NVHR Hepatitis C Project Booster Mini‐Grants

Budget & Budget Justification

Organization Name:

BUDGET

Instructions: Please complete the table by replacing the bracketed text with your information.

Amount Requested
Personnel / [enter total personnel amount here]
[Name 1, position title] / [enter dollar amount here]
[Name 2, position title] / [enter dollar amount here]
[insert more rows as needed]
Contractual/Consultant Costs / [enter total contractual/consultant amount here]
[Contractor/Consultant 1 name] / [enter dollar amount here]
[Contractor/Consultant 2 name] / [enter dollar amount here]
[insert more rows as needed]
Supplies / [enter total supply amount here]
[supply 1] / [enter dollar amount here]
[supply2] / [enter dollar amount here]
[insert more rows as needed]
Travel / [enter total travel amount here]
[trip 1 name] / [enter dollar amount here]
[trip 2 name] / [enter dollar amount here]
[insert more rows as needed]
Other / [enter total other amount here]
[other item 1] / [enter dollar amount here]
[other item 2] / [enter dollar amount here]
[insert more rows as needed]
TOTAL / [enter total budget amount here]

BUDGET JUSTIFICATION

Instructions: Please complete the table by replacing the bracketed text with your information.

Personnel

[Personnel 1 name (TBD is permissible), position title]

[requested salary including benefits]

[description of position duties (or qualifications for TBD role) as related to program objectives]

[Personnel 1 name, position title]

[requested salary including benefits]

[description of position duties as related to program objectives]

Contractual/Consultant Costs

  1. [Name of Contractor]
  2. [Method of Selection (competitive bids or sole source)]
  3. [Period of Performance]
  4. [Scope of Work]
  5. [Describe how the position will be supervised/work with the rest of the team]
  6. [Itemized Budget and Justification for the contractor’s work]
  1. [Name of Consultant (person giving professional services or advice)]
  2. [Services to be Rendered. Describe how the position will be supervised/work with the rest of the team]
  3. [Relevance of Service to the Project]
  4. [Period of Performance]
  5. [The Expected Rate of Compensation (travel, per diem, other related expenses) - list a subtotal for each consultant in this category.]

[repeat these 5 items for each contractor/consultant]

Supplies

[supply 1 description]

[number of supply] x [amount of supply needed] = [supply total amount]

[repeat for each supply]

Travel

[trip 1 name]

Add applicable charges

[conference fee] + [airfare cost] + [mileage cost] + [per diem] + [lodging] + [taxi/rail/bus] + [other] = [total]

[repeat for each trip]

Other

Include items here not applicable to the other categories (i.e., printing, telephone, software costs, equipment rental, etc.)

[other item 1 description]

[other item 1 cost]

[repeat for each item]