0920-1132 Budget Template

Performance Progress and Monitoring Report

Att. 1a Budget Template.xlsx

Performance Progress and Monitoring Report - All Attachments/Appendices

OMB: 0920-1132

Document [xlsx]
Download: xlsx | pdf

Overview

Home Page
Summary
Personnel Salary and Fringe
Contracts
Consultants
Equipment
Supplies
Travel
Other


Sheet 1: Home Page

[NOFO Title]


[NOFO Number] Budget Template


OMB Approval Number: 0920-XXXX 0920-1132

Expiration Date: XX/XX/XXXX



Recipient Name:





Program Year: [Select the Program Year…]





Submission Date:



The following navigation bar is available on all worksheets



Click a tab to jump to the corresponding sheet:
















Instructions:


You may use this template to prepare a complete and accurate budget narrative.


This workbook contains formulas that will automatically add up allocated costs onto the "Summary" sheet.


Allocate costs to one or more funding categories based on NOFO requirements.






Notes on Data Entry:


All light yellow cells are available for user input.


Conditional formatting may highlight cells red if values are missing, not valid, or violate program rules.






[Additional instructions can be provided here for convenient reference to NOFO specific requirements]



Sheet 2: Summary


Year [Select Year] Budget Summary - [Recipient Name]












Object Class [Category A] [Category B] Grand Total


Salary and Wages $- $- $-


Fringe Benefits $- $- $-


Contractual Costs $- $- $-


Consultant Costs $- $- $-


Equipment $- $- $-


Supplies $- $- $-


Travel $- $- $-


Other $- $- $-


Direct Costs $- $- $-


Indirect Costs

$-


TOTAL $- $- $-


Target

$-


Balance $- $- $-
















Indirect Cost Justification







Please remember to submit a copy of your indirect cost rate agreement.





Sheet 3: Personnel Salary and Fringe


Personnel Salary and Fringe
Salary Total $- Fringe Total $-








1 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








2 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








3 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








4 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








5 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








6 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








7 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








8 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








9 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








10 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








11 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








12 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








13 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








14 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








15 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








16 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








17 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








18 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








19 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








20 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








21 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








22 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








23 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








24 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








25 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








26 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








27 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








28 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








29 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








30 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








31 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








32 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








33 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








34 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








35 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








36 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








37 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








38 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








39 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-








40 Personnel Cost


Position Title Annual Salary and Wages % Paid by This Grant Months Salary and Wages






$-


Fringe Fringe (%) Fringe ($)
if not %
Fringe Total Planned



$- $-

Justification






Allocations

Funding Category % Allocated $ Allocated to Salary and Wages $ Allocated to Fringe Total Allocated

[Category A]
$- $- $-

[Category B]
$- $- $-

Sheet 4: Contracts


Contracts




Total $-










1.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description>




Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











2.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











3.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











4.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











5.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











6.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











7.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











8.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











9.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











10.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











11.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











12.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











13.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











14.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











15.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











16.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











17.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











18.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











19.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











20.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











21.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











22.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











23.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











24.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











25.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











26.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











27.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











28.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











29.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











30.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











31.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











32.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











33.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











34.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











35.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











36.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











37.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











38.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











39.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-











40.0625 Basic Information
Itemized Costs Justification

Contractor Title

Salary and Wages



Method of Selection

Fringe Benefits



Justification for Sole Source Selection

Consultant Costs $-


Period of Performance

Equipment $-


Scope of Work

Supplies




Travel



Method of Accountability

Deliverable Cost <enter description> $-



Other <enter description> $-


Allocations
Other <enter description> $-


Funding Category % Allocated $ Allocated
Other <enter description> $-


[Category A]
$-
Subcontract Costs $-


[Category B]
$-
Total Direct Costs $-






Indirect Costs







TOTAL FOR CONTRACT $-


Sheet 5: Consultants


Consultants




Total $-










1.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











2.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











3.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











4.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











5.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











6.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











7.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











8.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











9.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











10.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











11.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











12.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











13.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











14.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











15.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











16.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











17.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











18.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











19.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











20.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











21.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











22.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











23.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











24.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











25.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











26.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











27.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











28.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











29.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











30.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











31.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











32.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











33.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











34.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











35.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











36.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











37.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











38.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











39.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-











40.0625 Basic Information
Itemized Costs Justification

Consultant Title

Number of Days of Consultation



Organizational Affiliation

Expected Daily Rate of Compensation



Nature of Services to Be Rendered

BASE COMPENSATION SUBTOTAL $-


Relevance of Service to the Project

Travel $-


Method of Accountability

Per Diem (total for all days consultation) $-


Allocations
Supplies $-


Funding Category % Allocated $ Allocated
Deliverable Cost <enter description> $-


[Category A] 0% $-
Other <enter description> $-


[Category B] 0% $-
Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






Other <enter description> $-






EXPENSES SUBTOTAL $-






TOTAL FOR CONSULTANT $-


Sheet 6: Equipment


Equipment





Total $-

Equipment costs are for items with a Unit Cost over $5,000.
Most Applicants will not have Equipment costs.
Allocations

