Survey Cost Sheet Sample

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					                                    Survey Cost Sheet Sample
Receiving Organization:              Legislative Budget Board
Organization’s ID number:            104

Purchase Order Information: Most organizations use a PO to pay for administering the survey.

Performing Agency:          The University of Texas at Austin
                            Center for Social Work Research
UT Employer ID #:           74-6000203
Address Information:        Center for Social Work Research
                            Attn: Noel Landuyt
                            1925 San Jacinto Blvd.
                            Austin, TX 78712-1203
Contact Information:        Noel Landuyt
                            (512) 471-9831 - fax (512) 471-9600
Terms:                      Services are bill with the return of the data report. The receiving organization may
                            terminate this agreement, but is liable for the materials cost listed in basis for cost.
Service Description:
          At the request of the Governor’s Office, the Center for Social Work Research (CSWR) at The
     University of Texas at Austin will survey the attitudes and opinions of employees regarding the
     organization’s work environment. The CSWR will provide statistical analysis of the data from the Survey of
     Organizational Excellence including: summary of current responses on each of the survey’s items (mean,
     standard deviation, and frequency counts), summary of the entire organization and individual organizational
     categories, summary of demographic data provided by respondents, display of comparative benchmark data,
     summary items into construct areas, and produce hardcopy and electronic data reports.
Basis for Calculating Cost:
         The cost of administering the survey for your organization is in part based on the estimated number
of employees of 142.* If the employee count is incorrect, the cost (per person) for each additional employee
is $4.50

                   Services of Employees (Salary)                                    $286.65
                   Services of Employees (Fringe)                                     $95.55
                   Materials                                                         $191.10
                   Equipment                                                          $63.70
                   Total Amount                                                      $637.00

Optional Additional Cost:
        You may select from the following services and add them to your purchase order. Please contact
Noel Landuyt at or (512) 471-9831 for availability and pricing.
        Service: On-site consultation of data results or survey set-up meetings to be billed on daily rate of
                $500 plus travel and lodging if applicable (half day minimum).
        Service: On-site presentation (one hour) of data to board, leadership or employee group is billed at
                $250 plus travel and lodging if applicable for preparation and presentation.
        Service: Additional survey analysis and customized reports for combinations of demographic or
                categorical data are billed at $50-$150 a report depending on the complexity of the request.
        Service: Generating a statistical sample of your workforce ($250) and may change your cost per

Interagency Contract (IAC): If you select an IAC, please update the number of employees listed in the
“basis for calculating cost” and contact Noel Landuyt at or (512) 471-9831. A
surcharge may be added by UT for the cost of generating the IAC. Three signed contracts will be generated
by UT and forwarded to you for authorized signature. Two signed copies need to be returned via the mail.
Please allow 3 to 4 weeks for the IAC process. The Interagency Service performed as authorized in the
provisions of “The Interagency Cooperation Act”, 771-003, et seq. Texas Gov. Code Ann.

* Estimated number of employees was provided by the State Auditor’s Office or the Coordinating Board.