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Sheet1
| Attachment 3 Teledentistry Budget Table |
| Proposer Organization Name: |
Proposer:
You may insert rows after the first row and the last in each section when needed. Each section has a sum equation for convenience. Example: you need another row in "Total Projected Revenue" insert a row below row 7. The suming equation will then include the new row.
Revisions to row descriptions as needed.
| TOTAL PROJECT REVENUE | |
| PROGRAM INCOME (fees, premiums, 3rd party reimbursements, and payments generated from the projected delivery of services) | |
| LOCAL & STATE FUNDS (including local, foundation, and state grants) | |
| OTHER SUPPORT (including contributions and fundraising) | |
| FEDERAL 330 GRANT | |
| OTHER FEDERAL FUNDING (break out by source — e.g., HUD, CDC) | |
| TOTAL REVENUE | $ - 0 |
| TOTAL PROJECT BUDGET- INCLUDES ALL COSTS FOR PROJECT (WHICH MAY EXCEED THOSE REQUESTED FROM TELEDENTISTRY GRANT DUE TO OTHER FUNDING SOURCES AND IN-KIND SUPPORT) | |
| EXPENSES – Object class totals should be consistent with those presented in Budget Justification | |
| PERSONNEL – Identified personnel and total costs of staff salaries and wages, excluding benefits. | TOTAL |
| TOTAL PERSONNEL | $ - 0 |
| FRINGE BENEFITS | |
| May be represented as a percentage and not broken out make revisions to row descriptions as needed. | TOTAL | |
| FICA | |
| Medical | |
| Retirement | |
| Dental | |
| Unemployment and Workers Compensation | |
| TOTAL FRINGE | $ - 0 |
| TRAVEL | TOTAL |
| TOTAL TRAVEL | $ - 0 |
| EQUIPMENT | TOTAL |
| TOTAL EQUIPMENT | $ - 0 |
| SUPPLIES | TOTAL |
| TOTAL SUPPLIES | $ - 0 |
| CONTRACTUAL – Include sufficient detail to justify costs. Summaries of new and revised contracts must be included. | TOTAL |
| TOTAL CONTRACTUAL | $ - 0 |
| OTHER – Include sufficient detail to justify each item. Note: Funding CANNOT support grant-writing, fundraising, or lobbying costs. | TOTAL |
| TOTAL OTHER | $ - 0 |
| TOTAL DIRECT CHARGES (Sum of all TOTAL Expenses rows above (e.g. Travel, Equipment, etc.) | |
| INDIRECT CHARGES – Include approved indirect cost rate. | TOTAL |
| TOTALS (Total of TOTAL DIRECT CHARGES and INDIRECT CHARGES above) | $ - 0 |
| PROJECT BUDGET FOR TELEDENTISTRY REQUESTED GRANT FUNDS ONLY | |
| EXPENSES – Object class totals should be consistent with those presented in Budget Justification | |
| RECRUITMENT | TOTAL |
| TOTAL RECRUITMENT | $ - 0 |
| TRAVEL - shall be calculated based on the federal rates for mileage, per diem and lodging (www.gsa.gov/perdiem). | |
| TOTAL TRAVEL | $ - 0 |
| EQUIPMENT | |
| TOTAL EQUIPMENT | $ - 0 |
| SUPPLIES | |
| TOTAL SUPPLIES | $ - 0 |
| TOTAL (Sum of all TELEDENTISTRY GRANT FUNDS Expenses rows above (GREEN SEC TION) | $ - 0 |
RFGP OB S-44300-00008989
Attachment 3 Grant Budget Table