Form 0920-24FI Cost Study – Partner Interview Guide

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Overview

Instructions
Component Totals
Personnel
Facilities and Utilities
Equipment, Supplies, Materials
Travel
Other Funding Sources
Other Costs and Resources

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Sheet 1: Instructions

				Form Approved OMB No. 0920-XXXX Exp. Date xx/xx/20xx
[Cooperative Agreement: Partner Resource Use and Cost Inventory Tool
Introduction to Cost Study
Thank you for taking the time to participate in the <insert Cooperative Agreement> Resource Use and Cost Inventory Tool. We are conducting a program cost analysis, which estimates the overall costs of implementing the program. You will spend approximately 2.5 hours completing the tool, including time to retrieve information you may need to fill the form. You will have until {cost tool close date} to submit your response. Your participation in this program cost analysis is completely voluntary. Your are not required to provide any data that is sensitive or proprietary for your organization. All data are optional; if there are any cost or resource data that your organization cannot provide, please leave the cell blank. Your participation will not in any way impact the funding or technical assistance you receive from <insert Recipient and Cooperative Agreement the partner supports>. If you have any questions about the study or the tool, please contact the Comprehensive Evaluation Team, [email protected].
Instructions
Each of the corresponding worksheets have their own specific instructions. Note that boxes shaded in yellow do not need to be filled out by the respondent as these cells will automatically populate based on the Excel formula within these cells. Some information has been pre-populated with examples and with data based on documents from the <insert Cooperative Agreement> recipient that you partner with to implement activiites. Please review and adjust any data that is incorrect for your organization.
Key Program Activities
Below is a summary of the program activities for <sub-strategies the partner supports> during <Program Year 1/Program Year 2>. Please refer back to this list as you review and input data throughout this tool. Please adjust the descriptions if needed to capture additional detail important to understand the implementation costs and resources reported. [Note the following list of sub-strategies will be updated and tailored for each partner]
<Substrategy> : <Summary of partner activities that support the sub-strategy>
Suggestion for Ease of Use
To freeze header rows for improved table readability and cell navigation as you scroll:
1. Find the table that you want to "freeze" so that you can always see the first column and the first row (the row with colorful heading) as you move the left and right on the sheet.
2. Select the cell in the first row and the first column of the table as shown by the highlighted cell in the example here.
3. Select the view tab, then Freeze Panes as highlighted below:
4. Check that it worked by scrolling left to right, then up and down in the table. The first row and the first column should now always visible as you scroll.
Note: Public reporting burden of this collection of information is estimated to average 2.5 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. 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 (0920-24XXX)

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Sheet 2: Component Totals

[Cooperative Agreement]: Partner Resource Use and Cost Inventory Tool
Resource Totals
Instructions: Partner Organization, Recipient, Reporting Period, and Cost Study Component information on this page has been pre-populated. Items in yellow (Totals) will automatically be populated due to the Excel formula within each cell. Totals will update as you complete the tool. There is no need to fill out any of the information listed on this page.
		Partner Organization
		Recipient
		Reporting Period
		$334,574.09
		Total [Cooperative Agreement] Spending Amount
	Tabs	Cost Study Component	Total
	1	Parameters	N/A
	2	Personnel	$156,000.00
	3	Contractors and Subcontractors	$156,000.00
	4	Facilities and Utilities	$16,380.00
	4	Equipment, Supplies, Materials	$6,194.09
	5	Travel	$-
	6	Other Funding Sources	N/A
	7	Other Costs and Resources	$-

