Attachment J-5 Instructions for Travel Detail.docx

End Stage Renal Disease Network HHSM-500-2012-RFPCompetitive-ESRDCPFF Cost Plus Fixed Fee (CPFF)

Attachment J-5

INSTRUCTIONS FOR CMS FORMS

TRAVEL DETAIL IN-STATE/OUT-OF-STATE

RFP Number Enter the CMS Request for Proposal (RFP) number for the proposed contract (make sure the information is entered in the box shown at cell A6) in worksheet Year 1. Note: This information is linked throughout the following worksheets.

Name and Address of ESRD NW Organization Enter the name and address of the organization submitting the proposal (make sure the information is entered in the boxes shown at cells B6, B7 and B8) in worksheet Year 1. Note: This information is linked throughout the following worksheets.

ESRD NW Area (NW # __) Enter the area that the proposed ESRD NW contract will cover (make sure the information is entered in the box shown at cell G6) in worksheet Year 1. Note: This information is linked throughout the following worksheets.

Proposed Contract Period Enter the beginning and ending dates of the proposed ESRD NW contract (make sure the information is entered in the boxes shown at cells K6 and K7) in worksheet Year 1. Note: This information is linked throughout the following worksheets.

Mileage Rate.

ESRD NWs should enter the current Federal Travel Regulation mileage rate used for the proposed NW contract.

Trip Title & Description.

Enter a proposed trip title and provide a brief description of the purpose of the trip.

# of Days per Trip.

Enter the proposed number of days the trip will occur.

# of Nights per Trip.

Enter the proposed number of nights the trip will occur.

# of Travelers per Trip.

NWs should enter the number of travelers, per trip, in whole figures.

Airfare per Person.

NWs should enter the proposed airfare per person.

Departing from.

Enter the city and state the travelers are departing from.

Arriving to.

Enter the city and state the travelers will arrive to.

FTR Meals & Inc. Daily Rate.

NWs must enter the current Federal Travel Regulations (FTR) Meals and Incidental Rate for the current year based on www.gsa.gov. Note: The formula embedded in the Total column will calculate the max Per Diem rate for the first and last day based on the number of days reported previously.

FTR Lodging per Night.

NWs must enter the current Federal Travel Regulations (FTR) maximum Lodging Rate (excluding taxes) for the Primary Destination for each trip based on www.gsa.gov. Note: The formula embedded in the Total column will calculate the lodging costs based on the nights reported previously.

# of Trips for Year 1, 2, or 3.

Enter the number of trips for the respective year.

Mileage per Traveler per Trip.

Input the roundtrip mileage per trip, if applicable.

# of Rental Cars per Trip.

Enter the number of rental cars needed for each trip.

Daily Rental Car Rate.

Enter the proposed daily rental car rate.

Miscellaneous Cost per Person per Trip.

Enter the miscellaneous cost per person per trip. You may include parking fees, gas, taxi, metro fees, and the like.

Notes.

Provide a detailed explanation of the proposed miscellaneous cost calculations (what and how your organization reached the proposed figures).

** Shaded cells represent no entry required.

Business Proposal Form: Travel Detail for In-State/Out-of-State