Child Daycare Forms and Contracts Santa Clara County Social Services Agency EXHIBIT B

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					Santa Clara County- Social Services Agency                                                                                              EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                                               PROJECT SUMMARY
Contract Period: July 1, 2009 – June 30, 2010                                                                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                                                      -
                       Agency Name:

                       Project Name:                                                                                                         1st Submission
                                                                                                                                             2nd Submission
                                                                                                                                             3rd Submission



Brief Project Description




                                             Name of Component 1                     Name of Component 2                     Name of Component 3              TOTAL


Funding Category
                                        Child Abuse        Other Funding        Child Abuse        Other Funding        Child Abuse       Other Funding
                                            (a1)                (b1)                (a2)                (b2)                (a3)               (b3)
Unduplicated Children 0 – 5

Unduplicated Youth 6 – 18

Unduplicated Adults 19 & older

    Total Unduplicated Participants          0                   0                   0                   0                   0                   0             0
Duplicated Children 0 – 5

Duplicated Youth 6 -18

Duplicated Adults 19 & older

# Hours per Component

# Hours per Participant

Cost per Component

Cost per Participant


                               Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                      Page 1 of 21
Santa Clara County- Social Services Agency                                                                                                     EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                                                      PROJECT SUMMARY
Contract Period: July 1, 2009 – June 30, 2010                                                                                      Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                                                                       -
                    Agency Name:

                     Project Name:                                                                                                                   1st Submission
                                                                                                                                                     2nd Submission
                                                                                                                                                     3rd Submission

Cost per Hour

Start Date for Component

End Date for Component




Provide Explanation for the calculation of : (1) Cost per component , (2) Cost per participant, (3) Number of hours per Component, (4) Number of hours per participant, and (5) Cost
per hour. Also provide additional information as needed.




                            Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                   Page 2 of 21
          INSTRUCTIONS FOR THE PROJECT SUMMARY FORM


Information provided must reflect the approved proposal

Date Submitted/Revised                   Provide date when this form is submitted and/or revised
Name of Agency                           Name of your agency
Name of Project                          Name of your project (complete one for each project)
Brief Project Description                Provide a brief description of your project
Name of Component 1, 2, 3                Enter the name(s) of each component.
Funding Category                         Indicate if service is primary/secondary prevention or early intervention. This is
                                         important for funding sources.
Child Abuse (a1, a2, a3)                 Activities/participants funded by the Child Abuse Council
Other Funding (b1, b2, b3):              Activities/participants funded by other funding (matching funds). Also list in-
                                         kind contribution in dollar amount. Clearly document the in-kind amount(s).

Unduplicated Children 0-5                Each child is counted once only.
Unduplicated Youth 6-18                  Each youth is counted once only.
Unduplicated Adults 19-older             Each adult is counted once only.
Unduplicated Families                    Each family is counted once only. Do not count families if family members
                                         were already counted in any of the other unduplicated line.

Duplicated Children, Youth or Adults     individuals who are counted more than once (attend multiple activities)

Duplicated Families                      Families who are counted more than once (attend multiple activities).

Cost per Component                       Cost per Participant x Number of Participants (unduplicated count only)

Cost per Participant or Family           Cost per Component/Number of Participants (unduplicated count only)

Cost per Hour                            Cost per Component/Number of Hours of service per Component
Number of Hours per Component            Cost per Component/Cost per Hour
Number of Hours per Participant/Family   Cost per Participant/Cost per Hour (unduplicated count only)
Start Date for Component                 Date workshop, training, etc. begins
End Date for Component                   Date workshop, training, etc. ends
Hours per Component                      Length of a component measured by hours (example: 2 hours per week x 6
                                         weeks = 12 hours)
Hours per Participant                    Maximum number of hours required for successful completion of an activity

Criteria for Repeaters                   Agency must state criteria for repeaters. Repeaters must be counted only
                                         once under unduplicated counts.
Santa Clara County- Social Services Agency                                                                            EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                                          STAFFING
Contract Period: July 1, 2009 – June 30, 2010                                                      Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                         -
                  Agency Name:
                  Project Name:                                                                                   1st Submission
                                                                                                                 2nd Submission
                                                                                                                  3rd Submission

           Complete the table below for each staff person working in this project:


