Exhibit B - Colorado Prevail Program Grant Application Workbook.xlsx

XLSX spreadsheet 286 KB Posted Mar 20, 2026

Attached to: FY26; RFA Colorado Prevail Program
Solicitation number: RFP IBEH 2026000182 2
Issued by: Denver County, Denver City, Colorado

About this file

Written by GovTribe AI · Mar 23, 2026

This is a Grant Application Workbook for the Colorado Prevail Program, administered by the Colorado Department of Human Services' Behavioral Health Administration (BHA). The workbook serves as the application template for organizations seeking to implement the PREVAIL program, a behavioral health and criminal justice diversion initiative designed to reduce criminal justice involvement for individuals with unmet behavioral health or substance use needs. Applicants must be local government agencies (counties, municipalities, or law enforcement departments) or nonprofit organizations with executed partnerships or Memoranda of Understanding with qualifying law enforcement or judicial entities. Selected vendors shall implement PREVAIL according to BHA guidelines, establish Policy and Community Workgroups, maintain partnerships with law enforcement and judicial partners, deliver trauma-informed case management services using evidence-based practices, utilize BHA-approved data systems (CiviCore and GAIN), and participate in ongoing monitoring and evaluation. Minimum program performance standards require receiving no fewer than 100 annual referrals with 15% originating from law enforcement, achieving 60% enrollment of all referrals, and demonstrating that at least 70% of participants achieve one or more individualized goals.

The application is evaluated on mandatory and preferred criteria, with mandatory requirements including applicant eligibility, legal authority to operate in Colorado, and regulatory compliance, which must be certified through completion of Exhibit G. Preferred criteria worth up to 100 points include program model fidelity and implementation (30%), youth and transitioned-aged adult experience (20%), operational capacity (10%), community collaboration and partnerships (10%), staffing and training capacity (5%), program sustainability and funding integration (10%), data evaluation and continuous quality improvement (15%), and integration of FAIR principles—Fairness, Access, Impact, and Relationships—(10%). The maximum award amount is $475,000 annually for single applicants and $650,000 for joint or partnership applications. Budgets must be submitted using the FY27 BHA Cost Reimbursement Budget template and should include detailed narratives for each line item explaining how funds support specific Statement of Work activities, including staff wages, client costs, training and professional development, travel, vehicle leases and maintenance, office operations, and program evaluation. Applicants may utilize their federally negotiated indirect cost rate or the 15% de minimis rate, and all matching fund requirements must be clearly documented with revenue offsets and matching funds accounted for separately. The contract period runs from July 1, 2026, through June 30, 2027, with billing on a cost reimbursement basis for actual expenses incurred.

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Other files

File	Type	Posted
Exhibit D - HIPAA Business Associate Agreement (BAA).pdf	PDF	Mar 20, 2026
RFA IBEH 2026000182 Colorado Prevail Program.docx	DOCX document	Mar 20, 2026
Q&A - RFA IBEH 2026000182.docx	DOCX document	Mar 20, 2026
RFA IBEH 2026000182 - Amendment #1 Notice.docx	DOCX document	Mar 20, 2026
Exhibit G - Mandatory Requirements and Eligibility Certification.docx	DOCX document	Mar 20, 2026
Exhibit E - CDHS Personal Services Contract Template, Terms & Conditions Template.docx	DOCX document	Mar 20, 2026
Exhibit F - CDHS Personal Services Contract Template - Signature and Cover Pages.docx	DOCX document	Mar 20, 2026
Exhibit A- Stament of Work.docx	DOCX document	Mar 20, 2026
Exhibit C - Miscellaneous Provisions.docx	DOCX document	Mar 20, 2026
Exhibit H - Fidelity Implementation Plan.docx	DOCX document	Mar 20, 2026

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- SUMMARY-

Colorado Prevail Program

A. INTRODUCTION

Behavioral Health Administration (BHA) is dedicated to promoting whole-person, trauma-informed behavioral health care for all Coloradans. BHA works collaboratively with state and local partners to ensure that individuals, families, and communities have equitable access to high-quality behavioral health services and supports.

As part of this mission, BHA leads several statewide initiatives that integrate behavioral health and justice systems to promote early intervention, diversion, and recovery-oriented approaches. One of these initiatives is the PREVAIL Program—a model designed to reduce criminal justice involvement for individuals whose behaviors are influenced by unmet behavioral health or substance use needs.

B. Program Overview and Requirements

The selected vendors shall implement PREVAIL in accordance with BHA guidelines and maintain fidelity to the core principles of the program model. Awarded vendors shall:

1. Establish a Policy Workgroup (PWG) and a Community Workgroup (CWG) to provide program oversight, coordination, and accountability.

