Commonwealth Standard Budget Form for POS.doc
DOC document 88 KB Posted
- Attached to
- MRC AT 4-2020 - Assistive Technology Services
- Solicitation number
- BD-20-1071-AO-02021-50657
- Issued by
- Massachusetts
About this file
This document is a Commonwealth Standard Budget Form for Purchase of Service (POS) contracts. It provides a budget template for contractors to submit their costs for a program or service. The document includes line items for various direct care and program support staff positions, occupancy costs, other direct care and program support expenses, and direct administrative expenses. The budget form also includes a section for offsets and non-reimbursable costs. The document is related to a state and local contract opportunity for Assistive Technology Services in the state of Massachusetts.
The contract opportunity involves the provision of assistive technology services, but the specific details of the services requested are not provided in this budget form. The budget form does not include information on the procurement process, such as response dates, due dates, site visits, bidder's meetings, award dates, or the term of the contract. The pricing information is also limited, as it only includes a section for a commercial fee for for-profit contractors, and does not provide any details on set asides, funding requirements or sources, or incumbent contractors.
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Text version
FY:
Contractor Name:
Amendment #,if Applicable:
If Federal Funds, CFDA #:
PURCHASE OF SERVICE - ATTACHMENT 3: FISCAL YEAR PROGRAM BUDGET
Program Name:
| Document ID#: |
| MMARS Activity Code: |
| Program Type: |
| UFR Prog. #: |
| Current |
| Amend. Change |
| New |
| FTE |
| Amount |
| FTE |
| Amount |
| FTE |
| Amount |
| COST REIMBURSEMENT ONLY |
Program Component
| Offset |
| Source |
| Reimbursable |
Cost
UFR Title
Direct Care/Program Support Staff/Overtime/
Shift Differential & Relief (Titles 101-141)
SUBTOTAL STAFF
| 150 |
| Payroll Taxes |
| 151 |
| Fringe Benefits |
| T 100 |
| Total Direct Care/Program Staff |
| Title |
| Occupancy |
| 301 |
| Program Facilities |
| * |
| 390 |
| Fac. Oper/Main/Furn |
| T 300 |
| Total Occupancy |
| UFR Title |
| Other Direct |
Care/Program Support
| 201 |
| Direct Care Consultant |
| 202 |
| Temporary Help |
| 203 |
| Clients/Caregivers. Reimb/Stipends |
| 206 |
| Subcontract Dir.Care |
| 204 |
| Staff Training |
| 205 |
| Staff Mileage/Travel |
| 207 |
| Meals |
| 208 |
| Contracted Client Trans. |
| * |
| 208 |
| Vehicle Expenses |
| * |
| 208 |
| Vehicle Depreciation |
| 209 |
| Incid. Health/Med Care |
| 211 |
| Client Per. Allowances |
| 212 |
| Prov. of Material Good |
| 214 |
| Direct Client Wages |
| 214 |
| Other Commercial Prod. & Svs. |
| * |
| 215 |
| Program Supplies/Mat |
| T 200 |
| Total Other Direct Care/Program |
| Title |
| Direct Admin Expenses |
| 216 |
| Program Support |
| * |
| 510 (410 & 390) |
| Other Direct Administrative Expenses |
| T 500 |
| Total Direct Administrative Exp. |
| T |
| SUBTOTAL PROGRAM COSTS |
| * |
| 410 |
| Agency Admin. Support Allocation |
| % $ |
| T |
| PROGRAM TOTAL |
Commercial Fee, if applicable, for for-profit contractors only (for informational purposes only; not to be included in the price paid by the Commonwealth): %___$___: N/A for Cost Reimbursement
A. $ ___________ Subtotal of offsets which are for non-reimbursable costs.
Non-reimbursable costs must be shown in detail on Attachment 5 when the program is subject to the provisions of Federal OMB Circular A-122 and/or 808 CMR 1.00.
* Contractor’s Board approved capitalization level relative to any negotiated expense costs in lines 208, 215, 390 or 410 is $___________ Updated 6/19/07 Sensitivity level - low
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