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Salary Claiming Agreement

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					                                                      ASSOCIATED BLACK CHARITIES, INC.
                                                            RYAN WHITE PART A
                                                      BUDGET FORM INSTRUCTIONS FY2008
Associate Black Charities, Inc. has created and revised the format for budget submission
This set of instructions will help you in the completion of the Associated Black Charities Ryan
White Part A budget forms.
                       Please read the instructions before completing the forms.

COVER PAGE
Name of Organization :                     place the official name of your organization as chartered in your Articles
FEIN                 :                     place your federal employee identification number
Address              :                     the address of your organization
Contact Person       :                     the name of the person to be contacted and allowed to make decisions
Telephone            :                     the phone number to the contact person
Fax                  :                     fax number that you can receive facsimile messages/correspondence
Email                :                     email address of the contact person
Service Category     :                     the service category awarded (see Service Category on your award notice)
Grant Title          :                     Ryan White Part A
Period               :                     3/1/2009 through 2/28/2010
Fiscal Year          :                     2009
Contract Number      :                     your contract number (see Contract Number on your award notice)

NARRATIVE
A brief narrative description of each funded salary position must be submitted with your budget. The narrative should describe the
responsibilities and duties associated with the position.

FORM NUMBER                                FORM NAME
ABC form N-1                Program Budget Summary
This form is required for Ryan White awards issued by Associated Black Charities, Inc. It is divide into two sections:
              Section I
                         A Grant Title            : Ryan White Part A
                         B Organization           : your organizations name
                         C Address                : self explanatory
                         D City, State, County    : self explanatory
                         E Zip                    : self explanatory
                         F Contact Person         : name of contact person
                         G Phone                  : phone number of the contact person
                         H Contract Number        : see award notice
                         I Service Category       : see award notice
                         J Fiscal Year            : 2009
                         K Contract Period        : 3/1/09 - 2/28/10
                         L Date Submitted         : date submitted to ABC

               Section II This section is divided into four columns:
            Line Items and Totals Column
                          Line items are set and may not be changed. If an additional line item is needed list the
                              titles under "Other" line item and specify the item in Budget Line Item Narrative, N-6.
            Administrative Budget Column
                          This column contains all administrative cost, to include indirect cost, for this award and
                              can not exceed 10% of the total award.
                              Administrative Cost are:
                            * Usual and recognized overhead including established indirect rates for your agency,
                              such as supplies, rent, utilities, insurances and negotiated indirect cost.
                            * Management and oversight of specific programs funded under this title such as program
                              officers supervision, accountants, MIS support, audit and legal services.
                            * Other types of program support such as quality assurance, quality control and related
                              activities.
                           ** Providers claiming an indirect cost must submit their most current negotiated indirect
                              cost rate issued by the cognizant federal agency.




4ffd95d0-5f90-4bdb-abd9-4f30211b75e7.xls                                                                                             Rev 11/07 SJP
                                                      ASSOCIATED BLACK CHARITIES, INC.
                                                            RYAN WHITE PART A
                                                      BUDGET FORM INSTRUCTIONS FY2008
FORM NUMBER                                FORM NAME
         Direct Services Budget Column
                        Allocations for service that directly benefits Ryan White HIV clients such as staff, medicine
                            and drugs, clinical supplies, etc..
        The final determination for cost allocations resides with Associated Black Charities, Inc.
                    Total Budget Column
                             This column reflects the total amounts budgeted per line item and the total of all line items
                                 plus your indirect cost (if applicable). The total cost should not exceed the award
                                 amount shown on your award notice.

ABC form N-2                       Administrative Salary Schedule
                                       Record the full time equivalency rate for you organization on the line
                                       labeled "Organizations FTE".
                                   List the job number, position title, employee's name, annual salary, months in budget and full
                                       time equivalency percentage of administrative staff for the project. The total in the Base
                                       Amount column and Fringe column must match the Salaries and Fringe line item on budget
                                       form N-1 in the Administrative Budget column.
                                   In the box titled "Fringe Cost Composed of", delineate your fringe cost. The total fringe cost
                                       percentage is the one you will use in the Amount of Fringe box for both Salary Schedules
                                       N-2 and N-2a.

ABC form N-2a                      Direct Services Salary Schedule
                                       Record the full time equivalency rate for you organization on the line
                                       labeled "Organizations FTE".
                                   List the job number, position title, employee's name, annual salary, months in budget and full
                                       time equivalency percentage of program staff for the project. The total in the Base
                                       Amount column and Fringe column must match the Salaries and Fringe line item on budget
                                           form N-1 in the Direct Service Budget column.