2. Maintain and strengthen partnerships with law enforcement agencies, judicial partners, and community-based providers to support participant referrals and coordinated case management.

3. Deliver trauma-informed, harm-reduction, and person-centered case management services, using evidence-based practices approved by BHA.

4. Utilize BHA-approved data collection and reporting systems, including CiviCore and GAIN, to track participant outcomes and program performance.

5. Participate in ongoing monitoring, evaluation, and training as required by BHA.

6. Ensure that all program staff complete BHA-mandated trainings, which include Motivational Interviewing, Mental Health First Aid, GAIN, CiviCore, and PREVAIL Program Management Training.

7. Participate in monthly BHA-led coordination meetings.

Awarded vendors are expected to meet the following minimum program performance standards:

1. Receive no fewer than 100 referrals annually;

2. Ensure that 15% of referrals originate from law enforcement partners;

3. Ensure that 60% of all referrals are enrolled in program services; and

4. Demonstrate that at least 70% of participants achieve one or more individualized goals.

These requirements are intended to ensure consistency across statewide PREVAIL sites, maintain fidelity to the program model, and promote effective outcomes for participants and their communities.

Note for Applicants: All program requirements listed here are reflected in the workbook. Your responses in this workbook should address these requirements, and you must also complete Exhibit G – Mandatory Requirements and Eligibility Certification to demonstrate compliance with mandatory eligibility and legal authority requirements.

C. Program Goals

The overarching goals of PREVAIL are to:

1. Reduce high-risk behaviors and establish stability among individuals whose criminal justice involvement is driven by behavioral health or substance use needs;

2. Enhance community safety through collaborative, public health–centered responses to behavioral health challenges;

3. Expand access to behavioral health, housing, and recovery supports for vulnerable populations; and

4. Foster cross-system partnerships that integrate law enforcement, judicial entities, and behavioral health service providers.

C. Intent Of The Grant Application Template

Applicants must design their work plan to address all sections of the RFA and workbook, including mandatory and preferred criteria. Responses must be complete, clear, and aligned with RFA guidance.

E. Accountability

Grantees will be accountable to meet the combined standards of the work plan & grant requirements - How will your grant project be evaluated for success by your organization?

Responses in this workbook will be evaluated alongside your completed Exhibit G to determine eligibility and compliance with mandatory requirements.

General Instructions:

Mandatory vs. Preferred: Questions in this workbook are labeled as either Mandatory or Preferred.

Mandatory: Must be completed. Failure to respond may result in your application being deemed nonresponsive.

Preferred: Optional, but strong responses may improve scoring.

Proposals that do not follow the sequence, outline, and response format of the Grant Application & Budgets may be deemed non responsive and disqualified from further consideration.

Exhibit G – Mandatory Requirements and Eligibility Certification All applicants must complete and submit Exhibit G in addition to the workbook.

Exhibit G certifies applicant eligibility and legal/regulatory compliance, which are also reflected in this workbook.

Nonprofit applicants must attach their executed MOU or partnership agreement.

Ensure that your responses in the workbook match your certifications in Exhibit G.

Some questions may not apply to your organization, please respond with "Not Applicable"

Additional information about BHA grants can be found on

https://bha.colorado.gov/resources/funding-opportunities#

**This grant is not eligible for technical assistance, or grant writing assistance

Work Plan

A work plan should discuss goals and objectives of the entire grant project that is being funded, establish responsibilities

Discuss phases of your grant project. Time will be counted from the date of contract execution. i.e.; preparation, planning, goals, milestones, execution, assess risks, monitoring & controlling, completion, etc.

Your work plan responses should clearly demonstrate how your organization will meet the mandatory program requirements (e.g., referrals, enrollment, partnerships, staff training, monitoring). Include additional information for preferred criteria where applicable.

Appendix for additional files

List any additional files you would like to submit with your application. Adding the file name and brief description ensures that the evaluation committee has all documents required to review and score the submitted application. Files may be submitted to the VSS grant solicitation ,or added to the tabs in this workbook below. It is your responsibility to ensure the files submitted are readable and uploaded properly.

Budget Guidance

A cost reimbursement budget is where the BHA agrees to fund a service (s). BHA reimburses actual costs to establish and maintain service and service level, not to exceed the total value of the budget in the contract.

Use the Budget Template tabs in this workbook to submit your proposed budget. Budget submissions must align with your work plan and RFA requirements.