Line
#
Item Requested Number Needed Unit Cost Total Amount Planned % Allocated [Category A] % Allocated [Category B] $ Allocated [Category A] $ Allocated [Category B] Justification
1


$-

$- $-

2


$-

$- $-

3


$-

$- $-

4


$-

$- $-

5


$-

$- $-

6


$-

$- $-

7


$-

$- $-

8


$-

$- $-

9


$-

$- $-

10


$-

$- $-

11


$-

$- $-

12


$-

$- $-

13


$-

$- $-

14


$-

$- $-

15


$-

$- $-

16


$-

$- $-

17


$-

$- $-

18


$-

$- $-

19


$-

$- $-

20


$-

$- $-

21


$-

$- $-

22


$-

$- $-

23


$-

$- $-

24


$-

$- $-

25


$-

$- $-

26


$-

$- $-

27


$-

$- $-

28


$-

$- $-

29


$-

$- $-

30


$-

$- $-

31


$-

$- $-

32


$-

$- $-

33


$-

$- $-

34


$-

$- $-

35


$-

$- $-

36


$-

$- $-

37


$-

$- $-

38


$-

$- $-

39


$-

$- $-

40


$-

$- $-


Totals

$-

$- $-


Sheet 7: Supplies


Supplies






Total $-
Line
#
Item Requested Type (if appropriate) Number Needed Unit Cost Amount Planned % Allocated [Category A] % Allocated [Category B] $ Allocated [Category A] $ Allocated [Category B] Justification
1



$-

$- $-
2



$-

$- $-
3



$-

$- $-
4



$-

$- $-
5



$-

$- $-
6



$-

$- $-
7



$-

$- $-
8



$-

$- $-
9



$-

$- $-
10



$-

$- $-
11



$-

$- $-
12



$-

$- $-
13



$-

$- $-
14



$-

$- $-
15



$-

$- $-
16



$-

$- $-
17



$-

$- $-
18



$-

$- $-
19



$-

$- $-
20



$-

$- $-
21



$-

$- $-
22



$-

$- $-
23



$-

$- $-
24



$-

$- $-
25



$-

$- $-
26



$-

$- $-
27



$-

$- $-
28



$-

$- $-
29



$-

$- $-
30



$-

$- $-
31



$-

$- $-
32



$-

$- $-
33



$-

$- $-
34



$-

$- $-
35



$-

$- $-
36



$-

$- $-
37



$-

$- $-
38



$-

$- $-
39



$-

$- $-
40



$-

$- $-

Totals


$-

$- $-

Sheet 8: Travel


Travel







Total $-
Line
#
Description and Number of People Cost of Mileage or Airfare Cost of Per Diem or Lodging Cost of Ground Transport Other Costs Amount Planned % Allocated [Category A] % Allocated [Category B] $ Allocated [Category A] $ Allocated [Category B] Justification
1




$-

$- $-
2




$-

$- $-
3




$-

$- $-
4




$-

$- $-
5




$-

$- $-
6




$-

$- $-
7




$-

$- $-
8




$-

$- $-
9




$-

$- $-
10




$-

$- $-
11




$-

$- $-
12




$-

$- $-
13




$-

$- $-
14




$-

$- $-
15




$-

$- $-
16




$-

$- $-
17




$-

$- $-
18




$-

$- $-
19




$-

$- $-
20




$-

$- $-
21




$-

$- $-
22




$-

$- $-
23




$-

$- $-
24




$-

$- $-
25




$-

$- $-
26




$-

$- $-
27




$-

$- $-
28




$-

$- $-
29




$-

$- $-
30




$-

$- $-
31




$-

$- $-
32




$-

$- $-
33




$-

$- $-
34




$-

$- $-
35




$-

$- $-
36




$-

$- $-
37




$-

$- $-
38




$-

$- $-
39




$-

$- $-
40




$-

$- $-

Total



$-

$- $-

Sheet 9: Other


Other





Total $-
Line
#
Item Requested Number Needed Unit Cost Amount Planned % Allocated [Category A] % Allocated [Category B] $ Allocated [Category A] $ Allocated [Category B] Justification
1


$-

$- $-
2


$-

$- $-
3


$-

$- $-
4


$-

$- $-
5


$-

$- $-
6


$-

$- $-
7


$-

$- $-
8


$-

$- $-
9


$-

$- $-
10


$-

$- $-
11


$-

$- $-
12


$-

$- $-
13


$-

$- $-
14


$-

$- $-
15


$-

$- $-
16


$-

$- $-
17


$-

$- $-
18


$-

$- $-
19


$-

$- $-
20


$-

$- $-
21


$-

$- $-
22


$-

$- $-
23


$-

$- $-
24


$-

$- $-
25


$-

$- $-
26


$-

$- $-
27


$-

$- $-
28


$-

$- $-
29


$-

$- $-
30


$-

$- $-
31


$-

$- $-
32


$-

$- $-
33


$-

$- $-
34


$-

$- $-
35


$-

$- $-
36


$-

$- $-
37


$-

$- $-
38


$-

$- $-
39


$-

$- $-
40


$-

$- $-

Total

$-

$- $-
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File Modified0000-00-00
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