Form HUD 424 CBW HUD 424 CBW Grant Application Detailed Budget Worksheet

Assisted Living Conversion Program (ALCP) and Emergency Capital Repair Program (ECRP)

424-CBW

Assisted Living Conversion Program (ALCP) and Emergency Capital Repair Program (ECRP)

OMB: 2502-0542

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OMB Approval No. 2501-0017

Grant Application Detailed Budget Worksheet

(Exp. 03/31/2005)

Name and Address of Applicant:

Category
1. Personnel (Direct Labor)
Position or Individual

Estimated
Hours

Rate per
Hour

Detailed Description of Budget (for full grant period)
Applicant
Other
Other
Match
HUD
Federal
Estimated Cost
HUD Share
Funds
Share

State Share Local/Tribal
Share

Other

Program
Income

0.00
0.00

0.00
0.00
0.00
0.00

0.00
0.00

0.00

Total Direct Labor Cost

0.00

0.00

0.00
Applicant
Match

2. Fringe Benefits

Rate (%)

Base

Estimated Cost

HUD Share

0.00
Other
HUD
Funds

0.00
Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00
Other

0.00
Program
Income

0.00

0.00
0.00

0.00
0.00

0.00
0.00

Total Fringe Benefits Cost
3. Travel

3a. Transportation - Local Private Vehicle

0.00

Mileage

Rate per
Mile

0.00

0.00

Applicant
Match
Estimated Cost

HUD Share

0.00

Other
HUD
Funds

0.00

Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00

Other

0.00

Program
Income

0.00

0.00

0.00
0.00
0.00

0.00

Subtotal - Trans - Local Private Vehicle

0.00

0.00
1

0.00

0.00

0.00

0.00

0.00

0.00

form HUD-424-CBW (2/2003)

0.00

Grant Application Detailed Budget Worksheet
Detailed Description of Budget
3b. Transportation - Airfare (show destination)

Trips

Fare

Estimated Cost

Applicant
Match

Other
HUD
Funds

Other
Federal
Share

0.00
Applicant
Match

0.00
Other
HUD
Funds

0.00
Applicant
Match

0.00
Other
HUD
Funds

HUD Share

State Share Local/Tribal
Share

Other

Program
Income

0.00
0.00
0.00
Other
State Share Local/Tribal
Federal
Share
Share

0.00
Other

0.00
Program
Income

0.00
0.00
0.00
Other
State Share Local/Tribal
Federal
Share
Share

0.00
Other

0.00
Program
Income

0.00
0.00

0.00
0.00

0.00
0.00

Subtotal - Transportation - Airfare

3c. Transportation - Other

Quantity

Unit Cost

0.00

0.00

Estimated Cost

HUD Share

0.00

0.00
0.00

0.00
0.00
0.00

Subtotal - Transportation - Other

3d. Per Diem or Subsistence (indicate location)

Days

Rate per
Day

0.00

0.00

Estimated Cost

HUD Share

0.00

0.00
0.00

0.00
0.00

Subtotal - Per Diem or Subsistence
Total Travel Cost

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

Applicant
Match
4. Equipment (Only items over $5,000 Depreciated value) Quantity

Unit Cost

Estimated Cost

HUD Share

Other
HUD
Funds

Other
Federal
Share

State Share Local/Tribal
Share

Other

Program
Income

0.00

0.00
0.00

0.00

Total Equipment Cost

0.00

0.00
2

0.00

0.00

0.00

0.00

0.00

0.00

form HUD-424-CBW (2/2003)

0.00

Grant Application Detailed Budget Worksheet
Detailed Description of Budget
5. Supplies and Materials (Items under $5,000 Depreciated Value)
Applicant
Match
5a. Consumable Supplies

Quantity

Unit Cost

Estimated Cost

HUD Share

Other
HUD
Funds

Other
Federal
Share

State Share Local/Tribal
Share

Other

Program
Income

0.00

0.00
0.00
0.00

0.00
0.00

0.00

Subtotal - Consumable Supplies

0.00

0.00

0.00

Applicant
Match
5b. Non-Consumable Materials

Quantity

Unit Cost

Estimated Cost

HUD Share

0.00

Other
HUD
Funds

0.00

Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00

Other

0.00

Program
Income

0.00

0.00
0.00
0.00

0.00
0.00

Subtotal - Non-Consumable Materials
Total Supplies and Materials Cost

6. Consultants (Type)

Days

Rate per
Day

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

Applicant
Match
Estimated Cost

HUD Share

Other
HUD
Funds

Other
Federal
Share

State Share Local/Tribal
Share

Other

Program
Income

0.00
0.00

0.00

0.00
0.00

0.00

Total Consultants Cost

0.00

0.00

0.00

Applicant
Match
7. Contracts and Sub-Grantees (List individually)

Quantity

Unit Cost Estimated Cost

HUD Share

0.00

Other
HUD
Funds

0.00

Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00

Other

0.00

Program
Income

0.00
0.00
0.00

0.00
0.00

Total Subcontracts Cost

0.00

0.00
3

0.00

0.00

0.00

0.00

0.00

0.00

form HUD-424-CBW (2/2003)

0.00

Grant Application Detailed Budget Worksheet
Detailed Description of Budget
8. Construction Costs
Applicant
Match
8a. Administrative and legal expenses