Common Issues

If pasting sentences from another source into a cell and the text does not appear, then …

a) try pasting the information into the Formula bar.

b) Check that the font color selected is not white font color and select the black font color

If a webpage link does not work - copy the https link from the Formula bar and paste into your search engine. All linked information is also available in the RFA.

Rows can be resized, font size, alignment and wrapping can be controlled by all users

The cells can be expanded or shortened as needed, also text wrapping is enabled. It is not our intent to limit responses to the questions. Additionally, there are no character limits beyond those of Excel, which is 32,767 per cell.

Sections noted as "Internal Use" are for BHA internal use only and are not for grant applicants use.

https://bha.colorado.gov/resources/funding-opportunities Grant Application

GRANT APPLICATION WORKBOOK
Colorado Prevail Program
THE GRANT APPLICANT SUBMITS THIS GRANT APPLICATION AS A WORK PLAN FOR REVIEW AND APPROVAL AS AN APPLICANT FOR COLORADO PREVAIL PROGRAM
FULL LEGAL ORGANIZATION NAME & DBA NAME	SAM UNIQUE ID

ADDRESS		00-0000000
		PARTNER INFORMATION FOR JOINT COLLABORATION
WEBSITE	PHONE
		PARTNER NAME
EXECUTIVE DIRECTOR NAME	TITLE

EMAIL ADDRESS PHONE PARTNER EMAIL

ADDITIONAL POINT OF CONTACT NAME TITLE

EMAIL ADDRESS PHONE

E. 1. Mandatory Criteria (Pass or Fail)- The following criteria are mandatory and must be met in order for an application to be considered. Proposals that fail to demonstrate compliance with these requirements may be deemed nonresponsive and disqualified from evaluation. To respond to the mandatory criteria, Applicants are required to complete and submit Exhibit G- Mandatory Requirements and Eligibility Certification (attached to this RFA).

E.1.i. Applicant Eligibility Type. The applicant must be:

a. A local government agency, such as a county, municipality, or law enforcement department, or

b. A nonprofit organization that has an executed partnership or,

c. Memorandum of Understanding (MOU) with a local law enforcement agency or judicial entity.

I). Nonprofit applicants must also submit a copy of an executed MOU or partnership agreement with a qualifying law enforcement agency or judicial entity.

Answer: Applicants must complete and submit Exhibit G – Mandatory Requirements and Eligibility Certification for this request.

E.1.ii. Legal Authority and Regulatory Compliance. The applicant must be legally authorized to operate within the State of Colorado and comply with all applicable federal and state regulations governing behavioral health and criminal justice diversion programs.

Answer: Demonstration of Compliance: Applicants must complete and submit Exhibit G- Mandatory Requirements and Eligibility Certification, affirming legal authority to operate in Colorado and compliance with all applicable requirements.

E. 2. Preferred Criteria (100%) - The following criteria are preferred and will be awarded additional points during the evaluation process. These criteria are not required for eligibility but indicate a stronger likelihood of successful implementation, sustainability, and alignment with BHA priorities.

E.2.i. Program Model Fidelity and Implementation (30%)

a. Please describe your organization’s prior experience implementing diversion, deflection, or recovery-oriented programs similar in size and scope to PREVAIL.(10%) I. How has your organization implemented program models that require fidelity to defined standards or guidelines?

II. Describe your experience establishing or participating in governance structures such as a Policy Workgroup (PWG) or Community Workgroup (CWG).

III. Describe your experience collecting and reporting participant data using BHA-approved systems, such as CiviCore and GAIN, or comparable platforms.

IV. How have these practices supported consistent program implementation, improved participant outcomes, or informed continuous quality improvement?

E.2.i.a.I Response:

E.2.i.a.II Response:

E.2.i.a.III. Response:

E.2.i.a.IV Response:

E.2.i b. Youth and Transitioned Aged Adults (13-20) Specific Experience (20%)

E.2.i b.I Describe how your program is currently working with, or plans to work with, and will engage youth and young adults, particularly justice-involved or at-risk populations.In your response, please include:

i. Planned or existing services and outreach efforts, including partnerships with law enforcement, judicial entities, and community-based providers.

ii. Planned or existing operational framework, scope of services, and demographics served.The same applies here.

iii. Proposed methodology and programmatic activities for engaging and supporting youth and young adults in your designated service area.

iv. How your current and planned work aligns with the goals of the PREVAIL including supporting participant referrals, engagement in services, and positive outcomes for at-risk youth and young adults.

v. How your work incorporates, or plans to incorporate, trauma-informed, and person-centered approaches.

E.2.i.b.I Response:

E.2.ii. Experience and Operational Capacity (10%)

a. Please describe your organization's operational experience and capacity to manage high-volume, multi-system programs.

