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VOCA COVER SHEET
STATE OF UTAH 1. Subgrantee Agency Information
OFFICE OF CRIME VICTIM REPARATIONS Agency Name:
350 East 500 South, Suite 200 Address:
Salt Lake City, Utah 84111 City/Zip Code:
(801) 238-2360 (801) 533-4127 FAX Phone Number:
FAX Number:
2010 APPLICATION VOCA VICTIM ASSISTANCE FUNDS E-Mail:
Section 2 will automatically sum
9. Purpose of Award - check one 10. Funds will be Used To? - check one 2. Amount Requested $ $0.00
Initiate a New Victim Service Program Expand Services into a New Geographic Area 3. Contact Person
Enhance or Expand an Existing Program Offer New Types of Services Name:
NOT Funded by VOCA in the Previous Year Serve Additional Victim Populations Title/Position:
Continuation of Grant # - specify below Continue Existing Services to Crime Victims Phone Number:
Continue a RECOVERY ACT PROGRAM Email:
11. Type of Implementing Agency - 12. If the Implementing Agency is Non- 4. Program Period
check one Criminal Justice/Governmental, which?
Criminal Justice Governmental Social Services Begin Program Date
Non-Criminal Justice Governmental Mental Health End Program Date
Private Non-Profit Public Housing 5. Congressional District &Counties Served
Native American Tribe Hospital
Other (describe): Other (describe): 6. Federal Tax ID #:
13. If the Implementing Agency is a 14. If the Implementing Agency is 7. For this Victim Service Program indicate:
Criminal Justice Agency, which type? Private Non-Profit, which type? a.& b. will automatically calculate in FTE form
Law Enforcement Hospital a. Number of Paid Staff (FTE) 0.00
Prosecution Rape Crisis b. Number of Volunteer Staff 0.00
Probation Religious Organization 8. Project Short Title or Name - state below
Corrections Shelter
Courts Mental Health
Other (describe): Other (describe): asdfl
15. Subgrant Match Financial support a. Source(s) of b. Source(s) of Value of Cash: 0.00
from other Non-Federal Source(s) Cash Match In-kind Match Value of In-kind: 0.00
1 1
2 2 TOTAL VALUE
Minimum Match: 0.00 3 3 of MATCH: 0.00
20% of Total Costs. Will automatically sum Match section will automatically sum
NOTE: Section 16 will automatically calculate and sum following completion of the Budget Detail and Match Worksheets.
16. Project Budget Summary TOTAL COSTS VOCA Funds Cash Match In-kind Match
a. Personnel: 0.00 0.00 0.00 0.00
b. Contracted Fees: 0.00 0.00 0.00 0.00
c. Equipment: 0.00 0.00 0.00 0.00
d. Travel/Training: 0.00 0.00 0.00 0.00
e. Supplies: 0.00 0.00 0.00 0.00
f. Other: 0.00 0.00 0.00 0.00
TOTAL COSTS: 0.00 0.00 0.00 0.00
17. Official Authorized to Sign 18. Program Director or Manager For OCVR use only
Name: Name:
Position: Position:
Signature: Signature:
Date of Signature: Date of Signature: OCVR Approval Date
19a. ____ Competitive OR 19b. ____ Competitive Sexual Assault Set Aside
Cover Sheet
REQUIRED VOCA INFORMATION
19c. Indicate the anticipated number of victims that will be served by type of victimization. NOTE: Indicate the number of victims
served by VOCA-funded projects during the grant period (VOCA grant plus Match). Each victim should be counted only once
during the program year (i.e. a victim of a series of spouse abuse assaults should be counted more than once only as a result of
separate and unrelated crimes). EACH AGENCY WILL BE REQUIRED TO MAINTAIN THE NUMBER OF VICTIMS SERVED
THROUGHOUT THE CONTRACT YEAR.
