FAM-25-039 Attachment B Unit Cost and Budget Form With No Match - No Indirect Cost.xls

XLS spreadsheet 166 KB Posted Jun 10, 2026

Attached to: FAM-25-039 RFP Regional Post Permanency Consortia Services
Solicitation number: RFP-118530
Issued by: Virginia

About this file

Written by GovTribe AI · Jun 15, 2026

This is a Unit Cost and Budget Form attachment for the Virginia Department of Social Services (VDSS) RFP FAM-25-039 for Regional Post Permanency Consortia Services. The form serves as a comprehensive budgeting tool for offerors responding to the competitive procurement to establish regional contracts across Virginia's five VDSS regions: Central, Eastern, Piedmont, Northern, and Western. Offerors must propose provision of all Priority Services listed for their proposed region, including Basic Permanency Services (Information & Referral, Education and Training for Kinship and Adoptive Families), Enhanced Permanency Services (Peer Support, Case Management with Family Support and Advocacy, Mental Health Clinical Services, and Rest and Reconnect respite), Intensive Post-Adoption Services (Crisis Support), and Other Services (Outreach and Family Assistance Fund). The form requires offerors to project the number of clients to be served and service units to be provided for each category, with unit costs encompassing all associated expenses such as staff salaries and benefits, facility costs, technology, supplies, and travel. The budget period and submission deadline are not specified in this attachment, though the related RFP indicates a July 17, 2026 proposal deadline.

The budget form operates on a no-match, no-indirect-cost structure, with offerors entering unit costs and projected service volumes to calculate total pricing per service category. Quality Management and Quality Improvement initiatives are capped at 5 percent of total requested funds, while Other Costs such as consortium operations and development are limited to 15 percent of total requested amounts. The Family Assistance Fund services are provided on a limited, first-come, first-served basis with demonstrated need, and offerors may receive up to a 10 percent administrative fee for purchases made on behalf of families. The form integrates with supplementary budget worksheets (P1 Budget Summary, P2 Salary, P3 Benefits, P4 Other Expenses, and P5 Budget Narrative) to compile comprehensive budget documentation that must align across all budget documents and narrative justifications. All requested funding amounts and budget categories must be entered into designated yellow fields only, with automatic calculation of totals and percentages to ensure accuracy and compliance with stated limitations.

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Other files

File	Type	Posted
FAM-25-039 Addendum & QA.pdf	PDF	Jun 10, 2026
FAM-25-039 Attachment I EDI Certification.docx	DOCX document	Jun 10, 2026
FAM-25-039 Attachment K VDSS Regional Map.pdf	PDF	Jun 10, 2026
FAM-25-039 Attachment O DSS Post Adoption Best Practices Toolkit #1.pdf	PDF	Jun 10, 2026
FAM-25-039 RFP.pdf	PDF	Jun 10, 2026
FAM-25-039 Attachment J Assurances - Reimbursable Contract.docx	DOCX document	Jun 10, 2026
FAM-25-039 Attachment M VDSS Regional Post Adoption Services Evaluation _Final Report_December 2024.pdf	PDF	Jun 10, 2026
FAM-25-039 Attachment A Activities-Outcomes Work Plan Template.docx	DOCX document	Jun 10, 2026
FAM-25-039 Attachment G Kinship Legal Guardianship Proposed Services and Support Worksheet.docx	DOCX document	Jun 10, 2026
FAM-25-039 Attachment Q Success Coach Service Implementation Plan and Budget for Virginia.pdf	PDF	Jun 10, 2026
FAM-25-039 Attachment N Success Coach Program Overview.pdf	PDF	Jun 10, 2026
FAM-25-039 Attachment H Offeror Program Contact Information Sheet.doc	DOC document	Jun 10, 2026
FAM-25-039 Attachment L VDSS Post Adoption Services and Support Logic Model.pdf	PDF	Jun 10, 2026
FAM-25-039 Attachment P DSS Post Adoption Best Practices Toolkit #2.pdf	PDF	Jun 10, 2026

