bus tickets)			Cannot be paid for with HFO general fund $$				$ - 0		$ - 0
		"Welcome Baby" Packets (often provided during eligibility screening) or other eligibility screen materials/supplies			per month	24	months		$ - 0		$ - 0
		Office Space & Maintenance (utilities, insurance, etc.)			per month	24	months		$ - 0		$ - 0
					per month				$ - 0		$ - 0
					per month				$ - 0		$ - 0
					per month				$ - 0		$ - 0
		TOTAL MATERIALS AND SUPPLIES COSTS									$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

ADMINISTRATIVE/INDIRECT EXPENDITURES
				Expenditure Budget	General & ELA Funds	Medicaid	Title IV-B2	County GF, Fundraising, Foundation, Grants, Other
			FTE spent on HFO
		Executive Director		$ - 0
	If you have additional administration/indirect costs line items, you can add them here. You are not restricted to only these items. You may also delete positions if they do not apply to HFO. HFO General Funds cannot pay for any HUB personnel, indirect or not.	IT Manager		$ - 0
		IT Marketing/Internet/Web support		$ - 0
		Tech Support (computers)		$ - 0
		ACCTG Payroll MTG		$ - 0
		Finance Director		$ - 0
		HR Specialist		$ - 0
		HR Director		$ - 0
		Admin Audit/Accounting Fees		$ - 0
		Indirect		$ - 0
		IT		$ - 0
		Mental Health		$ - 0
		TOTAL ADMINISTRATIVE/INDIRECT COSTS		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

TOTAL EXPENDITURES	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
REVENUE LESS EXPENDITURES	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

&P of &N

Need cell info Healthy Families Oregon - Program Budget Detail

Prime Contractor - Agency Name:

Counties Served:

Do you subcontract HFO program services to other agencies?

Budget Period:	October 1, 2021 - September 30, 2023		REVENUE
NTE Contract Amount to Lead Agency:		ERROR:#REF!	Total Program Funding Summary
If Applicable, Number of MIECHV Slots:		- 0	Medicaid NTE

"DeahnE": "DeahnE":

See "instructions" tab, B33 Medicaid Carry-over from Prior Year(s) "DeahnE": "DeahnE":

See Instructions tab B34. Include ALL Medicaid carry over, from previous years, that has yet to be invested back into this HFO program

Medicaid Earnings Investment into this budget (Lead Agency) for this biennium "DeahnE": "DeahnE":

See Instructions Tab B35 Of the funds indicated in I10 and of your anticipated earnings this biennium (H12), how much Medicaid funding are you investing into this HFO program, for this biennium?

	Revenue	General Fund	Medicaid	Title IV-B2	MIECHV	County GF, Fundraising, Foundation, Grants, Other
Personal Services Fringe Benefits %							Budget
							$ - 0	$ - 0

	PERSONAL SERVICES EXPENDITURES
							Expenditure	General Fund	Medicaid	Title IV-B2	MIECHV	County GF, Fundraising, Foundation, Grants, Other
			Position FTE	Base Salary
(24 Months)	General Fund
FTE %	Medicaid
FTE %	Title IV-B2
FTE %	MIECHV
FTE %	County GF, Fundraising, Foundation, Grants, Other %	Fringe Benefits %		Budget
	SALARIES & BENEFITS
	Annual Salary
	$ - 0	Program Manager	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Program Manager Assistant	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Supervisor 1	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Supervisor 2	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Supervisor 3	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Supervisor 4	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Supervisor 5	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Community Outreach	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Eligibility Screener 1	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Eligibility Screener 2	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Eligibility Screener 3	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Eligibility Screener 4	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Data Entry & Admin Support	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 1	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 2	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 3	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 4	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 5	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 6	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 7	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 8	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 9	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 10	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 11	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 12	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 13	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 14	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 15	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 16	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 17	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 18	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 19	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	$ - 0	Home Visitor 20	0.00				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		Fringe				$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		TOTAL FTE	Position FTE	Base Salary
(24 Months)	Total # FTE GF Funded Home Visitors	Total # FTE Medicaid Home Visitors	Total # FTE Title IV-B2 Home Visitors	Total # FTE MIECHV Home Visitors	Total # FTE

Other Home Visitors

0.00 0.00 0.00 0.00 0.00 0.00

	Other Staff
Optional. Cannot be paid for by GFs	Mental Health Consultant	0.00	Cannot use this $ for non HFO CORE positions	Cannot use this $ for non HFO CORE positions		$ - 0	Cannot use this $ for non HFO CORE positions	$ - 0	Cannot use this $ for non HFO CORE positions	$ - 0	$ - 0
	Fringe				$ - 0	$ - 0		$ - 0		$ - 0	$ - 0
	OTHER Non HFO CORE position?	0.00				$ - 0		$ - 0		$ - 0	$ - 0
	Fringe				$ - 0	$ - 0		$ - 0		$ - 0	$ - 0
	TOTAL SALARIES AND BENEFITS					$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

MATERIALS & SUPPLIES EXPENDITURES

Expenditure

General Fund

Medicaid

Title IV-B2

MIECHV

County GF, Fundraising, Foundation, Grants, Other

Special notes or instructions:

Program

Cost

Time Frame

Quantity

Description

Cost

Budget

Advisory Board meetings

monthly? Quarterly?

# of Advisory Committee meetings during the 24 month budget period

$ - 0

Cell Phones Purchase

per staff

# of phones you anticipate needing to purchase. Do you need to replace any phones? Anticipate any additional staff positions?