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Sheet 3: Personnel

[Cooperative Agreement]: Partner Resource Use and Cost Inventory Tool
Personnel Costs
	Instructions: Partner Organization, Recipient, Reporting Period, Total Personnel Costs, and items in yellow will automatically be populated due to the Excel formula within each cell. Please fill out the information in the table by listing the job titles for those working on the <insert Cooperative Agreement> within Column B, starting in row 18. Insert extra rows if there is not enough space to list all staff positions. Please list the actual monthly salary of the specific individual that holds that current position. Please identify the percent of time allocated for work on the <insert Cooperative Agreement> sub-strategies. If staff do not have benefits (i.e. are temporary) please write 0 for their benefits. Use the box below the table to provide additional information or clarification of personnel costs/categories not accounted for in the table.
		Partner Organization:	-
		Recipient:	-
		Reporting Period:	-							1
		Total Personnel Costs:	$156,000.00
	List names of all staff positions (insert extra rows if there is not enough space to list all staff positions)
															<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>											<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>
	Job Title (Write-In)	Full-Time Employee (FTE), Part-Time Employee (PTE), In-Kind or Volunteer Contribution (Dropdown)	Actual monthly salary for job title (Write-in)	Average monthly benefits for job title (Write-in)	Total Personnel Costs (Monthly)	Start date of job position (month and year) during <insert Cooperative Agreement> reporting period (Write-in)	Is this a new position for <insert Cooperative Agreement> ? (Yes/No) (Dropdown)	# months worked on <insert Cooperative Agreement> during reporting period (Dropdown)	Total Personnel Costs (Annually)	# months position has been vacant in last 12 months (Dropdown)	Total # years expected to work on <insert Cooperative Agreement> during reporting period (Dropdown)	Total # of hours per week allocated to working on <insert Cooperative Agreement> (Write-In)	Annual % time dedicated to <insert Cooperative Agreement> (Write-In)	Avg # hours dedicated to <insert Cooperative Agreement>/wk	Based on the average hours dedicated to <insert Cooperative Agreement> (in Column O), what is the estimated percent of time allocated to each sub-strategy over the course of the reporting period. Note: If the staff member's time is allocated across multiple sub-strategies, provide the best estimate for each sub-strategy. If the staff member's time is allocated equally across multiple sub-strategies, divide their total time equally across each sub-strategy they worked on. Use 0% for any sub-strategy the staff member did not work on during the reporting period. (Write-In)											Total Personnel Costs (Annually) per sub-strategy
															1A	1B	1C	1D	2A	2B	2C	3A	3B	3C	3D	1A	1B	1C	1D	2A	2B	2C	3A	3B	3C	3D
	Program Director	FTE	$6,000.00	$1,000.00	$7,000.00	September-2024	No	12	$84,000.00					-	20%	20%	0%	0%	20%	20%	0%	20%	20%	0%	0%	$16,800.00	$16,800.00	$-	$-	$16,800.00	$16,800.00	$-	$16,800.00	$16,800.00	$-	$-
	Health System Coordinator	FTE	$4,000.00	$2,000.00	$6,000.00	September-2024	No	12	$72,000.00					-	50%	50%	0%	0%	0%	0%	0%	0%	0%	0%	0%	$36,000.00	$36,000.00	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
					$-				$-					-												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
	TOTAL	N/A	$10,000.00	$3,000.00	$13,000.00	N/A	N/A	N/A	$156,000.00	N/A	N/A	N/A	N/A	-	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	52,800.00	52,800.00	-	-	16,800.00	16,800.00	-	16,800.00	16,800.00	-	-
	Provide additional information or clarification here:

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Sheet 4: Facilities and Utilities

