attachment-6-rfp-2027-dbh-01-servi-app-g.xlsx

XLSX spreadsheet 38 KB Posted

Attached to
Service to Science
Solicitation number
RFP-2027-DBH-01-SERVI
Issued by
Grafton County, New Hampshire

About this file

This is a cost sheet template for RFP-2027-DBH-01-SERVI issued by the New Hampshire Department of Health and Human Services (DHHS). The document provides detailed instructions for contractors to complete budget proposals for state fiscal years 27 and 28, with the budget period running from the approval date through June 30, 2028. The cost sheet requires contractors to enter their name, project/program title, and indirect cost rate, then itemize all proposed costs across nine main categories: salary and wages, fringe benefits, consultants, equipment, supplies (educational, laboratory, pharmacy, medical, and office), travel, software, other costs (marketing/communications and education/training), and subrecipient contracts. Each line item must include whole dollar amounts with corresponding budget narrative explanations demonstrating direct relationships to the solicitation's objectives.

The template establishes specific compliance requirements with 2 CFR 200, including provisions that indirect cost rates cannot be applied to equipment costs and may only be applied to the first $50,000 of each subrecipient contract. The document includes a supplementary salary and wages breakdown section requiring itemization by position title, hourly rate, hours per week, full-time equivalent (FTE), and allocation percentages, with separate categories for administrative and direct service salaries. Total direct costs and total indirect costs are automatically calculated, with all costs required in whole dollars without cents. The cost sheet emphasizes that any single cost must be treated consistently as either direct or indirect and cannot be charged as both.

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Instructions

Cost Sheet Instructions
Contractor Name:Enter the Contractor's name, which must match the P-37.
Budget Request for:Enter the name of the project/program title.
Indirect Cost Rate (if applicable)The Contractor's indirect cost rate as a percentage will auto populate. See 2 CRF 200.414 Indirect (F&A) Costs for more information.

Line Item Instructions All costs should be entered in whole dollars with no cents.

Next to each cost, enter a description in the Budget Narrative column that explains the specific line item costs included and their direct relationship to meeting the objectives of this solicitation.

1. Salary & Wages Enter total salary and wage costs for personnel allocated to this agreement for the specified budget period.

2. Fringe Benefits Enter total fringe benefits costs for personnel allocated to this agreement for the specified budget period.

3. Consultants Enter total costs for individuals (who are not employees of the Contractor) to provide consultant services, including, but not limited to, professional expertise, training, and/or education.

4. Equipment
Enter total Equipment costs. Equipment is defined as tangible, non-expendable personal property (including exempt property) that has a useful life of more than one year AND an acquisition cost of $10,000 or more per unit. Note all equipment costs must be excluded when calculating indirect costs.
5.(a) Supplies - EducationalEnter total Educational Supplies costs.
5.(b) Supplies - LaboratoryEnter total Laboratory Supplies costs.
5.(c) Supplies - PharmacyEnter total Pharmacy Supplies costs.
5.(d) Supplies - MedicalEnter total Medical Supplies costs.
5.(e) Supplies OfficeEnter total Office Supplies costs.

6. Travel Enter Travel costs, including expenses for transportation necessary to complete the required services.

7. Software Enter Software costs.

8. (a) Other - Marketing/CommunicationsEnter Other - Marketing/Communications costs.
8. (b) Other - Education and TrainingEnter Other - Education and Training costs.
8. (c) Other - OtherEnter Other - Other costs in the available rows below.
Other (please specify)Using as many rows as needed, specify the type of Other costs (e.g. Postage) in Column A and enter the costs for the specified budget period.
9. Subrecipient Contracts
Enter total costs for Subrecipient Contracts. Note if a contractor is identified as a Subrecipient in accordance with 2 CFR § 200.331, the indirect cost rate may only be applied to the first $50,000 of each subrecipient contract (i.e. subaward) per Appendix IV to 2 CFR 200.
Total Direct CostsUnless the formula needs to be modified, Total Direct Costs will automatically total in this line.
Total Indirect CostsEnter the total indirect costs (if applicable) based on the indirect cost rate percentage. Any one cost must be treated consistently as either a direct or indirect cost and cannot be charged as both. Note the indirect cost rate cannot be applied to Equipment costs. The indirect cost rate may only be applied to the first $50,000 of each subrecipient contract (i.e. subaward).

