Contracts for Delivery

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                                                Department of Human Services
                                             Division of Contracts and Rate Setting

                                              Small Dollar
                                  Contract Budget Preparation Program
             The objective of this program is to facilitate the completion of DHS Form CM-468 for submission to
          OCRS as part of the contract application process. The Small Dollar Budget can be used for social
          services delivery contracts valued at $25,000 or less. Contracts valued at more than that amount must
          be prepared on the CM-468 form. Small dollar contract budget (CM-469) which can be generated by
          this MS-Excel spreadsheet application. It should be noted that the limitations in the CM-468 pertaining
          to allowable and unallowable costs, apply also to expenditures summarized on the CM-469.
             Use built-in Excel features to print and save the budget form. Click on the spreadsheet tabs at the
          bottom of the screen to display guidelines, purposes or instruction statements.

          Department of Human Services (DHS) will not discriminate against any individual or group because of
          race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender
          identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc.,
          under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office
          in your area.

CM-469 (Rev. 2-11) MS Excel
                     Department of Human Services - Office of Contracts and Rate Setting
                              Small Dollar Contract Budget (For Contracts Under $25,000)
Contractor:                                                  Contract #:
Contact Person:                                              Contract Amount:
Phone Number:                                                Budget Period:

Line Item DESCRIPTION                                              Hours Spent per
                                                                      Week on                            DHS Contract
                                                                      Program      Salary/Hourly Rate      Budget
Salaries: (List Position Titles & # hours spent per week on this

                                                                                 0                  0                      0

Fringe Benefits (Identify Each)

Occupancy (Describe Costs)

Communication (Describe Costs)

Supplies (Describe Costs)

Equipment (Describe Costs)

Transportation - (Describe Costs) (@ or below State rates)

Subcontractors (List Contractors, Service & Cost)

Specific assistance to individuals (List Services)

Miscellaneous total (List each cost item and cost)

Total:                                                                                                                     0

                                       <---Number of units to be provided               #DIV/0!         <--Rate per unit

    CM-469 (Rev. 2-11) MS Excel

              You may enter additional comments on this sheet or attach
                      supplemental materials to your CM-469.

CM-469 (Rev. 2-11) MS Excel

A contractor may be asked to prepare a budget which may be used for two different purposes:


  Actual Cost Reimbursement Method. The approved projected budget is part of the contract and
  serves as the basis for payment. Total expenditures are limited to the total budget amount. The
  contractor is paid actual expenditures made in accordance with the budget. Expenditures cannot
  exceed 5% or $1,500 (whichever is greater) of any line item without a transfer from underspent line
  items in the same budget approved in advance by DHS.


  Unit Rate Reimbursement Method. The approved projected budget is used to justify the unit
  price. The budget is used as basis for negotiation, or to analyze (together with the narrative
  proposal) the resources to be used in providing service. The budget does not control expenditures or
  serve as the basis for payment because the contractor is paid a set price for each unit of service
  provided. The unit rate cannot be changed during the term of the contract, unless the contract
  specifically provides for a rate change.

CM-469 (Rev. 2-11) MS Excel                           PURPOSE

The potential contractor is encouraged to review the entire budget package before completing the
Budget Statement. It is advisable to also review the Allowable and Unallowabe costs in CM-468.

* Budget development shall be based on sound cost accounting principles.

* Budget submitted by non-profit organizations for contracts involving federal funding, in whole
  or in part, shall be in compliance with OMB Circular A-122.

* Budget figures shall be the projected amount of actual allowable expenditures.

* Only those costs that support program activity shall be included in the budget.

* Costs not specifically identified under the "Allowable and Unallowable Costs" portions of the
  full Contract Budget form (CM-468) may be included if reasonable and necessary. These costs
  should be discussed with DHS staff.

* Unallowable costs shall not appear in the budget.

* Some cost items allowed by other funding sources may not be allowable in DHS' portion of the budget.
  A brief narrative describing these cost items should be provided on the budget statement comment

* Copies of appropriate budget and contract/grant award letters for services funded by other sources
  should be submitted to DHS along with this budget.

* Amounts from the other agencies (budgets) should be explained on the comment page. Please include
  who and the amount.

* The relationship of proposed program costs with those of existing programs will be determined
  as part of the budget review process. To the extent that duplicate costs can be identified, those
  duplicate costs will not be allowed by DHS, as well as costs not clearly supported as "reasonable
  and necessary."

CM-469 (Rev. 2-11) Ms Excel                           GUIDELINES
                             FOR COMPLETING BUDGET FORM

Contract Identification
1) Enter contractor's name. Make sure that the name you enter corresponds to the name
   which the contractor has registered with M.A.I.N. so that payment problems do not arise.
2) Enter contract number.
3) Enter the amount of the contract.
4) Enter the name of the local or program office contract from which the contract originates.
5) Enter the beginning and ending dates for the contract. For instance, 10-1-2006 to 9-30-2007.

Line Items
Within the space provided, and as specifically as you can, describe the item for which an
expenditure is proposed. If space does not permit an individual listing, a summary
description is acceptable. Additional information can be provided on the comment sheet.

Total Program Budget
Enter the total amount budgeted for the line item described.

CM-469 (Rev. 2-11) MS Excel                     INSTRUCTIONS

Description: Contracts for Delivery document sample