FSR to General Ledger Worksheet. The worksheet shall provide an analysis of the general ledger by documenting the expenses into the categorial budget category. The Worksheet shall be completed on the System Agency template. DocuSign Envelope ID: 35D9B1DF-1623-4677-AF84-E06F3CD5ACD1 Categorical Budget DocuSign Envelope ID: 35D9B1DF-1623-4677-AF84-E06F3CD5ACD1 Health and Human Services Contract Number HHS0001278700001
FSR to General Ledger Worksheet. The worksheet shall provide an analysis of the general ledger by documenting the expenses into the categorial budget category. The FSR to General Ledger Worksheet shall be completed on the System Agency template. Budget Summary Attachment B-1 Approved Categorical Budget EXHIBIT C Solicitation RFA HHS0012453 3 University of Texas at Arlington Organization Name: Region Budget Categories NOTE for the purpose of the RFA. Match is not required. Budget Categories HHSC Funds Requested Cash Match In Kind Match Contributions Category Total Personnel $178,345 $0 $15,000 $193,345 Fringe Benefits $53,503 $0 $1,500 $55,003 Travel $2,996 $0 $0 $2,996 Equipment $0 $0 $0 Supplies $2,619 $0 $0 $2,619 Contractual $0 $0 $0 Other $29,436 $0 $0 $29,436 Total Direct Costs $266,898 $0 $16,500 $283,398 Indirect Costs $63,102 $0 $0 $63,102 Totals $330,000 $0 $16,500 $346,500 Subcontracting Subcontracting Percentage: 0.0% Match Contributions Required Match Percentage: 5% Calculated Match Percentage: 5% Required Match Amount: $16,500 Calculated Match Amount: $16,500 Source of Cash Match Funds Volunteer master's level social work interns who qualify as case managers. They will be trained and supervised by licensed staff. Source of In Kind Match Funds Program Income Projected Earnings Source of Earnings Non-HHSC Funding $0 $0 $0 $0 $0 Direct Federal Funds: Other State Agency Funds: Local Funding Sources: Other Funds: Total Projected Non-HHSC Funding: INSTRUCTIONS When preparing the budget, you should budget for all costs that your organization will incur in carrying out the HHSC program If Match is not required for your program there should not be funds in the categories under Cash Match or In Kind Match Contributions after you enter funds in the HHSC Funds Requested column. Budget Categories
FSR to General Ledger Worksheet. The worksheet shall provide an analysis of the general ledger by documenting the expenses into the categorial budget category. The FSR to General Ledger Worksheet shall be completed on the System Agency template. Budget Summary Bluebonnet Trails Community MHMR Center N/A PADRES Organization Name Contract Number Program ID Region Budget Categories Budget Categories System Agency Funds Requested Cash Match Non System Agency funds Category Total Personnel $169,576.00 $0.00 $0.00 $169,576 00 Fringe Benefits $47,481.00 $0.00 $0.00 $47,481 00 Travel $2,645.00 $0.00 $0.00 $2,645 00 Equipment $0.00 $0.00 $0.00 $0 00 Supplies $15,725.00 $0.00 $0.00 $15,725 00 Contractual $0.00 $0.00 $0.00 $0 00 Other $51,504.00 $0.00 $16,500.00 $68,004 00 Total Direct Costs $286,931.00 $0.00 $16,500.00 $303,431.00 Indirect Costs $43,069.00 $0.00 $0.00 $43,069 00 Totals $330,000.00 $0.00 $16,500.00 $346,500.00 Subcontracting 0.0% Subcontracting Percentage: Rev. 4/18 Match Contributions Required Match Percentage: 5% Calculated Match Percentage: 5% Required Match Amount: $16,500.00 Calculated Match Amount: $16,500.00 Source of Cash Match Funds Source of In Kind Match Funds donated office space at various locations Program Income Projected Earnings Source of Earnings Non System Agency Funding $0.00 $0.00 $0.00 $0.00 $0.00 Direct Federal Funds: Other State Agency Funds: Local Funding Sources: O her Funds: Total Projected Non-System Agency Funding: Personnel Category Detail Bluebonnet Trails Community MHMR Center N/A PADRES 2024 Organization Name: Contract Number: Program ID: Region: Fiscal Year: Total Contract Value (System Agency+Match) Date Submitted to HHSC: Personnel Functional Title Justification Existing Proposed Vacant Total FTE's Total Avg Monthly Salary/Wage Number of Months Funding Source Salary / Wages Requested for Project Director of Substance Abuse Services Program oversight .2 0.2 $9,013 9 Cash 16,224.00 Program Director Program management 1 1 $6,370 9 Cash 57,330.00 PADRES Case Manager Case management services 1 1 $4,205 9 Cash 37,845.00 PADRES Case Manager Case management services 1 1 $3,720 9 Cash 33,478.00 PADRES Case Manager Case management services .5 0.5 $3,720 9 Cash 16,739.00 PADRES Case Manager Case management services 0 0 $3,720 10 Cash - Customer Service Representative manages scheduling, uploads paperwork, maintains paper f les, orders supplies, coordinates transportation for clients, answers phones .5 0.5 $1,769 9 Cash 7,960.00 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 ...
