Now you are ready to count the costs of your strategy/intervention (s). From the three best strategies identified in Assignment 2, select the strategy/s you would want to implement to address your practice issue. The assignment has two parts; a budget and a cost analysis.
For Your paper, you MUST include the headings in the grading guide to help organize your paper. The paper should not be more than 4-6 pages in length (excluding title page and reference list). You will need a minimum of six references for this paper.
Start out your paper with an introduction to the project. Briefly state what will be done by whom and where will it be done. What is your overall goal? (No more than 1/2 page….this and all subsequent page limits per item are recommendations).
Then prepare a line by line budget as an appendix
Now break down the expense for each item. For example, you may have listed $4000 for nursing expenses in your budget. Now you should explain that if an RN sees 10 patients per week, and there is a nursing assistant receptionist, the plan will cost $1000 each week. This would be a cost of $100 per patient to pay the salaries of the RN and assistant. If you plan to carry on the project for a month, it will cost $4000 for 40 patients.
These are the type of things you must consider in your budget:
Any increased personnel (RNs, LPNs, or NAs) needed to implement your plan. Any extra overtime for existing personnel to learn the new teaching plan.
The cost of duplicating handouts, booklets, etc to teach the program. The cost of flyers or ads to advertise about the new program.
Any new equipment needed for patients to take home (i.e. BP monitor, cook books, pedometer) Will you need a projector and computer to teach large groups of patients and families?
Will the patients need to come back for follow up assessment and possible reinforcement teaching or will this be a one time discharge teaching course.? (If another follow-up class is needed, calculate the cost of an individual doing this.)
Will you need a secretary or some other personnel to do a follow-up phone call and find out how the patient is doing, reinforce teaching, or schedule another class for more teaching?
Also look at the indirect cost of the plan (i.e. fringe benefits for extra employees). The cost of room to teach in may be an indirect in-kind cost.
What is the total cost of the project?
Grading guidelines for Budget /Cost Analysis
Develop your budget/cost analysis based on your selection of strategy/s from the Examining the Evidence assignment. In other words, you do not have to use all three strategies for your quality improvement initiative.
4-6 pages in length-use guidelines below. Include headings corresponding to rubric points.
Criteria Points
1. Introduction and thesis statement 1
2. Develop a line-item budget that shows all expenditures Determine total program costs (include as an appendix) 3
3. Include a breakdown of each individual item 3
4. Broad Scope Perspective of the Analysis 2
5. Estimate Program Effects
(use existing data to estimate to estimate program effects) 2
6. Estimate the Monetary Value of Outcomes 3
7. Account for the Effects of Time 3
8. Describe Distributional Consequences 3
9. Conduct Sensitivity Analysis 2
10. Discuss the Qualitative Residual 2
11.Conclusion, sum up the points of your paper. 1
Total points 25
Broad Scope of Analysis: Explain what you are comparing. For instance, you might be comparing the cost of an educational class on strategies to lower Hemoglobin A1Cs for diabetics vs. the costs of the consequences of diabetics not reducing A1Cs. Include the total estimated cost of the planned project or policy. (Please note: the program budget should already be developed and have identified the budgetary costs as a line item).
Estimate Program Effects: Here is where you bring in your background material. For instance, patients with this disease come to the ER or the clinic or the hospital typically 5 times per year. The length of stay is usually 3 days. The usual patient has to take these 3 medications for BP if they have not been educated about an exercise walking or diet plan, etc.
Estimate the Monetary Value of Outcomes: The cost of each ER visit is XX. The cost of each day in the hospital is YY. So if the program reduces the number of ER visits to 2 per year, it will save $LLLL. If this project will reduce the Length of Stay to 1 day, this will save $ZZZ. The project will reduce the use of emergency medications by YYY, etc.
Remember you are comparing the cost of the planned policy change with the status quo or with an alternate plan (i.e. comparing 2 different legislative bills).
Account for the Effects of Time: Discuss how many hospitals days will be saved. Discuss increased work productivity or increased attendance at school if these days are saved.
Estimate out the effects of time over a one year period.
Describe Distributional Consequences: Who all will benefit from this program? Look at family members. If this involves children, parents will have fewer days lost at work taking their children to the ER, Hospital, etc. Will insurance companies benefit through cost savings? Discuss how much more free time RNs might have to teach the program, follow- up or concentrate on other duties. Discuss nurse patient ratios that might be helped by decreased hospital visits, increased access to clinics, etc.
