FY27 Budget template non CUA .xlsx

XLSX spreadsheet 66 KB Posted Jun 8, 2026

Attached to: The Department of Human Services is interested in contracting with agencies able to provide group home care for Dependent Adolescents ages 13-21. The qualified applicant(s) must have both capacity and...
Solicitation number: 21260602151446
Issued by: Philadelphia County, Philadelphia City, Pennsylvania

About this file

Written by GovTribe AI · Jun 19, 2026

This is a budget template form (FY27 Budget Summary Exhibit PA1/SAA1) for the Pennsylvania Department of Human Services (DHS) designed for non-CUA (Consolidated Unusual Appropriation) providers seeking state contracts. The template is used to document financial projections for service delivery contracts and requires providers to specify their organization name, contract period, total contract amount, division, and service category (such as JJS, CWO, PMT, A&M, or PREVENTION). The form does not specify particular response dates, due dates, or site visit requirements, as it functions as a standardized budgeting instrument applicable across multiple contract opportunities rather than a solicitation document for a specific opportunity.

The budget template requires providers to itemize personnel costs (including salaries and fringe benefits with maximum allowable rates based on salary ranges), subcontract costs, and detailed operating expenses across multiple categories including travel, equipment, supplies, occupancy, utilities, communications, insurance, printing, repairs and maintenance, and other costs. Providers must allocate funding between DHS Regular Funds and DHS Special Grant Funds, calculate indirect costs for contracts exceeding $500,000 or with indirect rates greater than ten percent, and provide service descriptions with unit costs and client projections. The form includes a comprehensive indirect cost schedule detailing eligible and ineligible expense categories, fringe benefit computation worksheets for both salaried and hourly employees, and cost allocation plan requirements. This template applies to the DHS group home care contract for dependent adolescents ages 13-21, which requires qualified applicants to demonstrate capacity in providing residential services for this population.

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Group Home Care RFP Preproposal Meeting Link and Attendance List.pdf	PDF	Jun 8, 2026
RFP Q and A Group Home Care.pdf	PDF	Jun 8, 2026

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BUDGET SUMMARY

EXHIBIT PA1/SAA1

FY2026 BUDGET SUMMARY

Non - CUA

Instructions: Fill in blue shaded boxes as necessary

Provider Name: Contract Period:

Program Amount this Budget $: Contract No.

Total Contract Amount:	Division:
Service:	(example: JJS, CWO, PMT, A&M, PREVENTION)

	(1)	(2)	(3)	(4)
	DOLLARS FUNDED	DOLLARS FUNDED	TOTAL THIS DHS	PRIOR YEAR DHS funding for this contract
Classification	THIS CONTRACT BY	THIS CONTRACT BY	CONTRACT
	DHS REGULAR FUNDS	DHS SPECIAL GRANT FUNDS	Columns 1 + 2
	This column will auto-fill	This column will auto-fill	This column will auto-fill	Fill in this column
				↓

SECTION I

Personnel Costs
Salaries	$ - 0	$ - 0	$ - 0
Fringe Benefits	$ - 0	$ - 0	$ - 0
Subtotal Personnel Costs	$ - 0	$ - 0	$ - 0	$ - 0

SECTION II

Subcontract Costs $ - 0 $ - 0 $ - 0

SECTION III

Operating Costs:
Travel	$ - 0	$ - 0	$ - 0
Equipment	$ - 0	$ - 0	$ - 0
Supplies	$ - 0	$ - 0	$ - 0
Occupancy	$ - 0	$ - 0	$ - 0
Utilities	$ - 0	$ - 0	$ - 0
Communication	$ - 0	$ - 0	$ - 0
Insurance	$ - 0	$ - 0	$ - 0
Printing	$ - 0	$ - 0	$ - 0
Repairs/Maintenance	$ - 0	$ - 0	$ - 0
Other	$ - 0	$ - 0	$ - 0
Subtotal Operating Costs	$ - 0	$ - 0	$ - 0	$ - 0

Total Direct Costs
(Personnel + Subcontractor + Operating)	$ - 0	$ - 0	$ - 0	$ - 0
Total Indirect Costs	$ - 0	$ - 0	$ - 0

Total Budget Costs (Direct + Indirect Costs) $ - 0 $ - 0 $ - 0 $ - 0

Version 3

Page &P of &N

I. Personnel Costs

Section I

Personnel Costs

Instructions: Fill in blue shaded boxes as necessary

If additional rows are needed, use the insert row tool in the toolbar. Inserted rows must not go past the sum row in order to preserve the calculation.

