Description of Expenses

							                                                         ATTACHMENT J-3
                                                RENEWAL PERIOD(S) DETAILED BUDGET
                                                          PER UNIT COST


                            Category A:     Category B:       Category C:      Category D:       Category E:      Category F:
                            Validation of   Validation of      Review of       Validation of   Focused Studies   Dissemination
                           Performance      Performance     Compliance with   Encounter Data    (Hourly Rate)    and Education
                           Improvement        Measures          Access,         (Unit Cost)                       (Unit Cost)
 Description of Expenses
                              Projects       (Unit Cost)     Structural and
                             (Unit Cost)                      Operational
                                                               Standards
                                                              (Unit Cost)
DIRECT PERSONNEL
  Salaries
  Fringe Benefits
  Contracted Personnel
  Temporary Personnel
TOTAL DIRECT
PERSONNEL
OTHER DIRECT
  Office Supplies
  Postage, Shipping,
  Fulfillment
  Software, hardware
  Equipment
  Rental/Purchase
  Office Rent
  (Occupancy)
  Printing/Graphics
  (Materials)
  Telephone Charges
  Professional Services
  Training, Licensing,
  Recruiting
  Other Direct:
TOTAL OTHER DIRECT

CAPITAL
 Telecommunications
 Equipment
 Computer Equipment


                                               AHCA RFP 013-12/13, Attachment J-3, Page 1 of 4
                                                           ATTACHMENT J-3
                                                  RENEWAL PERIOD(S) DETAILED BUDGET
                                                            PER UNIT COST


                            Category A:       Category B:       Category C:      Category D:       Category E:      Category F:
                            Validation of     Validation of      Review of       Validation of   Focused Studies   Dissemination
                           Performance        Performance     Compliance with   Encounter Data    (Hourly Rate)    and Education
                           Improvement          Measures          Access,         (Unit Cost)                       (Unit Cost)
 Description of Expenses
                              Projects         (Unit Cost)     Structural and
                             (Unit Cost)                        Operational
                                                                 Standards
                                                                (Unit Cost)
 Furniture
 Installation/
 Construction
 Other Capital:
TOTAL CAPITAL
    INDIRECT
    Overhead and Profit
TOTAL INDIRECT
TOTAL PERSONNEL
TOTAL DIRECT
TOTAL CAPITAL
TOTAL INDIRECT
TOTAL EXPENSES PER
UNIT COST/HOURLY
RATE




Respondent Name


Name and Title of Respondent Representative


Signature of Respondent Representative                                 Date




                                                 AHCA RFP 013-12/13, Attachment J-3, Page 2 of 4
                                                       ATTACHMENT J-3
                                              RENEWAL PERIOD(S) DETAILED BUDGET
                                                        PER UNIT COST


                           Category G:    Category H:
                             Annual        Technical
                            Technical    Assistance on
 Description of Expenses
                             Report          Other
                           (Unit Cost)     Activities
                                         (Hourly Rate)
DIRECT PERSONNEL
  Salaries
  Fringe Benefits
  Contracted Personnel
  Temporary Personnel
TOTAL DIRECT
PERSONNEL
OTHER DIRECT
  Office Supplies
  Postage, Shipping,
  Fulfillment
  Software, hardware
  Equipment
  Rental/Purchase
  Office Rent
  (Occupancy)
  Printing/Graphics
  (Materials)
  Telephone Charges
  Professional Services
  Training, Licensing,
  Recruiting
  Other Direct:
TOTAL OTHER DIRECT

CAPITAL
 Telecommunications
 Equipment
 Computer Equipment
 Furniture
 Installation/


                                            AHCA RFP 013-12/13, Attachment J-3, Page 3 of 4
                                                            ATTACHMENT J-3
                                                   RENEWAL PERIOD(S) DETAILED BUDGET
                                                             PER UNIT COST


                            Category G:        Category H:
                              Annual            Technical
                             Technical        Assistance on
 Description of Expenses
                              Report              Other
                            (Unit Cost)         Activities
                                              (Hourly Rate)
 Construction
 Other Capital:
TOTAL CAPITAL
    INDIRECT
    Overhead and Profit
TOTAL INDIRECT
TOTAL PERSONNEL
TOTAL DIRECT
TOTAL CAPITAL
TOTAL INDIRECT
TOTAL EXPENSES PER
UNIT COST/HOURLY
RATE




Respondent Name


Name and Title of Respondent Representative


Signature of Respondent Representative                               Date




                                                 AHCA RFP 013-12/13, Attachment J-3, Page 4 of 4