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Instrument 5: Pilot costs and resources workbook - Local-level leadership staff

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File Type	application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Title	Instrument 5: Pilot costs and resources workbook - Local-level leadership staff
Author	Andrew Burwick
Last Modified By	Calc
File Modified	2026-06-08
File Created	2026-06-17
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If you have any questions about the pilot cost and resource data collection, please contact [assigned data co

Pilot Costs and Resources Workbook
[State Agency Workbook / Local Agency Workbook]
[Date Completed] Data Collection for the TANF Pilot Evaluatio
Introduction and Instructions

Your state is among five states that were selected by the U.S. Department of Health and Human Services (HHS) to participate in pilot
authorized by the Fiscal Responsibility Act of 2023 (FRA). Mathematica, The Adjacent Possible, and the American Public Human Serv
understand and learn from these pilots under contract with the Administration for Children and Families at HHS. This workbook colle
associated with implementing your TANF pilot to inform the evaluation. The study team will collect relevant information from you, p
information with you to fill in any gaps.

What is this workbook about?
This workbook collects information at the state-level, or selected county or local TANF offices or areas, and contracted providers, as
the TANF program as it shifts to the use of outcome measures for participants and the changes associated with implementing the pr
information on the costs of setting up and launching the pilot program and how these costs and use of resources change over the co
in this workbook is for research purposes only; it is not to monitor TANF spending.

We will gather costs of the TANF program where the pilot will occur; this might include statewide costs or be restricted to particula
focused on program management, service delivery to participants, and performance measurement. We will not gather informatio
administrative functions that are not directly related to the TANF program.
How is the workbook organized?
The workbook is divided into six (6) sections, labeled A through F.

• Section A collects basic information on [TANF PROGRAM/PILOT NAME] and the reporting period of focus for the information in
• Section B collects costs of starting up the TANF pilot program and ongoing costs that are specific to pilot implementation.
• Sections C and D collect information about staff. Section C collects details about the positions and time use of staff with roles t
performance measurement in the TANF program during the specified reporting period. Section D asks about personnel costs (sal
identified in Section C.
• Section E asks about contracted services that support service delivery to TANF participants (such as case management, employ
services, etc.) and program management and performance measurement (such as data systems or data management).
• Section F asks about the costs of services purchased from or payments made to providers, vendors, or employers to support ac
not part of larger contracts) and any direct payments made to participants (beyond their basic cash assistance).
You can access each section by clicking on the tabs at the bottom of this page.

What time period does the workbook cover?
The workbook should cover a one-year period for which information is available on expenditures made (rather than budgets)--either
the first data collection, this period should be as close to the planning period of October 2025 through September 2026 as possible.
study team. For easy reference, the reporting period is repeated throughout the instructions of each tab.

What information will help complete the workbook?
To get started, the study team will work with you to identify readily available data or information from your agency, such as existing
in the information needed. We are seeking actual payment information rather than budgets as much as possible. We will walk you t
use of processes you might already have in place to compile this type of information. Different people might be needed to complete
with the costs and accounting records of TANF management, people familiar with the staffing structure of the TANF program, people
with the pilot planning process.

How will my organization share information to complete the workbook?
We will use a File Transfer Protocol established specifically for this study to securely share information between your agency and ou

How will the information that I provide be used?
Information from this workbook will be kept private to the extent permitted by law. Only members of the study team will have acces
start-up costs for the pilots, the costs of different components and activities, and how the use of resources might change over the pi
TANF pilots.
Thank you for your participation in this important study.
Public Burden Statement

PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering information to learn more about measuring program perf
to average 4 hours per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information.
information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0XXX and the expiration date is XX/XX/XXXX. If you h
[email protected].

SECTION A: YOUR AGENCY
This section documents basic information about your agency, the time period for cost information, and any circumstances outside of launching or implementing the
pilot that could affect TANF program costs. For the first data collection, this period should be as close to the planning period of October 2025 through September 2026
as possible.
A1.

Agency name

A2.

State or local agency
[State or local agency]

A3.

TANF program name

A4.

Please enter costs for the agreed-upon reporting period listed below (i.e. fiscal or calendar year).
[Month]

A5.

NOTE: TANF is used throughout this workbook; whenever TANF is used it means the TANF program or pilot
that is the focus of the FRA pilot implementation and evaluation.