Conduct Sensitivity Analysis: How could your cost estimates change? For instance salaries might go up. Or you might have equipment donated by an organization or educational materials donated by a national foundation instead of developing and duplicating your own materials.
Discuss the Qualitative Residual: Discuss reduced pain and suffering to patients and families. Discuss improvement in quality of life. If your new project relates to foot care for diabetics and early intervention, talk about how this could save an amputation and how this would impact the individual. Or it might reduce retinopathy and blindness. If so the individual may be able to go to school, learn a new vocation, continue working in job that requires good eye sight, etc.
Examining the Evidence
?
Examining the Evidence
The nursing practice issue to be examined is: the screening of youngsters for type II diabetes mellitus in primary care. Generally, youngsters to be screened comprise adolescents and children. In this paper, the purpose is basically to examine the evidence: this entails examining the aforementioned nursing practice issue. This paper explains the reason why the practice issue is significant; why it is a quality and/or safety issue; and if anything has been done to address it. A PICO question is constructed and key search terms that relate to the question are identified. In addition, a synthesis of the evidence related to the topic of concern is provided. Three interventions for improving the practice issue are explained in detail and a synthesis of the supporting evidence is also provided.
Background
The practice issue is significant because it will help to identify and treat adolescents as well as children with type II diabetes mellitus (T2DM) and improve long-term outcome. The selected issue is a quality and/or safety issue because if diabetes mellitus is not treated, or if it is not treated properly, it could result in blindness, early death, coronary artery disease, renal failure, neuropathy, as well as peripheral vascular disease (Nesmith, 2009; Willi et al., 2004). In addition, screening adolescents and children who have particular risk factors could detect diabetes as well as insulin resistance early during the progression of the illness. It is noteworthy that early detection and treatment could promote treatment and/or alterations in lifestyle before serious complications arise (Bowen & Rothman, 2010). To address the issue in my practice, what has been done is the screening of type II diabetes with the use of hemoglobin (HbA1c) and fasting plasma glucose. In my present nursing practice, the problem which I have aware of is that there is inadequate knowledge regarding how to manage type II diabetes in children and in adolescents in primary care.
Using model
I will use the Institute of Medicine (IOM) model in my quality improvement initiative by ensuring that there is provision of quality care to children and adolescents with T2DM. The quality of care will comprise the following four imperative attributes: patient-centeredness, which basically centers on the patient’s experience of the disease and health care, and the extent to which systems succeed or fall short in satisfying the needs of the patient (Wald et al., 2012). Timeliness focuses on reducing delays and long waits. Safety of patient is an important element to high-quality healthcare, and effectiveness whereby effective care implies that patients do not get healthcare which is unable to assist them and/or where risks of health care outweigh benefits (Eriksson, Lindstrom & Tuomilehto, 2013). This model fits because by maintaining these characteristics, youngsters with T2DM will continue to stay healthy and keep getting better as they live with the disease. Another conceptual model that is guiding me in the process is Access to Care. This essentially focuses on healthcare utilization as well as barriers and facilitators to care. This model fits because by overcoming barriers to care and facilitating care to ensure effective healthcare utilization, the outcomes of children and adolescents with type II diabetes mellitus will improve (Reinehr, 2013).
PICO
The Patient, Intervention, Comparison, and Outcome (PICO) question is as follows: In children and adolescents with type II diabetes mellitus, will the use of metformin as initial therapy for the patients lead to better HbA1c control than glyburide? The key search terms which relate to the question are: diabetes type II therapy; HbA1c control; metformin; diabetic children; and glyburide. I determined the terms by listing down the words, which closely match with the PICO question, and then searched them on electronic databases. Using the key terms, I got twenty three hits; seven of them were broad but sixteen of them were close to my question. As such, I did not refine the question because there was no need.
Synthesis of the evidence
In relation to the screening of diabetes type II in children and adolescents, three of the ten studies reviewed pointed out that obesity is the primary indicator. Nurses within primary care settings are in a perfect position to spot adolescents as well as children who are at risk for T2DM and to begin suitable screening (Bowen & Rothman, 2010; Gahagan & Silverstein, 2003; Reinehr, 2013). However, one study revealed that providers of primary care such as nurses fail to identify the primary indication of T2DM screening, which is obesity (Hansen, Fulop & Hunter, 2009). It is recommended that the screening of type II diabetes should be done whenever obesity is seen and the youngster has at least two of the risk factors of this disease (Cox, Karen & Polvado, 2008).
