CMS Budget Spreadsheet.xlsx

XLSX spreadsheet 395 KB Posted Apr 15, 2026

Attached to: Civil Money Penalty Grant Opportunity
Solicitation number: MEDIOMC26022
Issued by: Polk County, Iowa

About this file

Written by GovTribe AI · Apr 16, 2026

This is a CMS Budget Spreadsheet template designed for grant applicants seeking funding through the Civil Money Penalty Quality Improvement Initiative (CMPQII) Grant Program administered by the Centers for Medicare & Medicaid Services (CMS) in Iowa. The spreadsheet provides a standardized format for applicants to submit comprehensive budgets covering the entire project period, with separate line-item budget sections for Years 1, 2, and 3, followed by an auto-calculating summary budget. The template requires detailed breakdowns across six primary budget categories: Personnel (with position titles, monthly salary rates, percentage of effort, fringe benefits, and justifications); Travel (including mileage, lodging, and per diem expenses at GSA rates); Equipment Purchases and Rentals; Contractual costs for third-party contractors and consultants; Other Direct Costs; and Indirect/Overhead costs. Applicants must populate only white cells while gray cells automatically calculate totals, and the spreadsheet explicitly prohibits alterations to built-in formulas. All submitted budgets must remain in their original, unaltered format per CMS requirements.

The budget spreadsheet accommodates projects with up to three years of funding and includes provisions for cost-sharing arrangements using non-federal funds, which can include in-kind contributions, donated supplies, waived indirect costs, and other non-federal sponsored activities. Applicants must provide comprehensive justifications for all budget line items, with particular emphasis on personnel costs (including detailed calculations of fringe benefits supported by organizational policies), equipment purchases, and any costs exceeding maximum category funding amounts, which may include geographic location justifications. The template also requires applicants to list participating nursing facility names, CMS Certification Numbers (CCNs), and certified bed counts on a separate facility sheet. CMS directs applicants to reference the CMPRP Application Handbook for detailed guidance on budget requirements and category-specific cost specifications. Contact information for the CMS CMPRP Team is provided at CMS-Info@cms.hhs.gov for questions regarding budget submission procedures and compliance.

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Other files

File	Type	Posted
MEDIOMC26022 Questions & Answers.xlsx	XLSX spreadsheet	Apr 15, 2026
Iowa CMPQII Supplemental Application Forms.docx	DOCX document	Apr 15, 2026
Nursing Home Participation List 2026.xlsx	XLSX spreadsheet	Apr 15, 2026
CMS Memo QSO-25-26-NH.pdf	PDF	Apr 15, 2026
MEDIOMC26022 RFP.docx	DOCX document	Apr 15, 2026
CMS Application Form.pdf	PDF	Apr 15, 2026
CMPRP Application Handbook.pdf	PDF	Apr 15, 2026

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Sheet 1 - Instructions

(DO NOT ALTER THE BUILT-IN FORMULAS WITHIN THIS SPREADSHEET)

Budget spreadsheets must be submitted in their original, unaltered format. CMS will not accept budget spreadsheets that have been altered.

For questions, contact the CMS CMPRP Team at CMS-Info@cms.hhs.gov.

Sheet 1 - Instructions: Applicants must provide the Participating Facility Names, Line-Item Budget, and Summary Budget as part of the budget submission.

Sheet 2 - Facility Names: The CMS Certification Number (CCN), participating facility name, and certified bed count.

Note: This sheet is not required for State Agency Conference Applications.

Sheet 3 - Example: This sheet provides helpful examples to reference while completing the budget spreadsheet for your convenience.

Sheets 4, 5, and 6 - Line Item Budget (Direct and Indirect Costs): The budget should be for the entire project period. Please ensure that the Project Duration in Sheets 4 through 7 corresponds to Section IIa, Project Details, in the CMPRP Application.

Sheet 7 - Summary Budget: Auto-fills from Sheet 4 (Year 1), Sheet 5 (Year 2), and Sheet 6 (Year 3)

Required Material Please refer to the "Application Budget Spreadsheet" section in the CMPRP Application Handbook for details on how the budget outlines specific cost requirements with justification within each of the following budget categories. The spreadsheet, as presented, contains elements common to most applications presented in the correct format; however, it is not exhaustive. Please populate the budget to reflect all planned expenditures.