ABC form N-3                       Consultant Budget Schedule
                                   List the names of each Consultant with a description of the duties to be preformed including
                                   the consultants Degree and/or license title, professional area, hourly wage and number of hours
                                   per week and number of weeks to be budgeted. Total funding requested is computed by
                                   multiplying the hourly wage by the number of hours per week then by the number of weeks.
                                       I.e.. Hrly wage x Hrs per Wk x Total Wks = Funds Requested
                                       * Submit this schedule blank if not applicable to your agency.

ABC form N-4                       Equipment Schedule
                                   Give a description or name of the equipment to be purchased (use the make and model number
                                      if known) and include a narrative describing the purpose of this equipment as it relates to
                                      the Ryan White Part A program
                                    * Submit this schedule blank if not applicable to your agency.

ABC form N-5                       Emergency Financial Voucher Schedule
                                   List the types of vouchers with a brief description, the cost per unit and the number of units
                                       budgeted for distribution. The total cost budgeted for each voucher is computed by
                                       multiplying the cost per unit by the number of units.
                                     * Submit this schedule blank if not applicable to your agency.

ABC form N-5PMC                    Medication / Lab Schedule
                                   List the types of lab test or medication, the cost per unit and the number of units
                                       budgeted for distribution. The total cost budgeted for each voucher is computed by
                                       multiplying the cost per unit by the number of units.
                                     * Submit this schedule blank if not applicable to your agency.




4ffd95d0-5f90-4bdb-abd9-4f30211b75e7.xls                                                                                             Rev 11/07 SJP
                                                   ASSOCIATED BLACK CHARITIES, INC.
                                                         RYAN WHITE PART A
                                                   BUDGET FORM INSTRUCTIONS FY2008
FORM NUMBER                                FORM NAME
ABC form N-5TRANS Transportation Schedule
                  List the types of transportation, the cost per unit and the number of units
                      budgeted for distribution. The total cost budgeted for each voucher is computed by
                      multiplying the cost per unit by the number of units.
                    * Submit this schedule blank if not applicable to your agency.

ABC form N-5SAT                    Substance Abuse Treatment Schedule
                                   List the separate modalities (Outpatient or Residential), the cost per unit and the number of
                                       units budgeted for distribution. The total cost budgeted for each voucher is computed by
                                       multiplying the cost per unit by the number of units.
                                     * Submit this schedule blank if not applicable to your agency.

ABC form N-5HOUSING                Housing Schedule
                                   List the types of housing, the cost per unit and the number of units
                                       budgeted for distribution. The total cost budgeted for each voucher is computed by
                                       multiplying the cost per unit by the number of units.
                                     * Submit this schedule blank if not applicable to your agency.

ABC form N-5ORAL                   Oral Health Schedule
                                   List the types of dental service, the cost per procedure and the number of procedures
                                       budgeted for distribution. The total cost budgeted for each voucher is computed by
                                       multiplying the cost per unit by the number of units.
                                     * Submit this schedule blank if not applicable to your agency.

ABC form N-5HEALTH                 Health Insurance Schedule
                                   List the co-pays, the cost per unit and the number of units
                                       budgeted for distribution. The total cost budgeted for each voucher is computed by
                                       multiplying the cost per unit by the number of units.
                                     * Submit this schedule blank if not applicable to your agency.

ABC form N-6                       Line Item Budget Narrative
                                   The budget narrative begins with the Rent line item, therefore it is important to include all
                                      schedules N-1 through N-5, for they all make up your budget narrative.
                                   The line items are predefined and may not be changed, In the Budget Narrative column give a
                                      detail description for that line item. If you have a line item that has been allocated amongst
                                      the two budget columns you must describe your computational method.
                                   Example: Supplies - to provide for the cost of pens, pencils and paper to be utilized by
                                      Ryan White staff for counseling and testing @ .25 FTE Direct and .75 FTE Admin.
                                      Annual cost at $3,500
                                      Admin Cost is 3,500 @.75FTE $2,625/Program Cost is 3,500 @ .25FTE $875

Attachment E                       Summary of Funding Sources
                                   See Worksheet Titled "Attachment E Instructions" for directions on how to fill out Attachment E.

ABC form                           Award Listing Detail
Attachment E-1a                    List all contract numbers awarded followed by the amounts of each contract then total these
                                       amounts.