Provider Name:

Salaried Employees ↓
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)
Employee	Total Annual Salary	% Of Time On Project	Position / Title	Dollar Percentage of Annual Salary this Contract	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Salary For This Contract ( 6 + 7 )
Example: John Smith	$ 35,000.00	100%	CEO	$ 35,000.00	$ 30,000.00	$ 5,000.00	$ 35,000.00
				$ - 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
Total Salaried Employees Cost	$ - 0			$ - 0	$ - 0	$ - 0	$ - 0

Hourly Employees ↓
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)
Employee	Hourly Rate	% Of Time On Project	Position / Title	Hours Per Contract	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Wages This Contract ( 5 + 6 )
Example: John Smith	$ 10.00	100.00%	Administrator	30	$ 20.00	$ 280.00	$ 300.00
							$ - 0
							$ - 0
							$ - 0
							$ - 0
							$ - 0
							$ - 0
Total Hourly Rate Costs					$ - 0	$ - 0	$ - 0
Fringe Benefits ( ENTER FRINGE BENEFITS HERE )							$ - 0
All Employee Salary Costs (Salaried + Hourly)				$0.00	$ - 0	$ - 0	$ - 0
Total Personnel Costs					$ - 0	$ - 0	$ - 0	FOR DHS OFFICIAL USE ONLY

Table of Maximum Allowable Fringe Benefit Rates
Average Salary	Allowable Rate (%)
$15,000	53.53%
$17,500	47.79%
$20,000	43.48%
$22,500	40.13%
$25,000	37.46%
$27,500	35.26%
$30,000	33.44%
$32,500	31.89%
$35,000	31.05%

FTE	0.00
AVERAGE SALARY
MAXIMUM ALLOWABLE RATE	31.05%
TOTAL SALARY	$0.00
TOTAL FRINGE	$0
SALARIED FRINGE RATE

Fringe Benefits

BUDGET INFORMATION FORM (SUMMARY)

Instructions: Please Fill In Unshaded Boxes As Necessary.

Agency: 0

Fringe Benefits*:

Fringe benefits should be based on actual known costs or an established

formula that is concurrent with the applicant organization. Fringe benefits are for the

Personnel listed on your Personnel Roster, and only for the percentage of time devoted

to the Contract.

Salaried Fringe Benefits	Computation (% with two decimals)	Cost
Unemployment Compensation	35%	$2
Workman's Compensation
Health Insurance
Group Life Insurance
Pension
FICA
Medicare
Other (please list)

Total: $2

Hourly Fringe Benefits	Computation (% with two decimals)	Cost
Unemployment Compensation		$2
Workman's Compensation
FICA
Medicare
Other (please list)

Total: $2

II. Operating Expenses Section II

Sub-Contractors

Instructions: Fill in blue shaded boxes as necessary

If additional rows are needed, use the insert row tool in the toolbar. Inserted rows must not go past the sum row in order to preserve the calculation.

Provider Name:

SUB-CONTRACTORS
Name	Service to Be Provided		Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
Example: Smith Services	Visit Youth In Placement		$ 1,000.00	$ 500.00	$ 1,500.00
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
		Total Costs	$ - 0	$ - 0	$ - 0

Section III

Operating Expenses

Category	Description & Calculation	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
a. Travel
Employee Travel
Example:	5 Token Packs = $15.50 * 10 =$155, Local mileage $0.565 * 300= $169.50, 5 Transpasses = $83 * 5 = $415	$ 591.60	$ 147.90	$ 739.50
				$ - 0
				$ - 0
	Employee Travel	$ - 0	$ - 0	$ - 0

Category Description & Calculation Dollars Funded This Contract by DHS Regular Funds Dollars Funded This Contract by DHS Special Grant Funds Total Funds This Budget

Client Travel
Example:	50 Miles * $0.50 = $25.00, 3 Client Tranpasses = $83 * 3 = $249, 2 Token Packs = $15.50 * 2 = $31	$ 205.00	$ 100.00	$ 305.00
				$ - 0
				$ - 0
	Total Client Travel	$ - 0	$ - 0	$ - 0
	Total Travel	$ - 0	$ - 0	$ - 0