Important

• If you are requesting funding that exceeds the maximum category funding amount (i.e., the budget cap), please include justification in Sheet 4 - Year 1, Line 4 for consideration. Justifications may include, but are not limited to, geographic location.

• CMS will compare line items from previously approved CMP-funded projects that are seeking expansion and require justification if budget variances are present. For example, a previous project budget lists the unit cost of a specific activity kit as $50. In a later application, the unit cost of the activity kit has increased to $90. The applicant will need to justify the increase in unit cost for the activity kit.

Budget Categories (Direct and Indirect Costs)

Personnel: Identify staffing requirements by each position title and brief description of duties and # of man hours. List monthly salary of each position, percentage of time and number of months devoted to project, and fringe if applicable. For fringe benefits, explain in the justification column how benefits are computed. Fringe rate should be supported by organization's policies and procedures (e.g., Administrative Director: $30,000/year x 25% level of effort x 8.5 months with 10% fringe; calculation: $30,000/12 = $2,500 x 25% x 8.5 months = $5,312 x 1+10% = $5,843). For percent effort for the project and the fringe rate, enter whole numbers only, and add a "%" sign after the number - e.g., "60%."

Travel: If applicable, identify staff travel requirements for domestic U.S. and international travel, including per diem rates broken out by lodging and meals and incidental expenses (M&IE). Per diem rates must be reasonable. Examples of reasonable rates include but are not limited to the published U.S. government allowance rates (available from the www.gsa.gov/travel-resources website). Include comprehensive justification for rates that exceed GSA guidelines.

Equipment Purchases and Rentals: If applicable, provide justification for any equipment purchase/rental. Note that any item that is determined to be a capital expenditure is not an allowable use of CMP funds.

Contractual: Provide a line item breakdown for each sub-project/contract and describe specific services. Include consultant costs in this line item.

Other Direct Costs: These will vary depending on the nature of the project. Justify each in the budget narrative. Detail items separately using unit costs and the percentage of each unit cost being charged to the project (e.g., telephone: $50/month x 50% = $25/month x 12 months) for other direct costs.

Indirect Costs: Overhead costs allocable to the project, such as a negotiated rate with a university. The rate should reflect the lowest possible rate obtainable that does not hinder project activities.

Note: It is important to note that justification is required for all rates reflected. Rates referenced in the budget spreadsheet without sufficient justification will result in a corrective action.

Cost Sharing: Cost-sharing is the portion of project costs not covered by CMP funds. In general, applications that include in-kind and/or cash contributions demonstrate a commitment to the project and greater cost effectiveness. Applicants should consider all types of cost-sharing. Examples include the use of office space owned by other entities; donated or borrowed supplies and equipment; (non-federal) sponsored travel costs; waived indirect costs; and program activities, translations, or consultations. Other federal funding does not constitute cost-sharing. If cost-sharing is included, it should be listed for each year of the project. If the proposed project is a component of a larger program, identify other funding sources for the proposal, and indicate the specific funding amount to be provided by those sources. Any amounts entered as cost-sharing will be subtracted from the total amount of requested CMP funds.

Sheet 2 - Facility Names

Instructions
Column A - CCN: Enter the six (6)-digit CMS Certification Number (CCN), line by line, for each participating nursing home.
Column B - Facility Name: Enter the facility name next to the CCN, line by line, for each participating nursing home.
Column C - Certified Bed Count: Enter the total number of beds that meet CMS standards, line by line, for each participating nursing home.
CCN	Facility Name	Certified Bed Count
123456	Example Facility	53
789101	Testing Facility	189

Sheet 3 - Example

EXAMPLE LINE ITEM BUDGET
Project Title	Music Therapy
Project Duration: [Start Date] - [End Date]	March 3, 2025 - March 2, 2026

	1. Personnel (Description: An employee of the organization whose work is directly related to the proposed project)
		Position/ Name of person (if available)	Monthly salary rate	# of Months	% Effort for Project	Fringe Rate (%)	Total Project Costs
(Monthly Salary X # of months X % Effort)x%Fringe Rate)	Description and Justification

