The file's text, extracted by GovTribe without its formatting.
SUD Prevention Cost Proposal
| Agency: |
| Key |
| Service area reflects the 6 CSAP Strategies (Information Dissemination, Education, Community Based, Enviornmental, Problem ID and Referral, and Alternatives) and indirect costs including Resource Development, Administrative, Ancillary, Evaluation and Travel. |
Cost Proposal reflects your proposed contract amounts for the 6 CSAP strategies and indirect costs. Detailed descriptions of these and their unit rates can be found on the tab labeled "SUD Billing Code Descriptions".
| Instructions |
| Please complete the Cost Proposal column for what funding you are requesting to carry-out activities for a 12 month budget. All service areas must have a detailed narrative completed on the "SUD Prev. Budget Narrative" tab outlining your planned activities and anticipated numbers served. Please note that is it not necessary to fill out every category below with a budgeted amount if you do not plan to do any services that fall within that category. The total of your combined cost proposals (both substance use prevention and mental health promotion) cannot exceed $135,885.00. At least 60% of your total budget of $135,885.00 must be used to support substance use prevention purposes. A maximum of 40% can be used to support mental health promotion services. |
Please note: ALL GRAY highlighted rows must be filled out if you are requesting funding in those categories. The YELLOW highlighted rows will be auto-populated and are there for informative purposes only to show the maximum you can request in that category. If you do not fill out the gray highlighted row, it will be assumed you are not requesting funding for that line item.
| Contracted Services | |
| Service Area | Cost Proposal |
| Direct Costs | |
| H0024: Information Dissemination | $ - 0 |
| H0025: Education | $ - 0 |
| H0026: Community Based | $ - 0 |
| H0027: Environmental | $ - 0 |
| H0028: Problem ID and Referral | $ - 0 |
| H0029: Alternatives | $ - 0 |
| Direct Costs Subtotal (plus RESD) | $ - 0 |
| RESD: Resource Development | $ - 0 |
| Administrative | $ - 0 |
| 5% maximum allowed of direct costs subtotal | $ - 0 |
| Ancillary | $ - 0 |
| 5% maximum allowed of direct costs subtotal | $ - 0 |
| Evaluation | $ - 0 |
| 10% maximum allowed of direct costs subtotal | $ - 0 |
| Travel | $ - 0 |
| Indirect Costs Subtotal | $ - 0 |
| Total | $ - 0 |
SUD Prev. Budget Narrative
| Agency: |
| Substance Use Prevention Budget Narrative Directions |
| Complete the Budget Narrative below for each of the service areas funding is requested. The Budget Narrative is required to justify each service area that funds are being requested. Please do not attach a separate document to complete the Budget Narrative, these will not be reviewed. |
Narrative comments can be as long as you need. Please be detailed and informative of your planned activities. The Budget Narrative must provide an explanation of the number of service hours projected. Please also detail how you calculated your number of units requested, for example: 12 sessions for 1 hour a week = 12x52 = 624 hrs x 4 units/hour = 2496 units.
| H0024 Information Dissemination - ($12.75/unit) |
| Narrative: In narrative, please provide specific examples and benchmarks, such as events you may plan to attend as well as how you plan to spend funds. |
| H0025 Education - ($12.75/unit) |
| Narrative: In narrative, please provide specific examples such as events and/or recurring groups you may plan to facilitate or implement and how you plan to spend funds. |
| H0026 Community-based - ($13.75/unit) |
| Narrative: In narrative, please provide specific examples such as events and/or trainings you plan to attend or facilitate and how you plan to spend funds. |
| H0027 Environmental - ($12.00/unit) |
| Narrative: In narrative, please provide specific examples such as strategies you plan to facilitate or initiate and how you plan to spend funds. |
| H0028 Problem Identification & Referral - ($15.00/unit) |
| Narrative: In narrative, please provide specific examples such as groups you plan to facilitate and how you plan to spend funds. |
| H0029 Alternatives - ($12.00/unit) |
| Narrative: In narrative, please provide specific examples/activities/events you may plan to attend or facilitate and how you plan to spend funds. |
| RESD - Resource Development |
| Narrative: In narrative, please provide specific examples of curriculms and/or data collection and expenses you may plan to use and how you plan to spend funds. |
| ADMIN - Administrative |
| Narrative: In narrative, please provide detailed information as to what costs Adminstrative funds are used for. |
| ANCL - Ancillary |
| Narrative: In narrative, please provide specific examples of supplies needed to facilitated and/or support coalition meetings and how you plan to spend funds. |
| EVAL - Evaluation |
| Narrative: In narrative, please provide specific examples of how you plan to spend funds. |
| TRVL - Travel |
| Narrative: In narrative, please provide specific examples of trainings and/or activites you attend to participte and how you plan to spend funds. |
SUD Billing Code Descriptions
| One unit of service is equal to 15 minutes of staff time. | |
| CSAP Strategy | Description |
| Information Dissemination | These activities provide awareness and knowledge of the nature and extent of alcohol use, abuse and addiction, and their effects on individuals, families and communities as well as available prevention programs and services. The unit rate for Information Dissemination is $12.75. |