I. Describe your experience managing programs with referral volumes similar to PREVAIL (e.g., ≥100 referrals annually) and achieving program enrollment or outcome targets.

II. How has your organization tracked, monitored, and improved program performance?

III. What outcomes or lessons learned demonstrate your organization's ability to manage complex, multi-system programs effectively?

IV.Describe any experience operating programs with defined performance targets, referral volumes, or model fidelity expectations, including lessons learned, monitoring practices, and continuous improvement strategies.

E.2.ii.a.I Response:

E.2.ii.a.II. Response:

E.2.ii.a.III Response:

E.2.ii.a.IV Response:

E.2.iii. Community Collaboration and Partnerships (10%)

a. Please demonstrate your organization's readiness to implement PREVAIL through community partnerships. Your response should address the following requirements:

I. Describe current or planned collaborations with key stakeholders (e.g., law enforcement, judicial partners, behavioral health agencies, housing providers).

II. How have you leveraged partnerships to support participant referrals, coordinated case management, or program oversight?

III. Provide a minimum of three examples of governance participation, MOUs, or letters of support that illustrate stakeholder commitment.

IV. Explain how these partnerships address identified community needs, including behavioral health-related arrests or service gaps.

E.2.iii.a.I. Response:

E.2.iii.a.II. Response:

E.2.iii.a.III. Response:

E.2.iii.a.IV. Response:

E.2.iv. Staffing and Training Capacity (5%)

E.2.iv.a. Please describe your organization’s staffing structure and approach to training for programs similar to PREVAIL.

E.2.iv.a. Response:

E.2.iv.b. How does your organization ensure that staff are trained in trauma-informed, harm-reduction, and person-centered approaches? Additionally, please explain how your organization tracks and ensures compilation of mandatory program training, such as Motivational Interviewing, Mental Health First Aid, GAIN, CiviCore, or PREVAIL Program Management Training?

E.2.iv.b. Response:

E.2.iv.c. How does your organization onboard, supervise, and retain staff assigned to multi-system programs?

E.2.iv.c. Response:

E.2.v Program Sustainability and Funding Integration (10%)

E.2.v.a. Please describe your organization's strategies to sustain the PREVAIL program beyond the grant period, including plans for continued funding and integration within existing systems.

E.2.v.a Response:

E.2.v.b How will your organization coordinate requirements if multiple funding sources support the same program activities?

E.2.v.b. Response:

E.2.v.c Affirm how BHA award requirements will remain primary and how potential funding conflicts will be managed or communicated.

E.2.v.c. Response:

E.2.vi. Data, Evaluation, and Continuous Quality Improvement (15 %)

a. Please demonstrate your organization's capacity to collect, manage, and analyze program data. Your response should address the following requirements:

I. Describe experience using structured data systems such as CiviCore, GAIN, or comparable platforms.

II. How do you ensure data quality, timeliness, and accuracy for monitoring program performance?

III. Explain how data will be used to support continuous quality improvement, performance monitoring, and accountability.

E.2.vi.a.I Response:

E.2.vi.a.II Response:

E.2.vi.a.III Response:

E.2.vii. FAIR Principles (10 %) Equity and Systems Approach (FAIR: Fairness, Access, Impact, Relationships).

a. Explanatory Note / Guidance to Applicants only, this section will not be evaluated as part of the application, please only respond to the FAIR criteria below in E.2.v.b.

I. FAIR Principles Defined:

i. Fairness: Everyone is equipped to succeed.

ii. Access: Everyone can fully participate.

iii. Impact: Everyone is empowered for excellence.

iv. Relationships: Everyone has a people-first approach.

II. Key Considerations:

i. People-first: Engage all stakeholders in program design and delivery.

ii. Outcomes over intentions: Measure success by progress and results, not effort alone.

iii. Systemic over individual: Focus on improving systems to create fair processes and scalable impact.

iv. Innovation: Continuously evaluate and refine strategies to improve results.

III. Applicants should use these definitions as a lens to describe how their program integrates FAIR principles in program implementation, monitoring, and continuous improvement, while maintaining equitable access and strong partnerships with law enforcement, judicial entities, and community stakeholders.

E.2.vii.b. Please describe how your organization integrates FAIR principles (Fairness, Access, Impact, Relationships) into the design and delivery of the PREVAIL program.

I. How does your program ensure fair and equitable access, positive participant outcomes, and a strong partnership with law enforcement, judicial entities, and community stakeholders? Please provide examples of policies, strategies, or practices that demonstrate how FAIR principles are applied in program implementation, monitoring, and continuous improvement.

