Attachment B - Fillable Budget Form.pdf

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Attached to
SFY 2027 SHEILA E. HIXSON BEHAVIORAL HEALTH SERVICES MATCHING GRANT PROGRAM
Solicitation number
BPM054527
Issued by
Maryland

About this file

This is a fillable budget form attachment for the Maryland Department of Health's SFY 2027 Sheila E. Hixson Behavioral Health Services Matching Grant Program, designed for local nonprofit organizations applying to establish and expand community behavioral health programs serving military-connected populations in Maryland. The form provides a structured template for applicants to detail their projected budgets and financial requirements for their proposed behavioral health initiatives. The budget form enables organizations to itemize anticipated expenses and revenue sources, allowing the Maryland Department of Health to evaluate the financial feasibility and cost-effectiveness of each proposed program during the application review process.

The fillable budget form serves as a critical component of the application package, requiring applicants to clearly document all anticipated costs associated with program implementation and service delivery to eligible service members, veterans, and their family members. By standardizing the budget submission format through this attachment, the Maryland Department of Health ensures consistency in financial reporting across all applications and facilitates comparative analysis of proposed project costs and funding needs relative to the scope of behavioral health services to be provided.

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Text version

ATTACHMENT B - BUDGET FORM

Name of Organization:

Project Title:

Award Number:

Fiscal Year:

Performance Period:

Project/Service Breakdown Total FY27

Budget Program 1 Program 2 Program 3 Total All Services

Difference (Should be 0) (Total FY27

Budget) - (Total All Services)

Salaries FICA - Salaries Retirement Health/Life Insurance Consultants FICA - Consultants Postage Cellular Telephone In-State Travel Training Advertising Client Transportation Educational Training Photocopy Rental Software Printing Human Service Contracts Educational Supplies Food Medical Supplies Office Supplies Other Supplies Personal Computer Equipment/Replace County Contribution Other-Misc Other- Other- Total Direct Costs Indirect Costs (Cap IDC 15%) Total Costs

Submitted By:

Authorized Signature: Date:

Printed Name and Title:

Company Name:

Company Address:

FEIN:

eMMA #:

Telephone:

Fax:

E-mail:

Sheila E. Hixson Behavioral Health Services Matching Grant Program

Location(s) where service(s) will be performed (City and/or County):

Sheet1

Locations where services will be performed 2:
(Project Title):
(Name of Organization):
(Award Number):
(Fiscal Year):
(Performance Period):
(Name of Individual Submitting Form):
(Name and Title of Authorized Representative):
(Locations where services will be performed 1):
(Date):
(FEIN):
(eMMA #):
(Telephone):
(Fax):
(E-mail):
(Company Address 1):
(Company Address 2):
(Company Name):
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