FSR to General Ledger Worksheet. The worksheet shall provide an analysis of the general ledger by documenting the expenses into the categorial budget category. The FSR to General Ledger Worksheet shall be completed on the System Agency template. DocuSign Envelope ID: 78AE0C53-2F73-4E85-89DD-3693D739BAAB The organization’s most recent indirect cost rate approved by a federal cognizant agency or state single audit coordinating agency. Expired rate agreements are not acceptable. Attach a copy of the rate agreement to this form (Form I - 7 Indirect) Rate Base EXHIBIT C Solicitation RFA HHS0012451 Lubbock Regional MHMR Center dba StarCare Specialty 1 Organization Name: Region: Personnel Functional Title Justification Existing Proposed Vacant Total FTE's Total Avg Monthly Salary/Wage Number of Months Funding Source Salary / Wages Requested for Project Case Manager A case manager is a Qualified Mental Health Professional that completes screenings and assessments, makes referrals, recruits and engages participants, develops treatment plans facilitating participant choice. Provides education about Teratogens, substances that can harm an unborn baby, including alcohol, nicotine, street drugs, as well as prescriptions, over the counter medications, herbs, and environmental agents; Uses motivational interviewing and counseling techniques to express acceptance, manage resistance and support self-confidence. 2 2 $3,290 12 Cash 78,960.00 Program Director/Case Manager A case manager is a Qualified Mental Health Professional that completes screenings and assessments, makes referrals, recruits and engages participants, develops treatment plans facilitating participant choice. Provides education about Teratogens, substances that can harm an unborn baby, including alcohol, nicotine, street drugs, as well as prescriptions, over the counter medications, herbs, and environmental agents; Uses motivational interviewing and counseling techniques to express acceptance, manage resistance and support self-confidence. Xxxxxx is based on 50% of the day working on Director responsibilities, and the remaining time working on case management. This position is responsible for providing leadership and overall management necessary to support program operations for all Outreach grants (PATH,PADRE). Will assist the SUD Services supervisor Behavioral Health Director in developing and monitoring budgets; manage contract and program performance and fiscal and workload data; ensures compliance with Center policies and procedures, ...
FSR to General Ledger Worksheet. The worksheet shall provide an analysis of the general ledger by documenting the expenses into the categorial budget category. The FSR to General Ledger Worksheet shall be completed on the System Agency template. DocuSign Envelope ID: 8472804D-2536-4323-B339-CE93E8DA21AB Attachment B-1 Approved Categorical Budget EXHIBIT C Solicitation RFA HHS0012451 Budget Summary University of Texas at Arlington Organization Name: Region Budget Categories NOTE for the purpose of the RFA. Match is not required. Budget Categories HHSC Funds Requested Cash Match In Kind Match Contributions Category Total Personnel $176,483 $0 $15,000 $191,483 Fringe Benefits $52,945 $0 $1,500 $54,445 Travel $2,996 $0 $0 $2,996 Equipment $0 $0 $0 Supplies $4,639 $0 $0 $4,639 Contractual $0 $0 $0 Other $29,836 $0 $0 $29,836 Total Direct Costs $266,898 $0 $16,500 $283,398 Indirect Costs $63,102 $0 $0 $63,102 Totals $330,000 $0 $16,500 $346,500 Subcontracting Subcontracting Percentage: 0.0% Match Contributions Required Match Percentage: 5% Calculated Match Percentage: 5% Required Match Amount: $16,500 Calculated Match Amount: $16,500 Source of Cash Match Funds Volunteer master's level social work interns who qualify as case managers. They will be trained and supervised by licensed staff. Source of In Kind Match Funds Program Income Projected Earnings Source of Earnings Non-HHSC Funding $0 $0 $0 $0 $0 Direct Federal Funds: Other State Agency Funds: Local Funding Sources: Other Funds: Total Projected Non-HHSC Funding: INSTRUCTIONS When preparing the budget, you should budget for all costs that your organization will incur in carrying out the HHSC program If Match is not required for your program there should not be funds in the categories under Cash Match or In Kind Match Contributions after you enter funds in the HHSC Funds Requested column. Budget Categories