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Service Unit Instructions

Instructions for Attachment B Unit Cost and Budget Form with No Match - No Indirect Cost
1	Fill in the Yellow Areas of the Form
2	Indicate number of clients projected to be served by each VDSS Priority Service category. Clients can be individuals or families. Note whether clients are individuals or families in the Explanation of How Price Was Determined cell.
3	Indicate Number of Service Units projected to be provided in each Priority Service Category. Pay attention to how the unit is defined for each category listed.
4	Unit cost should include all associated costs to provide the service. For example, the cost for providing case management services should include but is not limited to salary and benefits of staff, telephone costs, office space for case managers, computer usage, office supplies, travel, etc.
5	The Price Per Unit will automatically populate after entering the number of units and total price.
6	Enter the subtotal of requested funds for permanency services (cell C41)
7	Enter quality management and quality improvement initiatives estimated costs. Subtotal cannot be greater than 5% of total requested amount (cell C42)
8	Enter Other anticipated costs (cell C44). For example, consortium operations and development. Subtotal cannot be greater than 15% of total requested. The Offeror should describe these costs in the Budget Narrative.
9	Total requested funds should automatically total in cell C45. Check for accuracy. The Requested Funds total should match the Budget Summary and Budget Narrative amounts.

Service Unit Cost Sheet

Permanency Services and Support - Unit Price Estimate Sheet for VDSS Priority Services Offeror MUST Make Available and Accessible ALL Priority Services Listed in Proposed Region							ATTACHMENT B
Name of Offeror:		Region:
Budget Period:
	Priority Services	Service Unit Definition	# of Clients	# of Units	Price per Unit*	Total Price	Explanation of How Price Was Determined
I.	Basic Permanency Services
A.	Information & Referral	one 15-minute encounter = one unit			$0.00
	Warm lines for information, referral and support on a range of adoption related issues
	Proactive engagement of families to increase awareness of available services, awareness of adoption related issues, and reinforce help-seeking as a strength
	Phone/e-mail navigation assistance/advocacy, brief problem assessment, referral/linkage to services
B.	Education and Training for Kinship and Adoptive Families	one training hour = one unit			$0.00
	Training and support for kinship legal guardian families.
	Training and support for adoptive families, extended family, and natural support
	Kinship/adoption competency training for regional clinical mental health providers licensed to operate in Virginia **
II.	Enhanced Permanency Services
A.	Peer support	one hour session = one unit			$0.00
	Kinship legal guardian and parent support groups, mentor programs, in-person/online
	Social/recreational activities for children and youth – promoting positive development and identity
	Support groups for adolescents to support identity formation
B.	Case management to Include Family Support and Advocacy	one 15-minute encounter = one unit			$0.00
	Assistance from a permanency professional or team working with families to identify issues they need to address, develop and implement a family-specific plan, and connect with effective service providers to improve family functioning and reduce problems
C.	Mental Health Clinical Services	one visit with a clinical MH provider = one unit			$0.00
	Mental health assessment provided by a clinical MH provider licensed to operate in Virginia
	Mental health services for legal guardians, parents, children, and families provided by a clinical MH provider licensed to operate in Virginia
D.	Rest and Reconnect	one hour of respite = one unit			$0.00
	Respite Drop-off Parent Relief
	Respite Family Events
III.	Intensive Post-adoption Services
A.	Crisis Support	one encounter = one unit			$0.00
	Intense services to stabilize a difficult situation
III.	Other Services
A.	Outreach	one encounter = one unit			$0.00
	Outreach/Recruitment for non-participating kinship legal guardian and adoptive families
	Outreach/Recruitment to LDSS
	Outreach/Recruitment to Community Groups (mental health and medical providers, schools, etc.)
B.	Family Assistance Fund***	one service = one unit			$0.00		Can include up to 10% admin fee per purchase.
	Available concrete services and support to relieve stressors on the family unit, to maintain family well-being and to reduce the risk of an out of home placement episode
	Funds can be used for food, rent, mortgage payment, utilities (water, electric, gas, phone), and emergency housing. Funds can also be used for household needs (cleaning supplies, pest control, portable heat or a/c units, home maintenance, after-school programs, childcare, transportation, health and automobile insurance, medication.
	Subtotal Requested Funds for Permancy Services
	Subtotal Quality Management (Includes Quality Assurance and Quality Improvement Activities) - cannot be more than 5% of total requested amount.
	Subtotal Success Coach Statewide Training Costs (if Offeror is requesting to manage new case management training for all regional case managers and supervisors)
	Subtotal Other Costs (e.g. Consortium operations and development) - cannot be more than 15% of total requested amount.
	Total Requested Funds (total should match other budget documents)	$0
	*Unit Cost: Unit cost should include all associated costs to provide the service. As an example, for case management services, include salary and benefits of staff, telephone costs, office space for case managers, computer usage, office supplies, travel, etc.
	**Lead Agent can choose the direct provision of clinical MH services or kinship/adoption training for MH providers, or a combination of both. However, a Lead Agent must select from one of the categories based on regional needs identified by the Lead Agent and Regional Consortium for SFY27.
	***Family Assistance Funds are limited, based on first come, first serve, and demonstrated need. If eligibly, family can receive 1 service within a 12 month period. Any family member is eligible to receive a service, provided the service impacts the legal guardian or adoptive child. Lead agent or subcontractor is eligible to receive up to a 10% administrative fee for purchases made on behalf of a family.