E.2.vii.b.I Response:

E.3. Cost (10%).

Please answer or address the following questions or issues:

E.3. i. Cost Requirements. Applicants should submit their budget using the BHA Exhibit B- Colorado Prevail Program Grant Application Workbook, specifically completing the tab titled ”FY27 BHA Cost Reimbursement Budget”. The cost proposal should clearly demonstrate how BHA funds will be used to support the implementation, administration, and evaluation of the PREVAIL program, as described in Exhibit A – Statement of Work (SOW)

a. Instructions: Applicants should thoroughly and clearly describe every category of expense listed on the Budget. The narrative of the budget should I. Include correct calculations, II. Correspond with the information provided in the Grant Application.

III. Clearly explain how each cost supports proposed activities. Applicants may apply their federally negotiated indirect cost rate or the 15% de minimis rate, if applicable

b. Budget Narrative Instructions - Please complete the portion in the description of the work column from the tab titled FY27 BHA Cost Reimbursement Budget. For each budget line item, applicants should provide a narrative that clearly explains:

I. How the funds support specific SOW activities. Please include details at a minimum, such as:

i. PREVAIL Staff Training and Capacity Building

ii. Data Collection and Reporting (CiviCore, GAIN)

iii. Monthly BHA Coordination and Monitoring Activities

iv. Community Workgroup and Policy Workgroup Support

v. Outreach, Program Coordination, and Referral Management

vi. Program Evaluation and Quality Improvement Activities II. Suggested invoice line items that applicants may use (for guidance; applicants may include others as appropriate):

i. Staff Wages

ii. Client Costs

iii. Travel

iv. Training and Professional Development

v. Vehicle Leases, Maintenance, and Insurance

vi. Staff Cell Phones

vii. Office Lease, Supplies, Utilities, and Equipment

viii. Local Meetings and Events

ix. Program Manager Budget (may include the above items) III. How costs were calculated (e.g., staff hours × hourly rate, unit costs for materials or services).

IV. The source(s) of funds, including matching funds or in-kind contributions.

V. Justification that costs are reasonable, allowable, and necessary to accomplish program deliverables VI. Note- Applicants may also include any additional cost-related information to support the feasibility and efficiency of their proposed program implementation.

c. Dual-Funding / Coordination Requirement- If any proposed costs are supported by multiple funding sources, the applicant should:

I. Clearly explain how the requirements of each funding source will be coordinated to avoid conflicts.

II. Affirm that BHA award requirements will remain primary and will not be overridden by other funding sources.

III. Notify BHA within 30 days of the Notice of Intent (NOI) if the applicant intends to withdraw from the award due to funding conflicts, prior to award execution.

d. Submission Notes I. Use the Exhibit B- Colorado Prevail Program Grant Application Workbook exactly as provided; do not modify the structure or formulas. Include a short narrative for each line item describing how funds support program activities and calculations.

e. Maximum Award Amount I. The maximum award amount for a single applicant under this solicitation is up to $475,000 per year.

II. For joint or partnership applications, the maximum award amount is up to $650,000 per fiscal year. Partnership budgets should clearly demonstrate how funding will be distributed across all participating entities and how each partner’s role supports implementation of the PREVAIL program requirements.

III. Partnership applicants should all designate a fiscal agent responsible for contract management, financial oversight, reporting, and compliance with all BHA requirements. All partners should clearly outline their roles, responsibilities, and associated costs within the budget narrative and application materials, ensuring traceability of funds to specific program activities.

E.3. Response Guidance: Please complete the tab that is titled “FY27 BHA Cost Reimbursement Budget" on this workbook.

END OF GRANT APPLICATION.

Budget Instructions Colorado Department of Human Services - Behavioral Health Administration (BHA)

Budget Template Instructions

General Instructions:

The Budget Template should be used to explain how an agency plans to use BHA funds consistent with the proposed Work Plan. The Budget Template includes three worksheets: Instructions, Budget Example and Budget Template. The budget example does not reflect the actual dollar amount available for this grant. Please confirm this amount from your Program or Fiscal contact. Budget requests and their associated deliverables need to be in alignment and provide a consistent, logical picture of what is to be accomplished, by whom, and the associated costs. In the event that this alignment does not occur, applicants may be contacted with requests for clarifications and/or modifications. Additional information regarding Direct and Indirect Costs, Modified Total Direct Costs and unallowable costs can be found in the OMB Super Circular.

eCFR

Refer to the Behavioral Health Accounting and Auditing Guidelines 2022

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/Behavioral Health Accounting and Auditing Guidelines | HCPF

The budget groups in the template are provided for guidance purposes only. Contractors are not required to address each budget group if it is not applicable to the proposal.