ABC form N-7                      Budget Packet Check List
                                  A. Review your budget package to ensure it is completed. Place a check mark or X in the
                                     appropriate space. The Appendix Section list additional attachments which are documents
                                     needed to complete your budget packet.
                                  B. Affirmation and Signature of Certifying Official
                                     Print or type the name and title of the person certifying the budget submission.
                                     This person is authorized to make decisions and enter into contractual agreements for



4ffd95d0-5f90-4bdb-abd9-4f30211b75e7.xls                                                                                               Rev 11/07 SJP
                                                      ASSOCIATED BLACK CHARITIES, INC.
                                                            RYAN WHITE PART A
                                                      BUDGET FORM INSTRUCTIONS FY2008
FORM NUMBER                                FORM NAME
                                           your agency. He or she must also sign and date the checklist.


If you have any questions on the completion of the Associated Black Charities, Inc. budget forms,
       call Sonney J. Pelham-Senior Accountant, Ryan White Fiscal Office at (443) 524-7715.




4ffd95d0-5f90-4bdb-abd9-4f30211b75e7.xls                                                                   Rev 11/07 SJP
               Reporting Requirements Specific to Service Categories



Organizations awarded contracts to provide Transportation services, Emergency
Financial Assistance, Oral Health, Housing Assistance, Health Insurance,
Primary Care or Substance Abuse treatment, please be advised of the following,
NEW reporting Requirements.

Transportation:
            Providers’ budgets and monthly fiscal reports, must break out costs on the different modes of
            transportation, e.g., taxi, van, bus for FY 2009 executed service contracts.


            Guidance – on budget form N-1, section II in the column labeled “Line Items”, under “other” list all
            modes of transportation provided by your organization. Project the amount of money needed for each
            mode and put that amount in the “Direct Service” column on the budget. Then explain your projected
            allocation on form N-6 under other, to include the estimated number of trips for each mode and the
            estimated cost for each trip by mode If vouchers are used to pay for the transportation, budget form N-
            5 may be used in place of Form N-6.

Emergency Financial Assistance:


                Providers’ budgets and monthly fiscal reports, must identify the services that are funded as a sub-
                set of EFA and report expenditures for each of the services(e.g. utilities, food, transportation,
                professional services and medications).


            Guidance – on budget form N-1, section II in the column labeled “Line Items”, under “other” list all
            the services provided by your organization with EFA dollars. Project the amount of money needed
            for each type of service. Then explain your projected allocation on form N-5, to include the estimated
            number and cost for each trip by type of trip.

Oral Health:

            Providers’ budgets and monthly fiscal reports must identify expenditures used for Dentures and all
            other procedures paid for using Ryan White Title I funds.

            Guidance – on budget form N-1, section II in the column labeled “Line Items”, under “other” list
            dentures. Project amount of money to be used for dentures. On budget form N-6 breakout the
            estimated cost associated with the purchase of dentures for each client and the number and type of all
            other procedures paid for using Ryan White Title I funds.

Housing Assistance:
           Providers’ budgets and monthly fiscal reports must identify the number and expenditures for bed
           nights and rental assistance vouchers utilized.



            Guidance – on budget form N-1, section II in the column labeled “Line Items”, under “other” list
            bednights and under that, list rental assistance vouchers as line items. Project your annual expenditures
            for each. On budget for N-6 report the number of bed nights and the associated costs, and the number
            of rental assistance voucher and the corresponding cost. Projected costs for line items on form N-6
            should equal the costs listed on form N-1.
                                                               5
               Reporting Requirements Specific to Service Categories

            Guidance – on budget form N-1, section II in the column labeled “Line Items”, under “other” list
            bednights and under that, list rental assistance vouchers as line items. Project your annual expenditures
            for each. On budget for N-6 report the number of bed nights and the associated costs, and the number
            of rental assistance voucher and the corresponding cost. Projected costs for line items on form N-6
            should equal the costs listed on form N-1.

Substance Abuse Treatment (Outpatient & Residential):
         Providers’ budgets and monthly fiscal reports, must break out costs associated with each modality
         provided.


            Guidance – on budget form N-1, section II in the column labeled “Line Items”, under “other”; list
            each modality provided as a line item. Project expenditures for each modality and put that under
            “Direct Services” on for N-1 for the appropriate line item (modality). Project the number of clients for
            each modality and report that on form N-6 with the corresponding projected expenditures.

Health Insurance
          Providers' budgets and monthly fiscal reports must break out the number and costs associated with
          expenditures for "on-going" co-pays . Expenditures for "Co-pays" are no longer captured under the
          Case Management and Client Advocacy categories. Please Note: Co-pays under Emergency Financial
          Assistance are not affected by this change.



            Guidance – on budget form N-1, section II in the column labeled “Line Items”, under “other”; list "Co-
            pays" as a line item. Project expenditures for all co-pays and put that under “Direct Services” on form
            N-1 in the row now designated for "Co-pays". On form N-6 under other list "Co-pays" as a line item
            and provide details on the estimated number and cost of each co-pay to be utilized in FY2007 and the
            total projected expenditures for all.

