Instructions for Completing

FORM SPO-H-205  BUDGET

 Applicant/Provider:  

Enter the Applicant's legal name.

RFP#:

Enter the Request for Proposal (RFP) identifying number for this service activity.

Column (a)     Budget Request:

Budget Request.  Enter the requested budget amounts for each cost item listed.  Use the Cost Principles included in the RFP and the POS Manual as a guide to determine which costs are allowed.

TOTAL (A+B+C+D):

Sum the subtotals for Budget Categories A, B, C and D, for columns (a) through (d).

SOURCES OF FUNDING:     (a)     (b)     (c)     (d)

Identify all sources of funding to be used for this service activity.

TOTAL REVENUE:

Enter the sum of all revenue sources cited above.

Budget Prepared by:

Type or print the name of the person who prepared the budget request and their telephone number.  If there are any questions or comments, this person will be contacted for further information and clarification.

Provide signature of Applicant's authorized representative, and date of approval.

 As each State agency may have specific needs for information , the special instructions section is for each state agency to complete for each RFP should there be a need.  Be sure to check the RFP (Request for Proposal) as that is where any special instructions will be.

SPECIAL INSTRUCTIONS: