Basic Annual Budget

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Overview

Home Page
Personnel Salary and Fringe
Contracts
Consultants
Basic Budget
Domain 2 Budget
Domain 3 Budget
Domain 4 Budget
Budget Reports
424A-SectionB_PPHF
424A-SectionB_Non-PPHF
In-Kind Funding (Optional)

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Sheet 1: Home Page

1305 Year 2 Budget (PPHF)

Form Approved OMB No. 0920-XXXX Exp. Date XX/XX/XXXX

State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health

<Enter State Name>

Workbook Contents

Instructions

Public reporting of this collection of information varies from 1 to 9 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-XXXX).

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Sheet 2: Personnel Salary and Fringe

Personnel Salary and Fringe
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)
Personnel Cost
Name	Position Title	Annual Salary and Wages	% Paid by This Grant	Months	Salary and Wages	Fringe (%)	Fringe ($) if not %	Fringe	Total Planned
					$-			$-	$-
Allocation of Cost by Domain and Funding Category						Justification
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total
Basic Activities	0.0%			0.0%	0.0% ($0)
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)

---

Sheet 3: Contracts

Contracts
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-
Basic Information						Itemized Costs			Justification
Name of Contractor						Salary and Wages		$-
Method of Selection						Fringe Benefits		$-
Justification for Sole Source Selection (if applicable)						Consultant Costs		$-
Period of Performance						Equipment		$-
Scope of Work						Supplies		$-
						Travel		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
						Other	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Subcontract Costs		$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL DIRECT COSTS		$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Indirect Rate
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	TOTAL INDIRECT COSTS		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONTRACT		$-

---

Sheet 4: Consultants

Consultants
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
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Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
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Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
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Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
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Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
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Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
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Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
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Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
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Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
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Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
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Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
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Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
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Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-
Basic Information						Itemized Costs			Justification
Name of Consultant						Number of Days of Consultation
Organizational Affiliation						Expected Daily Rate of Compensation		$-
Nature of Services to Be Rendered						BASE COMPENSATION SUBTOTAL		$-
						Travel		$-
Relevance of Service to the Project						Per Diem (total for all days consultation)		$-
						Supplies		$-
Method of Accountability						Deliverable Cost	<enter description>	$-
Allocation of Cost by Domain and Funding Category						Other	<enter description>	$-
Funding Category Domain	HDSP	Diabetes	NPAO	SH	Domain Total	Other	<enter description>	$-
Basic Activities	0.0%			0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 2 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 3 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	Other	<enter description>	$-
Domain 4 Activities	0.0%	0.0%	0.0%	0.0%	0.0% ($0)	EXPENSES SUBTOTAL		$-
Funding Category Total	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	0.0% ($0)	TOTAL FOR CONSULTANT		$-

---

Sheet 5: Basic Budget

Basic Funding

BUDGET FOR BASIC

Planned Budget

Obligated to Date

Expended to Date

Unobligated Balance

Description of Indirect Cost Calculations (also applies to enhanced domains)

Salary and Wages

$-

$-

Fringe Benefits

$-

$-

Consultant Costs

$-

$-

Equipment

$-

$-

Supplies

$-

$-

Travel

$-

$-

Other

$-

$-

Contractual Costs

$-

$-

Total Direct Costs

$-

$-

$-

$-

Indirect Costs

TOTAL

$-

$-

$-

$-

TARGET

$-

DIFFERENCE (should be zero)

$-

Personnel Salary and Fringe

Totaled from Personnel Salary and Fringe tab (click to view)

Total Salary and Wages Planned

Total Fringe Planned

TOTAL:

$-

$-

Consultant Costs

Totaled from Consultants tab (click to view)

Total Amount Planned

TOTAL:

$-

Contractual Costs

Totaled from Contracts tab (click to view)

Total Amount Planned

TOTAL:

$-

Equipment

In most cases, awardees may not use funds from this grant for the purchase of furniture or equipment. Select "Yes" at right if you plan to purchase equipment.

Select

Item Requested

Number Needed

Unit Cost

Amount Planned

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

Supplies

Item Requested

Type (if appropriate)

Number Needed

Unit Cost

Amount Planned

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

Travel

Description and Number of People

Cost of Airfare or Mileage

Cost of Per Diem or Lodging

Cost of Ground Transportation

Other Costs

Total Amount Planned

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

$-

Other

Item Requested

Number Needed

Unit Cost

Amount Planned

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

---

Sheet 6: Domain 2 Budget

Domain 2: Environmental Approaches that Promote Health

BUDGET FOR DOMAIN 2

Planned Budget

Obligated to Date

Expended to Date

Unobligated Balance

Funding Category

HDSP

NPAO

SH

HDSP

NPAO

SH

HDSP

NPAO

SH

HDSP

NPAO

SH

Salary and Wages

$-

$-

$-

$-

$-

$-

Fringe Benefits

$-

$-

$-

$-

$-

$-

Consultant Costs

$-

$-

$-

$-

$-

$-

Equipment

$-

$-

$-

$-

$-

$-

Supplies

$-

$-

$-

$-

$-

$-

Travel

$-

$-

$-

$-

$-

$-

Other

$-

$-

$-

$-

$-

$-

Contractual Costs

$-

$-

$-

$-

$-

$-

Total Direct Costs

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

Indirect Costs

$-

$-

$-

TOTAL

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TARGET

$-

$-

$-

DIFFERENCE (should be zero)