Category	Description & Purpose	Justification ( purchase versus lease )	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
b. Equipment	Note: indicate if new or replacement
Example	2 New Laser Printers	Leased for six months to at $90 month = $1,080
		to Print Program Brochures.	$ 900.00	$ 180.00	$ 1,080.00
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
Total Equipment			$ - 0	$ - 0	$ - 0

Category	Description & Purpose	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
c. Supplies
Example	Pencils/Pens for Admin. Staff $30, Client Supplies (job search portfolios) =$35*3 = $105, Paper $200	$ 300.00	$ 35.00	$ 335.00
				$ - 0
				$ - 0
Total Supplies		$ - 0	$ - 0	$ - 0

Category	Description & Purpose	Cost Per Month	# Months This Budget	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
d. Occupancy
Example: Mortgage	Mortgage on Property at 123 Water Street	$600.00	2	$ 800.00	$ 400.00	$ 1,200.00
Lease/ Rent 1						$ - 0
Lease/ Rent 2						$ - 0
Mortgage						$ - 0
Total Occupancy				$ - 0	$ - 0	$ - 0

Category	Description & Purpose	Cost Per Month	# Months This Budget	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
e. Utilities
Example: Electric	Electric Usage Cost for 123 Water Street	$85.00	4	$ 200.00	$ 140.00	$ 340.00
Electric						$ - 0
Gas						$ - 0
Water						$ - 0
Sewer						$ - 0
Other						$ - 0
Total Utilities				$ - 0	$ - 0	$ - 0

Category	Description & Calculation	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
f. Communication
Example	Internet (5 Months) $42 * 5=$210.00, 4 T-Mobile Cells (1 month) = $40 * 4 = $160, Verizon Landline ($130)	$ 475.00	$ 25.00	$ 500.00
				$ - 0
				$ - 0
	Total Communication	$ - 0	$ - 0	$ - 0

Category	Description & Purpose	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
g. Insurance
Example: Property Insurance	Insurance to cover building on 123 Water Street	$ 700.00	$ 100.00	$ 800.00
				$ - 0
				$ - 0
				$ - 0
				$ - 0
				$ - 0
	Total Insurance	$ - 0	$ - 0	$ - 0

Category	Description & Calculation	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
h. Printing
Example	Placement Brochures = 100 pgs @ $1.00 ea.= $100, Outreach Flyers = 500 @ $0.06 ea = $30	$ 100.00	$ 30.00	$ 130.00
				$ - 0
				$ - 0
	Total Printing	$ - 0	$ - 0	$ - 0

Category	Description & Calculation	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
i. Repairs & Maint
Example: Building Maintenace	Concrete Replacement for 123 Water Street at $2500	$ 2,000.00	$ 500.00	$ 2,500.00
				$ - 0
				$ - 0
				$ - 0
				$ - 0
	Total Repairs / Maintenace	$ - 0	$ - 0	$ - 0

Category	Description & Purpose	Unit	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
j. Other (list)
Example: Staff Development	6 Staff @ $100 Per Class	Classes	$ 400.00	$ 200.00	$ 600.00
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
			$ - 0	$ - 0	$ - 0

TOTAL DIRECT COSTS ( OPERATING ) $0.00 $0.00 $0.00

Category	Description & Calculation	Dollars Funded This Contract by DHS Regular Funds	Dollars Funded This Contract by DHS Special Grant Funds	Total Funds This Budget
k. * Indirect Costs
Example: Indirect Costs	Costs for Items not Directly related to a cost object.	$ 200.00	$ 100.00	$ 300.00
				$ - 0
				$ - 0
				$ - 0
				$ - 0
	Total Indirect	$ - 0	$ - 0	$ - 0

* Each Contract with a Contract Award equal to or greater than $500,000, provider agency will insert an additional worksheet Tab to the budget for Indirect Costs.

Each Contract with a Contract Awards less than $500,000 and an Indirect Cost Rate greater than 10% provider agency will insert an additional worksheet Tab to the budget for Indirect Costs.

III. Service Description

Section IV

Service/ Activity Description

Instructions: Fill in blue shaded boxes as necessary

If additional rows are needed, use the insert row tool in the toolbar. Inserted rows must not go past the sum row in order to preserve the calculation.