No. of Victims VOCA Funds per Type
Percent of Services
Served of Victimization
This column will This column will
automatically calculate automatically calculate
Fill in this column
1. CHILD PHYSICAL ABUSE................... #DIV/0! #DIV/0! ...........
2. CHILD SEXUAL ABUSE...................... #DIV/0! #DIV/0! ...........
3. DOMESTIC VIOLENCE......................... #DIV/0! #DIV/0! ...........
4. ADULT SEXUAL ASSAULT/RAPE... #DIV/0! #DIV/0! ...........
5. DUI/DWI CRASHES………….............. #DIV/0! #DIV/0! ...........
6. SURVIVORS of HOMICIDE VICTIMS #DIV/0! #DIV/0! ...........
7. ASSAULT……………………………… #DIV/0! #DIV/0! ...........
8. ADULTS MOLESTED AS CHILDREN #DIV/0! #DIV/0! ...........
9. ELDER ABUSE......................................... #DIV/0! #DIV/0! ...........
10. ROBBERY….............................................. #DIV/0! #DIV/0! ...........
11. OTHER (specify) ....... #DIV/0! #DIV/0! ...........
TOTAL NUMBER of VICTIMS SERVED: 0
TOTAL PERCENT of SERVICES (should equal 100%) : #DIV/0!
TOTAL VOCA FUNDS (should equal award amount): #DIV/0!
20. Indicate the anticipated number of services crime victims will receive (VOCA grant plus Match).
No. of Services
Percent of Services
Provided
This column will
Fill in this column automatically calculate
1. CRISIS COUNSELING........................................................... #DIV/0! .............
2. FOLLOW UP........................................................................... #DIV/0! .............
3. THERAPY.............................................................................. #DIV/0! .............
4. GROUP TREATMENT/SUPPORT..................................... #DIV/0! .............
5. CRISIS HOTLINE COUNSELING………………………… #DIV/0!
6. SHELTER/SAFEHOUSE..................................................... #DIV/0! .............
7. INFORMATION/REFERRAL (IN-PERSON).................... #DIV/0! .............
8. CRIMINAL JUSTICE SUPPORT/ADVOCACY.............. #DIV/0! .............
9. EMERGENCY FINANCIAL ASSISTANCE.................... #DIV/0! .............
10. EMERGENCY LEGAL ADVOCACY................................. #DIV/0! .............
11. ASSISTANCE IN FILING COMPENSATION CLAIMS #DIV/0! .............
12. PERSONAL ADVOCACY................................................... #DIV/0! .............
13. TELEPHONE CONTACT INFORMATION/REFERRAL #DIV/0! .............
14. OTHER (specify): #DIV/0! ............
TOTAL NUMBER of SERVICES PROVIDED: 0
TOTAL PERCENT of SERVICES (should equal 100%): #DIV/0!
Cover Sheet
PROGRAM BUDGET
The applicant must provide a budget with detailed justification for all costs, including a basis for computation of these costs. The
program budget must be complete, reasonable, and cost-effective in relation to the proposed program. This section should include
the (1) Budget Detail Worksheet, (2) Match Worksheet, (3) the Program Expenditure Comparison Summary, and (4) the
Equipment Summary Sheet. It is important that instructions on each section are strictly followed. THE TOTALS OF EACH
SECTION WILL AUTOMATICALLY SUM AND TRANSFER TO THE CONTRACT COVER SHEET.
1. BUDGET DETAIL WORKSHEET
A. Personnel - (1) List each employee by name (if available); (2) the total hours this employee provides to your agency (ex: the
employee listed provides 2080 hours to the agency although the VOCA request may only be funding 1560 of the 2080 hours); (3)
the position or title; (4) indicate the number of hours the employee will spend on this project (VOCA-funded hours); and (5) indicate an
hourly rate of reimbursement. Include only individuals assigned to the program whose salaries are paid with VOCA victim assistance
monies. PLEASE DO NOT LIST ANY MATCH AMOUNTS IN THIS SECTION. NOTE: Each agency will be required to keep
detailed documentation of VOCA Personnel & Fringe Benefit expenditures (i.e. time-sheets, check stubs, activity logs, etc.).
