RHTbudget.xlsx
XLSX spreadsheet 167 KB Posted
- Attached to
- RHTP- Innovative Maternal Care
- Solicitation number
- RFA-127840
- Issued by
- Virginia
About this file
This is a budget template and instruction document for the Virginia Rural Health Transformation Program (RHTP), developed by the Centers for Medicare & Medicaid Services (CMS) for applicants seeking funding under the "Connected to Care, Closer to Home: Innovative Maternal Care" initiative. The template guides applicants through the development of a detailed Budget Year 1 project budget that documents assumptions, calculations, and cost estimates aligned with approved RHTP project activities. The workbook contains seven budget categories requiring completion: Personnel & Fringe Benefits, Travel, Equipment, Supplies, Contractual services, and Other Direct Costs, with a Budget Summary tab that auto-populates totals from the individual worksheets. All proposed costs must comply with 2 CFR Part 200 requirements, the RHTP Notice of Award (NOA), and the Notice of Funding Opportunity (NOFO), with applicants required to provide sufficient detail, itemized calculations, formulas, and supporting documentation for each cost line item.
The budget template establishes specific allowable cost categories and restrictions designed to ensure fiscal responsibility and alignment with federal requirements. Personnel costs should reflect compensation for employees performing approved project activities, with fringe benefits calculated separately for each position based on the organization's established methodology and policies, including employer-paid retirement contributions, Social Security and Medicare, health and dental insurance, and other allowable benefits. Equipment purchases exceeding $10,000 per unit are permissible, with Category J funding available for capital expenditures and infrastructure investments capped at 20 percent of total CMS award amounts, while construction and building expansions are prohibited as direct costs. Travel expenses must comply with GSA rates and organizational travel policies, supplies must have per-unit costs below $10,000, and contractual costs require subaward or contractor determinations per 2 CFR 200.331. Administrative costs are subject to a 10 percent cap of total award amounts across all recipient and subrecipient levels, with prohibited costs including construction, lobbying, promotional items, and advertising designed solely to promote the subrecipient.
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| File | Type | Posted |
|---|---|---|
| AppCoverPage.docx | DOCX document | |
| VDH_Innovative_Maternal_Care_Work_Plan_Template.docx | DOCX document | |
| IMC.RFA.Final.pdf |
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Instructions
Virginia Rural Health Transformation Program (RHTP) RFA Budget Template - Instructions
This template should be used by to develop a detailed Budget Year 1 project budget. This budget should document the assumptions and calculations used to estimate costs and demonstrate how requested funding supports proposed RHTP project activities. All proposed costs should be adequately supported, align with approved project activities, and comply with applicable RHTP Notice of Award (NOA), RHTP Notice of Funding Opportunity (NOFO), and 2 CFR Part 200 requirements.
| How to Complete this Workbook | |
| Step # | Step Description |
| 1 | Review General Budget Guidance. Carefully review the General Budget Guidance, Budget Category Definitions, Allowable Costs, and Prohibited Costs guidance included on the Budget Guidance and Definitions tab before completing the workbook. Verify that all proposed costs are reasonable, necessary, allocable, adequately documented, and consistent with the RHTP NOA, applicable NOFO requirements, and 2 CFR Part 200. |
| 2 | Complete Budget Worksheets. Populate the Personnel & Fringe, Travel, Equipment, Supplies, Contractual, Other Direct Costs, and Budget Summary tabs. Provide sufficient detail, assumptions, formulas, and calculations to support each requested cost. Complete all budget categories using the instructions provided within each worksheet. |
| 3 | Review Workbook Submission Directions. Verify that all budget worksheets are complete, formulas are functioning correctly, any supporting documentation has been assembled, and submission requirements have been satisfied prior to submitting the workbook in accordance with the applicable RFA instructions. |
Budget Guidance & Definitions
Virginia Rural Health Transformation Program (RHTP) RFA Budget Template - Budget Guidance & Definitions
This sheet provides guidance on allowable costs, budget development requirements, and cost category definitions applicable to the Rural Health Transformation Program (RHTP). Applicants should review this information prior to completing the workbook to ensure proposed costs are reasonable, necessary, allocable, adequately documented, and consistent with the CMS Notice of Award (NOA), Notice of Funding Opportunity (NOFO), and 2 CFR Part 200. The guidance in this section is intended to support consistent budget development, clarify allowable cost categories, and assist applicants in preparing a complete Budget Year 1 budget submission.