[Cooperative Agreement]: Partner Resource Use and Cost Inventory Tool
Buildings, Facilities, Utilities
	Instructions: Partner Organization, Recipient, Reporting Period, Total Costs and items in yellow will automatically be populated due to the Excel formula within each cell. Examples of office and facility-related expenditures are provided in Table 1 (starting at row 19). In the column for Space in Building/Facility, please provide overall square footage if available. If annual cost per unit of building/facility expenditure is not available, please provide the name of city/town the site is located so that the evaluation team can estimate value of space/utility by using the commercial rates within a given area. Please add additional items to Table 1 as needed.
		Partner Organization:	-
		Recipient:	-
		Reporting Period:	-
		Total Costs for Buildings & Facilities:	$16,380.00
	Table 1. Building-, Facility-, and Utility-Related Expenditures
	The items below are examples of building/facility related expenditures - please update with additional building/facility expenditures and per each site.										<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>											<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>
	Site (e.g., Partner organization or site locations)	Type of Building/Facility Expense	Annual Cost per Unit	Quantity (Annually)	Space in Building/Facility (Sq. ft)	% of Space used for Program Activities	Total costs (Annual)	Sq. Footage used for Program Activities	Name of City/Town, State (fill only if facility cost is not available)	Comments	Provide an estimate for the percent of facilities/utilities costs associated with activities for <sub-strategy partner supports> during the reporting period. Note: If the site costs align with multiple sub-strategies, provide the best estimate for each sub-strategy. If the site costs align with all sub-strategies equally, divide the total amount equally across each sub-strategy. Use 0% for any sub-strategy that is not applicable for the facility/utility cost. (Write-In)											Total Facilities Costs (Annually) per sub-strategy
											1A	1B	1C	1D	2A	2B	2C	3A	3B	3C	3D	1A	1B	1C	1D	2A	2B	2C	3A	3B	3C	3D
	Site 1	e.g. Office rental	$18,000.00	1	1500	40%	$7,200.00	600														$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
	Site 1	e.g. Office phone/internet utilities	$1,200.00	1	1500	40%	$480.00	600														$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
	Site 1	e.g. Office water/electricity utilities	$2,500.00	5	1500	40%	$5,000.00	600														$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
	Site 1	e.g. Annual maintenance/repair	$1,500.00	5	1500	40%	$3,000.00	600														$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
	Site 2	e.g. Office space	NA	1	2000	10%	$-	200	Birmingham, AL	Monthly cost not available, facility space is provided in-kind												$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
	Site 2	e.g. Office phone/internet utilities	$1,800.00	1	2000	10%	$180.00	200	Birmingham, AL													$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
	Site 2	e.g. Office water/electricity utilities	$3,200.00	1	2000	10%	$320.00	200	Birmingham, AL													$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
	Site 2	e.g. Annual maintenance/repair	$2,000.00	1	2000	10%	$200.00															$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
							$-															$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
							$-															$-	$-	$-	$-	$-	$-	$-	$-	$-	$-	$-
	TOTAL	N/A	N/A	N/A	N/A	N/A	$16,380.00	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	-	-	-	-	-	-	-	-	-	-	-

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Sheet 5: Equipment, Supplies, Materials

[Cooperative Agreement]: Partner Resource Use and Cost Inventory Tool

Equipment, Supplies, Materials

Instructions: Partner Organization, Recipient, Reporting Period, and Total Costs and items in yellow will automatically be populated due to the Excel formula within each cell. Please fill out Tables 1-3 below. For Table 1 (starting at row 21), some office equipment and non-medical items are provided for guidance; for Table 2 (starting at row 37), some medical equipment and health-related items are provided; and for Table 3 (starting at row 55), some in-kind contribution items are provided. If the equipment is a long-term asset (has a useful life greater than one year), please provide additional information on acquisition of asset and estimated years of useful life to facilitate calculations of depreciation. Fill in columns colored green based on whether the asset is long-term or short-term. Please add additional items to Tables 1-3 as needed.

Partner Organization:

-

Recipient:

-

Reporting Period:

-

Total Costs for Equipment & Supplies:

$6,194.09

Table 1. Office Equipment and Non-medical Expenditures

Office equipment is defined as assets such as computers, printers, copiers, paper, cartridges, etc. The items below are examples of office equipment - please update with office equipment used.

<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>

<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>

Resource/Equipment

Long-Term Asset? (use for >1 year?)

INSTRUCTION: FILL COLUMNS HIGHLIGHTED GREEN BELOW BASED ON WHETHER EQUIPMENT IS LONG-TERM:

Quantity (Annually)

Site (e.g., Recipient organization, Partner site)

Annuity Factor

Total costs (Annual)

Comments

Provide an estimate for the percent of resource/equipment costs associated with <sub-strategy partner supports> during the reporting period. Note: If the resource/equipment costs align with multiple sub-strategies, provide the best estimate for each sub-strategy. If the equipment costs align with all sub-strategies equally, divide the total amount equally across each sub-strategy. Use 0% for any sub-strategy that is not applicable for the resource/equipment cost. (Write-In)

Total Equipment/Resource Costs (Annually) per sub-strategy

Total Years of Useful Life (if equipment is long-term)

Purchase Price (if equipment is long-term)

Annual maintenance costs (if equipment is long-term)

Annual Cost per Unit (if equipment is NOT long-term)

1A

1B

1C

1D

2A

2B

2C

3A

3B

3C

3D

1A

1B

1C

1D

2A

2B

2C

3A

3B

3C

3D

e.g. Laptop computer

Yes

6

$1,200.00

$20.00

12

Site 1

5.08

$3,077.05

e.g. Desktop computer

Yes

8

$900.00

$10.00

5

Site 1

6.46

$746.25

e.g. Ink cartridge

No

$12.00

5

Site 2

0.00

$60.00

e.g. Paper

No

$0.05

1500

Site 2

0.00

$75.00

0.00

$-

0.00

$-

0.00

$-

0.00

$-

0.00

$-

TOTAL

N/A

N/A

$3,958.30

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

-

-

-

-

-

-

-

-

-

-

-

Table 2. Medical Equipment and Health-Related Expenditures

Medical equipment is defined as devices or tools used in the provisioning of health care services. The items below are examples of medical equipment - please update with key medical equipment used.