Provider Name:

Instructions: Describe the activity or service that this budget provides for DHS.
(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)
Describe the service or activity that this contract provides. If there is more than one type of service/ activity, list them seperately.	What is the total cost of this service on the budget?	What Percent of this budget funds this activity?	What is the Unit for this service? (i.e., visits, cases, lectures, classes, counseling sessions, etc.)	How many Units for this one activity are funded by this budget?	Cost per Unit	How many clients will receive this particular service?	Cost per Client
Example: Safety & Permancy	$ 500.00	20%	Visits	30	$ 16.67	20	$ 25.00	Classes
Example: Concrete Goods	$ 200.00	80%	Maintain Family Stability	20	$ 10.00	20	$ 10.00	Consultations
								Families
								Hours
								Individuals
								Lectures
								Students
								Visits
								Other
TOTAL COSTS	$ - 0			0		0	$ - 0

IV. Indirect Costs

INDIRECT COST FORM

Instructions: Fill in blue shaded boxes as necessary

If additional rows are needed, use the insert row tool in the toolbar. Inserted rows must not go past the sum row in order to preserve the calculation.

FY2024

INDIRECT	LESS: INELIGIBLE			DOLLARS FUNDED THIS CONTRACT	DOLLARS FUNDED THIS CONTRACT
COSTS	COSTS	TOTAL INDIRECT	PERCENTAGE ALLOCATED	BY DHS REGULAR FUNDS	BY DHS SPECIAL GRANT FUNDS	TOAL ALLOCATED COST

TOTAL ALLOCATED PAYROLL ( DO NOT FILL IN POPULATED FROM BELOW SCHEDULE )				$0.00	$ - 0	$ - 0	$ - 0	IN BALANCE
ADVERTISING	INELIGIBLE (MOSTLY)			$ - 0			$ - 0
AMORTIZATION				$ - 0			$ - 0
AUTOMOBILE				$ - 0			$ - 0
BAD DEBTS	INELIGIBLE			$ - 0			$ - 0
CONTRIBUTIONS	INELIGIBLE			$ - 0			$ - 0
DEPRECIATION				$ - 0			$ - 0
DUES & SUBSCRIPTIONS				$ - 0			$ - 0
ENTERTAINMENT	INELIGIBLE			$ - 0			$ - 0
FOOD/MEALS	INELIGIBLE (SOME)			$ - 0			$ - 0
ALCOHOLIC BEVERAGES	INELIGIBLE			$ - 0			$ - 0
EQUIPMENT RENTAL				$ - 0			$ - 0
INSURANCE				$ - 0			$ - 0
INTEREST ON BORROWED				$ - 0			$ - 0
CAPITAL	INELIGIBLE			$ - 0			$ - 0
LEGAL FEES				$ - 0			$ - 0
ACCOUNTING FEES				$ - 0			$ - 0
LIBRARY				$ - 0			$ - 0
MAINTENANCE/REPAIRS				$ - 0			$ - 0
OFFICE SUPPLIES				$ - 0			$ - 0
POSTAGE/SHIPPING				$ - 0			$ - 0
PRINTING & REPRODUCTION				$ - 0			$ - 0
RENT				$ - 0			$ - 0
PAYROLL TAXES				$ - 0			$ - 0
MISCELLANEOUS TAXES				$ - 0			$ - 0
TELEPHONE/COMMUNICATIONS				$ - 0			$ - 0
UTILITIES				$ - 0			$ - 0
OTHER (DESCRIBE)1				$ - 0			$ - 0
OTHER (DESCRIBE)2				$ - 0			$ - 0
OTHER (DESCRIBE)3				$ - 0			$ - 0
OTHER (DESCRIBE)4				$ - 0			$ - 0
OTHER (DESCRIBE)5				$ - 0			$ - 0
COLUMN TOTALS		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
INDIRECT PAYROLL SALARIES

Employee Name Position Reportable Compensation from the Organization ( W-2/1099-MISC) Reportable Compensation from Related Organization ( W-2/1099-MISC ) Actual and Estimated Amount of Other Compensation from the Organization and related organizations Fringe Benefits ( ONLY ) Allocated Percentage ( LIST PERCENTAGE ONLY ) Allocated Salaries Plus Fringe Benefits Dollars Funded this Contract by DHS Regular Funds Dollars Funded this Contract by DHS Special Grant Funds

					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
					$ - 0
TOTAL	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0

COST ALLOCATION PLAN

Sheet1

File details come from the government source that posted it. Updated Jun 19, 2026.