(Explain the costs, units, and # of man hours)

	1.1	Project Coordinator	$ 500.00	12	100%	10%	$ 6,600.00	Project requires a 40hr/week Project Coordinator to set up and manage day to day the music program, and has no other roles in the nursing home.
	1.2	Trainer	$ 250.00	12	50%	10%	$ 1,650.00	Project requires a 20hr/week trainer to support the two facilities.
	1.3						$ - 0
	1.4						$ - 0
	1.5						$ - 0
	1.6						$ - 0
	1.7						$ - 0
	1.8						$ - 0
	1.9						$ - 0
						1. Personnel Subtotal	$ 8,250.00
	2. Travel (Description: Provide mileage, lodging, and per diem as applicable. The lowest available commercial fares for coach or equivalent accommodations must be used. Generally, the unit of measure should be the number of trips.)
	Travel Expense		Item Description	Number of Miles/Nights/Days	Rate	Number of Units	Total Project Costs
(No. of Days x Rate x No. of Units)	Description and Justification
	2.1	Mileage	Travel between facilities	57	$ 0.58	2	$ 66.12	The project coordinator will travel between two facilities (57 miles) 2x per year. The mileage rate is the GSA rate.

Travel is required to support the project in participating facilities; the majority of the time, it will be virtual oversight.

2.2	Mileage	$ - 0
2.3	Mileage	$ - 0

2.4	Lodging	Hotel for two visits	2	$ 89.00	2	$ 356.00	Hotel for project coordinator for two nights.
2.5	Lodging					$ - 0
2.6	Lodging					$ - 0

2.7	Per Diem	Meals during travel	2	$ 41.25	2	$ 165.00	Meals for project coordinator for two trips; rate is GSA rate for the first and last day in all locations without a specified rate.
2.8	Per Diem					$ - 0
2.9	Per Diem					$ - 0
					2. Travel Subtotal	$ 587.12

	3. Equipment Purchases and Rentals (Description: Materials necessary to the roll out of the project and may also include room rentals for hosting an event. Generally, the unit of measure will be a piece of equipment.)
	Item Description		Unit of Measure	Cost Per Unit	Number of Units		Total Project Costs
(Cost Per Unit x No. of Units)	Description and Justification
	3.1	Drum Set	piece of equipment	$ 100.00	2		$ 200.00	Drum sets required for each facility to use for the music program.
	3.2	Ukulele	piece of equipment	$ 35.00	6		$ 210.00	Three ukuleles per facility for residents to use for the music program.
	3.3	Guitar	piece of equipment	$ 50.00	6		$ 300.00	Three guitars per facility for residents to use for the music program.
	3.4						$ - 0
	3.5						$ - 0
	3.6						$ - 0
	3.7						$ - 0
	3.8						$ - 0
	3.9						$ - 0
	3.10						$ - 0
	3.11						$ - 0
	3.12						$ - 0
	3.13						$ - 0
	3.14						$ - 0
	3.15						$ - 0
	3.16						$ - 0
	3.17						$ - 0
	3.18						$ - 0
	3.19						$ - 0
	3.20						$ - 0
						3. Equipment/Rentals Subtotal	$ 710.00

	4. Contractual (Description: The costs of project activities to be undertaken by a third-party contractor should be included in this category as a single line item charge.
	If there is more than one contractor, each must be budgeted separately. Generally, the unit of measure will be the period of performance.)
	Name/Item Description	Period of Performance	Unit Cost	Number of Units	Total Project Costs
(Cost Per Unit x No. of Units)	Description and Justification

(Explain the costs and units)

4.1	Consultant	1 hour	$ 100.00	1		$ 100.00	The project requires an expert for one hour during the initial implementation of the one-year project. The consultant will onboard facility staff in the Music Therapy program to ensure that each facility has the resources required to run the program smoothly without interruption.
4.2						$ - 0
4.3						$ - 0
4.4						$ - 0
4.5						$ - 0
4.6						$ - 0
4.7						$ - 0
4.8						$ - 0
4.9						$ - 0
					4. Contractual Subtotal	$ 100.00