With regards to the preferred method of testing, 2 of the ten studies emphasized that fasting plasma glucose is the preferred one and it needs to be collected after every twenty four months as long as the risk factors of the disease are still present (Eriksson, Lindstrom & Tuomilehto, 2013; Pozzo & Kemp, 2012). One of the studies pointed that notwithstanding the publication of screening recommendations for T2DM for the pediatric population, the rates of screening in adolescents and children who have the risk factors are very low (Willi et al., 2004). Five of the studies concluded that recognizing the relationship between fatness and T2DM in youngsters is a crucial initial step in the identification of youngsters at risk (Gahagan & Silverstein, 2003; Pozzo & Kemp, 2012; Wald et al., 2005; Eriksson, Lindstrom & Tuomilehto, 2013; Cox, Karen & Polvado, 2008). However, there is a gap in evidence: a review of the studies reveals that providers of healthcare are not conversant with the suitable time to begin screening or the recommendations of American Diabetes Association (ADA). Additionally, there is scarcity of research concerning the screening practices of primary care providers with regards to T2DM in children and adolescents. Three of the ten reviewed studies highlighted that screening for this disease is vital since if T2DM is not treated, or treated poorly, it could result in end-stage renal disease, peripheral vascular disease, coronary artery disease and blindness (Pozzo & Kemp, 2012; Bowen & Rothman, 2010; Hansen, Fulop & Hunter, 2009).
Best interventions/strategies
The three best interventions that I identified from the literature for improving the practice issue include the following. First, is lifestyle modifications, and this entails maintaining a weight that is healthy; increasing the everyday physical activity; and eating diet that is healthy (Hansen, Fulop & Hunter, 2009; Bowen & Rothman, 2010; Cox, Karen & Polvado, 2008). Second intervention measure entails screening for T2DM with the use of glycated hemeoglobin (HbA1c), two-hour oral-glucose tolerance test, and fasting plasma glucose (FPG) (Wald et al., 2005; Eriksson, Lindstrom & Tuomilehto, 2013; Bowen & Rothman, 2010). Third intervention is risk assessment basing on the presence of conditions or signs of related insulin resistance, personal and family history of the child or adolescent, and body mass index (BMI). (Hansen, Fulop & Hunter, 2009; Pozzo & Kemp, 2012; Gahagan & Silverstein, 2003; Willi et al., 2004)
From the reviewed studies on intervention, two of them emphasized that impaired fasting glucose (IFG) is diagnosed with a FPG between 6.1mmol/l – 6.9 mmol/l. Impaired glucose tolerance (IGT) is diagnosed using a FPG <7 mmol/l (Hansen, Fulop & Hunter, 2009; Bowen & Rothman, 2010). One study pointed out that lifestyle change is associated with positive safety profile and does not have any adverse effects. Moreover, lifestyle modification is more cost-effective and has other beneficial health-related effects (Cox, Karen & Polvado, 2008). Two of the studies revealed that aiming for BMI of <15 kg/m2 is an effective intervention measure for this population that comprises children and adolescents with T2DM (Gahagan & Silverstein, 2003; Willi et al., 2004). Four reviewed studies concluded that using glycated hemoglobin (HbA1c) in screening T2DM and fasting plasma glucose is appropriate in screening this disease (Hansen, Fulop & Hunter, 2009; Pozzo & Kemp, 2012; Wald et al., 2005; Willi et al., 2004).
I discovered two evidence-based guidelines/protocols: The first one is a clinical practice guideline for screening adolescents and children for T2DM in primary care. The second one is developed by the American Diabetes Association, titled: Evidence-Based Clinical Decision Making, which is fundamentally a framework for guiding clinical practice. There is enough quality evidence to support the three strategies. In assessing the quality of evidence, the following method was utilized: Weighting According to a Rating Scheme. The evidence is Good: it consists of reliable results from studies that were designed and carried out very well in representative populations that in a direct manner, evaluate effects on health outcomes. The tool used to level the recommendations and evidence is the United States Preventive Services Task Force (USPSTF). A copy of the tool used to rate the evidence is provided as a separate appendix.
Conclusions
In conclusion, the practice issue is significant since it will help to identify and treat adolescents and children with T2DM and improve long term outcome. The selected issue is a quality and/or safety issue because if diabetes mellitus is not treated, or if it is not treated properly, it could result in blindness, early death, coronary artery disease or renal failure. Early detection and treatment could promote treatment and/or alterations in lifestyle before serious complications arise. Intervention measures for this issue include lifestyle modifications; screening with the use of fasting plasma glucose and HbA1c; and risk assessment basing on family history and BMI. The evidence use is rated as Good. I will build on this beginning research by applying the intervention measures on children and adolescents with T2DM and using evidence-based guidelines in my practice.