Name (if not yet hired, list "New") Agency Hours Position/Title VOCA Hours Hourly Rate TOTAL SALARY
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
7 0.00
8 0.00
9 0.00
10 0.00
TOTAL VOCA FUNDED HOURS: 0
TOTAL PERSONNEL: $0.00
B. Fringe Benefits - Fringe benefits should be based on actual known costs or an established formula. Fringe benefits are only for
the personnel listed in budget category (A) and only for the percentage of time devoted to the project. (1) Indicate personnel name and/
or position; (2) include all applicable benefit categories VOCA will fund. Please abbreviate each category (FIC=FICA; MED=medicare;
INS = insurance; UNE=unemployment; RIT=retirement; OTH=all other); (3) List the total salary (not to exceed amounts in category A);
and (4) the total fringe benefit percentage. PLEASE BE SURE TO INCLUDE THE PERCENTAGE SIGN (ex: 30%). This table will
calculate and sum the total benefit for each position listed. PLEASE DO NOT LIST ANY MATCH AMOUNTS IN THIS SECTION.
Name or Position List Benefit Type Total Salary Benefit Percent BENEFIT COST
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
7 0.00
8 0.00
9 0.00
10 0.00
11 0.00
TOTAL BENEFIT COST: $0.00
TOTAL PERSONNEL/BENEFIT: $0.00
Budget Worksheet
C. Volunteers - A volunteer is one who provides direct services for your program without receiving compensation. VOCA requires
each agency to maintain and report volunteer services (keep accurate time-sheets, logs, etc.). (1) List each volunteer position by
title and provide the number of volunteers for each position (if applicable); (2) Indicate the number of hours to be spent on this
program; and (3) list the rate at which the volunteer position is valued. The total volunteer match will calculate and sum automatically.
Include all volunteers assigned to the program whose volunteer time supports VOCA-funded activities. If your agency DOES NOT
intend to use volunteer hours as in-kind match, please indicate by entering "0" in the box below. If your agency INTENDS to use
volunteer hours as in-kind match, please indicate by entering "1".
Position Duties Total Hours Hourly Rate VOLUNTEER Value
1 0 $0.00 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
7 0.00
8 0.00
9 0.00
10 0.00
TOTAL VOCA VOLUNTEER HOURS 0
TOTAL VOLUNTEER VALUE: $0.00
D.Contracted Fees - (1) Specify the type of consultant services or contracts needed; (2) list the total amount of hours dedicated
to the project; and (3) indicate the rate of reimbursement. The maximum reimbursement amount for contract fees is $56.25 per
hour or $450 per eight hour work day. All consultant services or contracts must be pre-authorized by OCVR and must be bid through
the proper channels. PLEASE DO NOT INCLUDE ANY MATCH AMOUNTS IN THIS SECTION.
Type of Consultant Services or Contracts Total Hours Rate CONTRACTED FEES
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
TOTAL CONTRACTED FEES: $0.00
E. Equipment - List nonexpendable items that are to be purchased. Nonexpendable equipment is tangible property having a useful
life of more than 1 year and an acquisition cost of $1,000 or more per unit. If requesting equipment funding, you are required to
fill out and sign the Equipment Summary Section (Pages 10-11 B). Remember, if the equipment is used for other programs, the
acquisition cost must be shared with those programs (example: acquisition cost x 60% VOCA usage). (1) List the equipment to be
purchased; (2) list the VOCA Use Percentage; (3) indicate the quantity; and (4) indicate the unit price. PLEASE INCLUDE THE
PERCENTAGE SIGN IN THE VOCA USE CATEGORY (example: 60%). PLEASE DO NOT INCLUDE ANY MATCH
AMOUNTS IN THIS SECTION.
Item VOCA Use Percentage Quantity Unit Price EQUIPMENT COST
1 0.00
2 0.00
3 0.00
4 0.00
Budget Worksheet
5 0.00
6 0.00
7 0.00
8 0.00
9 0.00
TOTAL EQUIPMENT COST: $0.00
F. Travel - include: (1) the travel destination and purpose; (2) the anticipated miles to be traveled; and (3) the per-mile reimbursement
rate (Not to exceed $0.50/mile or $0.36/mile for an agency vehicle) . Agencies will be required to keep a current travel log with miles
traveled, odometer readings, purpose of travel, dates of travel, driver, and signature.
