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U.S. Department of Health and Human Services

Budget Summary: Sample Template

(only include section for Non-Federal Match if required by the application)

Section A: Personnel - An employee of the applying agency whose work is tied to the application. Proposed salaries must be reasonable. Compensation paid for employees must be reasonable and consistent with that paid for similar work within the applicant’s organization and similar positions in the industry.
Non-Federal Match: Separately list all personnel that will be working on the project and whose time and effort will be used to meet the non-Federal Match requirement. Personnel used as match must be documented through signed time cards and payroll documents. List the source of the match – i.e. State funds.
Table 1:
​Position ​Name ​​Annual Salary/Rate ​Level of Effort ​​Federal
​Project Director ​Susan Jones    ​$45,000/year ​100% ​$45,000  ​
​Project Coordinator ​Brad Smith ​$42,000/year ​50% ​$21,000  ​
​ TOTAL ​  ​   ​ $66,000  ​
NARRATIVE JUSTIFICATION:  Enter a description of the personnel funds requested and how their use will support the purpose and goals of this proposal. Describe the role, responsibilities, and unique qualifications of each position.
B. Fringe Benefits: Fringe benefits may include contributions for items such as social security, employee insurance, and pension plans. Only those benefits not included in an organization's indirect cost pool may be shown as direct costs. If fringe benefits are not computed as a percentage of salary (i.e. 25%), list all components of the fringe benefits rate, for example:
Non-Federal Match: List for all personnel shown in table 1 under the match section.  Match documentation includes payroll records and pay slips.  List the source of the match – i.e. State funds.
Table 2: Fringe Benefits
​Component ​Rate ​Wage ​Federal Cost    ​Match
​FICA ​7.65% ​66,000 ​$5,049 ​ 
​Insurance ​5% ​66,000 ​$3,300    ​ 
​​​TOTAL ​    $8,349  ​
NARRATIVE JUSTIFICATION: Enter a description of the fringe funds requested and how the rate was determined.
C. Travel:  Federal funds requested for travel are for staff travel only (travel for consultants is listed in consultant category).  Travel for other participants, committee members, etc. should be listed under the cost category “other”.  Applicants are to use the lowest available commercial fares for coach or equivalent accommodations.  Note that Applicants will be expected to follow Federal travel policies
Non-Federal Match:  The travel costs must be documented through travel authorizations and paid vouchers.  Local travel should be documented by miles traveled.  List the source of the match – i.e. State funds.
Table 3:  Travel
​Purpose of Travel ​Location Item ​Rate ​Federal Cost Match​
​Attend awardee meeting ​Washington, DC ​Air Fare
Per Diem

Airport Parking
Airport Shuttle
​$350 X 4 people
$71/day X 4 days X 4 people
$10/day X 4 days
$28/RT X 4 people
$211/night X 3 nights X 4 people
​Local travel ​Various POV ​44/mile X 2,000 miles/year $880 ​ 
TOTAL ​   ​   $5,000 ​ 
NARRATIVE JUSTIFICATION: Explain the purpose for all travel and how costs were determined.  List any required travel, funds for local travel that are needed to attend local meetings, project activities, and training events. Local travel rate should be based on agency’s personally owned vehicle (POV) reimbursement rate, which should correspond with the GSA rate.
D. Equipment: Permanent equipment is defined as tangible nonexpendable personal property having a useful life of more than one year and an acquisition cost of $5,000 or more. If the applying agency defines “equipment” at a different rate, then follow the applying agency’s policy. In the case of vehicles, etc. applicant should justify purchase rather than rental.  If equipment is used by several different projects, you may only charge a percentage of the costs for the purchase based on the amount of time, etc. that the equipment will be used for this grant program.  Any purchased equipment must be inventoried according to the guidelines in the HHS Grants Policy Statement.
Non-Federal Match:  Enter a description of the equipment match provided and how its use will support the purpose and goals of this proposal.  Documentation of match should be in inventory and use records.  List the source of the match – i.e. State funds.
Table 4: Equipment
​Item(s) ​​Rate ​​Federal Cost ​​Match
​Computer Work Station ​$5,500 X 2 ​$11,000    ​ 
​Computer ​$6,000 X .5FTE ​$3,000 ​ 
TOTAL ​  $ 14,000    ​ 
NARRATIVE JUSTIFICATION: Enter a description of the equipment and how its purchase will support the purpose and goals of this proposal.
E. Supplies: Materials costing less than $5,000 per unit and often having one-time use, for example – general office supplies, postage, printers, etc.
Non-Federal Match: Please note that items such as computers, desks, and projection equipment may be counted as match only once throughout the life of the project.  Documentation includes invoices and donation records. List the source of the match – i.e. State funds.
Table 5: Supplies
​Item(s) ​​Rate ​​Federal Cost ​Match
​General Office Supplies ​$50/month X 4 FTE ​$200 ​ 
​​​TOTAL   $200 ​ 
NARRATIVE JUSTIFICATION: Enter a description of the supplies requested and how their purchase will support the purpose and goals of this proposal.  Rates for office supplies, etc. may be based on average monthly costs, FTE, etc.
F. Contracts and Consultants: An arrangement to carry out a portion of the programmatic effort by a third-party or for the acquisition of goods or services is allowed under the grant.  Such arrangements may be in the form of sub awards (grants) or contracts.  A consultant is a non-employee retained to provide advice and expertise in a specific program area for a fee.  List each contract, consultant or sub award separately and provide an itemization of the costs.  If a contractor is to be determined, provide a best estimate as to costs for the goods or services to be purchased. 
The awardee must establish written procurement policies and procedures that are consistently applied.  All procurement transactions are required to be conducted in a manner to provide to the maximum extent practical, open and free competition.  The awardee should be alert to organizational conflicts of interest as well as to noncompetitive practices among contractors that may restrict or eliminate competition or otherwise restrain trade. 
Method of Selection: This will be sole source, competition, or grant.
Scope of Work: Provide a breakout of the goods and/or services being provided by the contractor.  If personnel are being charged then should list name, position, hours and rate/hour.  Goods will be listed at number of units and cost/unit.  List method to be used for sub-recipient monitoring – site visit, semi-annual reports, etc. Documentation of monitoring should be kept with the contract/award file.  
Non-Federal Match:  Enter any contracts, etc. that are being used to meet this requirement.  When making a contract, a portion may be “donated” to this project by the contracted organizations and should be so noted in the contractual agreement (i.e.:  Media outlets may give one free ad for each purchased).  If this arrangement has been reached, it should be noted in the justification section.  Documentation includes copies of contractual agreements, payment and donation records.
Table 6: Contract/Sub award
​Activity ​Name ​Method of Selection Scope of Work ​Federal Cost ​Match
​WMTV ​Sole source ​Paid Ads  12/month X $250/ad X 6 mo.
Paid Ads  12/month X $250/ad X 6 mo
Monitoring: semi-annual report

