J-16_CLIN_0007_Cost_Proposal_Templates_Close_Out_Period.xls

XLS spreadsheet 41 KB Posted Mar 25, 2010

Attached to: DME MAC Jurisdiction D
Solicitation number: CMS-RFP-2010-0016
Issued by: Department of Health and Human Services Centers for Medicare and Medicaid Services

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Attachment J-16 CLIN 0007 Cost Proposal Templates Implementation ver 2003 and 2007

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Other files

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CLIN-0007

COST TEMPLATE - SAMPLE Attachment J-16
(Provide a cost spreadsheet for each CLIN proposed)
CLIN 0007		C.1.2			I
DME SERVICES	Total FTEs	Contractor Responsibilities during Closeout			AWARD FEE			GRAND TOTAL
		Hours	Rates	Total	Hours	Rates	Total	Hours	Total
COST ELEMENTS
Direct Labor
		0	$0.00	$0				0	$0.00
		0	$0.00	$0				0	$0.00
		0	$0.00	$0				0	$0.00
		0	$0.00	$0				0	$0.00
Add Other Appropriate Labor Categories (note: labor categories should match WBS)		0	$0.00	$0				0	$0.00
		0	$0.00	$0				0	$0.00
		0	$0.00	$0				0	$0.00
		0	$0.00	$0				0	$0.00
		0	$0.00	$0				0	$0.00
		0	$1.00	$0				0	$0.00
Subtotal Direct Labor		0		$0				0	$0.00
Fringe Benefits (at ____%)				$0					$0.00
Total Direct Labor				$0					$0.00
Travel (see separate schedule)				$0					$0.00
SUBCONTRACTORS
Subcontractor Name		0		$0				0	$0.00
Subcontractor Name		0		$0				0	$0.00
Subcontractor Name		0		$0				0	$0.00
Subcontractor Name		0		$0				0	$0.00
Subcontractor Name		0		$0				0	$0.00
Subcontractor Name		0		$0				0	$0.00
Total Subcontractor		0		$0				0	$0.00
Other Direct Costs (See separate schedule)				$0					$0.00
SUBTOTAL ALL DIRECT COSTS				$0					$0.00
Indirect Costs (at ______ %)				$0					$0.00
TOTAL OTHER BEFORE FEES				$0					$0.00
Base Fee (at ____%)				$0					$0.00
Award Fee (at ______%)							$0		$0.00
TOTAL OTHER AFTER FEES				$0			$0		$0
GRAND TOTAL									$0

&LCMS-RFP-2010-0016

Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) &LAttachment J-16 CLIN 0007 Cost Proposal Template&R&P

ODC Schedule

COST TEMPLATE - SAMPLE Attachment J-16
(Provide an ODC Spreadsheet for each CLIN Proposed)
CLIN 0007 DME SERVICES
Cost Element	TOTAL
Add costs by category
TOTAL ODCs	$0.00

&LCMS-RFP-2010-0016

Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) &LAttachment J-16 CLIN 0007 Cost Proposal Template&R&P

Travel

	TRAVEL SUMMARY
	CLIN 000X
	Purpose of Trip	SOW WBS
Crosswalk	Labor Category Taking Trip	Trip Origin	Destination	# People
(A)	# Trips
(B)	# Days
(C)	# Nights
(D)	Lodging Rate
(E)	Lodging
(F=EDA)	M&IE
(G)	Total Lodging

and M&IE

(H=F+G)	Airfare
(I)	Car Rental
(J)	Misc
(K)	Local

Mileage

(L)	Total Per Trip
(M=H+I+J+K+L)	Total For All Trips

(N=M*B )

	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
	$ -	$ -		$ -	$ -
			TOTAL TRAVEL		$ -
Travel Assumptions:

&L&"Arial,Bold"&12CMS-RFP-2010-0016 Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) &LAttachment J-16 CLIN 0007 Cost Proposal Template&R&P

File details come from the government source that posted it. Updated Nov 14, 2017.