Attachment A, Budget Detail and Narrative Template - 250108.xlsx

XLSX spreadsheet 28 KB Posted

Attached to
SCHOOL-BASED MENTAL TELEHEALTH SERVICES
Solicitation number
PH RFP 250108
Issued by
Maricopa County, Arizona

About this file

The document is a Budget Detail and Narrative Template for the Maricopa County Department of Public Health (MCDPH) School-Based Mental Telehealth Services contract (PH RFP 250108). The initiative aims to provide virtual mental health services to students in Maricopa County, with a goal of reaching 50,000 students annually. The cost-reimbursement contract will be funded with $750,000 from JUUL settlement funds for the first year, with potential renewal for two additional years. The selected contractor will deliver short-term virtual therapy sessions, recruit schools, and track program impact, with services available during and outside school hours.

The contract opportunity is open to nonprofit, private, and academic organizations with specific eligibility requirements, including at least five years of telehealth-based mental health service experience in school settings, three years of insurance billing for behavioral health services, and a track record of serving at least 300,000-600,000 students in the past five years. Contractors must have or commit to obtaining Arizona-licensed mental health providers and contribute a minimum of $100,000 in in-kind resources. The contract includes cooperative language allowing other Arizona government agencies to utilize the contract with their own funding, with each entity establishing its own scope of work and budget. The budget template provides a framework for detailing personnel, supplies, equipment, contractual services, and administrative costs, with an 8% indirect cost rate allowance.

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Other files

File Type Posted
PH RFP 250108, School-Based Mental Telehealth Services.docx DOCX document
Exhibit 3 Draft Contract 250108.docx DOCX document

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Text version

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
CategoryLine Item DescriptionTotal Salary
for Staff Person% of Staff Person
Budgeted to ContractRequested Amount
Personnel$ - 0100%$ - 0
Personnel$ - 0100%$ - 0
Personnel$ - 0$ - 0
Personnel$ - 0$ - 0
Personnel$ - 0$ - 0
Personnel$ - 0$ - 0
Total FTE2.00
Total Salaries & Wages:$ - 0
CategoryLine Item Description% Budgeted To ContractRequested Amount
PersonnelFringe Benefits (If fringe benefits vary by position, please provide an average.)18.00%$ - 0
Total Fringe Benefits:$ - 0
Total Personnel:$ - 0
Supplies & Materials
CategoryLine Item DescriptionRequested 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
CategoryLine Item DescriptionRequested Amount
Equipment$ - 0
Equipment$ - 0
Equipment$ - 0
Equipment$ - 0
Equipment$ - 0
Equipment$ - 0
Equipment$ - 0
Total Supplies & Equipment Costs:$ - 0
Contractual Services
CategoryLine Item DescriptionConsultant / Contractor NameRequested Amount
Contractual$ - 0
Contractual$ - 0
Contractual$ - 0
Contractual$ - 0
Total Contractual Costs:$ - 0
Admin
CategoryLine Item DescriptionRequested Amount
Admin$ - 0
Admin$ - 0
Admin$ - 0
Admin$ - 0
Admin$ - 0
Admin$ - 0
Total Operating/Admin Costs:$ - 0

Total Direct Costs: $ - 0

Indirect Costs
CategoryLine Item
DescriptionDescriptionICR %Requested Amount
Indirect CostsIndirect CostsIndirect costs may not exceed 15% of the total budget8%$ - 0
Total Indirect Costs:$ - 0

Total Budget Requested: $ - 0

Budget Narrative

PH RFP 250108 School-Based Mental Telehealth Services
0
Budget Narrative
Personnel
CategoryLine Item DescriptionJustificationRequested budget amount
PersonnelPositionDescription of role/responsibility$ - 0
PersonnelPositionDescription of role/responsibility$ - 0
Personnel$ - 0
Personnel$ - 0
Personnel$ - 0
Personnel$ - 0
Supplies & Materials
CategoryLine Item DescriptionJustificationRequested budget amount
Supplies & MaterialsJustification for expense$ - 0
Supplies & MaterialsJustification for expense$ - 0
Supplies & MaterialsJustification for expense$ - 0
Supplies & Materials$ - 0
Supplies & Materials$ - 0
Supplies & Materials$ - 0
Supplies & Materials$ - 0
Equipment
CategoryLine Item DescriptionJustificationRequested budget amount
EquipmentJustification for expense$ - 0
Equipment$ - 0
Equipment$ - 0
Equipment$ - 0
Equipment$ - 0
Equipment$ - 0
Equipment$ - 0
Contractual Services
CategoryLine Item DescriptionJustificationRequested budget amount
ContractualJustification for service(s)$ - 0
ContractualJustification for service(s)$ - 0
Contractual$ - 0
Contractual$ - 0
Admin
CategoryLine Item DescriptionJustificationRequested budget amount
AdminJustification for expense$ - 0
AdminJustification for expense$ - 0
AdminJustification for expense$ - 0
AdminJustification for expense$ - 0
Admin$ - 0
Admin$ - 0

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