Resource/Equipment (For WW, this will include HBSS cost breakdown)

Long-Term Asset? (use for >1 year?)

INSTRUCTION: FILL COLUMNS HIGHLIGHTED GREEN BELOW BASED ON WHETHER EQUIPMENT IS LONG-TERM:

Quantity (Annually)

Site (e.g., Recipient organization, Partner site)

Annuity Factor

Total costs (annual)

Comments

Provide an estimate for the percent of resource/equipment costs associated with each sub-strategy during the reporting period. Note: If the resource/equipment costs align with multiple sub-strategies, provide the best estimate for each sub-strategy. If the equipment costs align with all sub-strategies equally, divide the total amount equally across each sub-strategy. Use 0% for any sub-strategy that is not applicable for the resource/equipment cost. (Write-In)

Total Equipment/Resource Costs (Annually) per sub-strategy

Total Years of Useful Life (if equipment is long-term)

Purchase Price (if equipment is long-term)

Annual maintenance costs (if equipment is long-term)

Annual Cost per Unit (if equipment is NOT long-term)

1A

1B

1C

1D

2A

2B

2C

3A

3B

3C

3D

1A

1B

1C

1D

2A

2B

2C

3A

3B

3C

3D

e.g.stethoscope

Yes

10

$150.00

$-

3

7.72

$58.28

e.g.echocardiogram

Yes

15

$1,400.00

$12.00

$-

4

10.38

$587.52

e.g.electrocardiogram

No

$1,500.00

1

Site 1

0.00

$1,500.00

e.g.screening materials

No

$-

0.00

$-

e.g.stress test equipment

No

$-

0.00

$-

e.g.(clinic) blood pressure monitors

Yes

$75.00

15

Site 2

0.00

$-

e.g.(patient) blood pressure cuffs

No

$30.00

3

Site2

0.00

$90.00

0.00

$-

0.00

$-

0.00

$-

0.00

$-

TOTAL

N/A

N/A

N/A

$2,235.79

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

-

-

-

-

-

-

-

-

-

-

-

Table 3. In-Kind Contributions

Resource/Equipment

Quantity (annual)

% of Time in Year item/resource is made available (if applicable)

Site (e.g., Recipient organization, Partner site)

Description of In-Kind Contribution

Provide an estimate for the percent of resource/equipment costs associated with each sub-strategy during the reporting period. Note: If the resource/equipment costs align with multiple sub-strategies, provide the best estimate for each sub-strategy. If the equipment costs align with all sub-strategies equally, divide the total amount equally across each sub-strategy. Use 0% for any sub-strategy that is not applicable for the resource/equipment cost. (Write-In)

