RFA 67-207 - Budget (STANDARD).xls

XLS spreadsheet 352 KB Posted Jun 18, 2026

Attached to: Family Impact Initiative
Solicitation number: 67-207
Issued by: Dauphin County, Harveys Lake Borough, Pennsylvania

About this file

Written by GovTribe AI · Jun 19, 2026

This is a budget template document for Request for Applications (RFA) 67-207 related to Pennsylvania's Family Impact Initiative program, which aims to support community-based and family-focused systems of care for children with special healthcare needs (CSHCN). The template is designed to allow vendors to submit comprehensive budgets across a project period from January 1, 2027, through June 30, 2031, encompassing multiple fiscal years. The document provides a standardized format for detailing all anticipated costs across eight primary budget categories: Personnel Services, Consultant Services, Subcontract Services, Patient Services, Equipment, Supplies, Travel, and Other Costs. The template includes detailed sections for each year of the project period, with both summary-level budget information and granular budget details that require vendors to specify hourly rates, quantities, unit costs, and itemized breakdowns by expense category. The document contains instructions for completing budget entries, amendments, and how to handle multi-year funding scenarios.

The budget template requires vendors to clearly distinguish between original budget allocations and any proposed amendments, with all calculations automatically populated based on detailed line-item entries. Equipment purchases of $5,000 per unit or greater are categorized separately from general supplies under $5,000, while travel costs must be itemized according to GSA-approved rates by category (mileage, lodging, airfare, subsistence, parking/tolls, and ground transportation). Personnel budgets must include separate calculations for fringe benefits applied to each staff position's full project costs, with specification of included benefits. The template accommodates multiple funding sources if needed through an alternative template format and includes provisions for amendments to original budgets with clear documentation of amendment type and number. All summary pages are formula-driven and protected, requiring data entry only in designated highlighted areas to prevent calculation errors and ensure compliance with the RFA requirements.

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OVERALL SUMMARY

RFA 67-207
OVERALL BUDGET SUMMARY
(Insert Vendor Name)
January 1, 2027-June 30, 2031
CATEGORIES	Original Budget	Amendment (If Applicable)	Total Budget
I. PERSONNEL SERVICES	- 0	- 0	- 0
II. CONSULTANT SERVICES	- 0	- 0	- 0
III. SUBCONTRACT SERVICES	- 0	- 0	- 0
IV. PATIENT SERVICES	- 0	- 0	- 0
V. EQUIPMENT	- 0	- 0	- 0
VI. SUPPLIES	- 0	- 0	- 0
VII. TRAVEL	- 0	- 0	- 0
VIII. OTHER COSTS	- 0	- 0	- 0
TOTAL	- 0	- 0	- 0
-1-

SUMMARY - Year 1

RFA 67-207
BUDGET SUMMARY
(Insert Vendor Name)
January 1, 2027-June 30, 2027
CATEGORIES	Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES	- 0	- 0	- 0	0
II. CONSULTANT SERVICES	- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES	- 0	- 0	- 0	0
IV. PATIENT SERVICES	- 0	- 0	- 0	0
V. EQUIPMENT	- 0	- 0	- 0	0
VI. SUPPLIES	- 0	- 0	- 0	0
VII. TRAVEL	- 0	- 0	- 0	0
VIII. OTHER COSTS	- 0	- 0	- 0	0
TOTAL	- 0	- 0	- 0	0
- 0
-2-

BUDGET DETAILS - Year 1

RFA 67-207
(Insert Vendor Name)
January 1, 2027-June 30, 2027
Categories			Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES
A. Staff Personnel	Hourly	Number
	Rate	of Hours
					- 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
Sub-Total			- 0	- 0	- 0
-3-
B. Fringe Benefits
	Salary	Rate
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	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
Specify the benefits included in this rate:
Sub-Total			- 0	- 0	- 0
Total			- 0	- 0	- 0	0
-4-
II. CONSULTANT SERVICES
Consultants	Hourly	Number
	Rate	of Hours
					- 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			- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES
					- 0
					- 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
-5-
IV. PATIENT SERVICES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
V. EQUIPMENT
	Quantity	Unit Cost
					- 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			- 0	- 0	- 0	0
VI. SUPPLIES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
-6-
VII. TRAVEL
		Cost			- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
VIII. OTHER COSTS
					- 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
TOTAL			- 0	- 0	- 0
-7-