DO NOT enter your own formulas

The information contained in each expenditure category helps BHA understand the budget. Please provide narrative for each category in the "Description of Work" or the "Description of Item" section.

The form is an Excel worksheet that includes instructions in various cells that can be viewed by hovering the computer mouse over the cells. The instructions below give additional guidance.

Contact Information

Complete the top portion of the form by providing Agency Name, Budget Period, Project Name, and Contact Information for both Program and Fiscal contacts.

Agency Name: Enter agency's name	Program Contact Name, Title, Phone and Email
	Enter agency's program contact information here
Project Name: Enter the project name	Fiscal Contact Name, Title, Phone and Email
	Enter agency's fiscal contact information here
	Date Completed
	Enter the date this budget was completed and submitted to BHA

Total Fixed Deliverable based costs

This row should be the TOTAL of all expenses that the agency is requesting from BHA for the project. The Total will rounded up *This is the amount of your grant award

Match requirement

Use the chart provided to find you organizations annual budget. Then select the appropriate percentage in H47 to determine your required match amount. The required matching dollar amount must be represented in the Revenue Offset and Matching Funds sections below.

Revenue Offset

The contractor and subcontractors shall account for revenue offsets by reducing invoice submissions to BHA by cash received from other payer sources including but no limited to Medicaid capitation and fee for services, medicase, private insurance, co-payments or other patient revenue, grants, etc.

Client Services

Example: Medicaid Fee for Service cash, Medicaid Capitation Encounters, BHA Indigent Encounters, 3rd party insurance, Medicare Cash, sel-pay/ client fees and cash from other sources.

Matching Funds

Contracts and Grants

Example: non-governmental contracts, other state revenue, federal grant funds, local funds, private cash funds, public support, private support, in-kind donations, and other funds.

Net Cost

This row should be the TOTAL of all expenses, revenue offset, including Indirect Costs that the organization is requesting from BHA for the project. The TOTAL will be rounded up. This is the amount the BHA will award for your grant project.

Budget Instructions

&P of revised: 02_02_2023 https://www.ecfr.gov/https://hcpf.colorado.gov/sites/hcpf/files/2022%20Behavioral%20Health%20Accounting%20and%20Auditing%20Guidelines_0.pdf Sheet3

Lkup

Negotiated Federal Rate

Negotiated Colorado Rate

10% De Minimis Rate

N/A

Sheet1

Budget Example (1)

EXHIBIT B, FYxx ANNUAL BUDGET

BHA Program Behavioral Health Administration Programing

Agency Name	ABC Health Center	Program Contact Name, Title	Jane Smith, Project Coordinator
		Phone	303-888-5555
		Email	jane.smith@abchealthctr.org
Budget Period	07/01/2025-06/30/2026	Fiscal Contract Name, Title	John Williams, Finance Director
		Phone	303-888-5556
		Email	john.williams@abchealthctr.org
Project Name	XYZ Project	Date Completed	7/30/2024

