Attachment 3 - Fiscal Year Program Budget.docx
DOCX document 23 KB Posted
- Attached to
- 24PMOPRTCLNCLSFTYRSKSTE - RFR for Clinical and Safety Risk Assessment Sites, Staffing, and Related
- Solicitation number
- BD-24-1039-EHS01-ASHWA-96819
- Issued by
- Norfolk County, Massachusetts
About this file
The provided document is a Fiscal Year Program Budget for a state government contract opportunity. The contract is for the operation and staffing of one or more Clinical and Safety Risk Assessment Sites, issued by the Executive Office of Health and Human Services (EOHHS) in Massachusetts. The contract details the budget and cost reimbursement structure, including line items for direct care/program staff, occupancy, other direct care/program support, and direct administrative expenses. The contract has a commercial fee option for for-profit contractors, and requires the contractor to provide details on any non-reimbursable costs.
The budget document outlines the program components, staffing levels, and associated costs. It specifies that the contract is for a cost reimbursement program, and provides guidance on allowable and unallowable expenses. The contract has a capitalization level requirement for certain expense items. Contractors must adhere to federal OMB Circular A-122 and 808 CMR 1.00 regulations for the program.
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Text version
FY: Contractor Name: Amendment #,if Applicable: If Federal Funds, CFDA #:
PURCHASE OF SERVICE - ATTACHMENT 3: FISCAL YEAR PROGRAM BUDGET
Program Name:
| Document ID#: |
| MMARS Activity Code: |
| Program Type: |
| UFR Prog. #: |
| Current |
| Amend. Change |
| New |
| FTE |
| Amount |
| FTE |
| Amount |
| FTE |
| Amount |
| COST REIMBURSEMENT ONLY |
Program Component
| Offset |
| Source |
| Reimbursable |
Cost
UFR Title Direct Care/Program Support Staff/Overtime/ Shift Differential & Relief (Titles 101-141)
SUBTOTAL STAFF
| 150 |
| Payroll Taxes |
| 151 |
| Fringe Benefits |
| T 100 |
| Total Direct Care/Program Staff |
| Title |
| Occupancy |
| 301 |
| Program Facilities |
| * |
| 390 |
| Fac. Oper/Main/Furn |
| T 300 |
| Total Occupancy |
| UFR Title |
| Other Direct |
Care/Program Support
| 201 |
| Direct Care Consultant |
| 202 |
| Temporary Help |
| 203 |
| Clients/Caregivers. Reimb/Stipends |
| 206 |
| Subcontract Dir.Care |
| 204 |
| Staff Training |
| 205 |
| Staff Mileage/Travel |
| 207 |
| Meals |
| 208 |
| Contracted Client Trans. |
| * |
| 208 |
| Vehicle Expenses |
| * |
| 208 |
| Vehicle Depreciation |
| 209 |
| Incid. Health/Med Care |
| 211 |
| Client Per. Allowances |
| 212 |
| Prov. of Material Good |
| 214 |
| Direct Client Wages |
| 214 |
| Other Commercial Prod. & Svs. |
| * |
| 215 |
| Program Supplies/Mat |
| T 200 |
| Total Other Direct Care/Program |
| Title |
| Direct Admin Expenses |
| 216 |
| Program Support |
| * |
| 510 (410 & 390) |
| Other Direct Administrative Expenses |
| T 500 |
| Total Direct Administrative Exp. |
| T |
| SUBTOTAL PROGRAM COSTS |
| * |
| 410 |
Agency Admin. Support Allocation
| T |
| PROGRAM TOTAL |
Commercial Fee, if applicable, for for-profit contractors only (for informational purposes only; not to be included in the price paid by the Commonwealth): %___$___: N/A for Cost Reimbursement A. $ ___________ Subtotal of offsets which are for non-reimbursable costs.
Non-reimbursable costs must be shown in detail on Attachment 5 when the program is subject to the provisions of Federal OMB Circular A-122 and/or 808 CMR 1.00.
* Contractor’s Board approved capitalization level relative to any negotiated expense costs in lines 208, 215, 390 or 410 is $___________
Updated 6/19/07 Sensitivity level - low
File details come from the government source that posted it. Updated .