EDECH Private Sector

Table 1: Format for Grantee Expenditure Reports: Start-Up Period
OMB Control No: 0584-XXXX
Dates Covered:
Expiration date: XX/XX/XXXX
Grantee Contact:
Grantee Name:
Type of Cost

Start-up Costs

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

$0
$0
$0

Note: Table 1 could also be used as a model for other State Agencies involved in the demonstration.
* If available, please provide more detailed information on labor hours using Table 3.
** If appropriate, please provide more detailed reports using Table 2 or similar format.
***Please provide detail on other direct costs in Table 4, as applicable. 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: Start-Up 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 Costs
$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 project.

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

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

Start-up Costs
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0

* Please include a heading 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.

Table 4: Format for Detailed ODC Schedule: Start-Up 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 Costs
$0
$0
$0
$0
$0
$0
$0
$0

*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.