TOTAL TOTAL Costs will automatically total in this line.

Cost Sheet New Hampshire Department of Health and Human Services

Contractor Name:Enter Vendor Name
Budget Request for:RFP-2027-DBH-01-SERVI
Indirect Cost Rate (if applicable)ERROR:#DIV/0!

Line Item Budget - State Fiscal Year 27 (Upon G&C approval-6/30/27) Budget - State Fiscal Year 28 (07/01/27 - 06/30/28) Budget Total - All SFYs Budget Narrative Explain specific line item costs included and their direct relationship to meeting the objectives of this solicitation.

1. Salary & Wages$0$0$0
2. Fringe Benefits$0$0$0
3. Consultants$0$0$0
4. Equipment
Indirect cost rate cannot be applied to equipment costs per 2 CFR 200.1 and Appendix IV to 2 CFR 200.$0$0$0
5.(a) Supplies - Educational$0$0$0
5.(b) Supplies - Lab$0$0$0
5.(c) Supplies - Pharmacy$0$0$0
5.(d) Supplies - Medical$0$0$0
5.(e) Supplies Office$0$0$0
6. Travel$0$0$0
7. Software$0$0$0
8. (a) Other - Marketing/ Communications$0$0$0
8. (b) Other - Education and Training$0$0$0
8. (c) Other - Other (specify below)$0$0$0
Other (please specify)$0$0$0
Other (please specify)$0$0$0
Other (please specify)$0$0$0
Other (please specify)$0$0$0
9. Subrecipient Contracts$0$0$0
Total Direct Costs$0$0$0
Total Indirect Costs$0$0$0

TOTAL $0 $0 $0

Appendix G - Cost Sheet

Salary & Wages Breakdown

Salary & Wages Breakdown

New Hampshire Department of Health and Human Services

Proposal Agency Name:
Program:
Budget Period:
ABCDEFGH
Position TitleCurrent Individual in PositionProjected Hrly Rate as of 1st Day of Budget PeriodHours per Week dedicated to this program - FTEAmnt Funded by this program for Budget PeriodTotal Salary for Budget Period% of Salary Funded by this programSite*
Example:
Program CoordinatorExample Staff$21.0020$21,840$43,68050%
Administrative Salaries
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
Total Admin. Salaries$0$0ERROR:#DIV/0!
Direct Service Salaries
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
ERROR:#DIV/0!
Total Direct Salaries$0$0ERROR:#DIV/0!
Total Salaries by Program$0.00$0.00ERROR:#DIV/0!
*Please list which site(s) each staff member works at, if your agency has multiple sites.

Budget to Print New Hampshire Department of Health and Human Services

Contractor Name:Enter Vendor Name
Budget Request for:RFP-2027-DBH-01-SERVI
Budget PeriodERROR:#REF!
Indirect Cost Rate (if applicable)ERROR:#DIV/0!
Line ItemProgram Cost - Funded by DHHS
1. Salary & Wages$0
2. Fringe Benefits$0
3. Consultants$0
4. Equipment
Indirect cost rate cannot be applied to equipment costs per 2 CFR 200.1 and Appendix IV to 2 CFR 200.$0
5.(a) Supplies - Educational$0
5.(b) Supplies - Lab$0
5.(c) Supplies - Pharmacy$0
5.(d) Supplies - Medical$0
5.(e) Supplies Office$0
6. Travel$0
7. Software$0
8. (a) Other - Marketing/ Communications$0
8. (b) Other - Education and Training$0
8. (c) Other - Other (specify below)$0
Other (please specify)$0
Other (please specify)$0
Other (please specify)$0
Other (please specify)$0
9. Subrecipient Contracts$0
Total Direct Costs$0

Total Indirect Costs $0

TOTAL $0

&"Arial,Regular"Exhibit C-X Budget

&"Arial,Regular"Project ID # &"Arial,Regular"Contractor Initial: __________

Date: ___________

File details come from the government source that posted it. Updated .