Comprehensive Community Services Detailed Budget Plan Request

Document Sample
Comprehensive Community Services Detailed Budget Plan Request Powered By Docstoc
					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