[Year]

THROUGH

[Month]

[Year]

Please provide contact information for the person who will be the primary contact with the study team for completing this workbook.
Name
Position/Title
Email
Telephone
Address

A6.

If any unusual circumstances affected TANF program expenditures during the reporting period that are beyond changes associated with the pilot to
switch from the Work Participation Rate to outcome measures for TANF participants, please use this space to document them. For example,
unusually high staff turnover or substantial changes to funding or leveraged resources.

PLEASE SAVE AND CONTINUE TO THE NEXT SECTION.

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3 of 27

SECTION B: START UP COSTS
This section asks about the costs associated with starting up your TANF pilot during [specify reporting period, e.g. the pilot planning year of FY2026]. These might include investments in new
activities, staff hires, or infrastructure; or costs to prepare for and begin early implementation of the TANF pilot, such as planning and staff development time, or building new partnerships for
service delivery.
B1.

The table below tracks information about the costs to plan, prepare for, and initially launch your TANF pilot program. The study team pre-populated Column 1 with common
start-up or early implementation activities. Not every activity will apply to your program and you can enter -0- if you did not have costs for these activities during the planning
period. The list in column 1 is not exhaustive of implementation activities; we will add any other costs for activities associated with launching the TANF pilot program.
We can estimate expenditures based on information available about staff time or frequency of an activity, calculate expenditures using information across multiple sources, or
report actual expenditures based on tracking and financial reports. Note the method in column (4) by selecting an option from the drop-down menu. If the selected the option is
for "some other way," include a brief description of the method used in column (4a).

(1)
Costs for start up or early implementation
by type of activity
Example: Planning and preparing for the pilot among key staff (e.g. a
planning or implementation team)

(2)
Estimated or Actual
Expenditure
(Dollars)

(4)
Description of how you arrived at
amount reported in Column (2)
(Select from options)

(4a)
If other; specify how you arrived at the
amount reported in Column (2)

Estimate based on approximate staff time
$25,000.00 and frequency of activity

Planning and preparing for the pilot
Staff skill development, training, or manuals on new processes,
procedures, or activities
Building new partnerships or coordinating new or revised service delivery
with other agencies or external partners
New or upgraded facilities, equipment, furniture, supplies needed to
support new or restructured spaces, services, or activities
New or revised materials or information for participants
Data system upgrades
Data cleaning
Data matching (across systems or between state and local)
Other start-up costs relevant to pilot (specify)
Other start-up costs relevant to pilot (specify)
Other start-up costs relevant to pilot (specify)
Other start-up costs relevant to pilot (specify)
Other start-up costs relevant to pilot (specify)

B2.

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Use the space below to provide any additional information or other explanatory notes for this section.

4 of 27

PLEASE SAVE AND CONTINUE TO THE NEXT SECTION.

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SECTION C: STAFF POSITIONS AND FUNCTIONS
This section asks about the staff positions with roles that support program management, service delivery to participants, and p
recently vacated but that had been filled for most of the reporting period). Include all positions that regularly support management, se
operations support, or staff who do not spend any time working on the TANF program even if they work in the same location. The sec

C1.

Using the table below, indicate each staff position that supports the TANF program during the reporting period. Thi
direct services to participants; communication and outreach to participants, employers, and partners; staff profess
help you complete this section.

The table organizes staff by state-level, county/jurisdiction-level, and by contracted providers. ONLY INCLUDE CON
EMPLOYMENT COUNSELORS. Not all sections will apply to each pilot. The information may not be readily available
The table lists functions and asks you to indicate the functions that are relevant to each position. Each row should

Use one line for each position or job title (not each person):

1. Enter the staff position or job title for each distinct position that has a role that supports program management, service de

2. Select the function(s) for each position in the categories listed under Column (2a) by checking the boxes provided. Selec

3. Select the primary function each position performs by checking the box so it turns green under Column (2b). The primary
listed, please describe their primary function in Column (3). There is no need to include staff with primary functions other tha
4. Include additional information in Column (4), as needed, to describe the function(s) of the position.

Program management and administration

Policy, practices, and procedures

Staff support, communication,
supervision, training, or
professional development

(2a)

(2b)

(2a)

Select if staff
performs function

Select if primary
function for the
position

Example: Data specialist

TRUE

FALSE

Example: Program manager

TRUE

FALSE

Select if staff
performs function
(1)
Staff Position/Job Title
STATE-LEVEL STAFF POSITIONS (Responsibilities are at the state-level)

FALSE

REGIONAL, COUNTY, OR JURISDICTION-LEVEL STAFF POSITIONS (Responsibilities are at the local level even if p
Example: Case manager

FALSE

CONTRACTED PROVIDERS WHO HAVE FRONTLINE STAFF THAT WORK DIRECTLY WITH TANF PARTICIPANTS A

C2.