	5. Other Direct Costs (Description: Expenses not covered in any of the previous budget categories. The unit of measure will depend on the item or service.)
	Item Description	Unit of Measure	Cost Per Unit	Number of Units	Total Project Costs
(Cost Per Unit x No. of Units)	Description and Justification

(Explain the costs and units)

5.1	Shipping of project materials	Per box	$ 35.00	8		$ 280.00	Shipping materials and costs for two facilities to receive instruments for project activities.
5.2						$ - 0
5.3						$ - 0
5.4						$ - 0
5.5						$ - 0
5.6						$ - 0
5.7						$ - 0
5.8						$ - 0
5.9						$ - 0
5.10						$ - 0
5.11						$ - 0
5.12						$ - 0
5.13						$ - 0
5.14						$ - 0
5.15						$ - 0
5.16						$ - 0
5.17						$ - 0
5.18						$ - 0
5.19						$ - 0
5.20						$ - 0
					5. Other Direct Costs Subtotal	$ 280.00

6. Total Direct Costs
	Total Direct Costs
Sum of Subtotal Costs from #1-#5 above	$ 9,927.12

7. Total Indirect Costs
	%	Total Indirect Costs	Justification
Overhead costs allocable to the project

tc={F59BEC0F-4141-4185-A632-751B92D1EF55}: [Threaded comment]

Your version of Excel allows you to read this threaded comment; however, any edits to it will get removed if the file is opened in a newer version of Excel. Learn more: https://go.microsoft.com/fwlink/?linkid=870924

Comment:

The Team recommends only requesting justification for indirect costs if it appears unreasonable in relation to the amount of funds requested.	9. Total Costs
		Total Project Cost
	Sum of Direct and Indirect Costs from #6-#7 above	$ 9,927.12

The Team recommends only requesting justification for indirect costs if it appears unreasonable in relation to the amount of funds requested.

Sheet 4 - Year 1

LINE ITEM BUDGET (Year 1)		Only enter information into white cells. Gray cells auto-calculate. Blue cells are instructions. (DO NOT ALTER THE BUILT IN FORMULAS WITHIN THIS TEMPLATE)
Project Title
Project Duration: [Start Date] - [End Date]
	Justification for request above maximum category funding amount

	1. Personnel (Description: An employee of the organization whose work is directly related to the proposed project)
		Position/ Name of person (if available)	Monthly salary rate	# of Months	% Effort for Project	Fringe Rate (%)	Total Project Costs
(Monthly Salary X # of months X % Effort)x%Fringe Rate)	Description and Justification

(Explain the costs, units, and # man hours)

1.1	Job Title #1		$ - 0
1.2	Job Title #2		$ - 0
1.3	Job Title #3		$ - 0
1.4	Job Title #4		$ - 0
1.5	Job Title #5		$ - 0
1.6	Job Title #6		$ - 0
1.7	Job Title #7		$ - 0
1.8	Job Title #8		$ - 0
1.9	Job Title #9		$ - 0
		1. Personnel Subtotal	$ - 0

2. Travel (Description: Provide mileage, lodging, and per diem as applicable. The lowest available commercial fares for coach or equivalent accommodations must be used. Generally, the unit of measure should be the number of trips.)

tc={3B34D6B2-E3CF-4C20-A6E8-AE435202C1F4}: [Threaded comment]

Comment:

The team has removed a few lines from this section in all sheets, as applicants don’t usually use all 5 lines to list mileage, lodging, and per diem.	Travel Expense	Item Description	Number of Miles/Nights/Days	Rate	Number of Units	Total Project Costs
(No. of Days x Rate x No. of Units)	Description and Justification

tc={5C163553-0006-44A4-BD47-A25AA1E95C2B}: [Threaded comment]

Comment:

Completed C. Justification instructions edit

Remove the current justification column across budget category tabs (e.g., Travel, Equipment).

Applicants should provide more detailed information than just 1–2 sentences. This detail will be guided through other required fields or added sections.

