ATT005_SurvivorCCE_CostTrackingInvoice.xlsx

XLSX spreadsheet 215 KB Posted

Attached to
Solicitation - World Trade Center Health Program - Survivor Clinical Center of Excellence
Solicitation number
CDC-75D301-01-Solicitation-WTCHP
Issued by

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Written by GovTribe AI ·

The file is a Cost Tracking Invoice Template for the World Trade Center Health Program (WTCHP) Survivor Clinical Center of Excellence (CCE), version dated 01/24/2023. The spreadsheet is designed to track financial details across multiple institutions including ISMMS, MSSM, SUNY, FDNY, NYU, Rutgers, Northwell, H+H, and WSC, with award amounts ranging from the base year through Option Year 7. The template includes sections for budget snapshots, monthly invoice totals, burn rates, direct labor, subcontract labor, other direct costs, overhead, travel, and fee-for-service tracking.

The award amounts show a progressive increase across option years, with total contract values ranging from approximately $108.5 million in the base year to $114.3 million in Option Year 7. The template provides granular tracking mechanisms for each participating institution, allowing detailed financial monitoring of expenses across various cost categories like labor, overhead, travel, and administrative costs. The spreadsheet is structured to enable precise invoicing, expense tracking, and budget management for the WTCHP Survivor CCE contract, with specific columns and formulas to calculate cumulative expenses, remaining balances, and percentage of budget utilized.

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Version History Version History

Version DateSummary of Changes
12/7/22Added "Version Date" formula to "Contract & Invoice Summary sheet.
12/7/22Added column to Travel sheet to record "Description of Expense." Also modified guidance and instruction in the Travel sheet.
12/7/22Changed "Period of Performance" dates in lookup table to display revised dates for each CCE in the Contract & Invoice Summary sheet.
1/9/23Corrected Budget Snapshot formula to carryover subcontract labor
1/9/23Modified VBA to hide "Fee for Service" tab
1/19/23Corrected dropdown for invoice period to add December 2022
1/24/23Deleted "Revised Title" from labor category list
1/24/23Revised period of performance to reflect contract dates
1/24/23Loaded out-year fuding for inclusion in contract and invoice summary
1/24/23Corrected "Current Period Expenses" formula for Travel/Clin 2 in Budget Snapshot

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

Contract & Invoice Summary

WTCHP CCE Invoice TemplateVersion Date: 01/24/2023
CCE Name |

Contract Number | -

Option Period |

Option Period Total Award | -

Period of Performance | -

Invoice Period |

Budget Snapshot Budget Snapshot

Award AmountPrior Month ExpensesCurrent Period ExpensesCumulative ExpensesRemaining Balance
Budget Category-$ - 0$ - 0$ - 0$ - 0
Total Direct Labor$ - 0$ - 0
Total Sub Contracts Labor$ - 0$ - 0
Total Other Direct Costs$ - 0$ - 0
Total Rent / Lease$ - 0$ - 0
Subtotal CLIN1$ - 0$ - 0$ - 0$ - 0$ - 0
Overhead CLIN1$ - 0$ - 0
CLIN1 Total-$ - 0$ - 0$ - 0$ - 0
CLIN2 Travel$ - 0$ - 0
Overhead CLIN2$ - 0$ - 0
CLIN 2 Total-$ - 0$ - 0$ - 0$ - 0
Total$ - 0$ - 0$ - 0$ - 0$ - 0

Burn Rate Burn Rate

Award Amount
CLIN1CLIN2Total
0--$ - 0
Monthly Invoice TotalsBurn RatesPercent Change & Variance
Invoice Amount
CLIN1Invoice Amount
CLIN2Total Invoice AmountCLIN 1 Burn RateCLIN 2 Burn RateTotal Award Burn Rate% change from prior period% of budget Remaining% of YR RemainingVarianceComments
October$ - 0----92%-
November$ - 0-----83%-
December$ - 0-----75%-
January$ - 0-----67%-
February$ - 0-----58%-
March$ - 0-----50%-
April$ - 0-----42%-
May$ - 0-----33%-
June$ - 0-----25%-
July$ - 0-----17%-
August$ - 0-----8%-
September$ - 0-----0%-
Total$ - 0$ - 0$ - 00%0%0%0%

Direct Labor Direct Labor

WTC Billing Labor CategoryEmployee NameHourly RateHours WorkedMonthly LaborFringe RateTotal costComments
begin data entry in this rowbegin data entry in this row$0.000$0.000%$0.00Begin entering data in this row.