FALSE

Use the space below to provide any additional information or other explanatory notes for this section.

PLEASE SAVE AND CONTINUE TO THE NEXT SECTION.

service delivery to participants, and performance measurement in the TANF progam within the geographic area of the pilot during [specify repor
ns that regularly support management, service delivery, or performance measurement, even if it is a small part of their job. We will not include positions
if they work in the same location. The section also asks about the relevant functions of each position.

ogram during the reporting period. This should include all staff that contribute to management and service delivery of the TANF program, inc
employers, and partners; staff professional development and training; data tracking and reporting; and administrative and management func

racted providers. ONLY INCLUDE CONTRACTED PROVIDERS WHO HAVE FRONTLINE STAFF WHO WORK DIRECTLY WITH TANF PARTICIP
nformation may not be readily available from contracted providers, or not at this level of detail; fill in the information as best as possible for c

ant to each position. Each row should capture the functions performed by each distinct position and title.

upports program management, service delivery to participants, or performance measurement in the TANF progam.

a) by checking the boxes provided. Select all functions that apply to each distinct position. Leave function columns that do not apply to a position empty

ns green under Column (2b). The primary function is the function on which the staff position spends the most time, of the functions listed. If a staff posit
ude staff with primary functions other than the functions listed here (for example, an administrative assistant). Please only select one primary function

n(s) of the position.

(2)
Position function

management and administration

ff support, communication,
supervision, training, or
professional development

Service delivery

Administrative tasks to support
service delivery

Employer and partner engagement

Work-related frontline services to
TANF participants

(2b)

(2a)

(2b)

(2a)

(2b)

(2a)

Select if primary
function for the
position

Select if staff
performs function

Select if primary
function for the
position

Select if staff
performs function

Select if primary
function for the
position

Select if staff
performs function

FALSE

sibilities are at the local level even if positions are state employees)
FALSE

TRUE

FALSE

TRUE

FALSE

RECTLY WITH TANF PARTICIPANTS AS CASE MANAGERS, COACHES, OR EMPLOYMENT COUNSELORS
FALSE

FALSE

ory notes for this section.

rea of the pilot during [specify reporting period]. Staffing should be based on current positions (filled or
eir job. We will not include positions that do not directly support these functions such as general facilities or

delivery of the TANF program, including staff who are involved in oversight, delivery, or support of
ministrative and management functions. We will build from an organizational chart or a list of staff to

DIRECTLY WITH TANF PARTICIPANTS, SUCH AS CASE MANAGERS, COACHES, OR
ormation as best as possible for contracted providers.

hat do not apply to a position empty.

of the functions listed. If a staff position's primary function is not listed, but they do some functions that are
se only select one primary function per position.

ion

Service delivery

Performance measurement

Participation or other performance
metrics
Specialized services beyond work
(all related tasks such as
k-related frontline services to or work-related activities or work
compiling, entering, reporting,
TANF participants
supports
managing, etc.)

Outcome measures
(all related tasks such as
compiling, entering, reporting,
managing, etc.)

(2b)

(2a)

(2b)

(2a)

(2b)

(2a)

Select if primary
function for the
position

Select if staff
performs function

Select if primary
function for the
position

Select if staff
performs function

Select if primary
function for the
position

Select if staff
performs function

FALSE

TRUE

100%

TRUE

FALSE

TRUE

FALSE

TRUE

FALSE

urement

Outcome measures
(all related tasks such as
mpiling, entering, reporting,
managing, etc.)
(2b)

(3)
Other primary function
(3a)

(3b)

Select if primary
function for the
position is not listed

Describe
other function

FALSE

Description

FALSE

Select if primary
function for the
position

(4)
Description or
notes
Description

FALSE

SECTION D: PERSONNEL COSTS
This section asks about personnel costs (salaries and fringe benefits) for staff positions identified in Section C that support program management, service delivery to participants, and performance measurement in
the TANF progam within the geographic area of the pilot during [specify reporting period].

D1.

