EH Sample Budget Narrative and Personnel Justification Tables

Refer to these two sample tables. They’ll help as you apply for the Fiscal Year (FY) 2025 Expanded Hours (EH) funding opportunity.

What to do

Upload your 2-year budget narrative in the HRSA Electronic Handbooks (EHBs). Include your:

Refer to the Budget Narrative Section IV.2.iv of the FY 2025 EH notice of funding opportunity (NOFO).

Jump to:

Include budget details for each staff position in the personnel justification table(s).

Object Class Category	Year 1 Federal Request	Year 1 Non-Federal Funds	Year 2 Federal Request	Year 2 Non-Federal Funds
Physician to provide medical services during expanded hours at X proposed sites
Licensed clinical social worker (LCSW) to provide mental health services during expanded hours at X proposed sites
Nurse to provide medical services during expanded hours at X proposed sites
TOTAL PERSONNEL

Object Class Category	Year 1 Federal Request	Year 1 Non-Federal Funds	Year 2 Federal Request	Year 2 Non-Federal Funds
FICA @ X.XX%
Medical @ X%
Retirement @ X%
Unemployment & Workers Compensation @ X%
Disability @ X%
Dental @ X %
TOTAL FRINGE @ X%

Object Class Category	Year 1 Federal Request	Year 1 Non-Federal Funds	Year 2 Federal Request	Year 2 Non-Federal Funds
Local travel between sites for LCSW and nurse to provide services at the sites where we propose to expand hours ($X.XX mileage rate @ X miles for X trips per week x XX weeks)
LCSW training for group-based mental health to meet needs expressed by patients (X @ $XXX)
TOTAL TRAVEL

Provide the total cost for moveable equipment with a unit cost of $5,000 or more.

Your year 1 funding request for minor A/R and equipment combined cannot exceed $150,000.

You cannot request EH funds for equipment costs in year 2.

Include line-item costs in the Equipment List form (See Equipment List (PDF - 119 KB) for details).

Object Class Category	Year 1 Federal Request	Year 1 Non-Federal Funds	Year 2 Federal Request	Year 2 Non-Federal Funds
XXX item to support YYY
TOTAL EQUIPMENT

Include items that cost less than $5,000 per unit separated into three categories: office supplies, medical supplies, and educational supplies.

Object Class Category	Year 1 Federal Request	Year 1 Non-Federal Funds	Year 2 Federal Request	Year 2 Non-Federal Funds
Cameras for added security during late evening expanded hours (X @ $XXX)
Office supplies during expanded hours ($X per month x 12 months)
Medical supplies during expanded hours ($X per visit x X,XXX visits)
TOTAL SUPPLIES

Object Class Category	Year 1 Federal Request	Year 1 Non-Federal Funds	Year 2 Federal Request	Year 2 Non-Federal Funds
Consultant to facilitate the design and implementation of the workflow, staffing, and culture changes necessary to achieve the proposed expansion at X sites (X hours @ $XX per hour)
TOTAL CONTRACTUAL

Provide the total cost for each minor alteration and renovation (A/R) project.

Year 1 funding request for minor A/R and equipment combined may not exceed $150,000.

You cannot request EH funds for minor A/R in year 2.

Object Class Category	Year 1 Federal Request	Year 1 Non-Federal Funds	Year 2 Federal Request	Year 2 Non-Federal Funds
Conversion of storage space to group counseling space at ABC site to address the group-based mental health needs expressed by patients
TOTAL CONSTRUCTION

Object Class Category	Year 1 Federal Request	Year 1 Non-Federal Funds	Year 2 Federal Request	Year 2 Non-Federal Funds
EHR provider licenses for new staff hired to provide care during additional hours (X @ $XX per license)
Staff recruitment through internet advertisements (X @ $XX)
TOTAL OTHER

Object Class Category	Year 1 Federal Request	Year 2 Federal Request
TOTAL DIRECT CHARGES (Enter the sum of TOTAL from the tables above: Personnel, Fringe Benefits, Travel, Equipment, Supplies, Contractual, Construction, and Other)
TOTAL INDIRECT CHARGES (X.XX% Indirect Rate) Note: If applicable, you must provide your indirect cost rate agreement under Attachment 1: Other Relevant Documents.
TOTAL COSTS	$500,000 or less	$500,000 or less

List the personnel costs for all direct hire staff and contractors you will support with EH funding.

You may not use funds to pay an individual at a rate in excess of Federal Executive Level II of the Federal Executive Pay Scale (PDF - 3 KB) ($221,900 as of January 2024).

Staff Name	Position Title	% of FTE	Full-Time Base Salary	Adjusted Annual Salary*	Federal Amount Requested
T. Jones	Physician	0.3	$300,000	$221,900	$66,570
J. Smith	Licensed clinical social worker	0.2	$61,420	No adjustment needed	$12,284
B. Doe	Nurse	0.5	$81,220	No adjustment needed	$40,610
A. Martin	Consultant (contracted)	0.15	$95,290	No adjustment needed	$14,294
TOTALS		1.15 FTE	$537,930		$133,758

*Use this column only when the salary is over the limitation of $221,900.

Staff Name	Position Title	% of FTE	Full-Time Base Salary	Adjusted Annual Salary*	Federal Amount Requested
T. Jones	Physician	0.3	$300,000	$221,900	$66,570
J. Smith	Licensed clinical social worker	0.2	$61,420	No adjustment needed	$12,284
B. Doe	Nurse	0.5	$81,220	No adjustment needed	$40,610
TOTALS		1 FTE	$442,640		$119,464

Date Last Reviewed:

May 2024