HHS burden estimate for SF-424A Budget Information -- Non-Construction

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OMB Approval No. 4040-0006
mm/dd/yyyy
Expiration Date 07/30/2010

BUDGET INFORMATION - Non-Construction Programs
SECTION A - BUDGET SUMMARY
Grant Program
Function or
Activity

Catalog of Federal
Domestic Assistance
Number

(a)

(b)

1.

Estimated Unobligated Funds
Federal
(c)

New or Revised Budget

Non-Federal
(d)

Federal
(e)

Non-Federal
(f)

Total
(g)

$

$

$

$

$

$

$

$

$

$

2.

3.

4.

5.

Totals

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Standard Form 424A (Rev. 7- 97)
Prescribed by OMB (Circular A -102) Page 1

SECTION B - BUDGET CATEGORIES
6. Object Class Categories

a. Personnel

(1)

(2)

GRANT PROGRAM, FUNCTION OR ACTIVITY
(3)

(4)

$

$

$

$

Total
(5)

$

b. Fringe Benefits
c. Travel
d. Equipment
e. Supplies
f. Contractual
g. Construction
h. Other
i. Total Direct Charges (sum of 6a-6h)

$

j. Indirect Charges

$

k. TOTALS (sum of 6i and 6j)

7. Program Income

$

$

$

$

$

$

$

$

$

$

Authorized for Local Reproduction

Standard Form 424A (Rev. 7- 97)
Prescribed by OMB (Circular A -102) Page 1A

SECTION C - NON-FEDERAL RESOURCES
(a) Grant Program

(b) Applicant

8.

(c) State

(d) Other Sources

(e)TOTALS

$

$

$

$

$

$

$

$

9.

10.

11.
12. TOTAL (sum of lines 8-11)

SECTION D - FORECASTED CASH NEEDS
Total for 1st Year

13. Federal

$

14. Non-Federal

$

15. TOTAL (sum of lines 13 and 14)

$

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

$

$

$

$

$

$

$

$

SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT
(a) Grant Program
FUTURE FUNDING PERIODS (YEARS)
(d) Third
(b)First
(c) Second
16.

(e) Fourth

$

$

$

$

$

$

$

$

17.

18.

19.

20. TOTAL (sum of lines 16 - 19)

SECTION F - OTHER BUDGET INFORMATION
21. Direct Charges:

22. Indirect Charges:

23. Remarks:
Authorized for Local Reproduction

Standard Form 424A (Rev. 7- 97)
Prescribed by OMB (Circular A -102) Page 2