                  Staff’s Name

                  Position Title
  Direct Services or Indirect

Activities Staff Person Will
     Perform (Include                         Education, Experience,
                                                                                      Language and Cultural Competence "C"
 Activity/Service Number from                 and Qualifications "B"
Unit of Service Work Plan ) "A"




                  Staff’s Name

                  Position Title
  Direct Services or Indirect
              A                                          B                                                 C




                  Staff’s Name

                  Position Title
  Direct Services or Indirect
              A                                          B                                                 C




                  Staff’s Name

                  Position Title
  Direct Services or Indirect
              A                                          B                                                 C




                  Staff’s Name

                  Position Title
  Direct Services or Indirect
              A                                          B                                                 C




                  Staff’s Name

                  Position Title
  Direct Services or Indirect
              A                                          B                                                 C




                   Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                          Page 4 of 21
Santa Clara County- Social Services Agency                                                                                                 EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                                                 SERVICE DELIVERY GOALS
Contract Period: July 1, 2009 – June 30, 2010                                                                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                                                 -
                            Agency Name:
                            Project Name:                                                             1st Submission
                                                                                                      2nd Submission
                                                                                                      3rd Submission



                                                                                        Parents/
           COMPONENT 1                                     Children w/     Parents/    Caregivers                             Description of Component
                                            Children                                                    Families
           (Unduplicated)                                  Disabilities   Caregivers       w/                          & of Measurement Tool for the Component
                                                                                       Disabilities
Planned Q1 (unduplicated)
Planned Q2 (unduplicated)
Planned Q3 (unduplicated)
                                                                                                                          NAME & DESCRIPTION OF COMPONENT
Planned Q4 (unduplicated)

                     Total (unduplicated)              0              0            0              0                0

                                                                                        Parents/
                                                                                                                          Description & of Measurement Tool
  ACTIVITIES of COMPONENT 1                                Children w/     Parents/    Caregivers
                                            Children                                                    Families                    for Each Activity
          (Duplicated)                                     Disabilities   Caregivers       w/
                                                                                       Disabilities
                                                                                                                           TO BE FILLED OUT IF APPLICABLE




                      Total (duplicated)               0              0            0              0                0




                                   Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                          Page 5 of 21
Santa Clara County- Social Services Agency                                                                                                 EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                                                 SERVICE DELIVERY GOALS
Contract Period: July 1, 2009 – June 30, 2010                                                                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                                                 -
                            Agency Name:
                            Project Name:                                                             1st Submission
                                                                                                      2nd Submission
                                                                                                      3rd Submission




                                                                                        Parents/
           COMPONENT 2                                     Children w/     Parents/    Caregivers                             Description of Component
                                            Children                                                    Families
           (Unduplicated)                                  Disabilities   Caregivers       w/                          & of Measurement Tool for the Component
                                                                                       Disabilities

Planned Q1 (unduplicated)

Planned Q2 (unduplicated)

Planned Q3 (unduplicated)
                                                                                                                          NAME & DESCRIPTION OF COMPONENT
Planned Q4 (unduplicated)
                     Total (unduplicated)              0              0            0              0                0


                                                                                        Parents/
                                                                                                                          Description & of Measurement Tool
  ACTIVITIES of COMPONENT 2                                Children w/     Parents/    Caregivers
                                            Children                                                    Families                    for Each Activity
          (Duplicated)                                     Disabilities   Caregivers       w/
                                                                                       Disabilities
                                                                                                                           TO BE FILLED OUT IF APPLICABLE




                      Total (duplicated)               0              0            0              0                0




                                   Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                          Page 6 of 21
Santa Clara County- Social Services Agency                                                                                                 EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                                                 SERVICE DELIVERY GOALS
Contract Period: July 1, 2009 – June 30, 2010                                                                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                                                 -
                            Agency Name:
                            Project Name:                                                             1st Submission
                                                                                                      2nd Submission
                                                                                                      3rd Submission




                                                                                        Parents/
           COMPONENT 3                                     Children w/     Parents/    Caregivers                             Description of Component
                                            Children                                                    Families
           (Unduplicated)                                  Disabilities   Caregivers       w/                          & of Measurement Tool for the Component
                                                                                       Disabilities

Planned Q1 (unduplicated)

Planned Q2 (unduplicated)

Planned Q3 (unduplicated)
                                                                                                                          NAME & DESCRIPTION OF COMPONENT
Planned Q4 (unduplicated)
                     Total (unduplicated)              0              0            0              0                0