SUMMARY - Year 2

RFA 67-207
BUDGET SUMMARY
(Insert Vendor Name)
July 1, 2027-June 30, 2028
CATEGORIES	Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES	- 0	- 0	- 0	0
II. CONSULTANT SERVICES	- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES	- 0	- 0	- 0	0
IV. PATIENT SERVICES	- 0	- 0	- 0	0
V. EQUIPMENT	- 0	- 0	- 0	0
VI. SUPPLIES	- 0	- 0	- 0	0
VII. TRAVEL	- 0	- 0	- 0	0
VIII. OTHER COSTS	- 0	- 0	- 0	0
TOTAL	- 0	- 0	- 0	0
- 0
-8-

BUDGET DETAILS - Year 2

RFA 67-207
(Insert Vendor Name)
July 1, 2027-June 30, 2028
Categories			Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES
A. Staff Personnel	Hourly	Number
	Rate	of Hours
					- 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
Sub-Total			- 0	- 0	- 0	0
-9-
B. Fringe Benefits
	Salary	Rate
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	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
Specify the benefits included in this rate:
Sub-Total			- 0	- 0	- 0
Total			- 0	- 0	- 0	0
-10-
II. CONSULTANT SERVICES
Consultants	Hourly	Number
	Rate	of Hours
					- 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			- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES
					- 0
					- 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
-11-
IV. PATIENT SERVICES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
V. EQUIPMENT
	Quantity	Unit Cost
					- 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			- 0	- 0	- 0	0
VI. SUPPLIES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
-12-
VII. TRAVEL
		Cost			- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
VIII. OTHER COSTS
					- 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
TOTAL			- 0	- 0	- 0
-13-

SUMMARY - Year 3

RFA 67-207
BUDGET SUMMARY
(Insert Vendor Name)
July 1, 2028-June 30, 2029
CATEGORIES	Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES	- 0	- 0	- 0	0
II. CONSULTANT SERVICES	- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES	- 0	- 0	- 0	0
IV. PATIENT SERVICES	- 0	- 0	- 0	0
V. EQUIPMENT	- 0	- 0	- 0	0
VI. SUPPLIES	- 0	- 0	- 0	0
VII. TRAVEL	- 0	- 0	- 0	0
VIII. OTHER COSTS	- 0	- 0	- 0	0
TOTAL	- 0	- 0	- 0	0
- 0
-14-

BUDGET DETAILS - Year 3

RFA 67-207
(Insert Vendor Name)
July 1, 2028-June 30, 2029
Categories			Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES
A. Staff Personnel	Hourly	Number
	Rate	of Hours
					- 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
Sub-Total			- 0	- 0	- 0	0
-15-
B. Fringe Benefits
	Salary	Rate
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	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
Specify the benefits included in this rate:
Sub-Total			- 0	- 0	- 0
Total			- 0	- 0	- 0	0
-16-
II. CONSULTANT SERVICES
Consultants	Hourly	Number
	Rate	of Hours
					- 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			- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES
					- 0
					- 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
-17-
IV. PATIENT SERVICES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
V. EQUIPMENT
	Quantity	Unit Cost
					- 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			- 0	- 0	- 0	0
VI. SUPPLIES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
-18-
VII. TRAVEL
		Cost			- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
VIII. OTHER COSTS
					- 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
TOTAL			- 0	- 0	- 0
-19-

SUMMARY - Year 4

RFA 67-207
BUDGET SUMMARY
(Insert Vendor Name)
July 1, 2029-June 30, 2030
CATEGORIES	Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES	- 0	- 0	- 0	0
II. CONSULTANT SERVICES	- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES	- 0	- 0	- 0	0
IV. PATIENT SERVICES	- 0	- 0	- 0	0
V. EQUIPMENT	- 0	- 0	- 0	0
VI. SUPPLIES	- 0	- 0	- 0	0
VII. TRAVEL	- 0	- 0	- 0	0
VIII. OTHER COSTS	- 0	- 0	- 0	0
TOTAL	- 0	- 0	- 0	0
- 0
-20-