References
Bowen, M. E., & Rothman, R. L. (2010). Multidisciplinary Management of Type 2 Diabetes in Children and Adolescents. Journal of Multidisciplinary healthcare, 21(3): 113-124.
Cox, D., Karen, J., & Polvado, N. P. (2008). Type 2 Diabetes in Children and Adolescents. Advance Healthcare, 16(11): 43.
Eriksson, J., Lindstrom, J., & Tuomilehto (2013). Potential for the Prevention of Type 2 Diabetes. British Medical Bulletin, 60(1): 183-199.
Gahagan, S., & Silverstein, J. (2003). Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children. PEDIATRICS, 112(4): 188.
Hansen, J. R., Fulop., M. J., & Hunter, M. K. (2009). Type 2 Diabetes in Youth: A Growing Challenge. Clinical Diabetes, 18(2): 174-177.
Nesmith, D. J. (2009). Type 2 Diabetes Mellitus in Children and Adolescents. PEDIATRICS IN REVIEW, 2(5): 147-152.
Pozzo, A. M., & Kemp, S. (2012). Pediatric Type 2 Diabetes Mellitus. Medscape, 33(2): 72-81.
Reinehr, T. (2013). Type 2 Diabetes in Children and Adolescents. World Journal of Diabetes, 4(6): 270-281.
Wald, E. R., Moyer, S. C. L., Eickhoff, J., & Ewing, L. J. (2012). Treating Childhood Obesity in Primary Care. SAGE Journals, 74(4): 123-129.
Willi, S. M., Martin, K., Datko, F. M., & Brant, B. P. (2004). Treatment of Type 2 Diabetes in Childhood Using a Very-Low-Calorie Diet. Diabetes Care, 27(2): 348-353.
Appendix 1: Matrix of evidence
Author/ Year Title Question/Purpose Design Sample Data Collection Findings Level of Evidence
Eriksson, J., Lindstrom, J., & Tuomilehto (2013). Potential for the Prevention of Type 2 Diabetes. To identify successful prevention strategies for T2DM Prospective observational 2,400 children and adolescents with T2DM Not stated Altering the lifestyle and screening youngsters at high risk of T2DM is an effective strategy High. Good sample size used,
Bowen, M. E., & Rothman, R. L. (2010). Multidisciplinary Management of Type 2 Diabetes in Children and Adolescents Multidisciplinary healthcare management in youth with type 2 diabetes Prospective observational 4,100 youth with type 2 diabetes Not specified Effective treatment of T2DM calls for a mix of medications and lifestyle change High, sample size is good,
Reinehr, T. (2013). Type 2 Diabetes in Children and Adolescents Diagnosis and screening for T2DM in adolescents and children Comparison 6,900 children and adolescents with T2DM Not stated Screening is meaningful particularly in high risk groups like obese adolescent and children. Treatment of choice is lifestyle intervention and pharmacological treatment such as metformin High.
Large number of sample size
Hansen, J. R., Fulop., M. J., & Hunter, M. K. (2009). Type 2 Diabetes in Youth: A Growing Challenge How to combat the increasing prevalence of obesity that underlies the increase in T2DM in adolescents and children. Prospective observational 4,633 children and adolescents with T2DM The 3 authors collected all the data Best prevention strategy in pediatric population is to identify obese youngsters who are at risk and intervening with regular healthy eating and exercise High.
Large sample size.
Cox, D., Karen, J., & Polvado, N. P. (2008). Type 2 Diabetes in Children and Adolescents. How should children and adolescents with T2DM be treated? Prospective observational 9,441 adolescents and children with T2DM Experiment Interventions include pharmaceutical therapy, lifestyle changes, monitoring for complications, hyperlipidmia and hypertension treatment High
Large sample size employed
Pozzo, A. M., & Kemp, S. (2012). Pediatric Type 2 Diabetes Mellitus. Screening for T2DM in children and adolescents Comparison 1,900 youths with T2DM 2 investigators collected the data Screening should be done after every 24 months, the optimal screening study is a fasting plasma glucose Moderate.
modest sample size used
Gahagan, S., & Silverstein, J. (2003). Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children. Preventive efforts, early diagnosis and collaborative care of American native and Alaskan children with T2DM Comparison 1,200 American native and Alaskan children with T2DM 2 investigators collected data from the Indian and Alaskan children Early screening and lifestyle modification are effective interventions Moderate.
