Combined Funding Source Budget Narrative - Sample.docx

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Senior Medicare Patrol Projects - Empowering Seniors to Prevent Health Care Fraud
Opportunity number
HHS-2015-ACL-CCASD-MP-0091
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Combined Source Funding Narrative Sample

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Combined Funding Source Budget Narrative/Justification – Sample Format

NOTE : Applicants requesting funding for a multi-year grant program are REQUIRED to provide a detailed Budget Narrative/Justification for EACH potential year of grant funding requested.

Object Class Category
Federal Funds

HCFAC

Federal Funds

OAA

Non-Federal Cash
Non-Federal In-Kind
TOTAL
Justification
Personnel
$23,850
$47,700
$23,554
$0
$95,104
Federal HCFAC

Project Director (name) = .25 FTE @ $95,401/yr = $23,850 Federal OAA Project Director (name) = .5 FTE @ $95,401/yr = $47,700 Non-Federal Cash Office Manager (name) = .5 FTE @ $47,108/yr = $23,554

Total $95,104

Fringe Benefits
$8,741
$17,482
$8,632
$0
$34,855
Federal HCFAC

Fringe on Project Director at 36.65% = $8,741

FICA (7.65%)

Health (25%) Dental (2%) Life (1%) Unemployment (1%) Federal OAA Fringe on Project Director at 36.65% = $17,482

FICA (7.65%)

Health (25%) Dental (2%) Life (1%) Unemployment (1%) Non-Federal Cash Fringe on Office Manager at 36.65% = $8,632

FICA (7.65%)

Health (25%) Dental (2%) Life (1%) Unemployment (1%) Office Manager (name) = .5 FTE @ $47,108/yr = $23,554

Total $34,855

Travel
$0
$4,707
$2,940
$0
$7,647
Federal HCFAC

N/A Federal OAA Local travel: 6 TA site visits for 1 person Mileage: 6RT @ .585 X 700 miles $2,457 Lodging: 15 days @ $110/day $1,650 Per diem: 15 days @ $40/day $600 Total $4,707 Non-Federal Cash Travel to National Conference in (Destination) for 3 people Airfare 1 RT x 3 staff @$500 $1,500 Lodging: 3 days x 3 staff @ $120/day $1,080 Per diem: 3 days x 3 staff @ $40/day $360 Total $2,940

Total $7,647

Equipment
$0
$10,000
$0
$0
$10,000
Federal HCFAC

N/A Federal OAA Call Center Equipment Installation = $5,000 Phones = $5,000 Total = $10,000 Non-Federal Cash N/A

Total = $10,000

Supplies
$0
$4,000
$5,784
$0
$9,484
Federal HCFAC

N/A Federal OAA 2 desks @ $1,500 = $3,000 2 chairs @ $300 = $600 2 cabinets @ $200 = $400 Total $4,000 Non-Federal Cash 2 laptop computers = $3,000 Printer cartrides @ $50/month = $300 Consumable supplies (pens, paper, clips, etc…) @ $182/month = $2,184 Total $5,484

Total $9,484

Contractual
$25,000
$30,171
$0
$0
$55,171
(Provide organization name, purpose of contract and estimated dollar amount)

Federal HCFAC Contract with AAA to provide SMP program services:

SMP Program Coordinator = $11,500 Volunteer Coordinator = $13,500 Total $25,000 Federal OAA Contract with AAA to provide SMP program services:

SMP Program Coordinator = $18,502 Volunteer Coordinator = $11,660 Total $30,171 Non-Federal Cash or In-Kind N/A

Total $ 55,171

If contract details are unknown due to contract yet to be made provide same information listed above and:

A detailed evaluation plan and budget will be submitted by (date), when contract is made.

Other
$0
$5,600
$0
$5,880
$11,480
Federal HCFAC

N/A Federal OAA 2 consultants @$100/hr for 24.5 hours each = $4,900 Printing 10,000 Brochures @ $.05/each = $500 Local conference registration (name conf.) = $200 Total $5,600 Non-Federal In-Kind 15 Volunteers @ $8/hr for 49 hours = $5,880

Total $11,480

Indirect Charges
$7,007
$20,934
$0
$0
$27,941
Federal HCFAC

21.5% of salaries and fringe = $7,007 Federal OAA 21.5% of salaries and fringe = $20,934

IDC rate is attached

TOTAL
$64,598
$140,294
$40,910
$5,880
$251,682

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