Program_Budget_Form~1.doc

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Attached to
Citizenship for New Americans Program (CNAP) Technical Assistance
Solicitation number
BD-27-1078-ORI1A-ORI-131563
Issued by
Massachusetts

About this file

This is a Program Budget Form for a cost reimbursement purchase of service contract with the Massachusetts Office for Refugees and Immigrants (ORI) related to the Citizenship for New Americans Program (CNAP) Technical Assistance initiative. The form serves as Attachment 3 to the contract proposal and requires contractors to detail fiscal year budgeting across multiple cost categories, including direct care and program support staff with associated payroll taxes and fringe benefits, occupancy costs including facilities and operations, other direct care and program support expenses such as consulting, temporary help, client transportation, and program supplies, and direct administrative expenses. The budget structure accommodates both current and amended figures with separate columns for full-time equivalents (FTE) and dollar amounts, allowing contractors to present baseline budgets alongside any proposed modifications.

The form establishes reimbursable cost categories with designated UFR (Uniform Fiscal Reporting) title numbers and includes provisions for offset sources and non-reimbursable costs that must be detailed separately when federal OMB Circular A-122 or 808 CMR 1.00 provisions apply. Contractors must identify agency administrative support allocation percentages and amounts, with an additional line for commercial fees applicable only to for-profit organizations for informational purposes. The document requires contractors to specify their board-approved capitalization levels for negotiated expenses in designated line items and indicates a low sensitivity classification level, suggesting standard budgeting requirements without heightened financial scrutiny or restrictions.

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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

File details come from the government source that posted it. Updated .