attachment-4-rga-2027-dbh-02-tobac-app-d.xlsx

This is a budget template and program staff list form for the New Hampshire Department of Health and Human Services (DHHS) for the Tobacco Use Prevention Programs for Youth initiative. The document serves as the official budget submission worksheet for contractors responding to the solicitation, with completion required for the State Fiscal Year budget period of July 1, 2026 through June 30, 2027. The budget form requires contractors to itemize all costs across nine major categories including salary and wages, fringe benefits, consultants, equipment, supplies (educational, laboratory, pharmacy, medical, and office), travel, software, marketing and communications, education and training, and subrecipient contracts. Each line item must include a detailed budget narrative explaining the specific costs and their direct relationship to meeting the solicitation objectives. Additionally, contractors must complete a separate Program Staff List for each State Fiscal Year, documenting position titles, current staff assignments, hourly rates, hours per week dedicated to the program, total salaries, and the percentage of salary funded by the program, with notation of work sites for multi-site agencies.

The budget form automatically calculates totals for direct costs, indirect costs (when applicable), and the overall budget total. The indirect cost rate will auto-populate based on the contractor's established rate per 2 CFR 200.414, with the critical limitation that indirect costs cannot be applied to equipment purchases or may only apply to the first $25,000 of subrecipient contracts in accordance with federal regulations. All costs must be entered in whole dollars without cents. The template includes error notifications for missing data fields and references relevant federal cost principles and compliance requirements. The form requires the contractor name, vendor name, and indirect cost rate information to be completed, with an authorization section for contractor initials and date.