| General Budget Guidance |
| Supporting Calculations: All budget amounts must be supported by Excel formulas, itemized calculations, or written descriptions. Lump-sum amounts without support may be returned for clarification. Costs must be reasonable, necessary, allocable, consistently treated, and adequately documented. |
| Prohibited Costs: Funds may not be used for construction or building expansion, purchasing or significant retrofitting of buildings, cosmetic upgrades, or any other cost that materially increases the value of the capital or useful life as a direct cost. Construction costs (other than minor renovations or alterations that are clearly linked to program goals and receive prior CMS approval), capital expenditures without prior written CMS approval, lobbying, promotional items and memorabilia, and advertising or public relations activities designed solely to promote the Subrecipient are unallowable. |
| Budget Category Definitions | 2 CFR Part 200 Regulatory Citations | Additional Citations | Additional Citations |
| Personnel (2 CFR §200.430): Compensation paid to employees for work performed under the project. Personnel costs should reflect salary and wage costs attributable to approved project activities. | 2 CFR §200.430 | ||
| Fringe Benefits (2 CFR §200.431): Allowances and services provided by employers to their employees as compensation in addition to regular salaries and wages, including employer-paid health insurance, retirement contributions, FICA, disability insurance, leave benefits, and other benefits. | 2 CFR §200.431 | ||
| Travel (2 CFR §200.475): Travel costs for transportation, lodging, subsistence, and related expenses incurred by employees and other individuals authorized to travel on behalf of the project. The CMS Notice of Award requires recipients to comply with the requirements of 2 CFR §200.475. Travel costs must be reasonable, necessary, allocable to the project, and consistent with the applicant's established travel policies. Funds may not be used for goods or services not allocable to the project. |
| For budget development purposes, links to current General Services Administration (GSA) mileage reimbursement rates, lodging rates, and Meals and Incidental Expenses (M&IE) rates are provided for reference. Applicants should use their organization's established travel policies and actual anticipated costs when preparing budgets, provided those policies are consistent with the CMS Notice of Award, applicable NOFO requirements, and 2 CFR Part 200. If no organizational travel policy exists, current GSA rates may be used as a reasonable basis for estimating travel costs. All travel expenses must be supported by itemized calculations and documentation showing how costs were determined. For planning purposes, applicants may assume that travel to destinations more than 50 miles from the primary office location will require one overnight stay and two days of M&IE/per diem unless a different travel schedule is justified. | 2 CFR §200.475 Travel costs | GSA per diem rates | GSA transportation reimbursement rates | |
| Equipment (2 CFR §200.1): Tangible personal property (including information technology systems) having a useful life of more than one year and a per-unit acquisition cost which equals or exceeds $10,000. |
| Category J Capital Expenditures & Infrastructure: Category J funding supports investing in existing rural health care facility buildings and infrastructure, including minor building alterations or renovations and equipment upgrades to ensure long-term overhead and upkeep costs are commensurate with patient volume and is subject to restrictions in CMS funding policies and limitations. Category J funding cannot exceed 20% of the total funding CMS awards in a given budget period. Construction is unallowable under the Rural Health Transformation Program, and all capital expenditures and infrastructure investments must be part of an approved initiative. | 2 CFR §200.1 | Category J Funding for Capital Expenditures and Infrastructure Fact Sheet | |||
| Supplies (2 CFR §200.1): All tangible personal property other than those described in the definition of equipment that have a per unit cost less than $10,000. Examples may include office supplies, educational materials, medical or program supplies, computers and tablets costing less than $10,000 per unit, and other consumable or project-specific items directly supporting approved project activities. | 2 CFR §200.1 | ||||
| Contractual (2 CFR §200.331): Costs associated with contracts, consultant agreements, vendor services, and subawards necessary to carry out approved project activities. Recipients must comply with the requirements for contractor and subrecipient determinations under 2 CFR §200.331. | 2 CFR §200.331 | ||||