Primary Care
          Providers' budgets and monthly fiscal reports must break out the number type and cost of all
          medications and laboratory test paid for by Ryan White Title I funds.

            Guidance - on Budget Form N-5PMC provide detail on the name, number and cost of all
            medications and laboratory tests paid for using Ryan White Title I funds. Please add to the form all
            medications.




                                                              6
                      ASSOCIATED BLACK CHARITIES
                         1114 CATHEDRAL STREET
                       BALTIMORE, MARYLAND 21201
               RYAN WHITE PART A - BUDGET PACKET DOCUMENT


COVER PAGE



 NAME OF ORGANIZATION         HIV/AIDS Volunteeer Enrichment Network, Inc.

                       FEIN

                ADDRESS




         CONTACT PERSON


              TELEPHONE                       FAX                  E-MAIL



    SERVICE CATEGORY

         GRANT TITLE          Ryan White Part A



 PERIOD FOR WHICH                  FROM                                TO
 SUPPORT IS BEING
 REQUESTED                    FISCAL YEAR



 CONTRACT NUMBER
                                       ASSOCIATED BLACK CHARITIES, INC.
                                              RYAN WHITE PART A
                                                PROGRAM BUDGET SUMMARY
                                                    BUDGET FORM N-1

SECTION I

A   GRANT TITLE:                  RYAN WHITE PART A                               H   CONTRACT NUMBER:
B   ORGANIZATION:                                                                 I   SERVICE CATEGORY:
C   STREET ADDRESS:                                                               J   FISCAL YEAR:               2009
D   CITY, STATE, COUNTY:                                                          K   CONTRACT PERIOD:           3/1/09 - 2/28/10
E   ZIP:                                                                          L   DATE SUBMITTED:
F   CONTACT PERSON:
G   PHONE #:


SECTION II
                                                             ADMINISTRATIVE            DIRECT SERVICE             TOTAL
    LINE ITEMS MAY NOT BE CHANGED                                BUDGET                   BUDGET                  BUDGET
    SALARIES                                                                                                                        0
    FRINGE                                                                                                                          0
    CONSULTANT                                                                                                                      0
    EQUIPMENT                                                                                                                       0
    VOUCHERS                                                                                                                        0
    RENT                                                                                                                            0
    UTILITIES                                                                                                                       0
    COMMUNICATIONS                                                                                                                  0
    TRANSPORTATION/TRAVEL                                                                                                           0
    INSURANCE                                                                                                                       0
    LEGAL                                                                                                                           0
    ACCOUNTING                                                                                                                      0
    AUDIT                                                                                                                           0
    SUPPLIES                                                                                                                        0
    MEDICINE/DRUGS                                                                                                                  0
    CLINICAL SUPPLIES                                                                                                               0
    POSTAGE                                                                                                                         0
    CONTRACTUAL SERVICES                                                                                                            0
    PRINTING                                                                                                                        0
    EQUIPMENT MAINTENANCE/ REPAIRS                                                                                                  0
    STAFF TRAINING                                                                                                                  0
    OTHER                                                                                                                           0
                                                                                                                                    0
                                                                                                                                    0
                                                                                                                                    0
    TOTAL DIRECT COSTS                                                        0                         0                           0
    INDIRECT COST                                                                                                                   0
    TOTAL COST                                                                0                         0                           0
    PERCENTAGE UTILIZATION *                                     #DIV/0!                #DIV/0!                     #DIV/0!
    Admin Cost cannot exceed 10% of your total budget to include any Indirect cost allowances.
    * Percentage utilization is computed by dividing the total cost in each of the columns by the Total cost of the budget.




ABC N-1 (11/28/07)
                                                     ASSOCIATED BLACK CHARITIES, INC.
                                                            RYAN WHITE PART A
                                                       ADMINISTRATIVE SALARY SCHEDULE
                                                               BUDGET FORM N-2
                         ORGANIZATION NAME:                                     0                           Organization's
                          SERVICE CATEGORY:                                     0                             FTE in hrs :
                           CONTRACT PERIOD: 3/1/09 - 2/28/10
                          CONTRACT NUMBER: 00-0000-000

                                                                       ANNUAL           #          %          BASE           AMOUNT         TOTAL
                                                                       SALARY        MONTHS      TIME        AMOUNT          FRINGE        AMOUNT
JOB NO. POSITION TITLE                        EMPLOYEES NAME            RATE         BUDGET      (FTE)      REQUIRED          0.00%       REQUIRED