All budget numbers are estimates. Contract billing will be on a cost reimbursement basis for actual expenses incurred.
EXPENDITURE CATEGORIES
Personnel Services / Salaried Employees					Annual Budget
Position Title	Description of Work	Gross or Annual Salary	Fringe	Percent of Time on Project	Total Amount Requested from BHA
Case Manager	Responsible for in-reach to Mental Health Hospitals and other acute hospitals, to develop care plans with clients to support the successful transition of clients to community placements.	$ 50,000.00	$ 8,087.00	100%	$ 58,087.00
Peer Support Specialist	Support clients in all programs assist the clients in achieving their goals identified during the person centered planning process and during transition to the community.	$ 58,000.00	$ 11,555.00	5%	$ 3,477.75
Project Director	Oversee and guide program improvements and partnership development.	$ 70,000.00	$ 14,690.00	30%	$ 25,407.00
Project Accountant	Prepare and submit timely invoicing and required documentation.	$ 60,000.00	$ 13,252.00	10%	$ 7,325.20
Clinician	Lead therapy groups and individual services, including recruiting new clients and coordinating engagement services.	$ 62,000.00	$ 12,133.00	5%	$ 3,706.65
Clinician	Complete training to lead therapy groups and individual services, including recruiting new clients and coordinating engagement services.	$ 58,000.00	$ 11,529.00	45%	$ 31,288.05
					$ - 0
					$ - 0
Personnel Services / Hourly Employees					Annual Budget
Position Title	Description of Work	Hourly Wage	Hourly Fringe	Total # of Hours on Project	Total Amount Requested from BHA
Project Administrator	Supports Project Director with program administration.	$ 15.00	$ 3.75	780.00	$ 14,625.00
					$ - 0
Total Personnel Service (including fringe benefits)					$ 143,917.00
Contractors/Consultants (payments to third parties or entities)					Annual Budget
Contractor Name	Description of Work		Rate	Quantity	Total Amount Requested from BHA
ABC Contractor	Training sessions for clinical team ($1500 per session)		$ 1,500.00	5	$ 7,500.00
Total Contractors/Consultants					$ 7,500.00
Subaward					Annual Budget
Therapy Referral Group Inc.	Collaborate as a primary referral partner and in quality improvement efforts on care coordination		$ 110,000.00	1	$ 110,000.00
Total Contractors/Consultants					$ 110,000.00
Travel					Annual Budget
Item	Description of Item		Rate	Quantity	Total Amount Requested from BHA
Mileage	Mileage for transportation $0.54/mile estimated at 500mi/month for 12 months		$ 0.54	6000	$ 3,240.00
Client transportation access	Access to clients for transportation to appointments, group sessions, and other project activities. Including bus passes, ride share, and other options deemed necessary by the project team.		$ 150.00	100	$ 15,000.00
					$ - 0
					$ - 0
Total Travel					$ 18,240.00
Supplies & Operating Expenses					Annual Budget
Item	Description of Item		Rate	Quantity	Total Amount Requested from BHA
Cell phones, hotspots	Cell phones, hotspots for connectivity to facilitate project work while in the community and/or at clinic sites. $105/month.		$ 105.00	12	$ 1,260.00
IT supplies and software	Tableau software ($750 per license)		$ 1,500.00	2	$ 3,000.00
Training Materials	Training materials (e.g., manuals, books, handouts, web courses, fidelity monitoring assessments and documents)		$ 1,000.00	1	$ 1,000.00
Clinical Materials	Clinical materials (e.g., printing for group handouts/worksheets, group therapy materials)		$ 1,000.00	1	$ 1,000.00
					$ - 0
					$ - 0
Total Supplies & Operating Expenses					$ 6,260.00
TOTAL DIRECT COSTS (TDC)					$ 285,917.00
Exclustions from Indirect Cost Base expenses per OMB 2CFR § 200
Subaward in excess of $50,000					$ 60,000.00
Rent					$ - 0
Equipment (over $10,000)					$ - 0
Other Unallowable Expenses					$ - 0
Total Expenses per OMB 2CFR § 200					$ 60,000.00
MODIFIED TOTAL DIRECT COSTS (MTDC)					$ 225,917.00
Indirect Costs					Annual Budget
Indirect Cost	Description of Item			Percentage	Total Amount Requested from BHA
Drop Down Box	Describe what the cost includes and the use of allowance
15% De Minimis Rate	ABC Contractor does have a federally negotiated rate and utilized the de minimis 15% rate. Indirect costs include human resources, information systems, accounting and finance, grant management, quality and informatics, compliance, and other administrative supports.			15%	$ 33,887.55
					$ 0.15
Total Indirect					$ 33,888.00
TOTAL					$ 319,805.00
The Parties may mutually agree, in writing, to modify the Budget administratively using an BHA Budget Reallocation form

EXHIBIT B

Page &P of revised: 04_12_2021

2 CFT § 200.92-Subaward means an award provided by a pass-through entity to subrecipient for the subrecipient to carry out part of a Federal award received by the pass-through entity . A subaward may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract.

mailto:john.williams@abchealthctr.org FY27 BHA Cost Reimbursement Bud

EXHIBIT B, FY27 ANNUAL BUDGET

BHA Program

Agency Name		Program Contact Name, Title
		Phone
		Email
Budget Period	07/01/2026-06/30/2027	Fiscal Contract Name, Title
		Phone
		Email
Project Name		Date Completed

All budget numbers are estimates. Contract billing will be on a cost reimbursement basis for actual expenses incurred.
EXPENDITURE CATEGORIES
Personnel Services / Salaried Employees				Annual Budget
Position Title	Description of Work	Gross or Annual Salary	Fringe

ID#AAAAqs9XD14 Enter the total amount of fringe for the employee based on their annual salary. (2023-03-03 17:16:04) Do not use formula in cells Percent of Time on Project ID#AAAAqs9XD2Q Deborah J. Polk (2023-03-03 17:16:04) Enter the percentage of the employee's time spent on the project during the contract period.