                                                                                        Parents/
                                                                                                                          Description & of Measurement Tool
  ACTIVITIES of COMPONENT 3                                Children w/     Parents/    Caregivers
                                            Children                                                    Families                    for Each Activity
          (Duplicated)                                     Disabilities   Caregivers       w/
                                                                                       Disabilities
                                                                                                                           TO BE FILLED OUT IF APPLICABLE




                      Total (duplicated)               0              0            0              0                0




                                   Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                          Page 7 of 21
Santa Clara County- Social Services Agency                                                                                                 EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                                                 SERVICE DELIVERY GOALS
Contract Period: July 1, 2009 – June 30, 2010                                                                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                                                 -
                            Agency Name:
                            Project Name:                                                             1st Submission
                                                                                                      2nd Submission
                                                                                                      3rd Submission



                                                                                        Parents/
         ONE-TIME EVENT                                    Children w/     Parents/    Caregivers                             Description of Component
                                            Children                                                    Families
          (Unduplicated)                                   Disabilities   Caregivers       w/                          & of Measurement Tool for the Component
                                                                                       Disabilities

Planned Q1 (unduplicated)

Planned Q2 (unduplicated)

Planned Q3 (unduplicated)
                                                                                                                          NAME & DESCRIPTION OF COMPONENT
Planned Q4 (unduplicated)
                     Total (unduplicated)              0              0            0              0                0


        ACTIVITIES of                                                                   Parents/
                                                                                                                          Description & of Measurement Tool
                                                           Children w/     Parents/    Caregivers
 ONE-TIME EVENT COMPONENT                   Children
                                                           Disabilities   Caregivers       w/
                                                                                                        Families                    for Each Activity
        (Duplicated)                                                                   Disabilities
                                                                                                                           TO BE FILLED OUT IF APPLICABLE




                      Total (duplicated)               0              0            0              0                0




                                   Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                          Page 8 of 21
Santa Clara County- Social Services Agency                                                                                                                EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                                                                SERVICE DELIVERY GOALS
Contract Period: July 1, 2009 – June 30, 2010                                                                                             Funding Source: CHILD ABUSE PREVENTION
                                                                                                                                                                              -
                               Agency Name:
                               Project Name:                                                                    1st Submission
                                                                                                                2nd Submission
                                                                                                                3rd Submission



TOTALS                                         If you have not added more rows above, the TOTALS will be automatically calculated in the orange cells.
                                               You might need to enter values directly for the ONE-TIME EVENT


                                                                                                  Parents/
                                                                Children w/     Parents/
                UNDUPLICATED                     Children                                       Caregivers w/     Families
                                                                Disabilities   Caregivers
                                                                                                 Disabilities

Planned Q1 (unduplicated)                                   0              0                0              0                 0
Planned Q2 (unduplicated)                                   0              0                0              0                 0
Planned Q3 (unduplicated)                                   0              0                0              0                 0
Planned Q4 (unduplicated)                                   0              0                0              0                 0
                      Total (unduplicated)                  0              0                0              0                 0



                                                                                                  Parents/
        COUNT OF SERVICE RENDERED                               Children w/     Parents/
                                                 Children                                       Caregivers w/     Families
              (DUPLICATED)                                      Disabilities   Caregivers
                                                                                                 Disabilities

Parent Education and Support                                0              0                0              0                 0
Family Counseling                                           0              0                0              0                 0
Home Visiting                                               0              0                0              0                 0
Multidisciplinary Team Services                             0              0                0              0                 0
Teaching and Demonstrating                                  0              0                0              0                 0
Health Services                                             0              0                0              0                 0
Daycare / Childcare                                         0              0                0              0                 0
Transportation                                              0              0                0              0                 0
Outreach/Public Awareness Campaign                          0              0                0              0                 0
Media                                                       0              0                0              0                 0
Other                                                       0              0                0              0                 0
                        Total (duplicated)                  0              0                0              0                 0


                                      Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                             Page 9 of 21
    INSTRUCTIONS FOR EXHIBIT B-WORKPLAN - SERVICE DELIVERY
GOAL FORM

TYPES OF SERVICES
• For each Component, list all activities under that component. Choose a Type of Services from the
dropdown list.
• When choosing OTHER, please fill out a short description of the service in the DESCRIPTION cell.