2.1	Mileage	$ - 0
2.2	Mileage	$ - 0
2.3	Mileage	$ - 0

2.4	Lodging	$ - 0
2.5	Lodging	$ - 0
2.6	Lodging	$ - 0

2.7	Per Diem		$ - 0
2.8	Per Diem		$ - 0
2.9	Per Diem		$ - 0
		2. Travel Subtotal	$ - 0

	3. Equipment Purchases and Rentals (Description: Materials necessary to the roll out of the project and may also include room rentals for hosting an event. Generally, the unit of measure will be a piece of equipment.)
	Item Description	Unit of Measure	Cost Per Unit	Number of Units		Total Project Costs
(Cost Per Unit x No. of Units)	Description and Justification
	3.1					$ - 0
	3.2					$ - 0
	3.3					$ - 0
	3.4					$ - 0
	3.5					$ - 0
	3.6					$ - 0
	3.7					$ - 0
	3.8					$ - 0
	3.9					$ - 0
	3.10					$ - 0
	3.11					$ - 0
	3.12					$ - 0
	3.13					$ - 0
	3.14					$ - 0
	3.15					$ - 0
	3.16					$ - 0
	3.17					$ - 0
	3.18					$ - 0
	3.19					$ - 0
	3.20					$ - 0
					3. Equipment/Rentals Subtotal	$ - 0

	4. Contractual (Description: The costs of project activities to be undertaken by a third-party contractor should be included in this category as a single line item charge.
	If there is more than one contractor, each must be budgeted separately. Generally, the unit of measure will be the period of performance.)
	Name/Item Description	Period of Performance	Unit Cost	Number of Units	Total Project Costs
(Cost Per Unit x No. of Units)	Description and Justification

(Explain the costs and units)

4.1		$ - 0
4.2		$ - 0
4.3		$ - 0
4.4		$ - 0
4.5		$ - 0
4.6		$ - 0
4.7		$ - 0
4.8		$ - 0
4.9		$ - 0
	4. Contractual Subtotal	$ - 0

	5. Other Direct Costs (Description: Expenses not covered in any of the previous budget categories. The unit of measure will depend on the item or service.)
	Item Description	Unit of Measure	Cost Per Unit	Number of Units	Total Project Costs
(Cost Per Unit x No. of Units)	Description and Justification

(Explain the costs and units)

5.1		$ - 0
5.2		$ - 0
5.3		$ - 0
5.4		$ - 0
5.5		$ - 0
5.6		$ - 0
5.7		$ - 0
5.8		$ - 0
5.9		$ - 0
5.10		$ - 0
5.11		$ - 0
5.12		$ - 0
5.13		$ - 0
5.14		$ - 0
5.15		$ - 0
5.16		$ - 0
5.17		$ - 0
5.18		$ - 0
5.19		$ - 0
5.20		$ - 0
	5. Other Direct Costs Subtotal	0

6. Total Direct Costs
	Total Direct Costs
Sum of Subtotal Costs from #1-#5 above	$ - 0

7. Total Indirect Costs
	%	Total Indirect Costs	Justification
Overhead costs allocable to the project such as a negotiated rate with a university.		$ - 0

8. Cost-Sharing
	Total Cost-Sharing
Total Non-CMP funds received or anticipated for this project
9. Total Costs
	Total Project Cost
Sum of Direct and Indirect Costs from #6-#7 above	$ - 0

The team has removed a few lines from this section in all sheets, as applicants don’t usually use all 5 lines to list mileage, lodging, and per diem.

Completed C. Justification instructions edit

Remove the current justification column across budget category tabs (e.g., Travel, Equipment).

Applicants should provide more detailed information than just 1–2 sentences. This detail will be guided through other required fields or added sections.

