FIPSE Budget Summary Form

U.S. Department of Education Budget Summary				OMB Control Number: xxxx-xxxx
				Expiration Date: xx/xx/xxxx
1. Program ______________ (drop down box)			2. Select One: Lead (fiscal agent) Partner
3. Name of Institution/Organization:
Project Costs Requested from FIPSE:
Budget Categories	Project Year 1 (a)	Project Year 2 (b)	Project Year 3 (c)	Project Year 4 (d)	Total (e)
4. Personnel (salary & wages)
5. Fringe Benefits (employee benefits)
6. Travel
7. Equipment (purchase)
8. Supplies (and materials)
9. Contractual (enter partner totals here)
10. Other (equipment rental, printing, etc.)
11. Total Direct Costs (lines 4-10)
12. Indirect Costs* (8% of line 11)
13. Mobility Stipends
14. Language Stipends
15. Subtotal of Stipends (lines 13+14)
16. Total Requested from FIPSE (lines 11+12+15) (These figures should appear on the Title Form)
Project Costs Not Requested from FIPSE:
17. Lead Partner non-federal funds
18. Subcontractor(s) non-federal funds
Funds Requested by Foreign Partners:
19a. Total Requested from Canada
19b. Total Requested from Mexico
19c. Total Requested from Brazil
19d. Total Requested from Europe
*Indirect Cost Information (To be completed by Your Business Office): If you are requesting reimbursement for indirect costs on line 12, please answer the following questions: (1) Do you have an Indirect Cost Rate Agreement approved by the federal government? Yes No (Radio Button) (2) If Yes, please provide the following information: Period covered by the Indirect Cost Rate Agreement: From: mm/dd/yyyy To: mm/dd/yyyy Approving federal agency: ED Other (please specify): __________________ (Radio Button) (3) For Restricted Rate Programs (select one) - - Are you using a restricted indirect cost rate that: Is included in your approved Indirect Cost Rate Agreement? Or, Complies with 34 CFR 76.564(c)(2)? (Radio Button)