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PCA Sample Budget Narrative and Personnel Justification Tables

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 

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