Sheet 5 - Year 2

LINE ITEM BUDGET (Year 2)	Only enter information into white cells. Gray cells auto-calculate. Blue cells are instructions. (DO NOT ALTER THE BUILT IN FORMULAS WITHIN THIS TEMPLATE)
Project Title
Project Duration: [Start Date] - [End Date]

	1. Personnel (Description: An employee of the organization whose work is directly related to the proposed project)
		Position/ Name of person (if available)	Monthly salary rate	# of Months	% Effort for Project	Fringe Rate (%)	Total Project Costs
(Monthly Salary X # of months X % Effort)x%Fringe Rate)	Description and Justification

(Explain the costs, units, and # man hours)

1.1	Job Title #1		$ - 0
1.2	Job Title #2		$ - 0
1.3	Job Title #3		$ - 0
1.4	Job Title #4		$ - 0
1.5	Job Title #5		$ - 0
1.6	Job Title #6		$ - 0
1.7	Job Title #7		$ - 0
1.8	Job Title #8		$ - 0
1.9	Job Title #9		$ - 0
		1. Personnel Subtotal	$ - 0

	2. Travel (Description: Provide mileage, lodging, and per diem as applicable. The lowest available commercial fares for coach or equivalent accommodations must be used. Generally, the unit of measure should be the number of trips.)
	Travel Expense		Item Description	Number of Miles/Nights/Days	Rate	Number of Units	Total Project Costs
(No. of Days x Rate x No. of Units)	Description and Justification
	2.1	Mileage					$ - 0
	2.2	Mileage					$ - 0
	2.3	Mileage					$ - 0

2.4	Lodging	$ - 0
2.5	Lodging	$ - 0
2.6	Lodging	$ - 0

2.7	Per Diem		$ - 0
2.8	Per Diem		$ - 0
2.9	Per Diem		$ - 0
		2. Travel Subtotal	$ - 0

	3. Equipment Purchases and Rentals (Description: Materials necessary to the roll out of the project and may also include room rentals for hosting an event. Generally, the unit of measure will be a piece of equipment.)
	Item Description	Unit of Measure	Cost Per Unit	Number of Units		Total Project Costs
(Cost Per Unit x No. of Units)	Description and Justification
	3.1					$ - 0
	3.2					$ - 0
	3.3					$ - 0
	3.4					$ - 0
	3.5					$ - 0
	3.6					$ - 0
	3.7					$ - 0
	3.8					$ - 0
	3.9					$ - 0
	3.10					$ - 0
	3.11					$ - 0
	3.12					$ - 0
	3.13					$ - 0
	3.14					$ - 0
	3.15					$ - 0
	3.16					$ - 0
	3.17					$ - 0
	3.18					$ - 0
	3.19					$ - 0
	3.20					$ - 0
					3. Equipment/Rentals Subtotal	$ - 0

	4. Contractual (Description: The costs of project activities to be undertaken by a third-party contractor should be included in this category as a single line item charge.
	If there is more than one contractor, each must be budgeted separately. Generally, the unit of measure will be the period of performance.)
	Name/Item Description	Period of Performance	Unit Cost	Number of Units	Total Project Costs
(Cost Per Unit x No. of Units)	Description and Justification

(Explain the costs and units)

4.1		$ - 0
4.2		$ - 0
4.3		$ - 0
4.4		$ - 0
4.5		$ - 0
4.6		$ - 0
4.7		$ - 0
4.8		$ - 0
4.9		$ - 0
	4. Contractual Subtotal	$ - 0

	5. Other Direct Costs (Description: Expenses not covered in any of the previous budget categories. The unit of measure will depend on the item or service.)
	Item Description	Unit of Measure	Cost Per Unit	Number of Units	Total Project Costs
(Cost Per Unit x No. of Units)	Description and Justification

(Explain the costs and units)

5.1		$ - 0
5.2		$ - 0
5.3		$ - 0
5.4		$ - 0
5.5		$ - 0
5.6		$ - 0
5.7		$ - 0
5.8		$ - 0
5.9		$ - 0
5.10		$ - 0
5.11		$ - 0
5.12		$ - 0
5.13		$ - 0
5.14		$ - 0
5.15		$ - 0
5.16		$ - 0
5.17		$ - 0
5.18		$ - 0
5.19		$ - 0
5.20		$ - 0
	5. Other Direct Costs Subtotal	$ - 0

6. Total Direct Costs
	Total Direct Costs
Sum of Subtotal Costs from #1-#5 above	$ - 0

7. Total Indirect Costs
	%	Total Indirect Costs	Justification
Overhead costs allocable to the project such as a negotiated rate with a university.		$ - 0

8. Cost-Sharing

Total Cost-Sharing

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