Budget Forms template.pdf
PDF 129 KB Posted
- Attached to
- Domestic Violence Shelter Services
- Solicitation number
- P27000642
- Issued by
- Hawaii
About this file
This file contains budget forms and templates (Form SPO-H-205 through SPO-H-206H) used by the State of Hawaii for the Domestic Violence Shelter Services procurement issued by the Department of Human Services Child Welfare Services. The forms are standardized templates designed to guide applicants and providers in submitting detailed budget proposals and justifications for shelter services serving adults with or without children who are survivors of domestic violence, dating violence, or family violence throughout Hawaii.
The budget forms require comprehensive financial documentation across multiple categories including personnel costs (salaries, payroll taxes, and fringe benefits), other current expenses (airfare, contractual services, insurance, equipment leases, travel, supplies, and utilities), equipment purchases, and motor vehicle purchases. Supporting justification forms require detailed breakdowns for payroll taxes and assessments, inter-island travel expenses, administrative contractual services, and program activities. Applicants must identify funding sources and provide authorization signatures from officials, with all submissions directed to the State Procurement Office for review and processing.
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Other files
| File | Type | Posted |
|---|---|---|
| DV Shelter Services Work Plan Editable.docx | DOCX document | |
| Domestic Violence Shelter Services_RFPFY27_SSD_26_POS_9897.pdf |
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Text version
BUDGET
(Period _______________ to _________________)
Applicant/Provider:
RFP No.:
Contract No. (As Applicable):
B U D G E T Budget C A T E G O R I E S Request
(a) (b) (c) (d)
A. PERSONNEL COST
1. Salaries
2. Payroll Taxes & Assessments
3. Fringe Benefits
TOTAL PERSONNEL COST
B. OTHER CURRENT EXPENSES
1. Airfare, Inter-Island
2. Airfare, Out-of-State
3. Audit Services
4. Contractual Services - Administrative
5. Contractual Services - Subcontracts
6. Insurance
7. Lease/Rental of Equipment
8. Lease/Rental of Motor Vehicle
9. Lease/Rental of Space
10. Mileage
11. Postage, Freight & Delivery
12. Publication & Printing
13. Repair & Maintenance
14. Staff Training
15. Substance/Per Diem
16. Supplies
17. Telecommunication
18. Transportation
19. Utilities 21.
22.
23.
TOTAL OTHER CURRENT EXPENSES
C. EQUIPMENT PURCHASES
D. MOTOR VEHICLE PURCHASES
TOTAL (A+B+C+D)
Budget Prepared By:
SOURCES OF FUNDING
(a) Budget Request Name (Please type or print) Phone
(b)
(c) Signature of Authorized Official Date
(d) Name and Title (Please type or print)
For State Agency Use Only
TOTAL REVENUE
Signature of Reviewer Date
Form SPO-H-205 (Effective10/01/98)
BUDGET JUSTIFICATION
PERSONNEL: PAYROLL TAXES, ASSESSMENTS, AND FRINGE BENEFITS
Applicant/Provider:
RFP No.: Period: to Date Prepared:
Contract No.:
(As Applicable)
PAYROLL TAXES & ASSESSMENTS:
SUBTOTAL:
FRINGE BENEFITS:
SUBTOTAL:
TOTAL:
JUSTIFICATION/COMMENTS:
TYPE TOTAL
BASIS OF
ASSESSMENTS OR
FRINGE BENEFITS
As required by law
As required by law
As required by law
As required by law
As required by law As required by law
OF
SALARY
As required by law
As required by law
As required by law
As required by law
Temporary Disability Insurance
Health Insurance
Retirement
Unemployment Insurance (Federal)
Social Security
Unemployment Insurance (State)
Worker's Compensation
Form SPO-H-206B (Effective 10/01/98)
TRAVEL - INTER-ISLAND
Applicant/Provider:
RFP No.: Period: to Date Prepared:
Contract No.
(As Applicable)
NO.
PER DIEM
OR SUBSISTENCE
AIR
FARE TRANSPORTATION TOTAL
DAYS A B C A+B+C
JUSTIFICATION/COMMENTS:
NAME OF EMPLOYEE & TITLE DESTINATION
TOTAL:
Form SPO-H-206C (Effective 10/01/98)
CONTRACTUAL SERVICES - ADMINISTRATIVE
Applicant/Provider:
RFP No.: Period: to Date Prepared:
Contract No.
(As Applicable)
TOTAL BUDGETED JUSTIFICATION/COMMENTSNAME OF BUSINESS OR INDIVIDUAL
TOTAL:
SERVICES
PROVIDED
Form SPO-H-206E (Effective 10/01/98)
PROGRAM ACTIVITIES
Applicant/Provider:
RFP No.: Period: to Date Prepared:
Contract No. :
(As Applicable)
AMOUNTDESCRIPTION JUSTIFICATION/COMMENTS
Total:
Form SPO-H-206H (Effective 10/01/98)
| spoh-205 Budget |
| spoh205 |
| spoh-205A by Source |
| spoh205a |
| spoh-206B Personnel Fringe Benefits |
| spoh206B |
| spoh-206C Inter-Island Travel |
| spoh206C-e97 |
| spoh-206E Admin Costs |
| spoh206E |
| spoh-206H Program Activities |
| spoh206H |
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