reasonable sample size used
Wald, E. R., Moyer, S. C. L., Eickhoff, J., & Ewing, L. J. (2012). Treating Childhood Obesity in Primary Care To assess an intervention for children (9-12 years old) with obesity and their families delivered in primary care To determine the appropriateness of primary care in identifying and treating obese children 78 children entered treatment The investigators collected the data Primary care is a suitable place for identifying and treating children with obesity Moderate
Small low sample size used
Willi, S. M., Martin, K., Datko, F. M., & Brant, B. P. (2004). Treatment of Type 2 Diabetes in Childhood Using a Very-Low-Calorie Diet. To assess the use of a ketogenic, very-low-calorie-diet (VLCD) in the treatment of type 2 diabetes Comparison 20 pediatric patients with T2DM The researchers conducted a chart review of 20 children who consumed VLCD in the treatment of T2DM Ketogenic VLCD is an effective therapy for pediatric patients who have T2DM Low.
Small sample size used
Nesmith, D. J. (2009). Type 2 Diabetes Mellitus in Children and Adolescents. To describe the treatment for T2DM. Prospective observational 2,512 pediatric patients with T2DM Not stated. Screening is important to patients who are at great risk of T2DM. Treatment options range from exercise and diet modifications to medications including insulin and oral agents. High.
Good sample size used
Appendix 2: The IOM model used that aims for quality care – QR/DR Conceptual Framework (Reinehr, 2013).
Access to Care Quality to care
Facilitators and barriers to Care Health Care Utilization Safety Patient-centeredness Effectiveness Timeliness
Remaining healthy Remaining healthy
Getting better Getting better
Living with disability or disease Living with disability or disease
Dealing with the End of Life Dealing with End of Life
Appendix 3: A copy of the tool utilized in rating the evidence.
The USPSTF was used in grading the quality of the evidence on a three-point scale.
Rating
Low Evidence is inadequate in assessing the effects on health outcomes due to insufficient number of studies, errors in their design, lack of information on essential health outcomes, or chain of evidence having gaps
Moderate Evidence is adequate in determining the effects on health outcomes. However, the evidence strength is restricted by the generalizability to usual practice; uniformity, quality or number of individual studies; or indirect nature of the evidence.
High The evidence comprises studies that were carried out and designed properly in representative populations that assess directly the effects on health outcomes.
ATTACHMENT VIII: SAMPLE BUDGET
BUDGET GUIDELINES
INTRODUCTION
Guidance is offered for the preparation of a budget request. Following this guidance will facilitate the review and approval of a requested budget by insuring that the required or needed information is provided. These guidelines address major line items. They are not necessary aligned with the order of the applicable budget summary format that you will need to prepare nor will the line items necessarily reflect the order of the award instrument you ultimately receive. Please provide the justification and support in the same order as the summary budget form.
A. Salaries and Wages: For each requested position, provide the following information: name of staff member occupying the position, if available; annual salary; percentage of time budgeted for this program; total months of salary budgeted; and total salary requested. Also, provide a justification and describe the scope of responsibility for each position, relating it to the accomplishment of program objectives.
Sample budget
Personnel Position Title,
Annual
Time
Months
Total $ Amount Requested
Name, Hire Date
Project Coordinator, Susan Taylor, 10/1/01 $45,000 100% 12 months $45,000
Finance Administrator, John Johnson, 5/3/04 $28,500 50% 12 months $14,250
Outreach Supervisor, (Vacant)
8/05 (Anticipated) $27,000 100% 12 months $27,000
Sample Justification
The format may vary, but the description of responsibilities should be directly related to specific program objectives.
Job Description: Project Coordinator – (Name)
This position directs the overall operation of the project; responsible for overseeing the implementation of project activities, coordination with other agencies, development of materials, provisions of in service and training, conducting meetings; designs and directs the gathering, tabulating and interpreting of required data, responsible for overall program evaluation and for staff performance evaluation; and is the responsible authority for ensuring necessary reports/documentation are submitted to CDC. This position relates to all program objectives.
B. Fringe Benefits: Fringe benefits are usually applicable to direct salaries and wages. Provide information on the rate of fringe benefits used and the basis for their calculation. If a fringe benefit rate is not used, itemize how the fringe benefit amount is computed.
Sample Budget
25% of Total salaries = Fringe Benefits Fringe Benefits Total $_
If fringe benefits are not computed by using a percentage of salaries, itemize how the amount is determined.