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

Subcontract Labor Subcontract Labor

WTC Billing Labor CategoryEmployee NameHours WorkedTotal costComments
begin data entry in this rowbegin data entry in this rowbegin data entry in this row$0.00Begin entering data in this row.

ODC

Other Direct Costs

Invoice/Receipt #Category of expensesAmountDescription
Begin entering data in this row.Begin entering data in this row.$0.00Begin entering data in this row.

Rent - Lease Rent / Lease

FacilityCategoryAmountExplanation of calculation
Begin entering data in this row.Begin entering data in this row.$0.00Begin entering data in this row.

Overhead Overhead

CLINCategorySubcategoryRate AppliedApplicable Invoice
Costs for CalculationAmountBrief Explanation of the Method for Calculating
Begin entering data in this row.Begin entering data in this row.Begin entering data in this row.0%$ - 0$ - 0Begin entering data in this row.

Travel Travel

Description of TripDescription of ExpenseAmountComments
Begin entering data in this row.Begin entering data in this row.$0.00Begin entering data in this row.

Fee for Service Fee for Service

Provider NameHours Worked on
Fee for Service for the MonthNumber of Fee for Service

Claims Filed for Month Begin entering data in this row. 0 0

Activity & WTC Billing Title

Activity CodeWTC Billing Labor CategoryCategories of expenses
4.1 - Contract Management (Directors only for this activity)Administrative AssistantCleaning Supplies
4.2 - Other Administrative ResponsibilitiesAdministrative CoordinatorEquipment
4.3 - Member and Medical ServicesBenefits CoordinatorInformation Tech software
4.4 - Comprehensive Care ManagementCase ManagementInformation Tech Supplies
4.5 - Pharmacy ServicesClaims/Billing ManagerMedical Records
4.6 - Healthcare Provider Network and ReferralsClaims/Billing SpecialistMedical Supplies
4.7 - Transition-OutClinic ManagerOffice Supplies
5.1 - Data Management PlanData AnalystOther
5.2 - Data TransferDeputy DirectorPostage/Mailings
6.1 - Quality Assurance Surveillance PlanDirector
9 - DeliverablesFinance Specialist
10 - SubcontractingInformation Technology
11 - HIPAA Compliance and Business Associate AgreementMedical Assistant
12 - Information SecurityMedical Records Coordinator
Member Services Coordinator
Member Services Manager
Nurse
Nurse Manager
Pharmacist
Physician
Physician Assistant
Project Coordinator
Psychiatrist
Psychologist
Pulmonologist
Quality Assurance
Social Worker

Pivot of Micheles awards

Sum of Total Award for Option PeriodColumn LabelsLilian's award amounts
Row LabelsBase YearOption Year 1Option Year 2Option Year 3Option Year 4Option Year 5Option Year 6Option Year 7
ISMMS$33,234,184$36,624,945$39,743,766$41,945,033$43,916,907$46,450,964$48,677,045$50,248,715MSSM$33,234,183.57$36,624,944.74$39,743,766.01$41,945,033.05$43,916,906.97$46,450,963.71$48,677,044.96$50,248,714.62
SUNY$14,930,567$15,940,257$17,283,067$18,188,370$18,774,938$19,828,833$20,645,902$21,341,896SUNY$14,930,566.78$15,940,256.61$17,283,066.95$18,188,369.92$18,774,937.63$19,828,833.42$20,645,902.31$21,341,895.71
FDNY$13,413,738$13,700,901$13,901,039$14,427,858$14,850,971$15,392,431$15,903,242$16,453,448FDNY$13,413,738.30$13,700,900.76$13,901,038.68$14,427,858.25$14,850,970.57$15,392,431.37$15,903,242.16$16,453,447.53
NYU$2,810,683$2,857,331$2,934,420$3,013,825$3,095,612$3,179,849$3,266,616$3,355,989NYU$2,810,683.00$2,857,331.00$2,934,420.00$3,013,825.00$3,095,612.00$3,179,849.00$3,266,616.00$3,355,989.00
Rutgers$5,338,094$5,587,867$5,946,645$6,657,108$6,928,648$7,211,423$7,601,216$7,926,751Rutgers$5,096,900.07$5,339,930.88$5,681,352.47$6,360,931.37$6,619,185.12$6,888,280.09$7,259,028.45$7,577,269.19
Northwell$3,524,993$3,613,563$3,717,077$3,823,696$3,933,423$4,046,068$4,162,093$4,256,115Northwell$3,524,992.83$3,613,562.97$3,717,076.89$3,823,696.22$3,933,422.79$4,046,068.19$4,162,092.94$4,256,115.46
H+H$25,159,932$25,802,581$26,600,598$0$0$0$0$0H+H$25,159,931.76$25,802,580.85$26,600,598.04
WSC$10,135,703$7,372,925$7,749,537$8,212,083$8,931,706$9,602,797$10,117,502$10,762,094WSC$10,135,703.18$7,372,925.49$7,749,536.99$8,212,083.14$8,931,706.49$9,602,796.54$10,117,501.72$10,762,094.08
NYHCO$0$0$0$0$0$0$0$0
Grand Total$108,547,893$111,500,369$117,876,148$96,267,973$100,432,204$105,712,365$110,373,616$114,345,007
Base YearOption Year 1Option Year 2Option Year 3Option Year 4Option Year 5Option Year 6Option Year 7
MSSM0000000
SUNY0000000
FDNY0000000
NYU0000000
Rutgers1111111
Northwell0000000
H+H0000000
WSC0000000