PLEASE DO NOT INCLUDE ANY MATCH AMOUNTS IN THIS SECTION.
Travel Destination/Purpose Total Miles Per-Mile Rate TRAVEL COST
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
TOTAL TRAVEL COST: $0.00
Training - include: (1) the name of conference (if available ) and category (hotel, flight, per diem, cab, registration., etc.); (2) number
of people attending (list as "1" person if: sharing rooms/cabs/etc. or costs are combined); (3) the number of anticipated days (list as "1"
for registration, cab, flight and any cost where the number of days are not a factor); and (4) the rate of hotel, registration, per diem,
flight and any other associated training costs (PLEASE SEPARATE EACH COST). NOTE: Subgrantees are required to keep
accurate documentation (i.e. receipts, agendas, etc.). PLEASE DO NOT INCLUDED ANY MATCH AMOUNTS IN THIS SECTION.
MAXIMUM REIMBURSEMENT AMOUNTS FOR TRAVEL: $36.00/day per diem; $90.00/day hotel/lodging.
Conference Name Number of People Number of Days Rate: Hotel/ TRAINING COST
& Category Attending Enter "1" for Registration/
Hotel/Registration/Flight/Cab/ If sharing rooms, cab, Registration, Per Diem/
Per Diem/etc. etc., list as "1" person. Cab, & Flight Flight/etc.
EX: NOVA Conf - Hotel 2 3 $90.00 $540.00
EX: NOVA Conf - Per Diem 2 3 $36.00 $216.00
EX: NOVA Conf - Registration 2 1 $75.00 $150.00
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
7 0.00
8 0.00
9 0.00
10 0.00
11 0.00
TOTAL TRAINING COST: $0.00
TOTAL TRAVEL/TRAINING: $0.00
Budget Worksheet
G. Supplies - (1) List items within this category by major type (i.e. office supplies, telephones, utilities, postage, etc.). Generally,
supplies include materials that are expendable or consumed during the course of the project. Large items should be separately listed
and identified. (2) List the quantity of the item (if quantity item is unknown or difficult to determine, give best estimation); and (3) list
the unit price. NOTE: Subgrantees are required to maintain detailed documentation of expenditures (i.e. receipts with date, cost,
etc.). PLEASE DO NOT INCLUDE ANY MATCH AMOUNTS IN THIS SECTION.
Item & Description Quantity Unit Price SUPPLIES COST
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
7 0.00
8 0.00
9 0.00
10 0.00
11 0.00
TOTAL SUPPLIES COST: $0.00
H. Other - Other funds are those monies that are allocated to assist victims of crime for emergency purposes (petty cash funds)
and miscellaneous items. (1) List the item and brief description; (2) list the quantity of the item; and (3) list the unit price. PLEASE DO
NOT INCLUDE ANY MATCH AMOUNTS IN THIS SECTION.
Item & Description Quantity Unit Price OTHER COST
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
TOTAL OTHER COST: $0.00
TOTAL GRANT COST: $0.00
Budget Worksheet
PROGRAM MATCH
A program with a record of providing effective services is required to provide 20 percent of the total program costs with non-VOCA
and non-Federal funds. The program match must be complete, reasonable, and cost-effective in relation to the proposed program.
This match may include volunteer in-kind contributions listed on the Budget Detail Worksheet (category C). If your volunteer
contribution meets the 20 percent requirement (indicated on the Contract Cover Sheet, number 15), you will not be required to
fill out this section. However, if your organization has received four (4) or more years of funding, one-fourth (25%) cash match
must be provided. REMEMBER: In-kind is a match associated with donating (ex: received a computer through donation). Cash is
a match associated with an exchange of money (ex: purchased a computer for the program). The totals of each section will be
automatically summed and transferred to the Contract Cover Sheet.