                                                                                                                 0             0                     0

                                                                                                                 0             0                     0

                                                                                                                 0             0                     0

                                                                                                                 0             0                     0

                                                                                                                 0             0                     0

                                                                                                                 0             0                     0

                                                                                                                 0             0                     0

                                                                                                                 0             0                     0

                                                                                                                 0             0                     0

                                                                                                                 0             0                     0
 TOTALS                                                                         0                    0.00               0             0              0

FRINGE COSTS COMPOSED OF:                                                           PERCENTAGE
Social Security Contribution (FICA)
State Unemployment Insurance
Health Insurance
Pension
Workman's Compensation
Other (Specify)


TOTAL FRINGE COSTS (FOR BOTH SCHEDULES N-2 AND N-2A)                                               0.00%




    ABC N-2 (11/28/07)
                                               ASSOCIATED BLACK CHARITIES, INC.
                                                      RYAN WHITE PART A
                                                 DIRECT SERVICES SALARY SCHEDULE
                                                         BUDGET FORM N-2A
                      ORGANIZATION NAME:                                    0                      Organization's
                       SERVICE CATEGORY:                                    0                        FTE in hrs :            0
                        CONTRACT PERIOD: 3/1/09 - 2/28/10
                       CONTRACT NUMBER: 00-0000-000

 JOB NO. POSITION TITLE                           EMPLOYEES NAME   ANNUAL          #       %          BASE          AMOUNT         TOTAL
                                                                   SALARY       MONTHS   TIME        AMOUNT         FRINGE        AMOUNT
                                                                    RATE        BUDGET   (FTE)      REQUIRED         0.00%       REQUIRED

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

                                                                                                         0            0                     0

 TOTALS                                                                     0               0.00               0             0              0




ABC N-2a (11/28/07)
                                               ASSOCIATED BLACK CHARITIES, INC.
                                                      RYAN WHITE PART A
                                                   CONSULTANT BUDGET SCHEDULE
                                                        BUDGET FORM N-3
         ORGANIZATION NAME:
          SERVICE CATEGORY:
           CONTRACT PERIOD: 3/1/09 - 2/28/10
          CONTRACT NUMBER:

                                                        DEGREE                   HOURLY   HOURS   TOTAL   TOTAL
CONSULTANTS NAME                     DESCRIPTION OF      and/or   PROFESSIONAL   WAGE     PER     #       FUNDING
                                        DUTIES         LICENSES   AREA                    WEEK    WEEKS   REQUESTED


                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

                                                                                                                        0

TOTALS                                                                                                                0.00




   ABC N-3 (11/28/07)
                      ASSOCIATED BLACK CHARITIES, INC.
                             RYAN WHITE PART A
                              EQUIPMENT SCHEDULE
                                BUDGET FORM N-4
    ORGANIZATION NAME:                                   0
     SERVICE CATEGORY:                                   0
      CONTRACT PERIOD: 3/1/09 - 2/28/10
     CONTRACT NUMBER:

                                                              AMOUNT
EQUIPMENT DESCRIPTION                 BUDGET NARRATIVE       BUDGETED




TOTALS                                                              -




 ABC N-4 (11/28/07)
                     ASSOCIATED BLACK CHARITIES, INC.
                           RYAN WHITE PART A
       EMERGENCY FINANCIAL VOUCHERS SCHEDULE
                  BUDGET FORM N-5
   ORGANIZATION NAME:                                0
    SERVICE CATEGORY:                                0
     CONTRACT PERIOD: 3/1/09 - 2/28/10
    CONTRACT NUMBER:


                                         ESTIMATED       ESTIMATED         TOTAL
                                          COST PER        NUMBER           COST
VOUCHER TYPE/DESCRIPTION                    UNIT          OF UNITS       BUDGETED

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

                                                                                    0

 TOTALS                                                              0              0




ABC N-5 (11/28/07)
                        ASSOCIATED BLACK CHARITIES, INC.
                              RYAN WHITE PART A
                                  MEDICATION / LAB SCHEDULE
                                    BUDGET FORM N-5PMC
    ORGANIZATION NAME:                                                               0
     SERVICE CATEGORY:                                                               0
      CONTRACT PERIOD: 3/1/09 - 2/28/10
     CONTRACT NUMBER:

                                                                     ESTIMATED            ESTIMATED            TOTAL
                                                                      COST PER             NUMBER              COST
Type of Lab Test or Medication                                          UNIT               OF UNITS          BUDGETED
X-Ray Chest Abdomen                                                                                                      0
Computed Tomography                                                                                                      0
MRI                                                                                                                      0
Ultrasound , Abdomen                                                                                                     0
*CD4                                                                                                                     0
*CBC                                                                                                                     0
*Hepatitis BS Ab                                                                                                         0
*Hepatitis B core AB                                                                                                     0
*RPR                                                                                                                     0
RPR / titre confirmation                                                                                                 0
Toxoplasmosis                                                                                                            0
*Cholesterol                                                                                                             0
G6pd quanntitative                                                                                                       0
Mycobacterial Blood Culture                                                                                              0
Blood Cultures                                                                                                           0
Cryptoccal Antigen                                                                                                       0
                                                                                                                         0
                                                                                                                         0
Add all Medications below:                                                                                               0
                                                                                                                         0
                                                                                                                         0
                                                                                                                         0
                                                                                                                         0
                                                                                                                         0
                                                                                                                         0
                                                                                                                         0

 TOTALS                                                                                                  0               0
**Please Note: Reporting for all test on primary care contracts should not include tests processed through the central
laboratory service.



ABC N-5PMC (11/28/07)
                                         ASSOCIATED BLACK CHARITIES, INC.
                                                RYAN WHITE PART A
                                           TRANSPORTATION SCHEDULE
                                             BUDGET FORM N-5TRANS

    ORGANIZATION NAME:
     SERVICE CATEGORY:
      CONTRACT PERIOD:                      03/01/2009 Through 02/28/2010
     CONTRACT NUMBER:


                                                                                                                     ACTUAL
                                                                         COST PER               NUMBER                TOTAL
TYPE OF TRANSPORTATION                                                     UNIT                 OF UNITS              COST

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

Note:Weekly and Monthly Passes are not allowable

 TOTALS                                                                                                       0               0

Units and Expenditures reported on this form are actual expenditures for the Month and Not Cumulative year to date data.


       ABC N-5TRANS (11/28/07)
                                         ASSOCIATED BLACK CHARITIES, INC.
                                                RYAN WHITE PART A
                                    SUBSTANCE ABUSE TREATMENT SCHEDULE
                                            BUDGET FORM N-5SAT

    ORGANIZATION NAME:
     SERVICE CATEGORY:
      CONTRACT PERIOD:                         03/01/2009 Through 02/28/2010
     CONTRACT NUMBER:


                                                                                                                           ACTUAL
                                                                               COST PER              NUMBER                 TOTAL
Modalities                                                                       Unit                OF UNITS               COST

Substance Abuse Treatment Outpatient                                                                                                0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

Substance Abuse Treatment Residential                                                                                               0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0

                                                                                                                                    0




 TOTALS                                                                                                             0               0


Units and Expenditures reported on this form are actual expenditures for the Month and Not Cumulative year to date data.


       ABC N-5SAT (11/28/07)
                                         ASSOCIATED BLACK CHARITIES, INC.
                                                RYAN WHITE PART A

                                        HOUSING ASSISTANCE SCHEDULE
                                             BUDGET FORM N-5HOUSING

    ORGANIZATION NAME:
     SERVICE CATEGORY:
      CONTRACT PERIOD:
     CONTRACT NUMBER:


                                                                                                                     ACTUAL
                                                                         COST PER               NUMBER                TOTAL
TYPE OF HOUSING PROVIDED                                                   UNIT                 OF UNITS              COST



                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

 TOTALS                                                                                                       0               0

Units and Expenditures reported on this form are actual expenditures for the Month and Not Cumulative year to date data.


       ABC N-5HOUSING (11/28/07)
                                         ASSOCIATED BLACK CHARITIES, INC.
                                                RYAN WHITE PART A
                                              ORAL HEALTH SCHEDULE
                                              BUDGET FORM N-5ORAL

    ORGANIZATION NAME:
     SERVICE CATEGORY:
      CONTRACT PERIOD:                      03/01/2009 Through 02/28/2010
     CONTRACT NUMBER:


                                                                                                                     ACTUAL
                                                                         COST PER             NUMBER                  TOTAL
TYPE OF DENTAL SERVICE PROVIDED                                          Procedure          OF Procedures             COST

Diagnostic procedures                                                                                                         0

Restorative procedures                                                                                                        0

Endodontic procedures                                                                                                         0

Periodontic procedures                                                                                                        0

Prosthodontic (removal) procedures                                                                                            0

Oral Surgery procedures                                                                                                       0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

 TOTALS                                                                                                       0               0

Units and Expenditures reported on this form are actual expenditures for the Month and Not Cumulative year to date data.