$ - 0

Cell Phone Service

per staff/month

# of staff who use cell phones

$ - 0

Copies of Forms/Tools

per family/per month

# of families typically receiving services at any one time

$ - 0

This should not be an ongoing cost, only if new computers need to be purchased. Computer maintenance should be captured in Administration costs

Computers (purchase of new)

per staff

# of staff that will need new computers

$ - 0

Family Support Materials (ie - curriculum materials and home visit supplies)

per family/month

# of families

$ - 0

Family Support Meetings

per month

# of meetings

$ - 0

Land Line phone and/or Internet Service

per month

months

$ - 0

If your agency pays a different rate per mile, then change the amount in cells C116, C118 & C120

Mileage (Home visitors)

DEAHN Erin - ELD: DEAHN Erin - ELD:

Change this mileage reimbursement rate if needed	per mile	0			$ - 0	$ - 0
	Enter estimated # of miles here:		# miles/month/hvor	$ - 0			cost/mo/hv
	Mileage (Elig. Scrnrs & Outreach)

DEAHN Erin - ELD: DEAHN Erin - ELD:

Change this mileage reimbursement rate if needed	per mile	0			$ - 0	$ - 0
	Enter estimated # of miles here:		#miles/month/elig screeners & outreach	$ - 0			cost/mo/hv
	Mileage (PM & Supervisors)

DEAHN Erin - ELD: DEAHN Erin - ELD:

Change this mileage reimbursement rate if needed		#miles/month/PM & sups	0			$ - 0	$ - 0
		Enter estimated # of miles here:		# miles/month/hvor	$ - 0			cost/mo/hv
		Office Supplies		per staff/month	0			$ - 0	$ - 0
		Postage		per month	24			$ - 0	$ - 0
		Professional Development		per staff/year	0	Many programs choose to allocate a specific amount of funding per staff person, for trainings they are interested in.		$ - 0	$ - 0
	ELD will pay for hotel costs for CORE trainings, but the program is responsible for any mileage and per-diem costs	CORE Training Travel costs	$ 1,836.50	Travel costs per anticipated staff person		Anticipated # of new staff, including staff turn over		$ - 0	$ - 0
	Each site is responsible for training their staff in the primary curriculumn that they have chosen to use. Beginning in 2020, HFO will begin planning GGK trainings, paying for the registration fee and hotel accomodations for each participant.	Primary Curriculum Training		Cost per curriculum training		Anticipated # of staff that will need to be trained in primary curriculum		$ - 0	$ - 0
		Curriculum training travel costs		flight, hotel & car rental, and mileage reimbursement		# of trainings		$ - 0	$ - 0
	Attendance NOT required but a great opportunity for Program Managers and/or Supervisors	HFA Nat'l Conference Travel/registration		1x year		2020: Leadership Conference (state leads, PMs & Supervisors). 2021: FULL Conference, including home visitors Please include here registration (approx. $500/person & travel costs). Locations for these trainings vary. However, they are often in Chicago or other mid-west or southern state locations.		$ - 0	$ - 0
	This is not required, but highly encourages to build positive team relationships. If you'd like to make this part of your training plan you can.	Staff Training Retreat		1x/year				$ - 0	$ - 0
	Cannot be paid for with HFO general fund $$	Ancillary supplies (diapers, books, safety supplies, gas cards, bus tickets)		Cannot be paid for with HFO general fund $$				$ - 0	$ - 0
		"Welcome Baby" Packets (often provided during eligibility screening) or other eligibility screen materials/supplies		per month	24	months		$ - 0	$ - 0
		Office Space & Maintenance (utilities, insurance, etc.)		per month	24	months		$ - 0	$ - 0
				per month				$ - 0	$ - 0
				per month				$ - 0	$ - 0
				per month				$ - 0	$ - 0
		TOTAL MATERIALS AND SUPPLIES COSTS							$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

ADMINISTRATIVE/INDIRECT EXPENDITURES
				Expenditure	General Fund	Medicaid	Title IV-B2	MIECHV	County GF, Fundraising, Foundation, Grants, Other
				Budget
			FTE spent on HFO
		Executive Director		$ - 0	$ - 0	$ - 0
	If you have additional administration/indirect costs line items, you can add them here. You are not restricted to only these items. You may also delete positions if they do not apply to HFO. HFO General Funds cannot pay for any HUB personnel, indirect or not.	IT Manager		$ - 0	$ - 0	$ - 0
		IT Marketing/Internet/Web support		$ - 0	$ - 0	$ - 0
		Tech Support (computers)		$ - 0	$ - 0	$ - 0
		ACCTG Payroll MTG		$ - 0	$ - 0	$ - 0
		Finance Director		$ - 0	$ - 0	$ - 0
		HR Specialist		$ - 0	$ - 0	$ - 0
		HR Director		$ - 0	$ - 0	$ - 0
		Admin Audit/Accounting Fees		$ - 0	$ - 0	$ - 0
		Other?		$ - 0	$ - 0	$ - 0
		Other?		$ - 0	$ - 0	$ - 0
		Other?		$ - 0	$ - 0	$ - 0
		TOTAL ADMINISTRATIVE/INDIRECT COSTS		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

TOTAL EXPENDITURES	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
REVENUE LESS EXPENDITURES	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	Total Program Match	$ - 0

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File details come from the government source that posted it. Updated Jun 2, 2026.