Comprehensive Community Services Detailed Budget Plan Request by dvo17662

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									DEPARTMENT OF HEALTH SERVICES                                                                           STATE OF WISCONSIN
Division of Mental Health and Substance Abuse Services
F-00230 (03/2010)

      COMPREHENSIVE COMMUNITY SERVICES (CCS) DETAILED BUDGET PLAN REQUEST
                                       CALENDAR YEAR 2010 START-UP GRANT
Completion of this form is voluntary; however, the form is required to submit a proposal for funding.

This detailed budget plan request reflects expected expenses for the upcoming budget year. Page 2 includes a narrative
“Budget Justification” for how the CCS Start-up funding will be used.
Name - County                                                                               Date(s) – Budget Period


PERSONNEL DETAILS
                                                                               Hours per    # of Months
                   Position Title                  % of Time     Hourly Rate    Month        Budgeted          Total Cost
                                                                    $                                                 $
                                                                    $                                                 $
                                                                    $                                                 $
                                                                    $                                                 $
                                                                    $                                                 $
                                                                                            Grant             Contribution
                                                                                           Budget               Amount

 1.   Total Personnel Cost (from “Personnel Detail” table above)                             $                        $

 2.   Fringe Benefits for Project Personnel (Employers FICA; Employees
                                                                                             $                        $
      Insurance; etc.)

 3.   Agency Personal Liability Insurance and Other Insurance                                $                        $

 4.   Travel          a. Professional Staff                                                  $                        $
                      b. Consumers                                                           $                        $
 5.   Equipment (include details in Budget Justification)                                    $                        $
 6.   Supplies and Operating Expenses (include details in Budget Justification)              $                        $
 7.   Contractual and Consultant Costs (include details in Budget Justification)             $                        $

 8.   Training Expenses (include details in Budget Justification)                            $                        $
 9.   Support for Parents / Caregivers and Consumers (include details in Budget
      Justification)
                                                                                             $                        $

10.   Advertising (include details in Budget Justification)                                  $                        $

11.   Evaluation                                                                             $                        $
12.   Other Expenses (include details in Budget Justification)                               $                        $

13.   TOTAL BUDGET (lines 1 through 12)                                                      $                        $
F-00230, CCS Detailed Budget Plan Request                             Page 2

                                            JUSTIFICATION NARRATIVE
Please describe details for the following budget items.
Equipment




Supplies and Operating Expenses




Contractual and Consultant Costs




Training Expenses




Support for Parents / Caregivers and Consumers




Advertising




Other Expenses

								
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