ID#AAABHMzXV8U Deleted user (2024-02-23 17:18:55) _Marked as resolved_ ID#AAABHMzXV8Y Deleted user (2024-02-23 17:19:44)

_Re-opened_	Total Amount Requested from BHA
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
			$ - 0
	Personnel Services / Hourly Employees		Annual Budget
	Position Title	Description of Work

ID#AAAAqs9XD18 Public Health & Environment (2023-03-03 17:16:04) Enter budget justification for the employee or position title. Justification should address the role and expected contribution of budgeted personnel.

If less than full FTE, indicate in the description the % FTE worked for your agency.

Describe how fringe is projected and what components are included (insurance, paid time off, pension, etc.). Hourly Wage ID#AAAAqs9XD2c Public Health & Environment (2023-03-03 17:16:04) Enter the employee's hourly wage.

Do not use a formula in this cell Hourly Fringe ID#AAAAqs9XD2I Public Health & Environment (2023-03-03 17:16:04) Enter the employee's hourly fringe amount (not the percentage). DO NOT use formulas in cells ID#AAAAqs9XD14 Enter the total amount of fringe for the employee based on their annual salary. (2023-03-03 17:16:04) Do not use formula in cells ID#AAAAqs9XD2Q Deborah J. Polk (2023-03-03 17:16:04) Enter the percentage of the employee's time spent on the project during the contract period.

ID#AAABHMzXV8U Deleted user (2024-02-23 17:18:55) _Marked as resolved_ ID#AAABHMzXV8Y Deleted user (2024-02-23 17:19:44)

_Re-opened_	Total # of Hours on Project	Total Amount Requested from BHA
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
	Total Personnel Services (including fringe benefits)				$ - 0
	Contractors / Consultants (payments to third parties or entities)				Annual Budget
	Contractor Name	Description of Work	Rate	Quantity	Total Amount Requested from BHA
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
	Total Contractors/Consultants				$ - 0
	Subawards				Annual Budget
	Contractor Name	Description of Work	Rate	Quantity	Total Amount Requested from BHA
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
	Total Subawards				$ - 0
	Travel				Annual Budget
	Item	Description of Item	Rate	Quantity	Total Amount Requested from BHA
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
	Total Travel				$ - 0
	Supplies & Operating Expenses				Annual Budget
	Item	Description of Item	Rate	Quantity	Total Amount Requested from BHA
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
	Total Supplies & Operating Expenses				$ - 0
	TOTAL DIRECT COSTS (TDC)				$ - 0
	Exclusions from Indirect Cost Base expenses per OMB 2CFR § 200
	Subaward in excess of $50,000				$ - 0
	Rent				$ - 0
	Equipment in excess of $10,000				$ - 0
	Other Unallowable Expenses				$ - 0
	Total Expenses per OMB 2CFR § 200				$ - 0
	MODIFIED TOTAL DIRECT COSTS (MTDC)				$ - 0
	Indirect Costs

ID#AAAAqs9XD2E Tatia M. Konnick (2023-03-03 17:16:04) Applicants requesting indirect must provide OBH with a copy of their Negotiated Federal Indirect Cost rate plan or their Negotiated State Indirect Cost rate plan or apply 15% to the Modified Total Direct Costs (MTDC).

OBH will honor federal negotiated rate agreements.

Refer to Cost Principles Exhibit and the OMB Super Circular for possible disallowed expenses.

If less than full FTE, indicate in the description the % FTE worked for your agency.

Describe how fringe is projected and what components are included (insurance, paid time off, pension, etc.).			Annual Budget
	Indirect Cost	Description of Item		Percentage	Total Amount Requested from BHA
	Drop Down Box	Describe what the cost includes and the use of allowance
	15% De Minimis Rate	client community room costs, other overhead - less than 15% to reach allowable amount			$ - 0
					ERROR:#DIV/0!
	Total Indirect				$ - 0
	TOTAL Request				$ - 0
	The Parties may mutually agree, in writing, to modify the Budget administratively using an BHA Budget Reallocation form

EXHIBIT B

Page &P of Revised: 04_06_2023

2 CFT § 200.92-Subaward means an award provided by a pass-through entity to sub recipient for the sub recipient to carry out part of a Federal award received by the pass-through entity . A sub award may be provided through any form of legal agreement, including an agreement that the pass-through entity considers a contract.

Refer to Cost Principles Exhibit and the OMB Super Circular for possible disallowed expenses.

DO NOT use formulas in cells

Lkup (1)

15% De Minimis Rate

Negotiated Federal Rate

Negotiated Colorado Rate

N/A

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File details come from the government source that posted it. Updated Mar 23, 2026.