RFP 202401 DADBHS Benefit Specialist Program Budget Worksheet.xlsx

XLSX spreadsheet 51 KB Posted

Attached to
Kenosha County Benefit Specialist Program
Solicitation number
202401
Issued by
Kenosha County, Wisconsin

About this file

This is a budget worksheet template prepared by Kenosha County Department of Human Services for the Benefit Specialist Program RFP 202401 administered by the Division of Aging, Disability, and Behavioral Health Services (DADBHS). The program provides information and assistance to Kenosha County residents aged 60 and over or adults 18 and over with disabilities and their families regarding Medicare, Social Security, Medicaid, other health insurance, housing, and related matters. Benefit Specialists operate under off-site consultation by contract attorneys and offer consumers the opportunity to make voluntary contributions toward service costs in accordance with Bureau on Aging & Disability policy. The budget worksheet template is designed to capture staffing allocations, salary information, and overall program expenses.

The budget template comprises five worksheets structured to collect comprehensive financial information: Worksheet 1 captures FTE and salary allocation by position including degree level and direct staff versus administrative/clerical/supervision allocations; Worksheet 2 details benefit allocation including FICA, health insurance premiums, unemployment compensation, retirement, and other benefits; Worksheet 3 provides a total expense summary incorporating personnel costs, contracted services, equipment purchases, and line-item expenses such as data processing, training, travel, insurance, rent, supplies, and utilities, with provisions for administration allocation capped at 10 percent and expected profit at 5 percent for for-profit agencies; Worksheet 4 requires detailed explanations of contracted services and equipment purchases over $500 with useful life exceeding one year; and Worksheet 5 documents other revenue sources. The template is designated as version 141104 and accommodates unit-rate budgeting calculations based on direct staff FTE converted to billable units.

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Text version

1. FTE & Salary Allocation

Kenosha County Department of Human Services Budget Worksheet #1 -- FTE & Salary AllocationVersion: 141104
Contract ID:Entered by Kenosha CountyEnter Agency Name Here
Enter Dates of Contract Here
Please enter all information as indicated by BLUE font color and shaded in BLUE.
Enter Program Name Here
PositionFirst NameLast NameDegree LevelEnter Annual Salary regardless of time allocated to ProgramTotal FTEDirect Staff FTEAdmin/ Clerical/ SupervisionAllocation of Salary to Program
1- 0- 0
2- 0- 0
3- 0- 0
4- 0- 0
5- 0- 0
6- 0- 0
7- 0- 0
8- 0- 0
9- 0- 0
10- 0- 0
11- 0- 0
12- 0- 0
13- 0- 0
14- 0- 0
15- 0- 0
16- 0- 0
17- 0- 0
18- 0- 0
19- 0- 0
20- 0- 0
21- 0- 0
22- 0- 0
23- 0- 0
24- 0- 0
25- 0- 0
26- 0- 0
27- 0- 0
28- 0- 0
29- 0- 0
30- 0- 0
31- 0- 0
32- 0- 0
33- 0- 0
34- 0- 0
35- 0- 0
36- 0- 0
37- 0- 0
38- 0- 0
39- 0- 0
40- 0- 0
41- 0- 0
42- 0- 0
43- 0- 0
44- 0- 0
45- 0- 0
46- 0- 0
47- 0- 0
48- 0- 0
49- 0- 0
50- 0- 0
Total Time Allocation- 0- 0- 0- 0- 0

Date printed: &D &A Version: 141104

2. Benefit Allocation

Kenosha County Department of Human Services Budget Worksheet #2 -- Benefit AllocationVersion: 141104
Agency NameEnter Agency Name Here
Contract PeriodEnter Dates of Contract Here
Please enter all information as indicated by BLUE font color and shaded in BLUE.

Annual amounts should be entered. The last column will adjust to the actual FTE % allocated to the program as shown on the Time Allocation worksheet (#1).

Annual Salary and Benefit CalculationEnter Program Name Here
PositionAnnual SalaryFICAAnnual Health Insurance Premiums (if applicable)State and Federal UC (if applicable)Retirement (if applicable)Other ExplanationOther $Total Annual BenefitsAllocated Program Benefits
1-- 0- 0- 0- 0
2-- 0- 0- 0- 0
3-- 0- 0- 0- 0
4-- 0- 0- 0- 0
5-- 0- 0- 0- 0
6-- 0- 0- 0- 0
7-- 0- 0- 0- 0
8-- 0- 0- 0- 0
9-- 0- 0- 0- 0
10-- 0- 0- 0- 0
11-- 0- 0- 0- 0
12-- 0- 0- 0- 0
13-- 0- 0- 0- 0
14-- 0- 0- 0- 0
15-- 0- 0- 0- 0
16-- 0- 0- 0- 0
17-- 0- 0- 0- 0
18-- 0- 0- 0- 0
19-- 0- 0- 0- 0
20-- 0- 0- 0- 0
21-- 0- 0- 0- 0
22-- 0- 0- 0- 0
23-- 0- 0- 0- 0
24-- 0- 0- 0- 0
25-- 0- 0- 0- 0
26-- 0- 0- 0- 0
27-- 0- 0- 0- 0
28-- 0- 0- 0- 0
29-- 0- 0- 0- 0
30-- 0- 0- 0- 0
31-- 0- 0- 0- 0
32-- 0- 0- 0- 0
33-- 0- 0- 0- 0
34-- 0- 0- 0- 0
35-- 0- 0- 0- 0
36-- 0- 0- 0- 0
37-- 0- 0- 0- 0
38-- 0- 0- 0- 0
39-- 0- 0- 0- 0
40-- 0- 0- 0- 0
41-- 0- 0- 0- 0
42-- 0- 0- 0- 0
43-- 0- 0- 0- 0
44-- 0- 0- 0- 0
45-- 0- 0- 0- 0
46-- 0- 0- 0- 0
47-- 0- 0- 0- 0
48-- 0- 0- 0- 0
49-- 0- 0- 0- 0
50-- 0- 0- 0- 0
Total Benefits- 0- 0- 0- 0- 0- 0- 0- 0