DIRECT SERVICES
Direct services means that the services must be provided to an individual or family, and the planned
duration of the services should be more than a one-time engagement event. If the participant only
attends the direct service for one time and drops out, they should still be counted under Direct
Services category as the planned duration was for more than one time engagement.

COUNTING
• UNDUPLICATED (at the COMPONENT Level):
(i) Clients may access multiple services and shall be counted once per component rendered during the
reporting period. Count families only when service is provided to the entire family.
(ii) Do not count members of a family as individuals if family is counted as one unit.
(iii) If a client is counted as a person with disabilities, do not count them in another category.

• DUPLICATED (at the ACTIVITY Level): Clients may access multiple services and shall be counted for
all the services rendered during the reporting period.
Santa Clara County- Social Services Agency                                                   EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                OUTCOMES
Contract Period: July 1, 2009 – June 30, 2010                                  Funding Source: CHILD ABUSE PREVENTION
                                                                                                                           -
                          Agency Name:
                          Project Name:                                                     1st Submission
                                                                                           2nd Submission
                                                                                            3rd Submission

INSTRUCTIONS: 1) Enter the COMPONENT NAME. 2) Enter the Outcome Statement in full.
3) Specify "Time Frame" by selecting from the dropdown menu.
4) Make changes to the frequency of measurement as necessary.


          COMPONENT 1                                                   Enter Component Name:

     ENGAGEMENT OUTCOMES                      Qtr 1             Qtr 2           Qtr 3           Qtr 4           Total

Number of Participants



Outcome Statement


Time Frame to Achieve Outcomes


      SHORT-TERM OUTCOMES                     Qtr 1             Qtr 2           Qtr 3           Qtr 4           Total

Number of Participants



Outcome Statement


Time Frame to Achieve Outcomes


     INTERMEDIATE OUTCOMES                    Qtr 1             Qtr 2           Qtr 3           Qtr 4           Total

Number of Participants



Outcome Statement


Time Frame to Achieve Outcomes




          COMPONENT 2                                                   Enter Component Name:
     ENGAGEMENT OUTCOMES                      Qtr 1             Qtr 2           Qtr 3           Qtr 4           Total
Number of Participants


Outcome Statement


Time Frame to Achieve Outcomes

      SHORT-TERM OUTCOMES                     Qtr 1             Qtr 2           Qtr 3           Qtr 4           Total
Number of Participants
     Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                            Page 11 of 21
Santa Clara County- Social Services Agency                                                   EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                OUTCOMES
Contract Period: July 1, 2009 – June 30, 2010                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                           -
                         Agency Name:
                         Project Name:                                                      1st Submission
                                                                                           2nd Submission
                                                                                            3rd Submission



Outcome Statement


Time Frame to Achieve Outcomes

     INTERMEDIATE OUTCOMES                 Qtr 1            Qtr 2            Qtr 3             Qtr 4            Total
Number of Participants


Outcome Statement


Time Frame to Achieve Outcomes




     Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                            Page 12 of 21
Santa Clara County- Social Services Agency                                                   EXHIBIT B - WORK PLAN
Child Abuse Prevention Program FY 2009-10                                                                OUTCOMES
Contract Period: July 1, 2009 – June 30, 2010                               Funding Source: CHILD ABUSE PREVENTION
                                                                                                                           -
                         Agency Name:
                         Project Name:                                                      1st Submission
                                                                                           2nd Submission
                                                                                            3rd Submission



          COMPONENT 3                                               Enter Component Name:
     ENGAGEMENT OUTCOMES                   Qtr 1            Qtr 2            Qtr 3             Qtr 4            Total
Number of Participants


Outcome Statement


Time Frame to Achieve Outcomes

      SHORT-TERM OUTCOMES                  Qtr 1            Qtr 2            Qtr 3             Qtr 4            Total
Number of Participants


Outcome Statement


Time Frame to Achieve Outcomes

     INTERMEDIATE OUTCOMES                 Qtr 1            Qtr 2            Qtr 3             Qtr 4            Total
Number of Participants


Outcome Statement


Time Frame to Achieve Outcomes




     Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                            Page 13 of 21
Santa Clara County- Social Services Agency                                                                                             EXHIBIT C - BUDGET DETAIL
Child Abuse Prevention Program FY 2009-10                                                                                                       PROJECT BUDGET
Contract Period: July 1, 2009 – June 30, 2010                                                                             Funding Source: CHILD ABUSE      PREVENTION
Agency Name:                                                                                                                                                               -
 Project Name:

                                                                                                                                          1st Submission
                                                                                                                                         2nd Submission
                                                                                                                                          3rd Submission




        DIRECT COSTS

        I. PERSONNEL COSTS (Direct Service Staff Only)
          A                          B                                             C                       D                 E                 F                G
                                                                                                                                                            Direct Costs
                               Position Title                                Name                    Annual Salary      Agency FTE       Contract FTE
                                                                                                                                                               (D*F)
        1a                                                                                                                                                            0.00

        1b                                                                                                                                                            0.00

        1c                                                                                                                                                            0.00

        1d                                                                                                                                                            0.00

        1e                                                                                                                                                            0.00

        1f                                                                                                                                                            0.00

        1g                                                                                                                                                            0.00

        1h       SUBTOTAL SALARIES & WAGES                                                                                                                            0.00 1a:1g

        1i       FRINGE BENEFITS @                        (% OF SALARY AND WAGES EXPENSE)

        1j       SUBTOTAL PERSONNEL EXPENSES                                                                                                                          0.00 1h:1i

        II. NON-PERSONNEL OPERATING EXPENSES

        2a

        2b

        2c

        2d

        2e

        2f

        2g       SUBTOTAL OPERATING EXPENSES                                                                                                                          0.00 2a:2f

        III. OTHER COSTS (Only for Subcontracts)          List of Subcontractors

        3a

        3b

        3c       SUBTOTAL OTHER COSTS                                                                                                                                 0.00 3a:3b

        3d       TOTAL DIRECT COSTS                                                                                                                                   0.00 1j+2g+3c
                                                         Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                                               Page 14 of 21
Santa Clara County- Social Services Agency                                                                                    EXHIBIT C - BUDGET DETAIL
Child Abuse Prevention Program FY 2009-10                                                                                              PROJECT BUDGET
Contract Period: July 1, 2009 – June 30, 2010                                                                    Funding Source: CHILD ABUSE      PREVENTION
Agency Name:                                                                                                                                                   -
 Project Name:

                                                                                                                                 1st Submission
                                                                                                                                2nd Submission
                                                                                                                                 3rd Submission




                                                Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                                      Page 15 of 21
Santa Clara County- Social Services Agency                                                                                                    EXHIBIT C - BUDGET DETAIL
Child Abuse Prevention Program FY 2009-10                                                                                                              PROJECT BUDGET
Contract Period: July 1, 2009 – June 30, 2010                                                                                      Funding Source: CHILD ABUSE   PREVENTION
Agency Name:                                                                                                                                                                  -
 Project Name:

                                                                                                                                                1st Submission
                                                                                                                                                2nd Submission
                                                                                                                                                3rd Submission




        ADMINISTRATIVE/INDIRECT COSTS (Maximum 10% of total budget)
        IV. PERSONNEL COSTS (Administrative Staff Only- Indirect Costs)
                                                                                                                                                                 Indirect Costs
                               Position Title                                 Name                         Annual Salary         Agency FTE    Contract FTE
                                                                                                                                                                      (D*F)
        4a                                                                                                                                                                  0.00

        4b                                                                                                                                                                  0.00

        4c                                                                                                                                                                  0.00

        4d       SUBTOTAL SALARIES & WAGES                                                                                                                                  0.00 4a:4c

        4e       FRINGE BENEFITS @                        (% OF SALARY AND WAGES EXPENSE)

        4f       SUBTOTAL INDIRECT PERSONNEL EXPENSES                                                                                                                       0.00 4d:4e

        V. NON-PERSONNEL INDIRECT EXPENSES (INDIRECT COSTS)

        5a

        5b

        5c

        5d

        5e       SUBTOTAL OPERATING (NON-PERSONNEL) EXPENSES (INDIRECT COSTS)                                                                                               0.00 5a:5d
                         FEDERALLY APPROVED
        5f                                                                                                                   TOTAL ADMINISTRATIVE COSTS                     0.00 4f+5e
                          INDIRECT COST RATE
        6        GRAND TOTAL                                        Total of Direct Cost and Total Indirect Adminitrative Cost                                              0.00 3d+6

        7        TOTAL PROPOSED BUDGET                                    Same as Grand Total Allocated to Contract




                                                        Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                                              Page 16 of 21
                  INSTRUCTIONS FOR LINE ITEM PROJECT BUDGET FORM
                     Include ONLY funds requested from the Child Abuse Council on this form


Direct Costs are those for activities or services that benefit specific projects, e.g., salaries for project staff and materials required for a particularly project.
Because these activities are easily traced to projects, their costs are usually charged to projects on an item-by-item basis.