In the table below, we will indicate expenditures for salaries and fringe benefits for each staff position from Section C. The study team will carry over the positions and job titles from Section C, but
they may need to be separated into additional rows using the instructions below.
The table organizes staff by state-level, regional/county/jurisdiction-level, and by contracted providers in the same structure as Section C. ONLY INCLUDE CONTRACTED PROVIDERS WHO HAVE
FRONTLINE STAFF THAT WORK DIRECTLY WITH TANF PARTICIPANTS, SUCH AS CASE MANAGERS, COACHES, OR EMPLOYMENT COUNSELORS. Not all sections will apply to each pilot. The
information may not be readily available from contracted providers, or not at this level of detail; we will fill in the information as best as possible for contracted providers.
If available, include personnel expenses for relevant contracted providers for frontline staff ONLY (for example, case managers, coaches, or employment counselors).
Use one line for each position:
1. Enter each distinct staff position and job title in column (1).
2. Enter the average annual full-time wage paid for the position during the reporting period in column (2). If reporting a wage that is not on an hourly basis, include both regular and overtime pay. If the
position has a wage range, enter the range (for example, $40,000 to $50,000) or the median (for example $45,000).
3. Select the basis paid from the drop down menu in column (3) (e.g. per hour, per week, biweekly, etc.).
4. Enter the amount of payroll taxes and fringe benefits for each full-time equivalent (FTE) position as a percentage of salary or as an average dollar amount per FTE in column (4). If you only have a total
amount paid for all employees, record this amount in the workbook under explanatory notes at the bottom of this sheet (question D2).
5. Enter the number of FTE spots for each position in each separate row in column (6). Base the total FTEs on both (1) the percentage of time people in the position spend on TANF program activities and
(2) the number of hours they work a week (if they work less than full-time). For example, there are four Data Specialists; one works 20 hours a week all on the TANF program; another works full-time, 40
hours a week but spends 50% of their time on the TANF program, and two more both work full-time and spend all their time on the TANF program. The FTE for the Data Specialist position would be .5 + .5
+ 1 + 1 = 3.
NOTE: For contracted providers, we are most interested in personnel costs for frontline staff that work directly with TANF participants as case managers, coaches, or employment
counselors. Costs for other positions with contracted providers are not necessary to gather at the position level. If you are not able to gather information on personnel costs of frontline staff
who work for contracted providers at the position level, please skip that part of the table and follow the instructions in Section E.

(4)
Payroll taxes and fringe benefits (enter as a percentage of
salary or as a total dollar amount)
(1)
Staff Position/Job Title

(2)
Pay rate (dollars)

(3)
Basis paid

Value as a
percentage of salary

32.00%

Total amount paid
in dollars

(5)
Total full-time
equivalent (FTEs) for
position

STATE-LEVEL STAFF POSITIONS (Responsibilities are at the state-level)
Example: Data specialist

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$60,000.00

Per Year
[select from list]

[select from list]

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[select from list]

REGIONAL, COUNTY, OR JURISDICTION-LEVEL STAFF POSITIONS (Responsibilities are at the local level even if positions are state employees)
Example: Case manager

$35,000.00

Per Year

32.00%

[select from list]

10.5

CONTRACTED PROVIDERS: FRONTLINE STAFF THAT WORK DIRECTLY WITH TANF PARTICIPANTS AS CASE MANAGERS, COACHES, OR EMPLOYMENT COUNSELORS

D2.

[select from list]

Use the space below to enter any explanatory notes for the information provided in this section.

PLEASE SAVE AND CONTINUE TO THE NEXT SECTION.

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SECTION E: CONTRACTED SERVICES

This section asks about contracted goods or services purchased to support service delivery to participants and performance measurement in the TANF progam within the geographic area of the pilot during the [specify reporting period]

E1.

Use the table below to enter information on the contracted services purchased and their cost during [specify reporting period]. Include contracted goods and services that support service delivery to TANF participa
as case management or employment counseling) or goods and services that support performance measurement (such as data system upgrades, ongoing maintenance, and performance or outcomes reporting).
Do not include contracts or costs related to the purchase of office supplies, equipment, or general operating services (such as cleaning and upkeep of facilities, building purchases, or rent).
Include the name of the contractor or service provider in column (1), enter the expenditure in dollars in column (2), and list the types of services covered in column (3).

