Sample Budget Narrative and Personnel Justification Table PDF

Votre budget

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Sample

Budget

Na r rative and Personnel Justification Table As a required attachment in yo u r H8F A ward Submission in the HRSA E lectronic Handbooks (EH Bs), submit a budge t narrative with p ersonnel justification table. Refer to the H8F technical assistance webpage for the submission guidance and H8F examp le activities. U pload a 2-y

e ar budget narrative that clearly explains and jus tifies your proposed federal and non-fed eral expenditures for each

y ear. The

2-ye ar sum of line item costs for each category must align with those on the SF-424A, Section B, and the annual total costs

should be consistent wit h the

Federal Object

C lass C ategories f orm completed i n EH Bs To propose to us e fu nds t o suppor t costs d ating ba c k to J anuary

A detailed description of the pre-award costs (including any costs incurred between the award date and your submission

date)

The date incurred, and

How funds were used to meet the H8F funding purpose.

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Costs (Year 1 + Year 2)

Total Non-

Federal Costs

(Year 1 + Year 2)

Federal Non-Federal Federal Non-Federal

PERSONNEL

Administration

Medical Staff

Dental Staff

Mental Health Staff

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Costs (Year 1 + Year 2)

Total Non-

Federal Costs

(Year 1 + Year 2)

Federal Non-Federal Federal Non-Federal

Substance Use Disorder Staff

Pharmacy Staff

Vision Staff

Enabling Staff

Information Technology Staff

Pre-award costs back to January 31,

2020 (specify)

TOTAL PERSONNEL

FRINGE BENEFITS - List the components that comprise the fringe benefit rate. The fringe benefits should be directly proportional to allocated personnel costs.

FICA @

X.XX%

Health Insurance @ X%

Dental @ X%

Unemployment Insurance @ X%

Workers Compensation @ X%

Disability @ X%

Pre-award costs back to January 31,

2020 (specify)

TOTAL FRINGE BENEFITS

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Costs (Year 1 + Year 2)

Total Non-

Federal Costs

(Year 1 + Year 2)

Federal Non-Federal Federal Non-Federal

TRAVEL - Include details for both local and long distance travel.

Local travel for Patient Care Coordinator

to provide care management services at

X in-scope sites and locations (XXX miles

@ $0.XX per mile)

Local travel for

staff to provide vaccinations and testing services at X in- scope sites and locations (XXX miles @ $0.XX per mile)

Pre-award costs back to January 31,

2020 (specify)

TOTAL TRAVEL

EQUIPMENT - Provide the total cost of equipment purchases with a unit cost of $5,000 or more. Include line-item cost information in the Equipment List

form.

TOTAL EQUIPMENT

(see Equipment List for details)

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Costs (Year 1 + Year 2)

Total Non-

Federal Costs

(Year 1 + Year 2)

Federal Non-Federal Federal Non-Federal

SUPPLIES - Include equipment items that cost less than $5,000 each and other supplies.

COVID-19 Vaccination and Testing

Supplies

X boxes of X count rubber gloves @

X per box

X boxes of X count n-95 masks @ $X

p er each

X hazardous waste containers @ $X

Health information technology to

support telehealth, testing, and vaccine administration

EHR enhancement to support

v accination data sharing

X tablets @ $XXX each

X staff laptops @ $XXX each

Telehealth carts (portable systems used

for clinical and educational purposes such as for staff telemedicine consultations, training, meetings, and interviews)

X @ $XXX each

Peripherals for virtual care visits

X digital medical stethoscopes @

$XX e ach

X spirometers @ $XX each

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Costs (Year 1 + Year 2)

Total Non-

Federal Costs

(Year 1 + Year 2)

Federal Non-Federal Federal Non-Federal

Bluetooth and wireless-enabled remote

patient monitoring devices to collect data from individuals and electronically transmit that information securely to health care providers, XXX @ $XX each

Pre-award costs back to January 31,

2020 (specify)

TOTAL SUPPLIES

CONTRACTUAL

Provide a

clear explanation as to the purpose of each contract/subaward, how the costs were estimated, and the specific contract/subaward deliverables.

Consultant to support the adoption of

virtual technologies such as enhanced workflows to efficiently and effectively administer COVID-19 vaccines, administrative operations, and organizational health literacy (XX hours @ $XX per hour)

Consultant for COVID-19 testing,

vaccination, and treatment education (XX hours @ $XX per hour)

Contract to develop digital applications

to support patients' access to and engagement in virtual care, including self -management tools, remote patient monitoring, and patient portals)

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Costs (Year 1 + Year 2)

Total Non-

Federal Costs

(Year 1 + Year 2)

Federal Non-Federal Federal Non-Federal

Pre-award costs back to January 31,

2020 (specify)

TOTAL CONTRACTUAL

CONSTRUCTION

Provide the total cost associated with each minor A/R project. Line -item cost information for minor A/R should be included in the A/R Project Budget

Justification. Maximum federal request of $500,000 for minor A/R costs over the 2-year period of performance.