2. MATCH WORKSHEET
A. Personnel Match - ( 1) List source of match; (2) List each employee by name (if available) and position. Please include
every match hour and employee who provides services to the VOCA project. Include the hourly rate for positions you will use
as a VOCA contract match; (3) indicate the number of hours used in calculating the cash match for this project; and (4) indicate the
hourly rate of reimbursement. Matching funds include any individuals assigned to the program whose salaries are NOT paid with
federal monies. THIS IS A CASH MATCH SECTION. NOTE: If personnel services are donated to the project, involving no cash
exchange for services (in-kind match), the amounts should be listed under the Volunteer category of the Budget Detail Worksheet
for both personnel and fringe benefit categories.
List Source(s) of Match (ex: United Way, County, etc.):
Name Position Total Hours Hourly Rate TOTAL SALARY
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
TOTAL VOCA MATCH HOURS: 0
TOTAL PERSONNEL CASH MATCH: $0.00
B. Fringe Benefits Match - Fringe benefits should be based on actual known costs or an established formula. Fringe
benefits are for personnel listed in the match budget category (A) and only for the percentage of time devoted to the project. (1)
Indicate personnel name and/or position; (2) the total salary (not to exceed amounts in match category A); and (3) the match fringe
benefit percentage. PLEASE BE SURE TO INCLUDE THE PERCENTAGE SIGN (example: 30%). This table will calculate the
total match benefit automatically for each position listed. THIS IS A CASH MATCH SECTION.
Name/Position Total Salary Benefit Percent BENEFIT COST
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
TOTAL FRINGE BENEFIT CASH MATCH: $0.00
TOTAL PERSONNEL/BENEFIT CASH MATCH: $0.00
Match Worksheet
D.Contracted Fees Match- (1) List source of match; (2) Specify the type of consultant services or contracts needed; (3) list
the total amount of match hours dedicated to the project; and (4) indicate the hourly rate of match. The maximum reimbursement
amount for contract fees is $56.25 per hour or $450 per eight hour work day. THIS IS A CASH MATCH SECTION.
List Source(s) of Match (ex: United Way, County, etc.):
Type of Consultant Services or Contracts Total Hours Rate CONTRACTED FEES
1 0.00
2 0.00
3 0.00
4 0.00
TOTAL CONTRACTED FEES CASH MATCH: $0.00
THIS IS AN IN-KIND MATCH SECTION.
Type of Consultant Services or Contracts Total Hours Rate CONTRACTED FEES
1 0.00
2 0.00
3 0.00
4 0.00
TOTAL CONTRACTED FEES IN-KIND MATCH: $0.00
E. Equipment - List nonexpendable items that have been donated for program use. Nonexpendable equipment is tangible
property having a useful life of more than 1 year and an acquisition cost of $1,000 or more per unit. Remember, if the equipment is
used for other programs, the match amount must be shared with those programs (example: match amount x 60% VOCA usage).
PLEASE INCLUDE THE PERCENTAGE SIGN IN THE VOCA USE CATEGORY (example: 60 %) . (1) List source of match;
(2) List VOCA use percentage; (3) indicate the quantity of equipment; and (4) indicate the unit price. THIS IS A CASH MATCH
SECTION.
List Source(s) of Match (ex: United Way, County, etc.):
Item VOCA Use Percentage Quantity Unit Price EQUIPMENT COST
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
TOTAL EQUIPMENT CASH MATCH: $0.00
THIS IS AN IN-KIND MATCH SECTION.
Item VOCA Use Percentage Quantity Unit Price EQUIPMENT COST
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
TOTAL EQUIPMENT IN-KIND MATCH: $0.00
Match Worksheet
F. Travel/Training Match - For travel match include: (1) Source of match; (2) the travel destination; (3) the anticipated
miles to be traveled; and (4) the per-mile match rate (not to exceed $0.50 per mile or $0.36 per mile for an agency vehicle) .
THIS IS A CASH MATCH SECTION.
List Source(s) of Match (ex: United Way, County, etc.):
Travel Destination & Purpose Total Miles Per-Mile Rate TRAVEL COST
1 0.00
2 0.00
3 0.00
4 0.00
TOTAL TRAVEL CASH MATCH: $0.00
THIS IS AN IN-KIND MATCH SECTION.