• Use a separate line for each type or category of service even if a contractor provided multiple types of services.
• If you cannot separate out a contractor's different services, please enter on one line but describe the different services in column (4).
• If you have a multi-year contract with a contractor, remember to report just the cost for the [specify reporting period].
• If your records provide only a total value for contracted services rather than amount expended, list as much information as you can. Add a note in E5 below that only the total value for contracted services is available.

(1)
Name of contractor

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(2)
Expenditure
amount (Dollars)

(3)
Type of service purchased

(4)
Description or additional notes

Example: ABC Nonprofit Organization

$50,000.00 Employment services

Provides employment coaching and job search assistance

Example: XYZ Data Solutions

Data management and
$25,000.00 reporting

Assists with management information system revisions;
develops periodic reports on participation and outcomes

17 of 27

E2.

Do any of the contracted services above cover wages for FRONTLINE STAFF THAT WORK DIRECTLY WITH TANF PARTICIPANTS AS CASE MANAGERS, COACHES, OR EMPLOYMENT COUNSELORS for which
information is not included in Section D, Personnel Costs? Use the drop-down box to select YES or NO.

[select from list]

E3.

If you answered YES to question E2, use the table below to enter any information available about the personnel costs of frontline staff at contracted providers that work directly with TANF participants during the re
period and could not be gathered at the position level in Section D.

• Use a separate line for each contractor.
• You may report budgeted costs for frontline staff exactly as they are stated in the contract, whether that is a total dollar amount, an aggregate across multiple staff, or as a percentage of the overall contract.
• If your records provide only a total value for contracted staff, list as much information as you can--include a list of contractors and service providers in column (1), enter the total value in column (2), list the types of staff positio
covered in column (4), note the types of staffing costs included in the total (i.e. salary, fringe benefits, other benefits) in column (5). Enter descriptions or notes in column (6) to provide any additional information that can assist
estimating the personnel costs for frontline staff at contracted providers. Enter a note in E5 below if only the total value for contracted services is available.

(1)
Name of contractor

E4.

(2)
Expenditure
amount
(approximate)

(3)
How this payment is
calculated?

(aggregate, %, or some other
way)

Example: ABC Nonprofit Organization

$25,000.00

Aggregate amount

OR Example: ABC Nonprofit Organization

$25,000.00

Case managers

Total personnel

If you answered NO to question E2, so the wages for FRONTLINE STAFF THAT WORK DIRECTLY WITH TANF PARTICIPANTS AS CASE MANAGERS, COACHES, OR EMPLOYMENT COUNSELORS are included in S
Personnel Costs, answer the following question:
Are all staff positions included in Section D covered by the associated contract listed in E1?

E5.

(5)
(4)
Staffing costs included in
Staff included in this total
this total?
Case managers and employment
counselors
Salary and fringe benefits

DROP DOWN YES/NO

Use the space below to provide information on calculations and data sources or other explanatory notes for this section.

PLEASE SAVE AND CONTINUE TO THE NEXT SECTION.

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18 of 27

port service delivery to participants and performance measurement in the TANF progam within the geographic area of the pilot during the [specify reporting period].

ervices purchased and their cost during [specify reporting period]. Include contracted goods and services that support service delivery to TANF participants (such
nd services that support performance measurement (such as data system upgrades, ongoing maintenance, and performance or outcomes reporting).

office supplies, equipment, or general operating services (such as cleaning and upkeep of facilities, building purchases, or rent).

umn (1), enter the expenditure in dollars in column (2), and list the types of services covered in column (3).

en if a contractor provided multiple types of services.
please enter on one line but describe the different services in column (4).
er to report just the cost for the [specify reporting period].
ices rather than amount expended, list as much information as you can. Add a note in E5 below that only the total value for contracted services is available.

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ONTLINE STAFF THAT WORK DIRECTLY WITH TANF PARTICIPANTS AS CASE MANAGERS, COACHES, OR EMPLOYMENT COUNSELORS for which
Use the drop-down box to select YES or NO.

nter any information available about the personnel costs of frontline staff at contracted providers that work directly with TANF participants during the reporting
tion D.

they are stated in the contract, whether that is a total dollar amount, an aggregate across multiple staff, or as a percentage of the overall contract.
list as much information as you can--include a list of contractors and service providers in column (1), enter the total value in column (2), list the types of staff positions
d in the total (i.e. salary, fringe benefits, other benefits) in column (5). Enter descriptions or notes in column (6) to provide any additional information that can assist in
providers. Enter a note in E5 below if only the total value for contracted services is available.