1A

1B

1C

1D

2A

2B

2C

3A

3B

3C

3D

e.g. Transport Vouchers

50

e.g. blood pressure cuffs

1

TOTAL

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

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Sheet 6: Travel

[Cooperative Agreement]: Partner Resource Use and Cost Inventory Tool
Travel Costs
	Instructions: Partner Organization, Recipient, Reporting Period, and Total Costs and items in yellow will automatically be populated due to the Excel formula within each cell. Please fill out the following table for <insert Cooperative Agreement>-related travel only. Travel for <insert Cooperative Agreement> may include, but is not limited to: conferences where the attendee is attending/presenting for <insert Cooperative Agreement>; site visits; meetings with sites, other partners, etc. For columns Y to AI please indicate whether the travel supported any of the <insert Cooperative Agreement> sub-strategies.
		Partner Organization:	-
		Recipient:	-
		Reporting Period:	-
		Total Travel Costs:	$0.00
																								<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>											<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>
						Conference		Car Travel			Air Travel		Lodging			Per Diem			Other Ground Transportation		Other Travel Costs		TOTAL TRAVEL COSTS	Did travel support any of these sub-strategies? (Yes/No) (Dropdown)											Total Travel Costs per sub-strategy
	Purpose of travel (Write-In)	Does travel coincide with [complementary Cooperative Agreement] travel? (Yes/No) (Dropdown)	In-state/ out of state travel? (Dropdown)	Recipient traveled to (if applicable) (Write-In)	# of [cooperative agreement]-funded staff traveling (Dropdown)	Conference Registration Fees (if applicable) (Write-In)	Total Conference Registration Fees	If Driving - Total number of miles (Write-In)	Cost per mile (Write-In)	Total ground travel	Cost of airfare (unit cost) (Write-In)	Total Air Travel	Hotel cost per night (Write-In)	Number of nights (Write-In)	Total Lodging	Per Diem rate (Write-In)	Number of days (Write-In)	Total Per Diem	Unit cost (Write-In)	Total cost	Other travel costs (Write-In)	Total other costs		1A	1B	1C	1D	2A	2B	2C	3A	3B	3C	3D	1A	1B	1C	1D	2A	2B	2C	3A	3B	3C	3D
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
							$-			$-		$-			$-			$-		$-		$-	$-
	TOTAL	N/A	N/A	N/A	N/A		$-	N/A	N/A	$-	N/A	$-	N/A	N/A	$-	N/A	N/A	$-	N/A	$-	N/A	$-	$-	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	-	-	-	-	-	-	-	-	-	-	-
	Provide additional information or clarification here:

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Sheet 7: Other Funding Sources

[Cooperative Agreement]: Partner Resource Use and Cost Inventory Tool

Other Funding Sources

Instructions: Partner Organization, Recipient, Reporting Period, and Total Costs and Totals in yellow will automatically be populated due to the Excel formula within each cell. For the other funding sources table, please identify any in-kind funding or other funding sources that support the implementation of <insert Cooperative Agreement and sub-strategy partner supports> activities.

Partner Organization:

-

Recipient:

-

Reporting Period:

-

Total Additional Funding:

$0.00

<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>

Provide an estimate for the percent of Other Funding Sources associated with each sub-strategy during the reporting period. Note: If the funding sources aligns with multiple sub-strategies, provide the best estimate for each sub-strategy. If the funding sources align with all sub-strategies equally, divide the total amount equally across each sub-strategy. Use 0% for any sub-strategy that is not applicable for the funding source. (Write-In)

List of Other Funding Source(s) (State budget, other CDC program, other Federal program, Other in-kind, other funding) (Write-In)

Total Amount ($) (Write-In)

List Services/ Programs Supported (i.e. YMCA, Million Hearts, etc.) (Write-In)

1A

1B

1C

1D

2A

2B

2C

3A

3B

3C

3D

TOTAL

$-

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Provide additional information or clarification here:

---

Sheet 8: Other Costs and Resources

[Cooperative Agreement]: Partner Resource Use and Cost Inventory Tool

Other Costs and Resources

Instructions: Partner Organization, Recipient, Reporting Period and Totals in yellow will automatically be populated due to the Excel formula within each cell. Please fill out the information below by first identifying other costs and resources used for <insert Cooperative Agreement> implementation that have not been categorized or reported in other tabs of this tool. After identifying the cost or resource, briefly describe the cost/resource, associated dollar amounts, and use columns E-O to select the sub-strategies associated with the reported cost/resource.

Partner Organization:

-

Recipient:

-

Reporting Period:

-

Total Other Costs & Resources:

$-

<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>

<Only the columns associated with the sub-strategy the partner supports will be included in the tool. Any strategies that are not applicable to the partner will be deleted>

Provide an estimate for the percent of the Other Cost/Resource associated with each sub-strategy during the reporting period. Note: If the Other Cost/Resource aligns with multiple sub-strategies, provide the best estimate for each sub-strategy. If the Other Cost/Resource aligns with all sub-strategies equally, divide the total amount equally across each sub-strategy. Use 0% for any sub-strategy that is not applicable for the Other Cost/Resource. (Write-In)

Total Equipment/Resource Costs (Annually) per sub-strategy

List of Other Cost/Resource (Write-In)

Other Cost/Resource Description (Write-in)

Total Amount ($) (Write-In)

1A

1B

1C

1D

2A

2B

2C

3A

3B

3C

3D

1A

1B

1C

1D

2A

2B

2C

3A

3B

3C

3D

TOTAL

N/A

$-

-

-

-

-

-

-

-

-

-

-

-

Provide additional information or clarification here: