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Budget Cover Contract # and Title: PH RFP 250108 School-Based Mental Telehealth Services
| INSTRUCTIONS: | |
| Green fields should be filled with appropriate info. Any exisiting text is there as an example and can be edited. |
| Grey fields are automatically calculated. Do not input info here. |
| Organization Information |
| Date Prepared: |
| Organization Name: |
| Budget at a Glance | | |
| Personnel: | | $ - 0 |
| Supplies & Materials: | | $ - 0 |
| Equipment: | | $ - 0 |
| Contractual: | | $ - 0 |
| Admin: | | $ - 0 |
| Direct Costs: | | $ - 0 |
| Indirect Costs: | 8% | $ - 0 |
| Total Amount Requested: | | $ - 0 |
Budget Detail
| PH RFP 250108 School-Based Mental Telehealth Services |
| 0 |
| BUDGET DETAIL |
| Personnel | | | | |
| Category | Line Item Description | Total Salary | | |
| for Staff Person | % of Staff Person | | | | |
| Budgeted to Contract | Requested Amount | | | | |
| Personnel | | $ - 0 | 100% | $ - 0 |
| Personnel | | $ - 0 | 100% | $ - 0 |
| Personnel | | $ - 0 | | $ - 0 |
| Personnel | | $ - 0 | | $ - 0 |
| Personnel | | $ - 0 | | $ - 0 |
| Personnel | | $ - 0 | | $ - 0 |
| | | Total FTE | 2.00 | |
| Total Salaries & Wages: | | | | $ - 0 |
| Category | Line Item Description | | % Budgeted To Contract | Requested Amount |
| Personnel | Fringe Benefits (If fringe benefits vary by position, please provide an average.) | | 18.00% | $ - 0 |
| Total Fringe Benefits: | | | | $ - 0 |
| Total Personnel: | | | | $ - 0 |
| Supplies & Materials | | |
| Category | Line Item Description | Requested Amount |
| Supplies & Materials | | $ - 0 |
| Supplies & Materials | | $ - 0 |
| Supplies & Materials | | $ - 0 |
| Supplies & Materials | | $ - 0 |
| Supplies & Materials | | $ - 0 |
| Supplies & Materials | | $ - 0 |
| Supplies & Materials | | $ - 0 |
| Total Supplies & Equipment Costs: | | $ - 0 |
| Equipment | | |
| Category | Line Item Description | Requested Amount |
| Equipment | | $ - 0 |
| Equipment | | $ - 0 |
| Equipment | | $ - 0 |
| Equipment | | $ - 0 |
| Equipment | | $ - 0 |
| Equipment | | $ - 0 |
| Equipment | | $ - 0 |
| Total Supplies & Equipment Costs: | | $ - 0 |
| Contractual Services | | | |
| Category | Line Item Description | Consultant / Contractor Name | Requested Amount |
| Contractual | | | $ - 0 |
| Contractual | | | $ - 0 |
| Contractual | | | $ - 0 |
| Contractual | | | $ - 0 |
| Total Contractual Costs: | | | $ - 0 |
| Admin | | |
| Category | Line Item Description | Requested Amount |
| Admin | | $ - 0 |
| Admin | | $ - 0 |
| Admin | | $ - 0 |
| Admin | | $ - 0 |
| Admin | | $ - 0 |
| Admin | | $ - 0 |
| Total Operating/Admin Costs: | | $ - 0 |
Total Direct Costs: $ - 0
| Indirect Costs | | | | | |
| Category | Line Item | | | | |
| Description | Description | | ICR % | Requested Amount | | |
| Indirect Costs | Indirect Costs | Indirect costs may not exceed 15% of the total budget | | 8% | $ - 0 |
| Total Indirect Costs: | | | | | $ - 0 |
Total Budget Requested: $ - 0
Budget Narrative
| PH RFP 250108 School-Based Mental Telehealth Services |
| 0 |
| | Budget Narrative | |
| Personnel | | | |
| Category | Line Item Description | Justification | Requested budget amount |
| Personnel | Position | Description of role/responsibility | $ - 0 |
| Personnel | Position | Description of role/responsibility | $ - 0 |
| Personnel | | | $ - 0 |
| Personnel | | | $ - 0 |
| Personnel | | | $ - 0 |
| Personnel | | | $ - 0 |
| Supplies & Materials | | | |
| Category | Line Item Description | Justification | Requested budget amount |
| Supplies & Materials | | Justification for expense | $ - 0 |
| Supplies & Materials | | Justification for expense | $ - 0 |
| Supplies & Materials | | Justification for expense | $ - 0 |
| Supplies & Materials | | | $ - 0 |
| Supplies & Materials | | | $ - 0 |
| Supplies & Materials | | | $ - 0 |
| Supplies & Materials | | | $ - 0 |
| Equipment | | | |
| Category | Line Item Description | Justification | Requested budget amount |
| Equipment | | Justification for expense | $ - 0 |
| Equipment | | | $ - 0 |
| Equipment | | | $ - 0 |
| Equipment | | | $ - 0 |
| Equipment | | | $ - 0 |
| Equipment | | | $ - 0 |
| Equipment | | | $ - 0 |
| Contractual Services | | | |
| Category | Line Item Description | Justification | Requested budget amount |
| Contractual | | Justification for service(s) | $ - 0 |
| Contractual | | Justification for service(s) | $ - 0 |
| Contractual | | | $ - 0 |
| Contractual | | | $ - 0 |
| Admin | | | |
| Category | Line Item Description | Justification | Requested budget amount |
| Admin | | Justification for expense | $ - 0 |
| Admin | | Justification for expense | $ - 0 |
| Admin | | Justification for expense | $ - 0 |
| Admin | | Justification for expense | $ - 0 |
| Admin | | | $ - 0 |
| Admin | | | $ - 0 |