​$18,000 ​$18,000
​Mobil Medical Assets ​To Be Determined ​Competition ​Medical supply inventory ($1,600)
Wheelchair bus conversions( 6 X $37,000) Monitoring: semi-annual report
​$223,600  ​
TOTAL ​   ​   $ 241,600 $18,000
NARRATIVE JUSTIFICATION: Provide information as to how the contracted services or goods will enhance the project goals and objectives.  Provide sole source justification.
Table 7: Consultant
​Organization ​Name ​Number of Days ​Rates Federal Cost Match​
​Trepid ​Jon Smith ​20 ​$150/day
Travel 4 trips X 1,204 (travel @ $475; lodging @ $175/night X 3; Per Diem @ $51 x4) = $4,816
​$ 7,816  ​
​TOTAL ​  ​    $ 7,816  ​
NARRATIVE JUSTIFICATION: Provide information as to how the consultant services or goods will enhance the project goals and objectives.
G. Other: Expenses not covered in any of the previous budget categories. If rent is requested (direct or indirect), provide the name of the owner(s) of the space/facility. If anyone related to the project owns the building which is less than an arm’s length arrangement, provide cost of ownership/use allowance calculations.
Non-Federal Match: Break down costs into cost/unit (e.g., cost/square foot) and explain the use of each item requested.  Documentation includes donation, usage, transaction and/or payment records.  List the source of match funds – i.e. State funds.
Table 8: Other
​Item ​Rate ​Federal Cost ​Match
​Postage ​$65/mo. X 4 FTE ​$3,120  ​
​TOTAL   ​$3,120  ​
NARRATIVE JUSTIFICATION: Explain the need for each item and how it will support the purpose and goals of this proposal. Break down costs into cost/unit (e.g., cost/square foot or cost/month or cost/FTE).
H. Indirect Costs:  Also known as “facilities and administrative costs”, indirect costs are costs that cannot be specifically identified with a particular project, program, or activity, but are necessary to the operation of the organization (i.e., overhead). Facilities operation and maintenance costs, depreciation, and administrative expenses are examples of costs that are usually treated as indirect costs. The organization must not include costs associated with its indirect rate as direct costs. If indirect costs are claimed, applicant is to submit a copy of a current negotiated indirect cost rate agreement.  Indirect costs are only charged on the items cited in the indirect cost rate agreement (i.e. – personnel and fringe, subawards over $25,000).
Non-Federal Match:  Unclaimed indirect costs for costs incurred by using the Federal funds may be used to meet the match requirement.  Indirect costs may be charged on the appropriate costs listed in the match categories that are provided by the applicant agency.  Documentation should be included in the accounting records of the applicant agency.
Table 9: Indirect costs
​Total Direct Cost applied to Indirect Cost Indirect Cost Rate ​Federal Cost ​Match
​$450,000 ​22% ​$99,000 ​ 
 ​ TOTAL $99,000 ​ 


Provide a summary of the year one proposed costs (both direct and indirect).  Provide the best estimate of the funding that will be needed for each of the years to complete the total project period (for HPP 4 years). 

  1. Please justify and explain any changes to the budget that differs from the reflected amounts reported in the 01 Year Budget Summary.
  2. If a cost of living adjustment (COLA) is included in future years, provide your organization’s personnel policies and procedures that state all employees within the organization will receive a COLA.

  • This page last reviewed: November 20, 2017