Travel Destination & Purpose Total Miles Per-Mile Rate TRAVEL COST
1 0.00
2
3 0.00
4 0.00
TOTAL TRAVEL IN-KIND MATCH: $0.00
Training Match - For training match include: (1) the name of the conference and category (ex: Hotel, Registration,etc.); (2) the
number of people attending; (3) the number of anticipated days; and (4) the rate of hotel, registration, per diem, flight, etc.. (PLEASE
SEPARATE EACH COST). SAME MAXIMUM RATES APPLY AS IN BUDGET SECTION. THIS IS A CASH MATCH SECTION.
Conference Name Number of People Number of Days RATE: Hotel/ TRAINING COST
& Category Attending Enter "1" for Registration/
Hotel/Registration/Flight/Cab/ If sharing rooms, cab, Registration, Per Diem/
Per Diem/etc.(ex: NOVA - Hotel) etc., list as "1" person Cab, & Flight Flight/etc.
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
TOTAL TRAINING CASH MATCH: $0.00
THIS IS AN IN-KIND MATCH SECTION.
Conference Name Number of People Number of Days RATE: Hotel/ TRAINING COST
& Category Attending Enter "1" for Registration/
Hotel/Registration/Flight/Cab/ If sharing rooms, cab, Registration, Per Diem/
Per Diem/etc.(ex: NOVA - Hotel) etc., list as "1" person Cab, & Flight Flight/etc.
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
TOTAL TRAINING IN-KIND MATCH: $0.00
TOTAL TRAVEL/TRAINING CASH MATCH: $0.00
TOTAL TRAVEL/TRAINING IN-KIND MATCH: $0.00
Match Worksheet
G. Supplies Match - (1) List source of match; (2) List items within this category by major type (i.e. office supplies, telephones,
utilities, postage, etc.). Generally, supplies include materials that are expendable or consumed during the course of the project.
Large items should be separately listed and identified. (3) List the quantity of the item; and (4) list the unit price. THIS IS A CASH
MATCH SECTION.
List Source(s) of Match (ex: United Way, County, etc.):
Item Quantity Unit Price SUPPLIES COST
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
TOTAL SUPPLIES CASH MATCH: $0.00
THIS IS AN IN-KIND MATCH SECTION.
Item Quantity Unit Price SUPPLIES COST
1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
TOTAL SUPPLIES IN-KIND MATCH: $0.00
H. Other Match - Other funds are those match monies that are allocated to assist victims of crime for emergency purposes (ex:
petty cash) and miscellaneous items. (1) List source of match; (2) List the item(s); (3) list the quantity of the item(s); and (4) list
the unit price. THIS IS A CASH MATCH SECTION.
List Source(s) of Match (ex: United Way, County, etc.):
Item Quantity Unit Price OTHER COST
1 0.00
2 0.00
3 0.00
TOTAL OTHER CASH MATCH: $0.00
THIS IS AN IN-KIND MATCH SECTION.
Item Quantity Unit Price OTHER COST
1 0.00
2 0.00
3 0.00
TOTAL OTHER IN-KIND MATCH: $0.00
TOTAL CASH MATCH: $0.00
TOTAL IN-KIND MATCH (excluding volunteer match): $0.00
TOTAL CASH & IN-KIND MATCH (excluding volunteer match): $0.00
Match Worksheet
If you are asking for continued funding, a comparison between your current grant award and the new grant request is needed. Please
fill out the Program Expenditure Comparison Section and explain the difference in the program expenses incurred last fiscal year
and those anticipated during this fiscal year.
3. Program Expenditure Comparison Summary
If you have been funded during the last grant year, provide the following federal grant award figures. If you have not been funded
during the last grant cycle, leave this section blank. This year's funding will automatically appear in the column after you have
completed the Budget Detail Worksheet Section of the grant application. (1) Enter last year's funding amount; (2) complete the VOCA-
funded personnel section; and (3) justify the differences in expenses incurred during last fiscal year and those anticipated during
this fiscal year. PLEASE INCLUDE ONLY FEDERAL FUNDS.
