This sample line-item budget narrative is provided as a broad outline for the fiscal year 2023 competitive School-Based Service Expansion (SBSE)) funding opportunity. A detailed budget narrative is required for all items within each category for which funds are requested for each 12-month period (budget year) of the two-year period of performance. Clearly explain and justify each cost. The budget narrative should be classified into federal and non-federal resources, and a table of personnel to be paid with federal funds must be provided. See Section 5.1 of HRSA’s SF-424 Two-Tier Application Guide (PDF - 702 KB) and section IV.2.iv in the SBSE Notice of Funding Opportunity for detailed guidance on completing your budget narrative and personnel justification table.
Revenue
(Consistent with information presented in the SF-424A: Budget Information Form)
REVENUE | Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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SBSE Funding Request (up to $350,000 per year if proposing a new school-based service site, or up to $250,000 per year if proposing expansion of services at existing site(s) only) |
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Applicant Organization | ||||
State Funds | ||||
Other Support | ||||
Program Income (fees, third party reimbursements, and payments generated from the projected delivery of services) |
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TOTAL REVENUE |
Expenses
(Object class totals should be consistent with those presented in Section B of the SF-424A: Budget Information Form)
PERSONNEL (Include budget details for each staff position as seen in the Personnel Justification sample) |
Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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Administration | ||||
Medical | ||||
Mental Health Services | ||||
Substance Use Disorder Services | ||||
Dental | ||||
Vision Services | ||||
Enabling | ||||
TOTAL PERSONNEL |
FRINGE BENEFITS (Fringe benefits should be proportional to allocated personnel costs) |
Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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FICA @ X.XX% | ||||
Medical @ X% | ||||
Retirement @ X% | ||||
Dental @ X% | ||||
Unemployment & Workers Compensation @ X% | ||||
Disability @ X% | ||||
TOTAL FRINGE @ X% |
TRAVEL (Include details for local and long-distance travel) |
Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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Pediatric Mental Health Conference
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Local travel for Community Health Worker to travel to the schools where our proposed school-based service sites are located to provide health education and promote school-based services
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TOTAL TRAVEL |
EQUIPMENT (Provide the total cost for moveable equipment costing $5,000 or more each. Year 1 funding request for minor A/R and equipment combined may not exceed $150,000.) |
Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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TOTAL EQUIPMENT (see Equipment List for details) |
SUPPLIES (Include equipment items that cost less than $5,000 each and other supplies) |
Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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Tablets for providers to connect with EHR system (4 tablets @ $XXX each) | ||||
Office Supplies ($X per month x 12 months) | ||||
Medical Supplies ($X.XX per visit x X,XXX visits) | ||||
TOTAL SUPPLIES |
CONTRACTUAL (Include detailed justification) |
Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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Psychiatrist Services (contracted at 0.20 FTE) | ||||
Mental health first aid training for school-based personnel (30 hours @ $XX per hour) | ||||
Laboratory Services ($X per sample x X,XXX samples) | ||||
TOTAL CONTRACTUAL |
CONSTRUCTION (Minor Alteration and Renovation) (Provide the total cost for each minor A/R project. Include line-item costs in the A/R Project Budget Justification. Year 1 funding request for minor A/R and equipment combined may not exceed $150,000.) |
Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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TOTAL CONSTRUCTION (see Minor A/R Budget Justification for details) |
OTHER (Include detailed justification) |
Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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EHR provider licenses for new staff (4 @ $XX each) | ||||
Staff Recruitment – newspaper and Internet posting | ||||
Gas for mobile unit to travel to # schools in the XYZ school district | ||||
TOTAL OTHER | ||||
TOTAL DIRECT CHARGES (Sum of TOTAL Expenses) |
INDIRECT CHARGES (Include approved indirect cost rate agreement as an attachment or explain de minimis rate) |
Year 1: Federal Request | Year 1: Non-Federal Resources | Year 2: Federal Request | Year 2: Non-Federal Resources |
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X% indirect cost rate | ||||
TOTALS (Total of TOTAL DIRECT CHARGES and INDIRECT CHARGES) |
Federal Personnel Justification Sample
Provide personnel costs for all direct hire staff and contractors to be supported by SBSE funding. Funds may not be used to pay an individual at a rate in excess of Federal Executive Level II of the Federal Executive Pay scale (PDF - 3 KB) ($212,100 as of January 2023).
Name | Position Title | Base Salary | Adjusted Annual Salary* | % of FTE to Support SBSE Project | Federal Amount Requested |
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R. Lee | Nurse Practitioner | $95,000 | No adjustment needed | 100 | $95,000 |
A. White | Psychiatrist (contracted) | $245,000 | $212,100 | 20 | $42,420 |
S. Brown | Medical Assistant | $45,000 | No adjustment needed | 50 | $22,500 |
T. Ruiz | Social Worker | $55,000 | No adjustment needed | 50 | $27,500 |
TOTAL | $187,420 |
*Use this column only when the salary is over the limitation of $212,100.