| Other Direct Costs: Direct costs that cannot be appropriately assigned to another budget category but are necessary, reasonable, allocable, and allowable for the performance of approved project activities. Funds may not be used for goods or services not allocable to the project. Examples include training and technical assistance activities, grants management systems, software licenses and subscriptions, evaluation and performance measurement activities, meeting or conference costs, communications and outreach materials, and other project-specific operating expenses that directly support approved project activities. | 2 CFR §200.413 Direct costs. | ||||
| Direct Costs: Costs that can be clearly linked to and charged directly to a specific project, program, or grant. These expenses are incurred specifically to support project activities and can be assigned to the project with a high level of accuracy. | |||||
| Administrative Costs: Administrative costs include direct costs associated with program administration, financial management, reporting, compliance, grant management, contract administration, and similar oversight functions. Administrative costs are subject to a 10% cap of the total award, which includes direct costs across all levels of recipients and subrecipients. Applicants should identify and track administrative costs separately from programmatic costs where applicable. | CMS Rural Health Transformation Program FAQs (Administrative Costs). |
https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-E/subject-group-ECFRed1f39f9b3d4e72/section-200.475https://www.cms.gov/files/document/rural-health-transformation-frequently-asked-questions.pdfhttps://www.cms.gov/files/document/capital-expenditures-fact-sheet-category-j-payments.pdfhttps://www.ecfr.gov/current/title-2/section-200.431https://www.ecfr.gov/current/title-2/section-200.430https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-A/subject-group-ECFR2a6a0087862fd2c/section-200.1https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-A/subject-group-ECFR2a6a0087862fd2c/section-200.1https://www.ecfr.gov/current/title-2/section-200.331https://www.ecfr.gov/current/title-2/section-200.413https://www.gsa.gov/travel/plan-book/per-diem-rateshttps://www.gsa.gov/travel/plan-a-trip/transportation-airfare-rates-pov-rates Example MTDC calc. (delete)
| Category | Budget Totals | Amount included in MTDC |
| A. Personnel | $ 100,000.00 | $ 100,000.00 |
| B. Fringe | $ 30,000.00 | $ 30,000.00 |
| C. Travel | $ 5,000.00 | $ 5,000.00 |
| D. Equipment | $ 50,000.00 | Excluded from MTDC |
| E. Supplies | $ 15,000.00 | $ 15,000.00 |
| Vendor Contract | $ 100,000.00 | $ 50,000.00 |
| Subaward | $ 40,000.00 | $ 40,000.00 |
| Total | $ 340,000.00 | $ 240,000.00 |
| Indirect Cost Rate | 15% | |
| Modified Total Direct Cost | $ 240,000.00 | |
| Total Indirect Cost | $ 36,000.00 | |
| Total Contractual Cost or Subaward | Amount Included in MTDC Base | |
| Less than $50K | Full Amount | |
| $50K or Greater | 25K |
Budget Summary
| RHTP RFA Budget Template - Budget Summary | |
| Instructions: Budget Totals in Column B will auto-populate based on information populated in tabs A-H. Verify that total here reflects the method used to calculate Total Fringe Benefits. | |
| Category | Budget Totals |
| A. Personnel | $0.00 |
| B. Fringe | $0.00 |
| C. Travel | $0.00 |
| D. Equipment | $0.00 |
| E. Supplies | $0.00 |
| F. Contractual | $0.00 |
| G. Other Direct Costs | $0.00 |
| TOTAL | $0.00 |
| Total Administrative Costs | $0.00 |
| Total Budget | $0.00 |
| Administrative Costs as % of Total Budget | ERROR:#DIV/0! |
| Programmatic Costs | $0.00 |
| Programmatic Costs as % of Total Budget | ERROR:#DIV/0! |
A. Personnel & B. Fringe
| Personnel | Fringe | Instructions: Fringe benefits must be calculated separately for each personnel position and should be based on the organization's established fringe benefit methodology and policies. Applicants may either (1) itemize individual fringe benefit components using the detailed calculation table below or (2) use the "other rate" columns if using a single blended fringe rate. Complete only one method for each position. Regardless of methodology, fringe benefit calculations must be supported by formulas and should be based on costs attributable to the portion of time each position supports project activities. Fringe benefits may include employer-paid retirement contributions, Social Security and Medicare, health and dental insurance, disability insurance, leave benefits, and other allowable employer-paid benefits. Applicants are expected to enter formulas or calculations supporting all fringe benefit amounts. | ||||||||||||||||||||||
| Instructions: Please provide Position Title, Staff Name (if known), Annual Salary, Percentage of Staff Time Dedicated to RHTP (% Effort), and Percentage of the Budget Year Supporting RHTP (number months in the given budget year supporting RHTP divided by 12). Personnel costs should be prorated based on both effort and the portion of the budget year during which the individual will support project activities. | Additional Instructions: Use this table to calculate fringe benefits by individual benefit category. Enter the applicable rate and associated cost for Retirement, Social Security and Medicare, Health/Dental Insurance, Disability Insurance, and any other fringe benefit provided by your organization. Total Benefits Cost should equal the sum of all fringe benefit components for each position. | |||||||||||||||||||||||
