EDECH State, Local, Tribal Gov't

Table 1: Format for Grantee Expenditure Reports: Implementation Period
OMB Control No: 0584-XXXX
Dates Covered:
Expiration date: XX/XX/XXXX
Grantee Contact:
Grantee Name:
Type of Cost
Labor *
Staff Title I
Staff Title II
Staff Title III
Etc.†
Total
Fringe Benefits
Contractual (Benefits Related)
SNAP EBT Contractor
MIS or Other IT Contractor(s)
Other State Agency**
SFA Partner(s)**
Food Service Management Co.
Community Partner(s)**
Contractual (Outreach/ Case Management)
Outreach Provider**
Communications/Media Contractor**
Case Management Provider**
Other Direct Costs***
Total Direct Costs
Indirect Costs
Total

Start-Up

Ongoing

Total

$0
-

$0
-

$0
$0
$0
$0
$0
$0

-

-

$0
$0
$0
$0
$0
$0

$0
$0

$0
$0

$0
$0
$0
$0
$0
$0
$0

Note: Table 1 could also be used as a model for other State Agencies involved in the demonstration. Enter any
start-up costs that extend into the operation period in the "Start-up" column; all other costs should go in the
"ongoing" cost column.
* If available, please provide more detailed labor hours using Table 3.
** If appropriate, please provide more detailed reports using Table 2 or similar format.
***Other direct costs include items such as printing, postage, and shipping. They may also include travel costs or
transportation costs for food, purchase of food, and so forth.

†Please insert additional rows as needed for other staff titles.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this
information collection is 0584-XXXX. The time required to complete this information collection is estimated to average 2.25
hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information.

TABLE 2: Format for Subgrantee Expenditure Reports: Implementation Period
OMB Control No: 0584-XXXX
2015 Dates Covered:
Expiration date: XX/XX/XXXX

Type of Cost
Labor *
Staff Title I
Staff Title II
Staff Title III
Etc.***
Total
Fringe Benefits
Travel
Other Direct Costs**
Subcontracts
Total Direct Costs
Indirect Costs
Total

Start-Up

Ongoing

Total

$0
$0
$0

$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0

* If possible, please provide the more detailed labor information outlined in Table 3 and more detailed ODC information in
Table 4.
**Other direct costs include items such as printing, postage, and shipping. They may also include travel costs or
transportation costs for food, purchase of food, and so forth.

***Please insert additional rows as needed if more than three staff categories worked on the study.
Note: Start-Up Costs are any one-time costs needed to make the project fully operational. Most will occur
during the Start-Up period, but the "Start-Up" column is there in case some of these costs (such as hiring and
training staff) last into the early months of implementation.

Table 3: Format for Detailed Labor Schedule: Implementation Period
Dates Covered:
Labor Costs*
Staff Title I
Number of employees in this category
Hours per week worked on demonstration
Hourly wage rate
Fringe benefits per hour
Fringe benefit calculation**
Total Cost
Staff Title II
Number of employees in this category
Hours per week worked on demonstration
Hourly wage rate
Fringe benefits per hour
Fringe benefit calculation**
Total Cost
Staff Title III
Number of employees in this category
Hours per week worked on demonstration
Hourly wage rate
Fringe benefits per hour
Fringe benefit calculation**
Total Cost
Etc.***
Total Labor

OMB Control No: 0584-XXXX
Expiration date: XX/XX/XXXX

Start-Up

Ongoing

Total

$0
$0
$0
$0

$0
$0
$0
$0

0

$0

$0
$0
$0
$0
NA
$0

$0
$0
$0
$0

$0
$0
$0
$0

$0

$0

$0
$0
$0
$0

$0
$0
$0
$0

$0

$0

$0
$0
$0
$0
NA
$0

$0

$0

$0

$0
$0
$0
$0
NA
$0

* Please include a line for volunteer labor and number of hours, if applicable. Also, indicate if any staff is temporary
or if overtime labor is being used.
** Please specify whether the fringe benefit was calculated as a percentage of the employee's salary, fixed amount,
etc.

***Please copy rows 19-25 as needed to provide information for additional types of staff.
Notes: Instead of providing hours and an hourly rate, feel free to use annual salary and percentage of
time over the grant year, if that is easier.
Please include support staff such as clerical workers, as well as managers and professional staff.
Start-Up Costs are any one-time costs needed to make the project fully operational. Most will occur
during the Start-Up period, but the "Start-Up" column is there in case some of these costs (such as hiring
and training staff) last into the early months of implementation.

Table 4: Format for Detailed ODC Schedule: Implementation Period
Dates Covered:
Type of Cost
Grant-Related Other Direct Costs*
Food Packages
Printing
Telephone
Postage
Shipping
Staff Travel
Etc.**
Total

OMB Control No: 0584-XXXX
Expiration date: XX/XX/XXXX

Start-Up Ongoing
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

Total

$0
$0
$0
$0
$0
$0
$0
$0

Note: Start-Up Costs are any one-time costs needed to make the project fully operational. Most will occur
during the Start-Up period, but the "Start-Up" column is there in case some of these costs (such as hiring and
training staff) last into the early months of implementation.
*Other direct costs include items such as printing, postage, and shipping. They may also include travel costs or
transportation costs for food, purchase of food, and so forth.

**Please add rows for any other direct costs not listed.