Quantity

Unit Cost

Estimated Cost

HUD Share

Other
HUD
Funds

Other
Federal
Share

State Share Local/Tribal
Share

Other

Program
Income

0.00

0.00

0.00
0.00

0.00

Subtotal - Administrative and legal expenses

8b. Land, structures, rights-of way, appraisal, etc

0.00

Quantity

Unit Cost

0.00

Estimated Cost

0.00

0.00

0.00

0.00

0.00

Applicant
Match

Other
HUD
Funds

Other
Federal
Share

0.00
Applicant
Match

0.00
Other
HUD
Funds

0.00
0.00
0.00
Other
State Share Local/Tribal
Federal
Share
Share

HUD Share

State Share Local/Tribal
Share

0.00

0.00

Other

Program
Income

0.00
Other

0.00
Program
Income

0.00
0.00
0.00
0.00

Subtotal - Land, structures, rights-of way, …

8c. Relocation expenses and payments

Quantity

Unit Cost

0.00

0.00

Estimated Cost

HUD Share

0.00
0.00

0.00
0.00

0.00

Subtotal - Relocation expenses and payments

0.00

0.00

0.00

Applicant
Match
8d. Architectural and engineering fees

Quantity

Unit Cost

Estimated Cost

HUD Share

0.00

Other
HUD
Funds

0.00

Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00

Other

0.00

Program
Income

0.00

0.00
0.00
0.00

0.00

Subtotal - Architectural and engineering fees

0.00

0.00

0.00
Applicant
Match

8e. Other architectural and engineering fees

Quantity

Unit Cost

Estimated Cost

HUD Share

0.00
Other
HUD
Funds

0.00
Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00
Other

0.00
Program
Income

0.00

0.00

0.00
0.00

0.00

Subtotal - Other architectural and engineering fees

0.00

0.00
4

0.00

0.00

0.00

0.00

0.00

0.00

form HUD-424-CBW (2/2003)

0.00

Grant Application Detailed Budget Worksheet
Applicant
Match
8f. Project inspection fees

Quantity

Unit Cost

Estimated Cost

HUD Share

Other
HUD
Funds

Other
Federal
Share

State Share Local/Tribal
Share

Other

Program
Income

0.00

0.00
0.00

Subtotal - Project inspection fees

0.00

0.00

0.00

Applicant
Match
8g. Site work

Quantity

Unit Cost

Estimated Cost

HUD Share

0.00

Other
HUD
Funds

0.00

Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00

Other

0.00

Program
Income

0.00
0.00
0.00

Subtotal - Site work

0.00

0.00

0.00

Applicant
Match
8h. Demolition and removal

Quantity

Unit Cost

Estimated Cost

HUD Share

0.00

Other
HUD
Funds

0.00

Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00

Other

0.00
Program
Income

0.00
0.00
0.00

Subtotal - Demolition and removal

0.00

0.00

0.00

Applicant
Match
8i. Construction

Quantity

Unit Cost

Estimated Cost

HUD Share

0.00

Other
HUD
Funds

0.00

Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00

Other

0.00

Program
Income

0.00

0.00
0.00

0.00

Subtotal - Construction

0.00

0.00
Applicant
Match

8j. Equipment

Quantity

Unit Cost

Estimated Cost

HUD Share

0.00
Other
HUD
Funds

0.00
Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00
Other

0.00
Program
Income

0.00
0.00

0.00
0.00

Subtotal - Equipment

0.00

0.00

0.00

Applicant
Match
8k. Contingencies

Quantity

Unit Cost

Estimated Cost

HUD Share

0.00

Other
HUD
Funds

0.00

Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00

Other

0.00

Program
Income

0.00
0.00

0.00

Subtotal - Contingencies

0.00

0.00

0.00

Applicant
Match
8l. Miscellaneous

Quantity

Unit Cost

Estimated Cost

HUD Share

0.00

Other
HUD
Funds

0.00

Other
Federal
Share

0.00

0.00

State Share Local/Tribal
Share

0.00

Other

0.00

Program
Income

0.00

0.00

0.00

Subtotal - Miscellaneous
Total Construction Costs

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

5

form HUD-424-CBW (2/2003)

Grant Application Detailed Budget Worksheet
Applicant
Match
9. Other Direct Costs

Quantity

Unit Cost

Estimated Cost

HUD Share

Other
HUD
Funds

Other
Federal
Share

State Share Local/Tribal
Share

Other

Program
Income

Item
0.00
0.00

0.00
0.00
0.00
0.00

0.00

0.00
0.00

0.00
0.00
0.00

0.00

Total Other Direct Costs

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

Subtotal of Direct Costs

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

Applicant
Match
10. Indirect Costs

Rate

Base

Estimated Cost

HUD Share

Other
HUD
Funds

Other
Federal
Share

State Share Local/Tribal
Share

Other

Program
Income

Type
0.00

0.00
0.00

0.00

0.00
0.00
0.00

0.00

0.00

Total Indirect Costs

Total Estimated Costs

0.00

0.00
6

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

form HUD-424-CBW (2/2003)

OMB Approval No. 2501-0017

Grant Application Detailed Budget Worksheet

(Exp. 03/31/2005)

Detailed Description of Budget

Estimated Cost

Analysis of Total Estimated Costs
1
2
3
4
5
6
7
8
9
10

Personnel (Direct Labor)
Fringe Benefits
Travel
Equipment
Supplies and Materials
Consultants
Contracts and Sub-Grantees
Construction
Other Direct Costs
Indirect Costs
Total:
HUD Share:
Match (Expressed as a percentage of the Federal Share):

Percent of Total

0.00

0.00%

0.00
0.00

0.00%

0.00%

0.00

0.00%

0.00
0.00

0.00%
0.00%

0.00

0.00%

0.00
0.00

0.00%
0.00%

0.00

0.00%

0.00

100.00%

0.00

100.00%

0.00

0.00%

7

form HUD-424-CBW (2/2003)


File Typeapplication/pdf
File Titletestcbw.xls
AuthorEric C. Gauff
File Modified2003-06-03
File Created2003-02-14

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