| Position Title | Staff Name | Annual Salary | % Of Staff Time Dedicated to RHTP | |||||||||||||||||||||
| (% effort) | % of Budget Year Supporting RHTP | Pro-Rated Salary Total | Administrative Staff? (Y/N) | Position Title | Staff Name | Retirement - Rate | Retirement - $ | Social Security and Medicare - Rate | Social Security and Medicare - $ | Health/Dental Insurance - Rate | Health/Dental Insurance - $ | Life/STD/LTD - Rate | Life/STD/LTD - $ | Other Rate (please specify) | Other- $ | Pro-Rated Benefits Total | Benefits as percentage of Salary | Administrative Staff? (Y/N) | ||||||
| A | XX1 | $ - 0 | Instructions: Replace the Letters in Column A with Position Titles and Column B with Staff Names | A | XX1 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | Total Benefits Cost = Retirement Cost + Social Security and Medicare Cost + Health/Dental Insurance Cost + Disability Cost + Other Costs | |||||||||||
| B | XX2 | $ - 0 | B | XX2 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | |||||||||||||
| C | XX3 | $ - 0 | C | XX3 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | |||||||||||||
| D | XX4 | $ - 0 | D | XX4 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | |||||||||||||
| E | XX5 | $ - 0 | E | XX5 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | |||||||||||||
| F | XX6 | $ - 0 | F | XX6 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | |||||||||||||
| G | XX7 | $ - 0 | G | XX7 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | |||||||||||||
| H | XX8 | $ - 0 | H | XX8 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | |||||||||||||
| I | XX9 | $ - 0 | I | XX9 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | |||||||||||||
| J | XX10 | $ - 0 | J | XX10 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ERROR:#DIV/0! | |||||||||||||
| Total | $ - 0 | Instructions: If additional rows are added, adjust formula to ensure all rows are captured in the total | Total | $ - 0 | Instructions: If additional rows are added, adjust formula to ensure all rows are captured in the total |
C. Travel
| Travel | ||||||||||||||
| Instructions: Enter anticipated travel necessary to carry out approved project activities during Budget Year 1. Travel costs may include transportation, lodging, meals and incidental expenses (M&IE), mileage reimbursement, parking, tolls, registration fees, airfare, rail travel, rideshare services, baggage fees, and other allowable travel-related expenses. Travel costs must comply with 2 CFR §200.475 and be reasonable, necessary, allocable to the project, and consistent with the applicant's established travel policies. The CMS Notice of Award requires recipients to comply with the requirements of 2 CFR §200.475. Funds may not be used for goods or services not allocable to the project. Applicants should use their organization's established travel policies and actual anticipated costs when preparing budgets, provided those policies are consistent with the CMS Notice of Award, applicable NOFO requirements, and 2 CFR Part 200. Links to current General Services Administration (GSA) mileage reimbursement rates, lodging rates, and Meals & Incidental Expenses (M&IE) rates are provided for reference and may be used as a reasonable basis for estimating travel costs. All travel costs should be supported by itemized calculations demonstrating how the estimate was developed. For planning purposes, assume that destinations located more than 50 miles from the applicant's primary office location will require one overnight stay and two days of M&IE/per diem unless a different travel schedule is justified. | ||||||||||||||
| Purpose/Description of Travel | Destination | # miles (if not mileage, leave cell blank) | Mileage Rate (if not mileage, leave cell blank) | Mileage Reimbursement Amount $ | Lodging Rate | Per Diem Rate | # of days | Cost per Person | # of people/# of units | Non Mileage-Based Travel Costs | Total Cost | Administrative Cost? (Y/N) | GSA per diem rates | GSA transportation reimbursement rates |
| $ - 0 | 2 | $ - 0 | $ - 0 | If the travel trasnsportation expense is not mileage-based, enter the anticipated cost directly in Column K, the Non Mileage-Based Travel Costs column. Examples may include airfare, rail tickets, parking, tolls, rideshare fares, other allowable travel-related expenses consistent with the CMS Notice of Award, applicable NOFO requirements, organizational travel policies, and 2 CFR §200.475. Provide sufficient detail in the travel description to explain how the cost estimate was developed. | ||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| $ - 0 | 2 | $ - 0 | $ - 0 | |||||||||||
| Total | $ - 0 | Instructions: If additional rows are added, adjust formula to verify that all rows are captured in the total. |
Additional instructions: If you anticipate additional travel will be required for your initiative, please create an additional table which itemizes this travel in the same method described above.
