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OVERTIME

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                                APPLICANT AGENCY:
OVERTIME
                                PROJECT TITLE:
INSTRUCTIONS:
1. This form should include any requested overtime for   4. Enter the total in the Total Costs column.
   personnel.                                            5. Under the Fringe Benefits section, identify the
2. Under Name of Individual, list the name of the           particular benefits, if any, associated with the overtime
   person who the overtime is being requested for.          costs.
3. Under the column entitled Basis for Cost Estimate,    6. If you are submitting this form with the Personnel
   enter the formula for computing overtime for each        Budget page, the Total Cost listed for PERSONNEL on
   individual. (Ex: Hourly wage x number of hours per       the Application for Funding form should be the total
   week x number of weeks)                                  from both of these pages.
     NAME OF INDIVIDUAL                            BASIS FOR COST ESTIMATE                               TOTAL COST




                                                                       OVERTIME SUBTOTAL             $            0.00
       FRINGE BENEFITS                             BASIS FOR COST ESTIMATE                               TOTAL COST
FICA & MEDICARE (0.0765)

PENSION / SRETIREMENT

LIFE INSURANCE

MEDICAL INSURANCE

UNEMPLOYMENT COMPENSATION
WORKERS’ COMPENSATION
LIABILITY

OTHER (PLEASE IDENTIFY)


                                                                           FRINGE SUBTOTAL           $           0.00

                                                          TOTAL OVERTIME COST                    $               0.00

				
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