       ABC N-5ORAL (11/28/07)
                                         ASSOCIATED BLACK CHARITIES, INC.
                                                RYAN WHITE PART A
                                          HEALTH INSURANCE SCHEDULE
                                            BUDGET FORM N-5HEALTH

    ORGANIZATION NAME:
     SERVICE CATEGORY:
      CONTRACT PERIOD:                      03/01/2009 Through 02/28/2010
     CONTRACT NUMBER:


                                                                                                                     ACTUAL
                                                                         COST PER               NUMBER                TOTAL
On Going CO-PAYS                                                           UNIT                 OF UNITS              COST

CO-PAYS                                                                                                                       0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

                                                                                                                              0

 TOTALS                                                                                                       0               0

Units and Expenditures reported on this form are actual expenditures for the Month and Not Cumulative year to date data.


       ABC N-5HEALTH (11/28/07)
                                                          ASSOCIATED BLACK CHARITIES, INC.
                                                                RYAN WHITE PART A
                                                              LINE ITEM BUDGET NARRATIVE
                                                                    BUDGET FORM N-6
                        ORGANIZATION NAME:
                         SERVICE CATEGORY:
                          CONTRACT PERIOD: 3/1/09 - 2/28/10
                         CONTRACT NUMBER:

                                                                                           Administrative   Direct Service    AMOUNT
LINE ITEM DESCRIPTION               BUDGET EXPLANATION                                     Cost             Cost             BUDGETED



RENT                                                                                                                                    0.00


UTILITIES                                                                                                                               0.00


COMMUNICATIONS                                                                                                                          0.00


TRANSPORTATION/TRAVEL                                                                                                                   0.00


INSURANCE                                                                                                                               0.00


LEGAL                                                                                                                                   0.00


ACCOUNTING                                                                                                                              0.00


AUDIT                                                                                                                                   0.00


SUPPLIES                                                                                                                                0.00


MEDICINE/DRUGS                                                                                                                          0.00


CLINICAL SUPPLIES                                                                                                                       0.00


POSTAGE                                                                                                                                 0.00


CONTRACTUAL SERVICES                                                                                                                    0.00




PRINTING                                                                                                                                0.00




   ABC N-6 (REV 11/28/07)
                                                             ASSOCIATED BLACK CHARITIES, INC.
                                                                   RYAN WHITE PART A
                                                                    LINE ITEM BUDGET NARRATIVE
                                                                          BUDGET FORM N-6
                        ORGANIZATION NAME:
                         SERVICE CATEGORY:
                          CONTRACT PERIOD: 3/1/09 - 2/28/10
                         CONTRACT NUMBER:

                                                                                                                               Administrative          Direct Service           AMOUNT
LINE ITEM DESCRIPTION               BUDGET EXPLANATION                                                                         Cost                    Cost                    BUDGETED




EQUIPMENT MAINTENANCE/REPAIRS




STAFF TRAINING

                                    If you need to add more lines for 'OTHER', RIGHT MOUSE CLICK ONTO ROW 27 , hold
                                    and drag downward the amount of addition lines and release mouse, then click Insert then
OTHER (LIST BELOW):                 Row.


                                                                                                                                                                                          0.00


                                                                                                                                                                                          0.00


                                                                                                                                                                                          0.00

 TOTALS                                                                                                                                         0.00                    0.00              0.00




   ABC N-6 (REV 11/28/07)
Attachment E Summary of Funding Sources

Grantees must submit one Attachment E - Summary of Funding Sources for each
contractor/subcontractor receiving Part A funds that year. This includes contractors/subcontractors
providing a Grantee Administration or Quality Management, Planning Council Support, or Program
Support service/activity.

Enter the name of the contractor as it appears on the CRC at the top of the Summary, and follow the
instructions below to prepare each Summary.

1. Enter the amount of funds awarded under this Part A award only in column 1 activity(ies) for each
object class category. Refer to Object Class Categories, above, for guidance on each object class.


2. Use column 2 to report other Part A funds from other sources (i.e., prior fiscal year(s) that will be
used to provide this year’s Part A-funded service(s)/activity(ies) for each object class category).

3. Use column 3 to report Part B CARE Act funds awarded to the contractor/provider that will be used
to provide this year’s Part A-funded service(s)/activity(ies) for each object class category.

4. Use column 4 to report Part C CARE Act funds awarded to the contractor/provider that will be used
to provide this year’s Part A-funded service(s)/activity(ies) for each object class category.

5. Use column 5 to report Part D CARE Act funds awarded to the contractor/provider that will be used
to provide this year’s Part A-funded service(s)/activity(ies) for each object class category.

