Cost Questionnaire - School Administrators in PYFP Schoo

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Overview

Table of Contents
INTRO
Background
Definitions
Personnel
Personnel Cost
Supplies
Equipment
Facilities
Training and Other Activities
In Kind Contributions

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Sheet 1: Table of Contents

There are 10 pages in this survey. Some of the pages contain instructions; others ask for answers. Please look at all 10 pages:								Form Approved
								OMB No. 0920-xxxx
1	Table of Contents (this page)							Exp. Date xx/xx/xxxx
2	INTRO
3	Background
4	Definitions
5	Personnel
6	Personnel Costs
7	Supplies
8	Equipment
9	Facilities							Public reporting burden of this collection of information is estimated to average 60 minutes 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. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx)
10	Training and Other Activities

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Sheet 2: INTRO

Presidential Youth Fitness Program (PYFP)
Cost Questionnaire
Introduction
This questionnaire is designed to collect information about the costs of implementing the PYFP at your school. The ICF team understands that your school receives resources from PYFP for its implementation. These resources include the following to support 500 students and 2 physical educators:
	Year 1: Virtual training, FITNESSGRAM® (software, manual, tech support, and web hosting), PYFP student recognition awards and certificates
	Year 2: Virtual training and access to a professional learning community, FITNESSGRAM® (software, tech support, and web hosting), PYFP student recognition awards and certificates
	Year 3: Sustainability webinar and access to a professional learning community, FITNESSGRAM® (software, tech support, and web hosting), PYFP student recognition awards and certificates
Please include in this questionnaire any additional costs incurred other than those indicated above.
We recognize that you and your colleagues may work on the PYFP in various ways, and ask that you answer the questions to the best of your ability. Thank you for your participation!
If you have any questions about filling out the questionnaire, please feel free to contact NAME at [email protected]. Also, it is possible that we may need to contact you after you complete this questionnaire to make sure we understand the information that you provided. Will it be okay for a member of the ICF team  to contact you in the future (i.e., within the next 6 months)?
Place an X in the box that applies:
	Yes, it is okay for the ICF evaluation team to contact me.
	No, it is not okay for ICF evaluation team to contact me.

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Sheet 3: Background

Background
1.	What is your name?
2.	What is your role as it relates to the PYFP?

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Sheet 4: Definitions

Definitions
The following questions ask about the costs associated with implementing the PYFP at your school. Below, you will see 5 different input categories, their definitions, and potential data sources for each input.
	Input	Definition	Data Sources
	Personnel	- staff time used	School Budget, Human Resources, Self-Report
	Supplies	- recurring expenses, usually of smaller value	School Budget, Invoices, Expense Reports
	Equipment	- expenditures on durable equipment, for athletic or office use	School Budget, Invoices, Expense Reports
	Facilities	- facility space used to administer or implement the PYFP	School Budget, Administrator, PE teachers
	Training and Other Activities	- training and in-service expenses (including transportation)	School Budget, Expense Reports, Self-Report
	In-Kind Contributions	-labor and non-labor resources donated to implement PYFP	Self-Report

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Sheet 5: Personnel

3.	Please list all job categories and the number of staff in each category who are involved in PYFP. Please ensure to include personnel that may be occasionally used as well.
		# STAFF Involved in PYFP
	Job Category	School NAME
	School Administrator	Type answer here
	Physical Education Teacher	Type answer here
	Substitute Teacher	Type answer here
	IT Support Staff	Type answer here
	Other (specify)	Type answer here
	Other (specify)	Type answer here
	Other (specify)	Type answer here
	Other (specify)	Type answer here
	Other (specify)	Type answer here
	Other (specify)	Type answer here

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Sheet 6: Personnel Cost

4.	Please provide the average cost of employment for each of the job categories at each facility provided in the previous sheet. If multiple personnel perform a job category and some are part-time employees, please include in a separate row.
	● Cost of employment includes salaries, overtime, benefits, overhead, and other employment expenses. Please provide the average over each job category (e.g., all P.E. Teachers).
			Average Cost of Employment (Salary per Year, Including Fringe)
	Job Description/Category	Full-Time or Part-Time?	School Name
	School Administrator		Type answer here
	Physical Education Teacher		Type answer here
	Substitute Teacher		Type answer here
	IT Support Staff		Type answer here
	Other (specify)		Type answer here
	Other (specify)		Type answer here
	Other (specify)		Type answer here
	Other (specify)		Type answer here
	Other (specify)		Type answer here
	Other (specify)		Type answer here