Last Year's Project: Amount This Year's Request: Amount Amount
2009 2010 Difference
Number of Grant Months Number of Grant Months 12
Personnel Personnel 0.00 0.00
Contracted Fees Contracted Fees 0.00 0.00
Equipment Equipment 0.00 0.00
Travel/Training Travel/Training 0.00 0.00
Supplies Supplies 0.00 0.00
Other Other 0.00 0.00
TOTAL COSTS $0.00 TOTAL COSTS $0.00 $0.00
LAST YEAR'S Personnel. NOTE: THE TOTAL COLUMNS WILL CALCULATE AUTOMATICALLY
BENEFIT TOTAL TOTAL
VOCA
NAME OF VOCA HOURLY TOTAL PERCENT VOCA VOCA
POSITION FUNDED
FUNDED EMPLOYEE RATE SALARY include % FUNDED SALARY &
HOURS
sign BENEFIT BENEFIT
1 0.00 0.00 $0.00
2 0.00 0.00 $0.00
3 0.00 0.00 $0.00
4 0.00 0.00 $0.00
5 0.00 0.00 $0.00
6 0.00 0.00 $0.00
7 0.00 0.00 $0.00
TOTAL VOCA FUNDED SALARY & BENEFIT $0.00
Justify (in detail) the differences in expenses incurred during the 2009 grant year and those anticipated during the 2010 grant year.
Space is limited to the area below.
Program Expenditure Comparison Summary
4. VOCA FUNDED EQUIPMENT SUMMARY
This section requires all subgrantees requesting continued funding to list all VOCA purchased equipment received from 7/1/07 to 6/30/10.
It includes purchased equipment that has been fully or partially funded through VOCA. If you have not been funded by VOCA within
the last 3 years, leave this section blank. DO NOT INCLUDE MATCH AMOUNTS. (1) List all equipment paid fully or partially by
VOCA; (2) specify the program year equipment was purchased (example: 2007-2008); (3) include the total equipment amount supported
by VOCA funds (example: $1,250 funded by VOCA , although actual cost totals $2,500); and (4) indicate the total cost of the
equipment (see example under part "3").
TYPE OF EQUIPMENT PROGRAM YEAR COST FUNDED TOTAL COST
PURCHASED by VOCA of EQUIPMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
See Equipment Inventory Requirements. NOTE: All applicants are required to sign the Equipment Inventory Requirement,
regardless of whether or not your proposed contract contains a request for equipment within the budget detail worksheet.
Equipment Summary
EQUIPMENT INVENTORY REQUIREMENTS
Subgrantees are required to maintain, as part of the financial records of the grant, the following types of equipment management records
for all equipment acquired in whole or part with grantor agency funds. At a minimum, management records must meet the following
requirements:
1 Records must contain copies of purchase orders and invoices.
2 The records must include an inventory control listing for nonexpendable equipment which must be kept current, and the records
must contain:
a. Item description;
b. Source of equipment;
c. Manufacturer's serial number and, if applicable, control number;
d. Grantor agency funded cost equity at time of acquisition;
e. Acquisition date and cost;
f. Location, use and condition of property; and
g. Ultimate disposition data including sale price or the method used to determine current fair market value.
3 A physical inventory of all equipment costing more than $300 per item shall be taken and the results reconciled with the
equipment record to verify the existence, current utilization and continued need for the equipment. The result of the inventory
must be forwarded to the state for review and concurrence, and shall become part of the official grant file.
4 A control system shall be in effect to ensure adequate safeguards to prevent loss, damage or theft to nonexpendable equipment.
Any loss, damage or theft of nonexpendable equipment shall be investigated, fully documented and made part of the official
grant file.
5 Adequate maintenance procedures shall be established to keep the nonexpendable equipment in good condition.
6 Proper sales procedures which would provide for competition to the maximum extent practical and result in the highest possible
return shall be established for unneeded nonexpendable equipment.
7 Records for nonexpendable equipment which has been acquired in whole or in part with federal grant funds must be retained for
three years after final disposition of the nonexpendable equipment.
8 A copy of your agency's equipment inventory requirements shall be submitted to OCVR with the final Quarterly Progress
Report (due July 31, 2011).
As the duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above certifications.
Signature: Date:
Equipment Summary
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