Date printed: &D &A Version: 141104

3. Total Expense Summary

Kenosha County Department of Human Services Budget Worksheet #3 -- Total Expense SummaryVersion: 141104
Agency NameEnter Agency Name Here
Contract PeriodEnter Dates of Contract Here
Please enter all information as indicated by BLUE font color and BLUE shaded area.
Total Expense Summary
Enter Program Name Here
1Salary Allocation - Worksheet 1- 0
2Benefit Allocation - Worksheet 2- 0
Total Personnel Costs- 0
OTHER EXPENSES:
3Contracted Program (Enter detail found on Worksheet 4)- 0
4Contracted Other (Enter detail found on Worksheet 4)- 0
5Equipment Purchases (Single Item Purchase over $500 AND useful life of more than 1 year) Enter individual descriptions on Worksheet 4- 0
6Other (Enter detail found on Worksheet 4)- 0
7Data Processing
8Staff Training/Development
9Staff Travel
10Insurance
11Interest
12Legal & Accounting
13Licenses
14Postage
15Printing
16Rent - Building
17Rent - Equipment
18Repair & Maintenance
19Building Depreciation
20Supplies
21Non-Payroll Taxes
22Telephone
23Utilities
Sub-Total Other- 0
Sub-Total including Personnel- 0
Administration Allocation Rate (Maximum 10%) - A DETAILED EXPLANATION OF CALCULATION METHOD USED MUST BE ATTACHED0%
Admin Allocation - A detailed explanation of allocation method used must be attached to this worksheet.- 0
Expected Profit (Maximum 5%) (FOR PROFIT AGENCIES ONLY)0%
Total PROGRAM Budget- 0
Offset by Other Revenue Sources as Listed on Tab 5- 0
Total Agency Budget to be used for DHS Contract--Must NOT exceed Program Funding level as specified by Department of Human Services- 0
STOP HERE IF ACTUAL REIMBURSEMENT BUDGET HAS BEEN REQUESTED. CONTINUE ON ONLY IF UNIT RATE BUDGET HAS BEEN REQUESTED.
Optional: Input units based on Previous Years Actuals
Total Units-Calculated based on Time Allocation Worksheet from Direct Staff Column (DS FTE x 2080 x 75%)- 0
Cost Per Unit/Program$ - 0

Date Printed: &D &A Version: 141104

4. Other Services Explanation

Kenosha County Department of Human Services Budget Worksheet #4 - Detail of Other ExpensesVersion: 141104
Agency NameEnter Agency Name Here
Contract PeriodEnter Dates of Contract Here
Please enter all information as indicated by BLUE font color and BLUE shaded area.
List Detail of Other Services
Tab 3 Line 3 - Must provide detail explanation including consultant name and degree level if applicable:Enter Program Name Here
Contracted Program

Contracted Other:

List Equipment over $500 with a useful life of more than 1 year:

Other Expenses

Total - 0

Date Printed: &D &A Version: 141104

5. Revenue Sources (Optional)

Kenosha County Department of Human Services Budget Worksheet #5 -- Other Revenue SourcesVersion: 141104
Agency NameEnter Agency Name Here
Contract PeriodEnter Dates of Contract Here

Please enter all information as indicated by BLUE font color and BLUE shaded area.

List Other Revenue Sources by Program
Enter source of revenue here:Enter Program Name Here
Total Other Revenue Sources- 0
Use of above revenue sources--Provide detailed explanation:

Budget - Unit Rate &A Version: 141104

Utility Worksheet

Utility Worksheet
Field NameValueDescription
Workbook Type9Budget - Unit Rate
Template Version141104(Read-Only) Template Version Number
Workbook IDID of workbook as stored in tlog_CMS_ContractWorkbook
Contract IDForeign Key to the system ID for the Contract
Creation DateDate the Workbook was created
AuthorPerson creating the workbook
Upload DateDate the Workbook was uploaded

Revision History

Revision History
DateDeveloperNotes
5/22/06BR- Added Utility Worksheet
- Added Revision History Worksheet
- Added Macro 'UpdateFooter '
- Added Version # to display
- General formatting (font size, display %)
7/27/06BR- Protected all Worksheets
Note: Blue shaded areas are unprotected
- Corrected cell reference error (Benefit Allocation Worksheet Col B)
8/1/06EJSheet One, Columns D & E - Display 3 decimal places.
6/12/07BRSheet 3 - Decreased size of Column B to 32.57 (was not printing on OOD color printer)
10/22/09BRSheet 3 - Added Cell C38
Sheet 3 - Updated formula for Cell B38 to check for value in Cell C38
11/4/14BRSheet 1 - Added columns 'First Name', 'Last Name', 'Degree Level'
- Added Lists Worksheet (Hidden)

Lists

Degree Level
Advanced Practice Nurse Practitioner
Bachelors Degree
Masters Degree
Psychiatrist/MD
Less than Bachelor’s Degree
PhD Psychologist/Doctoral
Registered Nurse/Licensed Practical Nurse
Qualified Treatment Trainee

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