Minor A/R costs for HPC Site -

renovation of space to create exam rooms, lab, and vaccination space

Minor A/R costs for XYZ Site -

renovation of space to install computer network TOTAL

CONSTRUCTION

(See Minor A/R Budget Justifications) OTHER

Include justification of costs that do not fit into any other category. In some cases, rent, utilities and insurance may fall under this category if they are not

included in an approved indirect cost rate

EHR license fees for new staff (3 @ $XXX

each)

Staff recruitment - newspaper and

Internet posting

Pre-award costs back to January 31,

2020 (specify)

TOTAL OTHER

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Costs (Year 1 + Year 2)

Total Non-

Federal Costs

(Year 1 + Year 2)

Federal Non-Federal Federal Non-Federal

Total Direct Charges (Sum of TOTAL

Expenses)

INDIRECT COSTS

Include only if your organization has a negotiated indirect cost rate or has previously claimed a de minimus rate of 10% of modified total direct costs.

Upload

your approved indirect cost agreement in the Appendices section of the H8F Award Submission, if applicable.

X.XX% indirect rate

TOTALS (Total of Total Direct Charges

and Indirect Charges)

Example Personnel Justification Table

Provide personnel costs for all direct hire staff and contractors to be supported by

H8F funding.

Name Position Title Base Salary

Adjusted Annual

Salary*

FTE to Support ϴ Project

Federal Amount Requested

J. SmithPhysician $235,000 $199,300 0.50 $99,650

J. JohnsonClinical Pharmacist $100,000 N/A 0.25 $25,000 R. DoePatient Care Coordinator $57,550 N/A 0.50 $28,775

P. JonesPatient/Community Education

S pecialist $25,000 N/A 0.50 $12,500 A. MartinezCommunity Health Worker $55,000 N/A 1.00 $55,000 J. FoxCommunity Health Worker $55,000 N/A 1.00 $55,000 S. ChenCommunity Health Worker $55,000 N/A 1.00 $55,000 A. LeePhysician Assistant $90,000 N/A 0.50 $45,000 M. Peterson Telehealth Director $97,500 N/A 0.75 $73,125

N. GreyIT Specialist $75,000 N/A 1.00 $75,000

E. ReyesData Specialist $48,000 N/A 1.00 $48,000

M. MooreNurse $71,000 N/A 1.00 $71,000

TOTAL 9 FTE $643,050

* If the salary is over the federal limitation of $199,300, include the adjusted annual salary.quotesdbs_dbs22.pdfusesText_28

[PDF] Sample Budget Narrative and Personnel Justification Table

Sample

Budget

2-ye ar sum of line item costs for each category must align with those on the SF-424A, Section B, and the annual total costs

Federal Object

The date incurred, and

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Total Non-

Federal Costs

Federal Non-Federal Federal Non-Federal

PERSONNEL

Administration

Medical Staff

Dental Staff

Mental Health Staff

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Total Non-

Federal Costs

Federal Non-Federal Federal Non-Federal

Substance Use Disorder Staff

Pharmacy Staff

Vision Staff

Enabling Staff

Information Technology Staff

Pre-award costs back to January 31,

2020 (specify)

TOTAL PERSONNEL

FICA @

Health Insurance @ X%

Dental @ X%

Unemployment Insurance @ X%

Workers Compensation @ X%

Disability @ X%

Pre-award costs back to January 31,

2020 (specify)

TOTAL FRINGE BENEFITS

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Total Non-

Federal Costs

Federal Non-Federal Federal Non-Federal

Local travel for Patient Care Coordinator

X in-scope sites and locations (XXX miles

Local travel for

Pre-award costs back to January 31,

2020 (specify)

TOTAL TRAVEL

TOTAL EQUIPMENT

Object Class Category with Line

Item Justification

Year 1 Year 2

Total Federal

Total Non-

Federal Costs

Federal Non-Federal Federal Non-Federal

COVID-19 Vaccination and Testing

Supplies

X boxes of X count rubber gloves @

X per box

X boxes of X count n-95 masks @ $X

X hazardous waste containers @ $X

Health information technology to

EHR enhancement to support

X tablets @ $XXX each

X staff laptops @ $XXX each

Telehealth carts (portable systems used

X @ $XXX each

Peripherals for virtual care visits

X digital medical stethoscopes @

X spirometers @ $XX each

Object Class Category with Line

Item Justification