Budget Detail Instructions

Instructions for Completing Budget Sheets

P1-Budget Summary: Fill in the cells titled "CONTRACTOR Name" and "Contract Period" at the top of the worksheet. Proceed to entering budget items on the sheet called "P2 Salary" and continue until you have completed all worksheets that apply to your application.

P2-Salary This worksheet details which program staff positions will be funded through this grant.

Please list names of program staff to be funded. Only list the staff that will be funded (in whole or part) by this grant. (Attachments with a list of staff members will not be accepted.)

List the titles of staff.

List total hours worked per week.

List hours per week spent on THIS program.

List # of hours per week to be paid by VDSS.

List total gross annual salary.

P-3 Itemized Budget for Employee Benefits: This section of the worksheet details the benefits offered to employees of your program.

Names and titles of employees will populate from P2 Salary. Be sure to work down the column instead of across for each employee.

Enter total amount of each benefit for each employee for the year (except FICA. FICA will be automatically calculated.)

Enter the percentage of benefits that you would like VDSS to pay for each employee for each benefit. This may or may not be the same percentage you are requesting for salaries. However, the benefits percentage cannot exceed Column K in the tab called "P2 - Salary."

P-4 Other Expenses This tab allows for line items that are being requested for expenses other than salaries and benefits. All expenses must directly relate to THIS program.

P-5 Budget Narrative: Use this worksheet to provide your budget narrative according to amounts requested on Pages 2-4. Provide an in depth summary along with examples of calculations in this sheet.

Example: Printing 500 copies of a new brochures. The cost per item is .39.

The cost of 500 (brochures) x .39 (each copy) = $195.00.

P 1-Budget Summary

Please enter data into yellow fields only!
BUDGET SUMMARY - DSS FUNDS AND MATCH FUNDS
CONTRACTOR NAME
Contract Period
Contract #
Attachment #
BUDGET CATEGORY	TOTAL PROGRAM BUDGET (Including amount requested from VDSS)		TOTAL VDSS REQUEST
SALARIES			$0.00
EMPLOYEE BENEFITS			$0.00
RENT			$0.00
OFFICE & PROGRAM			$0.00
EQUIPMENT			$0.00
SUBCONTRACTING			$0.00
TRAINING/TRANSPORTATION			$0.00
OTHER			$0.00
INDIRECT COSTS
Total	$ - 0	$ - 0	$ - 0
Percentage of Total Program Budget Requested from DSS			0%
* Awarded funds cannot be used to supplant existing funds.
Please enter data into yellow fields only!