Indirect/Administrative Costs are those for activities or services that benefit more than one project. Their precise benefits to a specific project are often
difficult or impossible to track; for example, it may be difficult to determine precisely how the activities of the director of an organization benefit a specific
project.

It is possible to justify the handling of almost any kind of cost as either direct or indirect. Labor cost, for example, can be indirect, as in the case of
maintenance personnel and executive officers; or they can be direct, as in the case of project staff members. Similarly, materials such as miscellaneous
supplies purchased in bulk -- pencils, pens, paper -- are typically handled as indirect costs, while materials required for specific projects are charged as
direct costs.
Annual Salary: salary per year whether it's a full time or part-time position
Agency FTE: List percentage of full-time equivalent for the entire agency
Contract FTE: List percentage of full-time equivalent allocated for this child abuse contract

         color       Value to be entered
         color       Value automatically calculated

Page 1               DIRECT COSTS
Line 1               Direct Service Personnel (the column headers are explained below).
                     Detailed Direct Service Personnel: List each person on each line, including contractors. If a separate sheet needs to be added, please
Lines 1a-1g
                     use this form and make note.
                     Subtotal Salaries & Wages: add up across personnel. Remember to add those who are on separate sheet(s) mentioned in Lines 1a-
Line 1h
                     1h
Line 1i              Fringe benefit percentage as a % of salary & wage expenses. Enter percentage and calculate amount
Line 1j              Subtotal Personnel Expenses. This line will be automatically calculated.
Line 2               Non-Personnel (Operating) Direct Expenses
Lines 2a-2f          Detailed Non-Personnel (Operating) Direct Expenses
Line 2g              Subtotal Non-Personnel (Operating) Direct Expenses
Line 3               Other costs: Only fill this part out if your contract has subcontractors
Lines 3a-3b          List out other costs incurred with subcontractors
Line 3c              Subtotal other costs
Line 3d              Total Direct Cost


Page 2               INDIRECT COSTS
                     Administrative (Indirect) Personnel: Include those who are counted in the indirect costs to the project (the column headers
Line 4
                     are explained below).
                     Detailed Administrative Personnel: List each person on each line. If a separate sheet needs to be added, please use this form and make
Lines 4a-4c
                     note.

Line 4d              Subtotal Salaries & Wages: add up across personnel. Remember to add those who are on separate sheet(s) mentioned in Lines 4a-4d

Line 4e              Fringe benefit percentage as a % of salary & wage expenses. Enter percentage and calculate amount
Line 4f              Subtotal Indirect Personnel Expenses. This line will be automatically calculated.
Line 5               Non-Personnel (Operating) Indirect Expenses
Lines 5a-5d          Detailed Non-Personnel (Operating) Indirect Expenses
Line 5e              Subtotal Non-Personnel Direct Expenses
Line 5e              Federally Approved Indirect Cost Rate: State if Agency has received this information from Federal contracts
Line 6               Grand Total: Add together Direct and Administrative costs
Line 7               Total Proposed Budget: Same as Grand Total Allocated to Contract
Santa Clara County- Social Services Agency                                                                             EXHIBIT C - BUDGET DETAIL
Child Abuse Prevention Program FY 2009-10                                                                                    BUDGET NARRATIVE
Contract Period: July 1, 2009 – June 30, 2010                                                               Funding Source: CHILD ABUSE   PREVENTION
                                                                                                                                                     -

                                                                                                                        1st Submission
                                                                                                                       2nd Submission
                                                                                                                       3rd Submission



            DIRECT COSTS
                   Salaries & Wages
                                              1. Core Personnel: List name(s) of the person(s) and describe main role in project.

