We created these two sample tables. They’ll help as you apply for the Fiscal Year 2025 (FY25) Health Center Controlled Network (HCCN) Cooperative Agreement.
What to do
Include a budget narrative and personnel justification tables. Show how you’ll use HCCN funds for costs that will advance progress on the objectives.
Find guidance
See the Notice of Funding Opportunity (NOFO) under Budget Narrative with Personnel Justification Table.
View on grants.gov: HRSA-25-018 Fiscal Year 2025 Health Center Controlled Network (HCCN) Cooperative Agreements.
Jump to:
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 |
|---|---|---|---|
| John Dillard, Chief Executive Officer (CEO) | $55,475 | ||
| Marsha Braxton, HCCN Program Lead | $70,000 | ||
| Edwina Finch, Quality Improvement Team Lead | $90,000 | ||
| Paul Potter, Program Coordinator | $75,000 | ||
| TOTAL PERSONNEL | $290,475 |
Fringe benefits
| Budget Line Item | Federal Amount Requested: Year 1 |
Federal Amount Projected Year 2 Total |
Federal Amount Projected Year 3 Total |
|---|---|---|---|
| FICA @ X.XX% |
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| Health Insurance Coverage @ X% |
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| Retirement @ X% |
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| Unemployment & Workers Compensation @ X% |
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| Disability @ X% |
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| Tuition Reimbursement |
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| TOTAL FRINGE @ X% |
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Travel
| Budget Line Item | Federal Amount Requested: Year 1 | Projected Year 2 Total |
Projected Year 3 Total |
|---|---|---|---|
| Conference participation, Trip Total = Airfare ($XXX for each FTE) + hotel and transportation expense ($XXX for each FTE x Y days) |
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| Workshop participation, Trip Total = Airfare ($XXX for each FTE) + hotel and transportation expense ($XX for each FTE x Y days) + training fee (X trainings @ $XX for each FTE) |
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| Local travel to meet with health center staff, Trip Total = Mileage reimbursement (XXX miles @ $X.XX per mile) |
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| TOTAL TRAVEL |
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Equipment
Provide the total cost for moveable equipment with a unit cost of $5,000 or more and with a useful life of one year or more.
| Budget Line Item | Federal Amount Requested: Year 1 | Projected Year 2 Total |
Projected Year 3 Total |
|---|---|---|---|
| 1 printer and fax combo @ $X,XXX needed for materials distribution |
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| TOTAL EQUIPMENT |
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Supplies
Include items that cost less than $5,000 per unit.
| Budget Line Item | Federal Amount Requested: Year 1 | Projected Year 2 Total |
Projected Year 3 Total |
|---|---|---|---|
| Office Supplies: $XX per month x 12 months |
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| Educational Supplies: X Adobe Professional software licenses at $XX each | |||
| TOTAL SUPPLIES |
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Contractual
| Budget Line Item | Federal Amount Requested: Year 1 | Projected Year 2 Total |
Projected Year 3 Total |
|---|---|---|---|
| Data Analytics Inc. (data strategy for T/TA evaluation), fixed price contract; remote (no travel) |
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| Health Information Technology Training Center (surveyor T/TA consultants): XXX hours, @ $XXX/hour, remote (no travel) | |||
| TOTAL CONTRACTUAL |
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Other
| Budget Line Item | Federal Amount Requested: Year 1 | Projected Year 2 Total |
Projected Year 3 Total |
|---|---|---|---|
| Printing Services: $X per brochure x 2,500 copies |
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| Utilities: $XXX/month x 12 months | |||
| TOTAL OTHER |
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Total costs
| Total Costs | 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) |
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| TOTAL INDIRECT CHARGES (X.XX% Indirect Rate) | |||
| TOTAL COSTS |
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Sample personnel justification tables
List the personnel costs for all direct hire staff and contractors you will support with the HCCN project. (There’s one table for staff and one for contractors.)
You may not use funds to pay someone at a rate that exceeds the Federal Executive Level II of the Federal Executive Pay Scale (PDF - 3 KB) ($221,900 as of January 2024).
Table 1: Personnel justification table for direct hire staff
| Staff Name | Position Title | FTE | Full Time Annual Base Salary | Adjusted Annual Salary* | Federal Amount Requested |
|---|---|---|---|---|---|
| John Dillard | Chief Executive Officer | 0.25 | $240,000 | $221,900 | $55,475 |
| Marsha Braxton | HCCN Program Lead | 0.50 | $140,000 | No adjustment needed | $70,000 |
| Edwina Finch | Quality Improvement Team Lead | 1.0 | $90,000 | No adjustment needed | $90,000 |
| Paul Potter | Program Coordinator | 1.00 | $75,000 | No adjustment needed | $75,000 |
| TOTAL | $290,475 | ||||
*Use this column only when the salary is over the $221,900 limit.
Table 2: Personnel justification table for contractors
| Staff Name | Position Title | FTE | Full-Time Base Salary | Adjusted Annual Salary* | Federal Amount Requested |
|---|---|---|---|---|---|
| TBD | Data Analyst (Fixed price contract; contractor 1 of 3) | N/A | N/A | N/A | $13,000 |
| TBD | Data Analyst (Fixed price contract; contractor 2 of 3) | N/A | N/A | N/A | $13,000 |
| TOTAL | $26,000 |