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P 2-Salary

Please enter data into yellow fields only!
ITEMIZED BUDGET - SALARIES
CONTRACTOR NAME:	0
Contract Period:	0									Column K
Name of Staff (List names of program staff to be funded in whole or part by DSS only)	Title	Total hours per week	# of hours per week spent on this program	# of hours per week spent on this program to be paid by DSS	% of time spent on this program	% of program salary to be paid by DSS	Total Gross Annual Salary	Amount of salary devoted to this program	Amount of salary to be paid by DSS	Maximum % of benefits that DSS will pay for this employee
					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%	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%		$ - 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	$ - 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
Please enter data into yellow fields only!

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P 3 Benefits

Please enter data into yellow fields only! Make sure to work down the column for each employee.
ITEMIZED BUDGET - BENEFITS
CONTRACTOR NAME:	0
Contract Period:	0
Name of Employee	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Title	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Total FICA per employee	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
% requested from DSS
Amt requested from DSS	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total RETIREMENT cost per employee
% requested from DSS
Amt requested from DSS	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total LIFE INSURANCE
% requested from DSS
Amt requested from DSS	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total UNEMPLOYMENT
% requested from DSS
Amt requested from DSS	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total WORKERS COMP
% requested from DSS
Amt requested from DSS	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total HEALTH INSURANCE
% requested from DSS
Amt requested from DSS	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total OTHER BENEFITS
% requested from DSS
Amt requested from DSS	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Benefits per employee	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Total benefits requested from DSS				$ - 0

&R &LPage 3

P 4-Other Expenses

Please enter data into yellow fields only!
ITEMIZED BUDGET - OTHER PROPOSED EXPENSES
CONTRACTOR NAME:	0
Contract Period:	0
LINE ITEM	Amount Requested	LINE ITEM	Amount Requested
1. RENT -- Office		4. SUBCONTRACTING OF PROGRAM SERVICES
		5. STAFF TRAVEL & TRAINING	$ - 0
		Travel
2. OFFICE and PROGRAM EXPENSES	$0.00	Training
Printing
Postage		6. OTHER	$ - 0
Supplies		Other (Specify)
Utilities		Other (Specify)
Phone		Other (Specify)
Program Expenses - Participant Support Costs		Other (Specify)
Program Expenses (Specify)		Other (Specify)
Program Expenses (Specify)		Other (Specify)
Program Expenses (Specify)		Other (Specify)
Program Expenses (Specify)
3. EQUIPMENT	$ - 0
Place each individual equipment purchase over $5,000 below. Each equipment purchase under $5,000 should be placed under Supplies above. Place each equipment purchase with a service life of one year or less (no matter the cost) under Supplies as well.
Equipment Purchase (Specify)
Equipment Purchase (Specify)
Equipment Leases		Total	$ - 0
* Awarded funds cannot be used to supplant existing funds.
Please enter data into the yellow fields only!

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P 5-Budget Narrative

Please provide a COMPLETE description for all expenses.
Please enter data in yellow cells only. Rows will expand upon typing.
BUDGET NARRATIVE
CONTRACTOR NAME:	0
Contract Period:	0
Line Item	Budget Request	Narrative Description
SALARIES
	$0.00
BENEFITS
	$0.00
RENT
	$0.00
OFFICE AND PROGRAM
Printing	$0.00
Postage	$0.00
Supplies	$0.00
Utilities	$0.00
Phone	$0.00
Program Expenses - Participant Support Costs	$0.00
Program Expenses (Specify)	$0.00
Program Expenses (Specify)	$0.00
Program Expenses (Specify)	$0.00
Program Expenses (Specify)	$0.00
EQUIPMENT PURCHASES
Equipment Purchase (Specify)	$0.00
Equipment Purchase (Specify)	$0.00
Equipment Leases	$0.00
SUB CONTRACT SERVICES
	$0.00
TRAVEL & TRAINING
Travel	$0.00
Training	$0.00
OTHER
Other (Specify)	$0.00
Other (Specify)	$0.00
Other (Specify)	$0.00
Other (Specify)	$0.00
Other (Specify)	$0.00
Other (Specify)	$0.00
Other (Specify)	$0.00
INDIRECT
	$0.00
Total	$0.00

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File details come from the government source that posted it. Updated Jun 15, 2026.