https://www.gsa.gov/travel/plan-book/per-diem-rateshttps://www.gsa.gov/travel/plan-a-trip/transportation-airfare-rates-pov-rates D. Equipment
| Equipment | ||||||||
| Instructions: List each equipment item separately and describe how it supports the proposed project, including the purpose of the equipment, per-unit cost, number of units, and total cost. Only items with a per-unit cost greater than $10,000 should be budgeted as Equipment. If applicable, indicate whether the item qualifies as a Category J Capital Expenditure and provide any required justification or supporting information. Applicants should consult the Notice of Award and applicable CMS guidance when determining whether an equipment purchase qualifies as a Category J capital expenditure. | ||||||||
| Equipment Description | Purpose to Support Project Aim | Per Unit Cost ($) | # of Units | Category J Capital Expenditure? (Yes/No) | Total Cost | Administrative Cost? (Y/N) | Equipment Definition from 2 CFR 200.1. | Category J Fact Sheet |
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| Total | $ - 0 | Instructions: If additional rows are added, adjust formula to verify that all rows are captured in the total. |
https://www.ecfr.gov/current/title-2/part-200/section-200.1https://www.cms.gov/files/document/capital-expenditures-fact-sheet-category-j-payments.pdf E. Supplies
| Supplies | ||||
| Instructions: Please list all supplies necessary to carry out proposed project activities, including a description of the item, unit cost, quantity, and total cost requested. Supplies are tangible items with a per-unit cost of less than $10,000. Examples may include office supplies, educational materials, medical or program supplies, computers and tablets costing less than $10,000 per unit, and other consumable or project-specific items directly supporting approved project activities. Costs that are more appropriately categorized as Equipment, Contractual, or Other Direct Costs should not be included in this section. | ||||
| Supply Description | Unit Cost in $ | # of Units | Total Request | Administrative Cost? (Y/N) |
| $ - 0 | $ - 0 | |||
| $ - 0 | $ - 0 | |||
| $ - 0 | $ - 0 | |||
| $ - 0 | $ - 0 | |||
| $ - 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 | Instructions: If additional rows are added, adjust formula to ensure all rows are captured in the total |
F. Contractual
| Contractual | ||||
| Instructions: Please list all anticipated subawards, contractor agreements, vendor services, consultant agreements, and other contractual costs necessary to support the project. For each item, identify whether the entity is a Subaward or Vendor/Contractor and provide a description of the services to be performed. Attach a detailed budget and budget narrative for each proposed subaward and major contractual arrangement, if applicable. Subrecipient and contractor determinations should be made in accordance with 2 CFR §200.331. | ||||
| Name | Vendor Contract or Subaward | Description of Role/Service | Total Cost | Administrative Cost? (Y/N) |
Total $ - 0 Instructions: If additional rows are added, adjust formula to ensure all rows are captured in the total
G. Other Direct Costs
| Other Direct Costs | ||||||
| Instructions: Use this section for allowable direct costs that do not fit within the Personnel, Fringe Benefits, Travel, Equipment, Supplies, or Contractual categories. Provide a clear description, quantity, unit cost, and total cost for each item. Common examples may include training and technical assistance activities, grants management systems, software licenses and subscriptions, data collection and reporting tools, evaluation and performance measurement activities, meeting or conference expenses, and other project-specific operating costs that directly support approved project activities. Applicants should provide sufficient justification for each cost and explain why the expense is appropriately categorized as an Other Direct Cost. | ||||||
| Item | Description | # of Units | Cost per Unit ($) | Total Cost | Administrative Cost? (Y/N) | |
| $ - 0 | ||||||
| $ - 0 | ||||||
| $ - 0 | ||||||
| $ - 0 | ||||||
| $ - 0 | ||||||
| $ - 0 | ||||||
| Total | $ - 0 | Instructions: If additional rows are added, adjust formula to ensure all rows are captured in the total |
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