BUDGET DETAILS - Year 4

RFA 67-207
(Insert Vendor Name)
July 1, 2029-June 30, 2030
Categories			Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES
A. Staff Personnel	Hourly	Number
	Rate	of Hours
					- 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
Sub-Total			- 0	- 0	- 0	0
-21-
B. Fringe Benefits
	Salary	Rate
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	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
Specify the benefits included in this rate:
Sub-Total			- 0	- 0	- 0
Total			- 0	- 0	- 0	0
-22-
II. CONSULTANT SERVICES
Consultants	Hourly	Number
	Rate	of Hours
					- 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			- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES
					- 0
					- 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
-23-
IV. PATIENT SERVICES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
V. EQUIPMENT
	Quantity	Unit Cost
					- 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			- 0	- 0	- 0	0
VI. SUPPLIES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
-24-
VII. TRAVEL
		Cost			- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
VIII. OTHER COSTS
					- 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
TOTAL			- 0	- 0	- 0
-25-

SUMMARY - Year 5

RFA 67-207
BUDGET SUMMARY
(Insert Vendor Name)
July 1, 2030-June 30, 2031
CATEGORIES	Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES	- 0	- 0	- 0	0
II. CONSULTANT SERVICES	- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES	- 0	- 0	- 0	0
IV. PATIENT SERVICES	- 0	- 0	- 0	0
V. EQUIPMENT	- 0	- 0	- 0	0
VI. SUPPLIES	- 0	- 0	- 0	0
VII. TRAVEL	- 0	- 0	- 0	0
VIII. OTHER COSTS	- 0	- 0	- 0	0
TOTAL	- 0	- 0	- 0	0
- 0
-26-

BUDGET DETAILS - Year 5

RFA 67-207
(Insert Vendor Name)
July 1, 2030-June 30, 2031
Categories			Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES
A. Staff Personnel	Hourly	Number
	Rate	of Hours
					- 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
Sub-Total			- 0	- 0	- 0	0
-27-
B. Fringe Benefits
	Salary	Rate
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	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
Specify the benefits included in this rate:
Sub-Total			- 0	- 0	- 0
Total			- 0	- 0	- 0	0
-28-
II. CONSULTANT SERVICES
Consultants	Hourly	Number
	Rate	of Hours
					- 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			- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES
					- 0
					- 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
-29-
IV. PATIENT SERVICES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
V. EQUIPMENT
	Quantity	Unit Cost
					- 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			- 0	- 0	- 0	0
VI. SUPPLIES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
-30-
VII. TRAVEL
		Cost			- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
VIII. OTHER COSTS
					- 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
TOTAL			- 0	- 0	- 0
-31-

SUMMARY - Year 6

RFA 67-207
BUDGET SUMMARY
(Insert Vendor Name)
(Insert Budget Period)
CATEGORIES	Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES	- 0	- 0	- 0	0
II. CONSULTANT SERVICES	- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES	- 0	- 0	- 0	0
IV. PATIENT SERVICES	- 0	- 0	- 0	0
V. EQUIPMENT	- 0	- 0	- 0	0
VI. SUPPLIES	- 0	- 0	- 0	0
VII. TRAVEL	- 0	- 0	- 0	0
VIII. OTHER COSTS	- 0	- 0	- 0	0
TOTAL	- 0	- 0	- 0	0
- 0
-32-

BUDGET DETAILS - Year 6

RFA 67-207
(Insert Vendor Name)
(Insert Budget Period)
Categories			Original Budget	Amendment Type & Number	Total Budget
I. PERSONNEL SERVICES
A. Staff Personnel	Hourly	Number
	Rate	of Hours
					- 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
Sub-Total			- 0	- 0	- 0	0
-33-
B. Fringe Benefits
	Salary	Rate
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	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
Specify the benefits included in this rate:
Sub-Total			- 0	- 0	- 0
Total			- 0	- 0	- 0	0
-34-
II. CONSULTANT SERVICES
Consultants	Hourly	Number
	Rate	of Hours
					- 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			- 0	- 0	- 0	0
III. SUBCONTRACT SERVICES
					- 0
					- 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
-35-
IV. PATIENT SERVICES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
V. EQUIPMENT
	Quantity	Unit Cost
					- 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			- 0	- 0	- 0	0
VI. SUPPLIES
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
-36-
VII. TRAVEL
		Cost			- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
					- 0
Total			- 0	- 0	- 0
VIII. OTHER COSTS
					- 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
TOTAL			- 0	- 0	- 0
-37-