(6)
Description or additional notes
Personnel costs isolated and provided as one figure just
for frontline workers
Staff costs for frontline staff estimated as a percentage
of total contract

LINE STAFF THAT WORK DIRECTLY WITH TANF PARTICIPANTS AS CASE MANAGERS, COACHES, OR EMPLOYMENT COUNSELORS are included in Section D,

and data sources or other explanatory notes for this section.

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SECTION F: PURCHASED SERVICES

This section asks questions about payments to service providers, vendors, or employers made to support activities or services provid
geographic area of the pilot during the [specify reporting period]. It also asks about payments made directly to TANF participants
such as an incentive, stipend, or to reimburse them for specific costs incurred.
F1.

Use the table below to enter information on any services or goods purchased on behalf of participants and its cost du
could include costs for education or training program slots, work clothing or uniforms, educational materials (such as
medical expenses, dental costs, housing vouchers, licenses, etc. This could include money paid to employers for part
wages.
Note: Do not include transfers of TANF funding to other public programs.

Enter a separate line for each type or category of service or good. Do NOT include costs reported elsewhere in this wo
contracted services in Section E).

These costs can be recorded in whatever way is easiest—by total expenditure, by unit and quantity, or both. Include a
support and how the cost is calculated in column (4).

(1)
Type of item or service

(2)
Expenditure amount (Dollars)

Example: Computers

$1,500.00

Example: CNA training

$15,000.00

Example: Subsidized wages

$20,000.00

F2.

Use the table below to enter information on the cost of direct, cash payments--BEYOND THE BASIC CASH ASSISTANC
[specify reporting period]. This could be money or gift cards given to participants as an incentive tied to milestones (for
for enrolling in or completing a class), stipend for work experience or subsidized job, or to reimburse them for the cos
transportation, etc.). This should also include in-kind goods given to participants such as computers or work uniforms

Enter a separate line for each type or category of service or good. Do NOT include costs reported elsewhere in this wo
contracted services in Section E or in F1 above).

These costs can be recorded in whatever way is easiest—by total expenditure, by unit and quantity, or both. Include a
support and how the cost is calculated in column (4).

(1)
Type of payment
Example: Incentives

F3.

(2)
Expenditure amount (Dollars)
$5,000.00

Use the space below for any explanatory notes on the information provided in this section.

END OF WORKBOOK. Thank you for helping the study team gather this information!

ors, or employers made to support activities or services provided to TANF participants within the
asks about payments made directly to TANF participants
curred.

goods purchased on behalf of participants and its cost during [specify reporting period]. This
work clothing or uniforms, educational materials (such as books or supplies), child care,
, etc. This could include money paid to employers for participants' training or to subsidize their

lic programs.

good. Do NOT include costs reported elsewhere in this workbook (for example, under
total expenditure, by unit and quantity, or both. Include a brief description of each type of

(3)
Quantity
computers for each of 10 participants;
estimate is per computer

(4)
Description
support for participants to take an online 10week training program

aggregate for reporting period

paid for participants to take CNA training and
costs for certification exam

aggregate for reporting period

subsides paid to approved employers to
enhance wages of participants

t, cash payments--BEYOND THE BASIC CASH ASSISTANCE--made to participants during the
ven to participants as an incentive tied to milestones (for example, a gift card or bonus payment
rience or subsidized job, or to reimburse them for the cost of something (clothes,
given to participants such as computers or work uniforms.

good. Do NOT include costs reported elsewhere in this workbook (for example, under
total expenditure, by unit and quantity, or both. Include a brief description of each type of

(3)
(4)
Quantity
Description
Gave $20 to each participant for showing up Gave $20 to each participant for showing up
for each workshop
for each workshop

mation provided in this section.

r this information!

[select from list]
Per Hour
Per Week
Biweekly (26 pay periods)
Bimonthly (24 pay periods)
Per Month
Per Year
I3. Indirect costs
[select from list]
Salaries only
Salaries and fringe benefits
Salaries and fringe benefits and other direct costs
[select from list]
Yes
No
[State or local agency]

State
County
Local
Contracted provider
[Description of how you arrived at amount reported in Column 2]
Estimate based on approximate staff time and frequency of activity
Estimate based on information across multiple sources
Actual expenditure based on system or financial reports
Unable to estimate or report
Some other way (please specify)

[Month]
January
February
March
April
May
June
July
August
September
October
November
December

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[Year]
2024
2025
2026

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