2022 COVID-19 Community-Based Organization Budget Template
       Community-based organization grantees are encouraged to create a calendar year 2022 
       budget with funds remaining from calendar year 2021. Amounts below are provided as an 
       example only.
                Fill in your Community-based organization name here (fiscal agent, if applicable)
                                                       Grant Period: December 31, 2020-June 30, 
                                                     2023                                                         Budget 
                                                         period: January 1-December 31, 2022
       PERSONNEL                                                     Subtotal
                                                     List as an      % FTE based on 
                                                     Annual Salary   12 months
       (Position Title and Name)                             $10,000              10%
       Brief description of activities, for example, This 
       position has primary responsibility for ______ 
       activities or scope of work activities.
       Example: Community Health Worker                       $5,000             100%
       Desciption here
       Example: Outreach Specialist                           $5,000              50%
       Description here
       Fringe Benefits @ (__)% of describe rate or 
       method (enter value in orange box as .###) 
       for calculation to work                                                     0.5
       TRAVEL
         Total In-State Travel: (describe travel to 
       include meals, registration, lodging and 
       mileage)                                                    $525
                     Hotel Costs:                                                $100
                     Per Diem Costs:                                              $50
                     Mileage or Car Rental Costs:                                $250
                     Registration Costs:                                         $120
                                           Page 1 of 9
                                               Grant Period: December 31, 2020-June 30, 
                                              2023                                                         Budget 
                                                 period: January 1-December 31, 2022
                   Misc. Costs:                                         $5
      CAPITAL EQUIPMENT (include any items 
      beyond start up costs for quarter 1)                                
                                                                        $0
                                                                        $0
      SUPPLIES                                                            
      Printer paper                                                   $500
      Pencils/pens                                                    $100
      Folders                                                         $100
      Clipboards                                                       $50
      CONTRACTUAL (list each Contract 
      separately and provide a brief description)                         
      Contract with (____) Company for $_______, 
      for (________) services.                                      $1,000
      Contract with (____) Company for $_______, 
      for (________) services.                                      $1,500
      Contract with (____) Company for $_______, 
      for (________) services.                                        $500
      OTHER                                                
      Outside printing - health education booklet                     $500
                                     Page 2 of 9
                                           Grant Period: December 31, 2020-June 30, 
                                          2023                                                         Budget 
                                             period: January 1-December 31, 2022
      TOTAL DIRECT CHARGES
      INDIRECT CHARGES (enter rate as .### in 
      box) for calculation to work                              0.15
                                  Indirect Rate ( _______ %)
      TOTAL BUDGET:
                                 Page 3 of 9
  2022 COVID-19 Community-B2a0s2ed2  COrgOVIaDn-iz19atio Conm Bmuudngityet -TBemasedpla Orgte  anization Budget Template
Community-based organizatioConm gmraunnteesity-b aare seden ocorguaranizgaedtio ton  gcrearante teesa  caare lenendacor uyearagr ed20 2to2  create a calendar year 2022 
budget with funds remainingb ufrodgmet  cawlenithd fuar nydeas remr 20a2in1. inAgm frooumnts ca blenelodwa r ayre eapr ro2v0id21ed. A amso aunn ts below are provided as an 
                   example only.
Fill in your Community-basedF ill orgina ynoizuar tioConm nmamune ityhere -bas(fiedsca orgl aagnenizat, tioif na pnpalicame bhle)ere (fiscal agent, if applicable)
                                    Grant Period: December 31, 2020-June 30, 
                                  2023                                                         Budget 
                                       period: January 1-December 31, 2022                 
                   PERSONNEL                                                 $12,750
                   (Position Title and Name)                                      1,000
                   Brief description of activities, for example, This 
                   position has primary responsibility for ______ 
                   activities or scope of work activities.                                 
                   Example: Community Health Worker                               5,000
                   Desciption here
                   Example: Outreach Specialist                                   2,500
                   Description here
                                                                                       0
                   Fringe Benefits @ (__)% of describe rate or 
                   method (enter value in orange box as .###) 
                   for calculation to work                                        4,250
                   TRAVEL                                                          $525
                     Total In-State Travel: (describe travel to 
                   include meals, registration, lodging and 
                   mileage)
                                   Hotel Costs:  
                                   Per Diem Costs: 
                                   Mileage or Car Rental Costs: 
                                   Registration Costs: 
                                                  Page 4 of 9