6. Use column 6 to report funds awarded to the contractor/provider under the Housing Opportunities
for People With AIDS (HOPWA) grant program that will be used to provide this year’s Part A-funded
service(s)/activity(ies) for each object class category.
7. Use column 7 to report city/county and/or State funds awarded to the contractor/provider that will be
used to provide this year’s Part A-funded service(s)/activity(ies) for each object class category.

8. Use column 8 to report General Operating funds from private sources awarded to the
contractor/provider (e.g., a grant from a corporation, foundation, or United Way, that will be used to
provide this year’s Title I-funded service(s)/activity(ies) for each object class category).
9. Total the amounts budgeted from various sources that will be used by the contractor/provider to
provide this year’s Part A-funded service(s)/activity(ies) in column 9, across each object class
category.
10. Total Costs: Add up the amounts budgeted for each object class in each column, and enter the
resulting sums for each column on the bottom line.
                                                                                                                                                            ATTACHMENT E
Fiscal Year: 2009
Period of Title I Contracts: 3/1/09-2/28/10

NAME OF CONTRACTOR:*



                                                                         SUMMARY OF FUNDING SOURCES

                                                             PART A                                                                                         GENERAL
                                          PART A             OTHER                                                                            CITY AND/OR   OPERATING/
  OBJECT CLASS CATEGORIES              THIS AWARD**         SOURCES           PART B          PART C        PART D          HOPWA                STATE      PRIVATE      TOTAL BUDGET

PERSONNEL                                                                                                                                                                          -

FRINGE BENEFITS                                                                                                                                                                    -

TRAVEL                                                                                                                                                                             -

EQUIPMENT                                                                                                                                                                          -

SUPPLIES                                                                                                                                                                           -

CONTRACTUAL                                                                                                                                                                        -

OTHER                                                                                                                                                                              -

TOTAL DIRECT CHARGES                                 -              -                  -             -            -                   -               -             -              -

INDIRECT CHARGES***                                  -              -                  -             -            -                   -                                            -

TOTAL COSTS                                          -              -                  -             -            -                   -               -             -              -
       Prepare only one summary for each provider.
       * Name of Contractor = Do not use acronyms.
       ** Amount for this Title I award only.

       Heading of columns may be changed to accommodate other funding sources.
       *** Indirect charges - allowable only with a Federally approved indirect cost rate; or agreement between the grantee and contractor.




ABC-RWAA Attachment E, FY 2008
                                        ASSOCIATED BLACK CHARITIES, INC.
                                               RYAN WHITE PART A

                                              AWARD LISTING DETAIL
                                          BUDGET FORM ATTACHMENT E-1A
        FISCAL YEAR 2009
        PERIOD OF CONTRACTS: 3/1/09 THROUGH 2/28/10

                    NAME OF CONTRACTOR:



                                                                              PART A
                     CONTRACT NUMBER                  SERVICE CATEGORY     AWARD AMOUNT

    1

    2

    3

    4

    5

    6

    7

    8

    9

   10

   11

   12

   13

   14

   15

   16

   17

   18

   19

   20

   21

   22

   23

   24

   25

   26

   27

   28

   29

   30

   31


        TOTAL COSTS                                                                       -




ATTACHMENT E-1a (11/28/07)
                                                     ASSOCIATED BLACK CHARITIES, INC.
                                                            RYAN WHITE PART A
                                                      BUDGET PACKET CHECKLIST
                                                          BUDGET FORM N-7

A.   BUDGET PACKET CHECK LIST

     Check off the ones completed for the Budget Packet
1. COVER PAGE

2. PROGRAM BUDGET SUMMARY

3. ADMINISTRATIVE SALARY SCHEDULE

4. DIRECT SERVICES SALARY SCHEDULE

5. CONSULTANT BUDGET SCHEDULE

6. EQUIPMENT SCHEDULE

7. EMERGENCY FINANCIAL VOUCHER SCHEDULE

8. LINE ITEM BUDGET NARRATIVE PAGES

9. SUMMARY OF FUNDING SOURCES

10. AWARD LISTING DETAIL


11. APPENDIX: (Additional attachments)
     A. Lease Agreement

     B. Mortgage Agreement

     C. Insurance Certification

     D. DHMH Certification

     D. AUDIT REPORT (most recent)

B.   Affirmation and Signature of Certifying Official:

     On behalf of the governing board or other executive authority of the above named organization, I
     affirm that the information and estimates conveyed in this application are true and accurate to the
     best of my knowledge.


     Signature:                                                                        Date:


     Name Printed or Typed:                                                            Title:



            Budget Packet Checklist N-7 (11/28/07)

				
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Description: Salary Claiming Agreement document sample