| Education | These activities involve two-way communication and are distinguished from merely disseminating information by the fact that it is based on an interaction between the educator and the participants. The unit rate for Education is $12.75. |
| Community Based | These activities aim to enhance the ability of the community to more effectively provide prevention services for alcohol use, abuse and addiction. The unit rate for Community Based is $13.75. |
| Environmental | These activities seek to establish or change community standards, policies and attitudes, thereby influencing the incidence and prevalence of alcohol use, abuse and addiction in the general population. The unit rate for Enviornmental is $12.00. |
| Problem Identification and Referral | |
These activities aim to identify youth who have engaged in age-inappropriate use of alcohol. Initial step is to determine if an individual’s alcohol abuse behavior can be reversed through education. Activities under this strategy would include structured prevention education programs to change the behavior, screening for tendencies toward alcohol abuse and referral to outside agencies/services. The unit rate for Problem Identification and Referral is $15.00. Problem Identification and Referral may includes these three sub service activities:
Student Assistance Programs: Structured prevention programs intended to provide alcohol information for students whose alcohol abuse may be interfering with their school performance. Examples are: early identification of students’ problems, referral to designated helpers, follow-up services, in-school services (e.g., support groups), screening for referral to outside agencies, and school policy development.
DUI/DWI/MIP Programs: Otherwise known as Diversion Programs (Prime for Life), are structured prevention education programs, utilizing EBPs, intended to change the behavior of youth and young adults who have been involved in the use of alcohol while operating a motor vehicle. Examples are: alcohol-related highway traffic safety classes, and court-mandated awareness and education programs.
Prevention Assessment and Referral Services: Refers to those activities intended to provide a risk screening, assessment, and referral to prevention service populations for placement in prevention or other appropriate services.
| Alternatives | These activities provide the opportunity to participate in healthy, positive, and constructive activities that exclude alcohol use. Alternatives must be implemented as part of a comprehensive alcohol use prevention plan and support the local evidence-based programming that is being implemented. The unit rate for Alternatives is $12.00. |
| Indirect Cost Category | Description |
| Resource Development (RESD) | This category includes other expenses related to carrying out an evidence based strategy that are not covered under another area of the budget. This may include the following: curriculum costs, purchase of media time or space, data collection (Pride Survey), training costs, professional development etc. The narrative must explain each expense in detail and the EBP it is needed for when billing information is entered electronically via the State’s prevention management information system. Resource Development is reimbursed at cost of the item and at the staff's hourly rate for any staff time utilized for training. |
| Ancillary (ANCL) | This category includes the costs associated with incidental items needed for coalition meetings and incentives. Ancillary is reimbursed at the cost of the item. |
| Administrative Costs (ADMIN) | This category includes costs associated with invoice/voucher preparation and management, project funding oversight, accountability requirements, and other related duties required to ensure fiscal compliance related to this funding. These costs cannot exceed 5% of the subtotal of direct costs. |
| Evaluation (EVAL) | This category includes all costs associated with a hired evaluator. This should include expense(s) for attending required trainings and all evaluation services provided to the coalition. Evaluation is reimbursed at the cost of the evaluator. |
| Travel (TRVL) | This category includes project director and other key staff's travel expenses to attend state trainings and carry out services outside of local travel. Trainings may include one statewide training or meeting (2 days) and and two regional trainings or meetings (1 day). Local travel is defined as 20 miles one direction from agency address. Local travel to carry out services, including attending coalition meetings is included in the direct services rates above and should not be included here. Travel to carry out services, outside of the local travel, may be reimbursed at the current state rate for mileage. Documentation related to travel must be submitted to DSSPREVCONT@state.sd.us and reference the corresponding invoice number to include: mileage from the office to the meeting location in order to be reimbursed at $0.67 per mile, receipts for lodging, if applicable, to be reimbursed at cost, not to exceed a standard state room rate and meals to be reimbursed at state per diem guidelines, if not provided at the meeting or training. |
Non-billable activities: Data entry/billing in the prevention management information system; agency staff meetings; services that are not addressing issues identified by the funding source; preparation for an accreditation review and time spent during the on-site visit; applications for funding/grants; travel time to and from training or prevention activities are not billable.