                                              2. Other Personnel: List other project's team members and describe main responsibities of each staff



                   Fringe Benefits (explain the rate that is used to calculated Fringe Benefits)


                   Non-personnel Direct Expenses
                   (List each line item included in the Project Budget page as well as a description of the expense)




                   Other Costs (only if there is a subcontractor)




                                                                          Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                                                                Page 18 of 21
Santa Clara County- Social Services Agency                                                                               EXHIBIT C - BUDGET DETAIL
Child Abuse Prevention Program FY 2009-10                                                                                      BUDGET NARRATIVE
Contract Period: July 1, 2009 – June 30, 2010                                                               Funding Source: CHILD ABUSE    PREVENTION
                                                                                                                                                    -

                                                                                                                          1st Submission
                                                                                                                          2nd Submission
                                                                                                                          3rd Submission



            INDIRECT / ADMINISTRATIVE COSTS
                   Salaries & Wages
                                              Administrative Personnel charged to Project
                                              List name(s) of the person(s) and describe main administrative responsibilities




                   Fringe Benefits (explain the rate that is used to calculated Fringe Benefits)


                   Non-personnel Indirect/Administrative Expenses
                   (List each line item included in the Project Budget page as well as a description of the expense)




                                                                          Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                                                                                Page 19 of 21
Santa Clara County- Social Services Agency                                                                                            EXHIBIT C - BUDGET DETAIL
Child Abuse Prevention Program FY 2009-10                                                                                                   BUDGET NARRATIVE
Contract Period: July 1, 2009 – June 30, 2010                                                                       Funding Source: CHILD ABUSE PREVENTION
                       Agency Name:                                                                                                                                          -
                       Project Name:

                                                                                                                                           1st Submission
                                                                                                                                           2nd Submission
                                                                                                                                           3rd Submission

PLEASE Include all funding sources, both Child Abuse and matching funds for FY 2009-2010


                   A                                            B                                   C                   D                       E                   F
                                                                                                                                                              % Difference
                                                                                             Commitment            FY 09 Dollar            FY 10 Dollar       Year to Year
Source of Funds                                    Name or Type of Funds                       Code*                 Amount                  Amount             (E-D)/D
Child Abuse Council                    Child Abuse Prevention




Total Resources                                                                                                $                  -    $                  -


      Matching Amount**                            Requested Amount
                                                                                            Amount

                                                                                            % of Total Project Budget                 will be automatically calculated
              Matching Amount** = Total Resources - Requested Amount

NOTES:
Commitment Code*                                           Definitions
                   1                   Firm Commitment - Already have an agreement or letter confirming funding
                   2                   Anticipated Renewal of Existing Funding - Continuation of current year funding
                   3                   Anticipated Resource - Projection of previous fees or donations
                   4                   Application Pending - Application has been submitted, no confirmation at this time
                   5                   Pre-Application - Not yet submitted and expect funding




               Master Contract between the County of Santa Clara and ___________________________________ Contract # ______________
                                                                     Page 20 of 21
THIS SHEET IS ONLY FOR DATA RANGES USED IN THE VARIOUS
FORMS IN THIS WORKBOOK. DO NOT DELETE NOR ALTER FORMULAS.
FILL OUT DATA IN GREEN SHADED BOXES

                                              Agency Name:

                                              Project Name:

                     Abbreviated Agency Name (Acronym)

                     Abbreviated Project Name (Acronym)


                                      Date of 1st Submission
                                      Date of 2nd Submission
                                      Date of 3rd Submission

                    Types of Direct Service                                              Notes
Parent Education and Support
Family Counseling
Home Visiting
Multidisciplinary Team Services
Teaching and Demonstrating
Health Services
Daycare / Childcare                                            Must be child-abuse-prevention focused
Transportation                                                 Must be child-abuse-prevention focused
Other                                                          Describe in full in text box



                 Types of One-time Event
Outreach/Public Awareness Campaign
Media
Other                                                          Describe in full in text box



                 Types of FundingCategories
primary/secondary prevention
early intervention



                         Timeframe
Quarterly
Once every 6 months
After 1 year
Half-way Thru



                     Commitment Codes
                                                               Firm Commitment - Already have an agreement or
        1                                                      letter confirming funding
                                                               Anticipated Renewal of Existing Funding - Continuation
        2                                                      of current year funding
                                                               Anticipated Resource - Projection of previous fees or
        3                                                      donations
                                                               Application Pending - Application has been submitted,
        4                                                      no confirmation at this time

        5                                                      Pre-Application - Not yet submitted and expect funding

				
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Description: Child Daycare Forms and Contracts document sample