Award Amounts from Michele

VendorClin 1Clin 2
FDNY_Base YearFDNYBase Year13413738.30
FDNY_Option Year 1FDNYOption Year 113700900.760
FDNY_Option Year 2FDNYOption Year 213901038.680
FDNY_Option Year 3FDNYOption Year 314427858.250
FDNY_Option Year 4FDNYOption Year 414850970.570
FDNY_Option Year 5FDNYOption Year 515392431.370
FDNY_Option Year 6FDNYOption Year 615903242.160
FDNY_Option Year 7FDNYOption Year 716453447.530
H+H_Base YearH+HBase Year25148291.7611640
H+H_Option Year 1H+HOption Year 125790940.8511640
H+H_Option Year 2H+HOption Year 226588958.0411640
H+H_Option Year 3H+HOption Year 3TBDTBD
H+H_Option Year 4H+HOption Year 4TBDTBD
H+H_Option Year 5H+HOption Year 5TBDTBD
H+H_Option Year 6H+HOption Year 6TBDTBD
H+H_Option Year 7H+HOption Year 7TBDTBD
ISMMS_Base YearISMMSBase Year33224171.0710012.5
ISMMS_Option Year 1ISMMSOption Year 136614932.2410012.5
ISMMS_Option Year 2ISMMSOption Year 239733753.5110012.5
ISMMS_Option Year 3ISMMSOption Year 341935020.5510012.5
ISMMS_Option Year 4ISMMSOption Year 443906894.4710012.5
ISMMS_Option Year 5ISMMSOption Year 546440951.2110012.5
ISMMS_Option Year 6ISMMSOption Year 648667032.4610012.5
ISMMS_Option Year 7ISMMSOption Year 750238702.1210012.5
NYU_Base YearNYUBase Year28106830
NYU_Option Year 1NYUOption Year 128573310
NYU_Option Year 2NYUOption Year 229344200
NYU_Option Year 3NYUOption Year 330138250
NYU_Option Year 4NYUOption Year 430956120
NYU_Option Year 5NYUOption Year 531798490
NYU_Option Year 6NYUOption Year 632666160
NYU_Option Year 7NYUOption Year 733559890
Northwell_Base YearNorthwellBase Year3524992.830
Northwell_Option Year 1NorthwellOption Year 13613562.970
Northwell_Option Year 2NorthwellOption Year 23717076.890
Northwell_Option Year 3NorthwellOption Year 33823696.220
Northwell_Option Year 4NorthwellOption Year 43933422.790
Northwell_Option Year 5NorthwellOption Year 54046068.190
Northwell_Option Year 6NorthwellOption Year 64162092.940
Northwell_Option Year 7NorthwellOption Year 74256115.460
WSC_Base YearWSCBase Year10135703.180
WSC_Option Year 1WSCOption Year 17372925.490
WSC_Option Year 2WSCOption Year 27749536.990
WSC_Option Year 3WSCOption Year 38212083.140
WSC_Option Year 4WSCOption Year 48931706.490
WSC_Option Year 5WSCOption Year 59602796.540
WSC_Option Year 6WSCOption Year 610117501.720
WSC_Option Year 7WSCOption Year 710762094.080
SUNY_Base YearSUNYBase Year14744199.837560
SUNY_Option Year 1SUNYOption Year 115931940.618316
SUNY_Option Year 2SUNYOption Year 217273919.359147.6
SUNY_Option Year 3SUNYOption Year 318178764.949604.98
SUNY_Option Year 4SUNYOption Year 418764852.410085.23
SUNY_Option Year 5SUNYOption Year 519818243.9310589.49
SUNY_Option Year 6SUNYOption Year 620634783.3411118.97
SUNY_Option Year 7SUNYOption Year 721330220.811674.91
Rutgers_Base YearRutgersBase Year5336473.631619.89
Rutgers_Option Year 1RutgersOption Year 15584529.923336.97
Rutgers_Option Year 2RutgersOption Year 25943307.743336.97
Rutgers_Option Year 3RutgersOption Year 36653770.643336.97
Rutgers_Option Year 4RutgersOption Year 46925310.863336.97
Rutgers_Option Year 5RutgersOption Year 57208086.053336.97
Rutgers_Option Year 6RutgersOption Year 67597879.123336.97
Rutgers_Option Year 7RutgersOption Year 77923413.83336.97