Example: Project Coordinator — Salary $45,000
Retirement 5% of $45,000 = $2,250
FICA 7.65% of $45,000 = 3,443
Insurance $2,000/year = 2,000
Workers’ Compensation .05% of $45,000 =
23
Total = $7,716
C. Consultant Costs: This category is appropriate when hiring an individual to give professional advice or services (e.g., staff training, expert consultant, evaluation, development of curriculum, etc.) for a fee but not as an employee of the grantee organization. The consultant’s efforts contribute to the program objectives; however, their work is not designed to achieve the objectives. The services are usually professional in nature (as opposed to clerical or manual), requiring advanced education or experience in a specific technical field. See also Contractual/Subcontractual in Section H below. Written approval must be obtained from CDC prior to establishing a written agreement for consultant services. Approval to initiate program activities through the services of a consultant requires submission of the following information to CDC (see Budget Appendix A):
1. Name of Consultant;
2. Organizational Affiliation (if applicable);
3. Nature of Services To Be Rendered;
4. Relevance of Service to the Project;
5. The Number of Days of Consultation (basis for fee); and
6. The Expected Rate of Compensation (travel, per diem, other related expenses)—list a subtotal for each consultant in this category.
7. The basis of selection (competitive bids, sole source, single source, customer directed, etc.)
If the above information is unknown for any consultant at the time the application is submitted, the information may be submitted at a later date as a revision to the budget. In the body of the budget request, a summary should be provided of the proposed consultants and amounts for each.
D. Equipment: Provide justification for the use of each item and relate it to specific program objectives. Maintenance or rental fees for equipment should be shown in the “Other” category.
Sample Budget
Equipment Total $
Item Requested How Many Unit Cost Amount
Computer Workstation 2 ea. $1,500 $3,000
Fax Machine 1 ea. 200 200
Total $3,200
Sample Justification
Provide complete justification for all requested equipment, including a description of how it will be used in the program. If this equipment is expected to be used on more than one project or grant, then you must allocate that portion of the cost of the unit that will be used on this award.
E. Supplies: Individually list each item requested. Show the unit cost of each item, number needed, and total amount. Provide justification for each item and relate it to specific program objectives. If appropriate, General Office Supplies may be shown by an estimated amount per month times the number of months in the budget category tied to some basis of allocation (usually FTEs).
Sample Budget
Supplies General office supplies (pens, pencils, paper, etc.)
Total $
12 months x $20/month x 10 FTEs = $2,400
Educational Pamphlets (3,000 copies @ $1 each) = $3,000
Educational Videos (10 copies @ $150 each) = $1,500
Word Processing Software (@ $400—specify type to
be used on all projects) $4,000 x (10/100)FTEs = $ 400
Sample Justification
General office supplies will be used by staff members to carry out daily activities of the program. The education pamphlets and videos will be purchased from XXX and used to illustrate and promote safe and healthy activities . Word Processing Software will be used to document program activities, process progress reports, etc.
F. Travel: Dollars requested in the travel category should be for staff travel only. Travel for consultants should be shown in the consultant category. For other attendees, advisory committees, review panels, etcetera, the costs should show up as Other Direct Costs. Travel for staff, consultants, advisory committees, review panel, etc. should be itemized in the same way specified below. It is helpful to provide clear information regarding who, when, where, why, and how and to tie it to specific program objectives.
In-State Travel—Provide a narrative justification describing the travel staff members will perform. List where travel will be undertaken, number of trips planned, who will be making the trip, and approximate dates. If mileage is to be paid, provide the number of miles and the cost per mile. If travel is by air, provide the estimated cost of airfare. If per diem (Meals and Incidental Expenses (M&IE) and lodging) is to be paid, indicate the number of days and amount of daily per diem as well as the number of nights and estimated cost of lodging. Include the cost, mode, and purpose of ground transportation when applicable.
Out-of-State Travel—Provide a narrative justification describing the same information requested above. Include CDC meetings, conferences, and workshops if required by CDC. Itemize out-of-state travel in the format described above.
NOTE: It is helpful if you utilize the allowable travel and per diem rates that are established
for all Government-related travel. These can be found at:
Per diem: http://policyworks.gov/org/main/mt/homepage/mtt/perdiem/perd01d.html (don’t forget to add taxes to lodging)
Airline Flights: http://www.fedtravel.com/gsa/
Total $
The Project Coordinator and the Outreach Supervisor will travel to (location) to attend AIDS conference. The Project Coordinator will make an estimated 25 trips to local outreach sites to monitor program implementation.
