You must include two items when you apply for a Primary Care Association (PCA) cooperative agreement. You must include a budget narrative. This shows how you will use the funds. You must also include one or more personnel justification tables. These show how much staff and contractors will be paid from the federal funds.
These samples are for reference only. Use them to help you write your application.
The Budget Narrative section of the Notice of Funding Opportunity (NOFO) will tell you what to include. The NOFO can be found on the PCA technical assistance webpage.
On this page:
Sample budget narrative
Personnel
Include budget details for each staff position in the Personnel Justification table(s).
| Budget Line Item | Federal Amount Requested: Year 1 |
Federal Amount Projected Year 2 Total |
Federal Amount Projected Year 3 Total |
|---|---|---|---|
| L. Minjarez, Chief Executive Officer (CEO) | $31,800 | ||
| R. Perez, T/TA Director | $125,000 | ||
| J. Jones, Project Manager | $90,000 | ||
| J. Rodriguez, Data Analyst | $115,000 | ||
| P. Singh, Project Director | $62,500 | ||
| C. Pepper, Workforce Lead | $50,000 | ||
| TOTAL PERSONNEL | $474,300 |
Fringe Benefits
| Budget Line Item | Federal Amount Requested: Year 1 |
Federal Amount Projected Year 2 Total |
Federal Amount Projected Year 3 Total |
|---|---|---|---|
| FICA @ X.XX% | |||
| Health Insurance Coverage @ X% | |||
| Retirement @ X% | |||
| Unemployment & Workers Compensation @ X% | |||
| Disability @ X% | |||
| Tuition Reimbursement | |||
| TOTAL FRINGE @ X% |
Travel
| Budget Line Item | Federal Amount Requested: Year 1 |
Federal Amount Projected Year 2 Total |
Federal Amount Projected Year 3 Total |
|---|---|---|---|
| Conference participation, Trip Total = Airfare ($XXX for each FTE) + hotel and transportation expense ($XXX for each FTE x Y days) | |||
| Workshop participation, Trip Total = Airfare ($XXX for each FTE) + hotel and transportation expense ($XX for each FTE x Y days) + training fee (X trainings @ $XX for each FTE) | |||
| Local travel to meet with health center staff, Trip Total = Mileage reimbursement (XXX miles @ $X.XX per mile) | |||
| TOTAL TRAVEL |
Equipment
Include items of movable equipment that cost $5,000 or more and will last one year or more.
| Budget Line Item | Federal Amount Requested: Year 1 |
Federal Amount Projected Year 2 Total |
Federal Amount Projected Year 3 Total |
|---|---|---|---|
| 1 printer and fax combo @ $X,XXX needed for materials distribution | |||
| TOTAL EQUIPMENT |
Supplies
Include items that cost less than $5,000 per unit and other supplies.
| Budget Line Item | Federal Amount Requested: Year 1 |
Federal Amount Projected Year 2 Total |
Federal Amount Projected Year 3 Total |
|---|---|---|---|
| Office Supplies: $XX per month x 12 months | |||
| Educational Supplies: X Adobe Professional software licenses at $XX each | |||
| TOTAL SUPPLIES |
Contractual
| Budget Line Item | Federal Amount Requested: Year 1 |
Federal Amount Projected Year 2 Total |
Federal Amount Projected Year 3 Total |
|---|---|---|---|
| Data Strategy Inc. (data strategy for T/TA evaluation), fixed price contract; remote (no travel) | |||
| Consulting Partners (workforce T/TA consultants): XXX hours, @ $XXX/hour, remote (no travel) | |||
| TOTAL CONTRACTUAL |
Other
| Budget Line Item | Federal Amount Requested: Year 1 |
Federal Amount Projected Year 2 Total |
Federal Amount Projected Year 3 Total |
|---|---|---|---|
| Printing Services: $X per brochure x 2,500 copies | |||
| Utilities: $XXX/month x 12 months | |||
| TOTAL OTHER |
Total Costs
| Budget Line Item | Federal Amount Requested: Year 1 | Projected Year 2 Total | Projected Year 3 Total |
|---|---|---|---|
| TOTAL DIRECT CHARGES (Sum of TOTAL Expenses tables above (e.g., Personnel, Fringe Benefits, Travel, Equipment, Supplies, Contractual, and Other) | |||
| TOTAL INDIRECT CHARGES (X.XX% Indirect Rate) Note: Approved indirect cost rate must be included under Attachment 8: Other Relevant Documents. |
|||
| TOTAL COSTS |
Sample personnel justification tables
Provide information for all personnel paid with federal funds. Use one table for direct hire staff, one for contractors.
Do not use federal funds to pay anyone more than Federal Executive Level II of the Federal Executive Pay scale. This amount may change annually ($212,100, as of January 2023). This applies to the base salary. It does not include fringe benefits or outside income.
Refer to the NOFO for further guidance.
Table 1: Personnel justification table for direct hire staff
| Staff Name | Position Title | FTE | Full-Time Base Salary | Adjusted Annual Salary* | Federal Amount Requested |
|---|---|---|---|---|---|
| L. Minjarez | Chief Executive Officer | 0.15 | $225,000 | $212,100 | $31,800 |
| P. Singh | Project Director | 0.5 | $125,000 | No adjustment needed | $62,500 |
| R. Perez | T/TA Director | 1.0 | $125,000 | No adjustment needed | $125,000 |
| J. Jones | Project Manager | 1.0 | $90,000 | No adjustment needed | $90,000 |
| J. Rodriguez | Data Analyst | 1.0 | $115,000 | No adjustment needed | $115,000 |
| C. Pepper | Workforce Lead | 1.0 | $50,000 | No adjustment needed | $50,000 |
Total: $474,300
*Use this column only when the salary is over the limitation of $212,100.
Table 2: Personnel justification table for contractors
| Staff Name | Position Title | FTE | Full-Time Base Salary | Adjusted Annual Salary* | Federal Amount Requested |
|---|---|---|---|---|---|
| TBD | Data Strategy Inc. (Fixed price contract; contractor 1 of 3) | N/A | N/A | N/A | $15,000 |
| TBD | Data Strategy Inc. (Fixed price contract; contractor 2 of 3) | N/A | N/A | N/A | $15,000 |
| TBD | Data Strategy Inc. (Fixed price contract; contractor 3 of 3) | N/A | N/A | N/A | $15,000 |
Total: $45,000