Sf 424c

sf424c.pdf

HRSA Electronic Health Record Readiness Assessment

SF 424C

OMB: 0915-0325

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OMB Approval No. 4040-0008
Expiration Date 07/30/2010

BUDGET INFORMATION - Construction Programs

NOTE: Certain Federal assistance programs require additional computations to arrive at the Federal share of project costs eligible for participation. If such is the case, you will be notified.

c. Total Allowable Costs
(Columns a-b)

b. Costs Not Allowable
for Participation

a. Total Cost

COST CLASSIFICATION
1.

Administrative and legal expenses

$

$

$

0.00

2.

Land, structures, rights-of-way, appraisals, etc.

$

$

$

0.00

3.

Relocation expenses and payments

$

$

$

0.00

4.

Architectual and engineering fees

$

$

$

0.00

5.

Other architectural and engineering fees

$

$

$

0.00

6.

Project inspection fees

$

$

$

0.00

7.

Site work

$

$

$

0.00

8.

Demolition and removal

$

$

$

0.00

9.

Construction

$

$

$

0.00

10.

Equipment

$

$

$

0.00

11.

Miscellaneous

$

$

$

0.00

12.

SUBTOTAL (sum of lines 1-11)

$

$

0.00

13.

Contingencies

$

$

0.00

14.

SUBTOTAL

$

$

0.00

15.

Project (program) income

$

$

0.00

16.

TOTAL PROJECT COSTS (subtract #15 from #14) $

0.00

$

0.00

%

$

0.00

0.00

$

0.00

$
0.00

$

0.00

$
0.00

$

FEDERAL FUNDING
17. Federal assistance requested, calculate as follows:
(Consult Federal agency for Federal percentage share.)
Enter the resulting Federal share.
Previous Edition Usable

Enter eligible costs from line 16c Multiply X

Authorized for Local Reporoduction

Standard Form 424C (Rev. 7-97)
Prescribed by OMB Circular A-102


File Typeapplication/pdf
File TitleSF424C-V1.0.pdf
AuthorKvemula
File Modified2008-10-08
File Created2008-10-08

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