Sample Budget
Out-of-State Travel:
1 trip x 1 person x $500 r/t airfare = $500
3 days per diem x $38/day x 1 person = 114
2 nights lodging x $67/night x 1 person = 134
2 nights taxes on lodging $67 x 14% x 1 per.. = 19
Ground transportation 1 person = 50
Total $817
Sample Justification
The Project Coordinator will travel to CDC, in Atlanta, GA, to attend the CDC Conferences schedule for January, April, and August .
G. Other: This category contains items not included in the previous budget categories. Individually list each item requested and provide appropriate justification related to the
program objectives. It is helpful to provide a basis of allocation.
Sample Budget
Other Total $
Monitoring and Evaluation (M&E) Activities:
Basis of Allocation: Per the 10-12% CDC program requirement for M&E activities (for future PEMS activities as they are determined).
Calculations: Total M&E costs are anticipated to be 10% of the total budget, $30,000. Total M&E costs for this project is $30,000
Telephone: Local and Long Distance Basis of Allocation: FTEs
Calculations: Total phone costs are anticipated to be $5,000. There are 8.3 FTEs on this project relative to the total number of FTEs of 26; therefore, the application rate is 32%. Total Telephone for this project is $1,600
Postage: Regular, Bulk, Express
Basis of Allocation: Percentage of income
Calculations: Total postage costs are anticipated to be $42,500. Program income is
$256,000 relative to total income of $3.6 million; therefore, the application rate is 7%. Total Postage for this project is $2,975
Printing:
AIDS Awareness Brochures
($ per x documents) = $ Subtotal
Safer Sex Guidelines
($ per x documents) = $ Subtotal
Photocopying:
Basis of Allocation: FTEs
Calculations: Total photocopying costs are anticipated to be $1,320. There are 8.3 FTEs on this project relative to the total number of FTEs of 26; therefore, the application rate is 32%. Total Photocopying for this project is $422
Equipment Rental: Postage Machine Basis of Allocation: Percentage of income
Calculations: Total machine rental is anticipated to be $1,200 ($100 x 12 months). Program income is $256,000 relative to total income of $3.6 million; therefore, the application rate is 7%. Total machine rental for this project is $84
Internet Provider Service:
($18 per month x 9 months x 5.4 FTEs) =$875
DSL Service:
Basis of Allocation: FTEs
Calculations: Total DSL costs are anticipated to be $900 ($100 per month for 9 months). There are 5.4 FTEs on this project relative to the total number of FTEs of 12; therefore, the application rate is 45%. Total DSL Service for this project is $405
Occupancy Costs: Anticipated Occupancy Costs are as follows –
Basis of Allocation: Square Footage
Calculations: There are 1,150 square feet of space (of total 5,365 square feet) dedicated specifically to this program; therefore, the application rate is 21.4%. Total Occupancy Costs for this project are $14,404
Sample Justification
Some items are self-explanatory (telephone, postage, rent) unless the unit rate or total amount requested is excessive. If not, include additional justification. For printing costs, identify the types and number of copies of documents to be printed (e.g., procedure manuals, annual reports, materials for media campaign).
Note: Any item that exceeds one percent of the grant value is subject to additional scrutiny. Please be sure to provide adequate information for these items.
H. Contractual Costs: There are two types of contractual relationships: The first is closer to being subcontractual, the second is more general in nature. For the purposes of preparing your proposal, include subcontractual costs in the section of your budget headed Contractual. A subcontractor is an entity that performs duties that are either the same as or directly related to the scope of work of the project. Their efforts contribute directly to the outcome of the project. They actually do the program objectives. The subcontractor is basically doing the work on behalf of the grantee. Examples of subcontractors would be program trainers, community outreach workers, community advisors.
Cooperative Agreement recipients must obtain written approval from CDC prior to establishing a third-party contract to perform program activities. Approval to initiate program activities through the services of a contractor requires submission of the following
information to CDC (see Budget Appendix B):
1. Name of Contractor;
2. Method of Selection (competitive bids, single source, customer directed, same as last year, etc.);
3. Period of Performance;
4. Scope of Work;
5. Method of Accountability; and
6. Itemized Budget and Justification.
If the above information is unknown for any contractor at the time the application is submitted, the costs will be restricted. It is essential that supporting information along with a request to have restrictions lifted be submitted to PGO as soon after award as possible. Failure to do this will result in delays and withholding of payments. Copies of the actual contracts should not be sent to CDC, unless specifically requested. In the body of the budget request, a summary should be provided of the proposed contracts and amounts for each.