SF 1034

Standard Form 1034PUBLIC VOUCHER FOR PURCHASES AND SERVICES
OTHER THAN PERSONALVOUCHER NO.
Revised October 1987
Department of the Treasury
TFM 4-2000
1034-122
U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT AND LOCATIONDATE VOUCHER PREPAREDSCHEDULE NO.
Centers for Disease Control & PreventionCONTRACT NUMBER AND DATEPAID BY
Financial Management Office (FMO)
P. O. Box 15580
Atlanta, GA 30333
PAYEE'S
NAMEDATE INVOICE RECEIVED
AND
ADDRESSDISCOUNT TERMS

PAYEES ACCOUNT NUMBER

SHIPPED FROM TO WEIGHT GOVERNMENT B/L NUMBER

NUMBER AND DATE OF ORDERDATE OF DELIVERY OR SERVICEARTICLES OR SERVICESQUANTITYUNIT PRICE
(Enter description, item number of contract of Federal supply schedule, and other information deemed necessary)AMOUNT
COSTPER(1)
$ - 0
$ - 0
$ - 0
(Use continuation sheet(s) if necessary)(Payee must NOT use the space below)TOTAL$ - 0
PAYMENT:Approved for Provisional PaymentEXCHANGE RATEDIFFERENCES
oPROVISIONALSubject to later audit. =$=$1.00
oCOMPLETEBY (2)
oPARTIAL
oFINALAmount verified correct for payment
oPROGRESSTITLE(Signature or initials)
oADVANCEAuditor, Defense Contract Audit Agency
Pursuant to the authority vested in me, I certify that this voucher is correct and proper for payment.
(Date)(Authorized Certifying Officer)(Title)
ACCOUNTING CLASSIFICATION

PAID BY CHECK NUMBER ON ACCOUNT OF U.S. TREASURY CHECK NUMBER ON (Name of bank)

CASHDATEPAYEE (3)
$
1. When stated in foreign currency, insert name of currency.PER
2. If the ability to certify and authority to approve are combined in one person one signature only is necessary; otherwise the approving officer will sign in the space provided, over his official title.

3. When a voucher is receipted in the name of a company or corporation, the name of the person writing the company or corporate name, as well as the capacity in which he signs, must appear. For example: "John Doe Company, per John Smith, Secretary:, or "Treasurer", as the case may be. TITLE

Previous edition usableNSN 7540-00-900-2234
Privacy Act Statement
The information requested on this form is required under the provisions of 31 U.S.C 82B and 82c, for the purposes of disbursing Federal money. The information requested is to identify the particular creditor and the amounts to be paid. Failure to furnish this information will hinder discharge of the payment obligation.

SF 1035

Standard Form 1035 (EG) September 1973 4 Treasury FRM 2000

1035-110PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL
CONTINUATION SHEETVOUCHER NO.
SCHEDULE NO.
SHEET NO. 2
U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT
NUMBER AND DATE OF ORDERDATE OF DELIVERY OR SERVICEARTICLES OR SERVICES
(Enter description, item number of contract or Federal supply schedule, and other information deemed necessary)QUANTITYUNIT PRICEAMOUNT
COSTPER
Total$0
(Transfer to SF1034)
TOTAL$0
(Transfer to SF1034)
TOTAL
(Transfer to SF1034)

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