BUDGET INSTRUCTIONS

Budget Instructions
General Instructions
-	Please copy this file to your hard drive before making any edits. Do not make any changes to this template.
-	Complete only highlighted areas. All other areas are formula driven and are template protected. Data should only be entered on the "Budget Details" tab and the shaded area of the Overall Summary tab.
-	Rows should not be deleted (even if a particular category is not being used). If additional rows are needed, please contact the Office of Procurement.
-	If additional columns are needed, please use the budget template for "Multiple Funding Sources."
-	Tabs are provided to input data for up to 5 separate budget years. For agreements with multiple years, fill in the budget details for each applicable year. For the original base document, the Budget Details, accompanying Budget Summary and Summary-Overall should be used for submission.
-	This template can also be used for amendments. When preparing an amendment, start with the original budget information already completed and add the amendment changes within the budget category, directly below the original information. Please indicate the Amendment Type and Number in the appropriate column heading and update the Appendix C reference to indicate the amendment number. For amendments, the Budget Details and accompanying Budget Summary should be used for submission.
Budget Details - Personnel Services
-	Complete all highlighted areas.
-	List all personnel positions/titles to be funded, the hourly rate and number of hours. Do not list personnel names. This calculation will automatically appear under Total Budget.
-	Complete the amount of costs associated to either the Original Budget or to an Amendment, as applicable. The amount must equal the "Total Budget", otherwise an ERROR message will reflect on the Summary Page.
-	Once all personnel costs are completed under Staff Personnel, each staff identified and their full project costs will also automatically appear under Fringe Benefits. Complete the benefit rate for each staff identified. The Full Project Costs will automatically calculate.
-	Complete the amount of costs associated to either the Original Budget or to an Amendment, as applicable. The amount must equal the "Total Budget", otherwise an ERROR message will reflect on the Summary Page.
-	Identify the fringe rate and specific benefits included in the rate.
Budget Details - Consultants Services
-	List services to be provided, the hourly rate and number of hours. Do not name the consultant(s) that will be retained. This calculation will automatically appear under Total Budget.
-	Complete the amount of costs associated to either the Original Budget or to an Amendment, as applicable. The amount must equal the "Total Budget", otherwise an ERROR message will reflect on the Summary Page.
Budget Details - SubContract Services
-	Identify services to be provided. Do not name sub contractor to be retained.
-	Complete costs associated to the Original Budget or to an Amendment. The Total Budget costs will automatically calculate.
Budget Details - Patient Services
-	Identify services.
-	Complete costs associated to the Original Budget or to an Amendment. The Total Budget costs will automatically calculate.
Budget Details - Equipment
-	Identify equipment, the quantity and unit cost. (Use this category for equipment that is $5,000/unit or greater.) This calculation will automatically appear under Total Budget.
-	Complete the amount of costs associated to either the Original Budget or to an Amendment, as applicable. The amount must equal the "Total Budget", otherwise an ERROR message will reflect on the Summary Page.
Budget Details - Supplies
-	Identify supplies (in general terms). Equipment items under $5000 unit cost should be listed here
-	Complete costs associated to the Original Budget or to an Amendment. The Total Budget costs will automatically calculate.
Budget Details - Travel
-	Identify travel cost by event and show the breakdown for that event to show amounts by Mileage, Lodging, Airfare, Subsistence, Parking/Tolls, and Ground Transportation using the approved rates at https://www.gsa.gov/travel-resources. See example below.
-	Identify travel costs for any work that doesn’t relate to a specific event but to work in general as “General Travel” and show the breakdown for general travel to show amounts by Mileage, Lodging, Airfare, Subsistence, Parking/Tolls, and Ground Transportation using approved rates at https://www.gsa.gov/travel-resources. See example below.
-	Complete costs associated to the Original Budget or to an Amendment. The Total Budget costs will automatically calculate.
Budget Details - Other Costs
-	Identify other costs. (Indirect costs, if applicable, should be reflected under this category.)
-	Complete costs associated to the Original Budget or to an Amendment. The Total Budget costs will automatically calculate.
	Items such as equipment rental/maintenance should be listed here
Budget Details - Total
-	Totals calculate automatically.
Summary
-	All areas are formula driven and password protected. No entry is required on this page.
Summary - Overall
-	Most areas are formula driven and password protected. Data entry is only required to reflect the total project period.

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