For contractual costs that are more general in nature (janitorial, maintenance, payroll services, bookkeeping services, CPA, Audit, etc.) but their costs can be directly tied to the project at hand (the cost is allocable), then these should be considered contractual costs under Other Direct Costs. If you charge indirect via a rate, be careful that these indirect- type costs were not included in the indirect cost pool when the indirect cost rate was calculated. If they were included, then you will be double billing the Government and you will have an audit finding. You do not need to provide the level of justification that you do for subcontractual costs. However, be certain to include the basis of allocation and the method of formulation.
Sample Budget
Contractual Total $
CPA Consulting Services
Basis of Allocation: Hourly rate of $45 x 100 hours =$4,500
Payroll Services:
Basis of Allocation: Payroll Dollars/FTEs
Calculations: Total payroll costs are anticipated to be $354,000. The service costs us 1% of payroll: $3,540. There are 8.3 FTEs on this project relative to the total number of FTEs of 26; therefore, the application rate is 32%. Total Payroll costs for this project is $1,133
Housekeeping:
Basis of Allocation: Square Footage
Calculations: Total Housekeeping contract is $235/month x 12 months = $2,820. There are 1,150 square feet of space (of total 5,365 square feet) dedicated specifically to this program; therefore, the application rate is 21.4%. Total Housekeeping Costs for this project are $603
I. Total Direct Costs $
Show total direct costs by listing totals of each category.
J. Indirect Costs $
To claim indirect costs, the applicant organization must have a current approved indirect cost rate agreement established with the cognizant Federal agency. A copy of the most recent indirect cost rate agreement must be provided with the application.
Sample Budget
The rate is % and is computed on the following direct cost base of $ .
Personnel $
Fringe $
Travel $
Supplies $
Other $
Total $ x % = Total Indirect Costs
NOTE: If the applicant has an approved indirect rate but they still elect to charge a portion of indirect-types of costs (administrative, occupancy, telecommunications, insurance, etc.) as direct costs, please be certain that the direct charged costs were not included in the indirect cost pool when the rate was formulated. It is important that you provide an assurance on the budget that the costs were removed. Failure to remove the costs will result in double charging to this agreement and it will be a serious finding on your audit. Please consult your CPA on this matter.
If the applicant organization does not have an approved indirect cost rate agreement, then costs normally identified as indirect costs (overhead costs) can be budgeted and identified as direct costs. Cost breakdowns, justifications, and calculations such as indicated above will be necessary in order to support these costs.
Appendix A:
Required Information for Consultant Approval
This category is appropriate when hiring an individual who gives professional advice or provides services for a fee and who is not an employee of the grantee organization. All consultants require prior approval from CDC annually. Submit the following required information for consultants:
1. Name of Consultant: Identify the name of the consultant and describe his or her qualifications.
2. Organizational Affiliation: Identify the organization affiliation of the consultant, if applicable.
3. Nature of Services To Be Rendered: Describe in outcome terms the consultation to be provided including the specific tasks to be completed and specific deliverables. A copy of the actual consultant agreement should not be sent to CDC.
4. Relevance of Service to the Project: Describe how the consultant services relate to the accomplishment of specific program objectives.
5. Number of Days of Consultation: Specify the total number of days of consultation.
6. Expected Rate of Compensation: Specify the rate of compensation for the consultant (e.g., rate per hour, rate per day). Include a budget showing other costs such as travel, per diem, and supplies.
7. Method of Accountability: Describe how the progress and performance of the consultant will be monitored. Identify who is responsible for supervising the consultant agreement.
Appendix B:
Required Information for Contract Approval
All contracts require prior approval from CDC. Funds may not be used until the following required information for each contract is submitted to and approved by CDC:
1. Name of Contractor: Who is the contractor? Identify the name of the proposed contractor and indicate whether the contract is with an institution or organization.
2. Method of Selection: How was the contractor selected? State whether the contract is sole source or competitive bid. If an organization is the sole source for the contract, include an explanation as to why this institution is the only one able to perform contract services.
3. Period of Performance: How long is the contract period? Specify the beginning and ending dates of the contract.
4. Scope of Work: What will the contractor do? Describe in outcome terms, the specific services/tasks to be performed by the contractor as related to the accomplishment of program objectives. Deliverables should be clearly defined.
5. Method of Accountability: How will the contractor be monitored? Describe how the progress and performance of the contractor will be monitored during and on close of the contract period. Identify who will be responsible for supervising the contract.
6. Itemized Budget and Justification: Provide an itemized budget with appropriate justification. If applicable, include any indirect cost paid under the contract and the indirect cost rate used.
Last Completed Projects
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