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Sheet 7: Supplies

5.	CDC User: Again, documenting all supplies purchased might be challenging. Please list all supplies purchased since the start of the school year/semester, that are used in the implementation of the PYFP. This includes office supplies, gear, athletic supplies, gym supplies, or any other recurring purchase.
	● Bulk estimates are aceptable, and supplies can be reported in the largest meaningful unit. For example, if 10% of all pens, pencils, staplers, paper, etc., are used for PYFP, "Office Supplies" can be reported in the Item Description column, rather than listing the individual supplies.
	● If you do report each item, please indicate the cost of the item as it is listed. For example, Pack of 10 Notebooks, for $20.
	● For each item, indicate the proportion the item is used to implement the PYFP. For example, if half of the notebooks purchased were used for PYFP, put 50% for Column E.
			School Name
	Item Description	Cost per Item	# Items Purchased Since DATE	% Used for PYFP
	Other (specify)	Type answer here	Type answer here	Type answer here
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Sheet 8: Equipment

6.	Please list all equipment purchased since {DATE}, that are used to implement PYFP. This includes office furniture, computers, and any athletic equipment used for PYFP.
	● Equipment is defined as items that are purchased for longer-term use. As a general rule, think about items that cost over $50 per item. For items that cost less than $50 each (stapler, a box of pens, etc.), please list them under the "Supplies" tab.
	● For each item, indicate the cost of the item as listed.
	● For each item, indicate the proportion of the item is used to implement the PYFP. For example, if half of the athletic gear you purchased was used for PYFP purposes, put 50% for Column E.
			School Name
	Item Description	Cost per Item	# Item Purchased Since DATE	% Used for PYFP
	Other (specify)	Type answer here	Type answer here	Type answer here
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Sheet 9: Facilities

7.	What is the monthly rent for your facility? If not applicable, please indicate N/A in the box below.
	Type answer here
8.	Are there any spaces that were not used previously for PE, which are now being used for PYFP-related activities? If so, please describe.
	For example, a new outdoor space or classroom space that is used for PYFP activities only. If the same space has been used for PE before, please do not include.
	Type answer here
9.	If the space has been newly constructed, please include the cost of building the space and percentage of the day used for PYFP-related activities.
	For example, if the space is used for 2 hours, please enter 120 minutes. If you're more comfortable with providing a percentage, you may enter the answer that way, for example, 10%.
	Cost of Space
	Type answer here
	Minutes Per School Day	OR	Percent of School Day
	Type answer here		Type answer here
10.	If the space was previously used for another activity, please include the square footage of the space and the percentage of the day currently used for PYFP-related activities.
	For example, if the space is used for 2 hours, please enter 120 minutes. If you're more comfortable with providing a percentage, you may enter the answer that way, for example, 10%.
	Square Footage
	Type answer here
	Minutes Per School Day	OR	Percent of School Day
	Type answer here		Type answer here

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Sheet 10: Training and Other Activities

11.	In the table below, please fill in information about Trainings or Other Activities related to PYFP that have happened since {DATE}.
	● Include trainings (on and offsite), conferences, presentations, and other activities related to PYFP.
	● Include training of subsitute teacher(s) related to PYFP.
	● Include transportation, if applicable, for example for an off-site training.
	● Describe the activity (e.g., additional training, accomodation, other expenses and the date(s) of the activity).
	● For each activity, indicate the cost.
	● For each activity, indicate the proportion of the activity related to implementing the PYFP.
	Activity Description	Date	Cost per Item	% Used for PYFP
	Other (specify)		Type answer here	Type answer here
	Other (specify)		Type answer here	Type answer here
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Sheet 11: In Kind Contributions

12.	Please list the title of any individuals volunteering their time for PYFP, along with the number of hours volunteered.
		# of Hours Volunteered
	Title	School NAME
	Other (specify)	Type answer here
	Other (specify)	Type answer here
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13.	Please describe any non-labor in-kind contribution provided (e.g., donated materials) and the dollar value of the donated resource.
		$ Amount
	Description	School NAME
	Other (specify)	Type answer here
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