MH Promotion Cost Proposal
| Agency: |
| Key |
| Service area reflects Mental Health Promotion services and associated costs. |
Cost Proposal reflects your proposed contract amounts for the services and any indirect costs allowed. Detailed descriptions of these and their unit rates can be found on the tab labeled "MH Billing Code Descriptions".
| Instructions |
| Please complete the Cost Proposal column for what funding you are requesting to carry-out activities for a 12 month budget. All service areas must have a detailed narrative completed on the "Budget Narrative" tab outlining your planned activities and anticipated numbers served. Please note that is it not necessary to fill out every category below with a budgeted amount if you do not plan to do any services that fall within that category. The total of your combined cost proposals (both substance use prevention and mental health promotion) cannot exceed $135,885.00. At least 60% of your total budget of $135,885.00 must be used to support substance use prevention purposes. A maximum of 40% can be used to support mental health promotion services. |
Please note: ALL GRAY highlighted rows must be filled out if you are requesting funding in those categories. The YELLOW highlighted rows will be auto-populated and are there for informative purposes only to show the maximum you can request in that category. If you do not fill out the gray highlighted row, it will be assumed you are not requesting funding for that line item.
| Contracted Services | |
| Service Area | Cost Proposal |
| Direct Costs | |
| Mental Health Promotion Staff hours | $ - 0 |
| Resource Development | $ - 0 |
| Travel | $ - 0 |
| Administrative | $ - 0 |
| 5% maximum allowed of direct costs subtotal | $ - 0 |
| Total | $ - 0 |
MH Budget Narrative
| Agency: |
| Mental Health Promotion Budget Narrative Directions |
| Complete the Budget Narrative below for each of the service areas funding is requested. The Budget Narrative is required to justify each service area that funds are being requested. Please do not attach a separate document to complete the Budget Narrative, these will not be reviewed. |
Narrative comments can be as long as you need. Please be detailed and informative of your planned activities. The Budget Narrative must provide an explanation of the number of service hours projected. Please also detail how you calculated your number of units requested, for example: 12 sessions for 1 hour a week = 12x52 = 624 hrs x 4 units/hour = 2496 units.
| Mental Health Promotion Staff Hours - ($12.75/unit) |
| Narrative: In narrative, please provide specific examples and benchmarks, such as events you may plan to attend as well as how you plan to spend funds. |
| RESD - Resource Development |
| Narrative: In narrative, please provide specific examples of curriculms and/or data collection and expenses you may plan to use and how you plan to spend funds. |
| ADMIN - Administrative |
| Narrative: In narrative, please provide detailed information as to what costs Adminstrative funds are used for. |
| TRVL - Travel |
| Narrative: In narrative, please provide specific examples of trainings and/or activites you attend to participte and how you plan to spend funds. |
MH Billing Code Descriptions
| One unit of service is equal to 15 minutes of staff time. | |
| Cost Category | Description |
| Mental Health Promotion staff time | This category includes activities that provide awareness and promotion of mental health. The unit rate for Mental Health Promotion staff time is $12.75. |
| Indirect Cost Category | Description |
| Resource Development (RESD) | This category includes other expenses related to carrying out an evidence based strategy that are not covered under another area of the budget. This may include the following: curriculum costs, purchase of media time or space, data collection (Pride Survey), training costs, professional development etc. The narrative must explain each expense in detail and the EBP it is needed for when billing information is entered electronically via the State’s prevention management information system. Resource Development is reimbursed at cost of the item and at the staff's hourly rate for any staff time utilized for training. |
| Administrative Costs (ADMIN) | This category includes costs associated with invoice/voucher preparation and management, project funding oversight, accountability requirements, and other related duties required to ensure fiscal compliance related to this funding. These costs cannot exceed 5% of the subtotal of direct costs. |
| Travel (TRVL) | This category includes project director and other key staff's travel expenses to attend state trainings and carry out services outside of local travel. Trainings may include one statewide training or meeting (2 days) and and two regional trainings or meetings (1 day). Local travel is defined as 20 miles one direction from agency address. Local travel to carry out services, including attending coalition meetings is included in the direct services rates above and should not be included here. Travel to carry out services, outside of the local travel, may be reimbursed at the current state rate for mileage. Documentation related to travel must be submitted to DSSPREVCONT@state.sd.us and reference the corresponding invoice number to include: mileage from the office to the meeting location in order to be reimbursed at $0.67 per mile, receipts for lodging, if applicable, to be reimbursed at cost, not to exceed a standard state room rate and meals to be reimbursed at state per diem guidelines, if not provided at the meeting or training. |
Non-billable activities: Data entry/billing in the prevention management information system; agency staff meetings; services that are not addressing issues identified by the funding source; preparation for an accreditation review and time spent during the on-site visit; applications for funding/grants; travel time to and from training or prevention activities are not billable.
Drop Down List Options
| Column1 |
| Additional Funds Requested |
| Shift Between Current Program Budgets |
| No Additional Funds Requested Here |