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 Allocation | Version: 141104 | ||
| Contract ID: | Entered by Kenosha County | Enter 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 | |||||||||
| Position | First Name | Last Name | Degree Level | Enter Annual Salary regardless of time allocated to Program | Total FTE | Direct Staff FTE | Admin/ Clerical/ Supervision | Allocation 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 Allocation | Version: 141104 | |
| Agency Name | Enter Agency Name Here | |
| Contract Period | Enter 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 Calculation | Enter Program Name Here | |||||||||
| Position | Annual Salary | FICA | Annual Health Insurance Premiums (if applicable) | State and Federal UC (if applicable) | Retirement (if applicable) | Other Explanation | Other $ | Total Annual Benefits | Allocated 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 Summary | Version: 141104 | |
| Agency Name | Enter Agency Name Here | |
| Contract Period | Enter 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 | |||
| 1 | Salary Allocation - Worksheet 1 | - 0 | |
| 2 | Benefit Allocation - Worksheet 2 | - 0 | |
| Total Personnel Costs | - 0 | ||
| OTHER EXPENSES: | |||
| 3 | Contracted Program (Enter detail found on Worksheet 4) | - 0 | |
| 4 | Contracted Other (Enter detail found on Worksheet 4) | - 0 | |
| 5 | Equipment Purchases (Single Item Purchase over $500 AND useful life of more than 1 year) Enter individual descriptions on Worksheet 4 | - 0 | |
| 6 | Other (Enter detail found on Worksheet 4) | - 0 | |
| 7 | Data Processing | ||
| 8 | Staff Training/Development | ||
| 9 | Staff Travel | ||
| 10 | Insurance | ||
| 11 | Interest | ||
| 12 | Legal & Accounting | ||
| 13 | Licenses | ||
| 14 | Postage | ||
| 15 | Printing | ||
| 16 | Rent - Building | ||
| 17 | Rent - Equipment | ||
| 18 | Repair & Maintenance | ||
| 19 | Building Depreciation | ||
| 20 | Supplies | ||
| 21 | Non-Payroll Taxes | ||
| 22 | Telephone | ||
| 23 | Utilities | ||
| Sub-Total Other | - 0 | ||
| Sub-Total including Personnel | - 0 | ||
| Administration Allocation Rate (Maximum 10%) - A DETAILED EXPLANATION OF CALCULATION METHOD USED MUST BE ATTACHED | 0% | ||
| 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 Expenses | Version: 141104 | |
| Agency Name | Enter Agency Name Here | |
| Contract Period | Enter 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 Sources | Version: 141104 | |
| Agency Name | Enter Agency Name Here | |
| Contract Period | Enter 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 Name | Value | Description |
| Workbook Type | 9 | Budget - Unit Rate |
| Template Version | 141104 | (Read-Only) Template Version Number |
| Workbook ID | ID of workbook as stored in tlog_CMS_ContractWorkbook | |
| Contract ID | Foreign Key to the system ID for the Contract | |
| Creation Date | Date the Workbook was created | |
| Author | Person creating the workbook | |
| Upload Date | Date the Workbook was uploaded |
Revision History
| Revision History | ||
| Date | Developer | Notes |
| 5/22/06 | BR | - Added Utility Worksheet |
| - Added Revision History Worksheet | ||
| - Added Macro 'UpdateFooter ' | ||
| - Added Version # to display | ||
| - General formatting (font size, display %) | ||
| 7/27/06 | BR | - Protected all Worksheets |
| Note: Blue shaded areas are unprotected | ||
| - Corrected cell reference error (Benefit Allocation Worksheet Col B) | ||
| 8/1/06 | EJ | Sheet One, Columns D & E - Display 3 decimal places. |
| 6/12/07 | BR | Sheet 3 - Decreased size of Column B to 32.57 (was not printing on OOD color printer) |
| 10/22/09 | BR | Sheet 3 - Added Cell C38 |
| Sheet 3 - Updated formula for Cell B38 to check for value in Cell C38 | ||
| 11/4/14 | BR | Sheet 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 .