$-

$-

$-

Personnel Salary and Fringe

Totaled from Personnel Salary and Fringe tab (click to view)

Total Salary and Wages Planned

Salary and Wages funded by HDSP

Salary and Wages funded by NPAO

Salary and Wages funded by SH

Total Fringe Planned

Fringe funded by HDSP

Fringe funded by NPAO

Fringe funded by SH

TOTAL:

$-

$-

$-

$-

$-

$-

$-

$-

Consultant Costs

Totaled from Consultants tab (click to view)

Total Amount Planned

Amount funded by HDSP

Amount funded by NPAO

Amount funded by SH

TOTAL:

$-

$-

$-

$-

Contractual Costs

Totaled from Contracts tab (click to view)

Total Amount Planned

Amount funded by HDSP

Amount funded by NPAO

Amount funded by SH

TOTAL:

$-

$-

$-

$-

Equipment

In most cases, awardees may not use funds from this grant for the purchase of furniture or equipment. Select "Yes" at right if you plan to purchase equipment.

Select

Item Requested

Number Needed

Unit Cost

Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to NPAO activities

Amount funded by NPAO

% allocated to SH activities

Amount funded by SH

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

Supplies

Item Requested

Type (if appropriate)

Number Needed

Unit Cost

Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to NPAO activities

Amount funded by NPAO

% allocated to SH activities

Amount funded by SH

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

Travel

Description and Number of People

Cost of Airfare or Mileage

Cost of Per Diem or Lodging

Cost of Ground Transportation

Other Costs

Total Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to NPAO activities

Amount funded by NPAO

% allocated to SH activities

Amount funded by SH

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

$-

$-

$-

$-

Other

Item Requested

Number Needed

Unit Cost

Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to NPAO activities

Amount funded by NPAO

% allocated to SH activities

Amount funded by SH

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

---

Sheet 7: Domain 3 Budget

Domain 3: Health System Interventions

BUDGET FOR DOMAIN 3

Planned Budget

Obligated to Date

Expended to Date

Unobligated Balance

Funding Category

HDSP

Diabetes

HDSP

Diabetes

HDSP

Diabetes

HDSP

Diabetes

Salary and Wages

$-

$-

$-

$-

Fringe Benefits

$-

$-

$-

$-

Consultant Costs

$-

$-

$-

$-

Equipment

$-

$-

$-

$-

Supplies

$-

$-

$-

$-

Travel

$-

$-

$-

$-

Other

$-

$-

$-

$-

Contractual Costs

$-

$-

$-

$-

Total Direct Costs

$-

$-

$-

$-

$-

$-

$-

$-

Indirect Costs

$-

$-

TOTAL

$-

$-

$-

$-

$-

$-

$-

$-

TARGET

$-

$-

DIFFERENCE (should be zero)

$-

$-

Personnel Salary and Fringe

Totaled from Personnel Salary and Fringe tab (click to view)

Total Salary and Wages Planned

Salary and Wages funded by HDSP

Salary and Wages funded by Diabetes

Total Fringe Planned

Fringe funded by HDSP

Fringe funded by Diabetes

TOTAL:

$-

$-

$-

$-

$-

$-

Consultant Costs

Totaled from Consultants tab (click to view)

Total Amount Planned

Amount funded by HDSP

Amount funded by Diabetes

TOTAL:

$-

$-

$-

Contractual Costs

Totaled from Contracts tab (click to view)

Total Amount Planned

Amount funded by HDSP

Amount funded by Diabetes

TOTAL:

$-

$-

$-

Equipment

In most cases, awardees may not use funds from this grant for the purchase of furniture or equipment. Select "Yes" at right if you plan to purchase equipment.

Select

Item Requested

Number Needed

Unit Cost

Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to Diabetes activities

Amount funded by Diabetes

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

Supplies

Item Requested

Type (if appropriate)

Number Needed

Unit Cost

Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to Diabetes activities

Amount funded by Diabetes

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

Travel

Description and Number of People

Cost of Airfare or Mileage

Cost of Per Diem or Lodging

Cost of Ground Transportation

Other Costs

Total Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to Diabetes activities

Amount funded by Diabetes

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

$-

$-

$-

Other

Item Requested

Number Needed

Unit Cost

Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to Diabetes activities

Amount funded by Diabetes

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

---

Sheet 8: Domain 4 Budget

Domain 4: Community-Clinical Linkages

BUDGET FOR DOMAIN 4

Planned Budget

Obligated to Date

Expended to Date

Unobligated Balance

Funding Category

HDSP

Diabetes

SH

HDSP

Diabetes

SH

HDSP

Diabetes

SH

HDSP

Diabetes

SH

Salary and Wages

$-

$-

$-

$-

$-

$-

Fringe Benefits

$-

$-

$-

$-

$-

$-

Consultant Costs

$-

$-

$-

$-

$-

$-

Equipment

$-

$-

$-

$-

$-

$-

Supplies

$-

$-

$-

$-

$-

$-

Travel

$-

$-

$-

$-

$-

$-

Other

$-

$-

$-

$-

$-

$-

Contractual Costs

$-

$-

$-

$-

$-

$-

Total Direct Costs

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

Indirect Costs

$-

$-

$-

TOTAL

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TARGET

$-

$-

$-

DIFFERENCE (should be zero)

$-

$-

$-

Personnel Salary and Fringe

Totaled from Personnel Salary and Fringe tab (click to view)

Total Salary and Wages Planned

Salary and Wages funded by HDSP

Salary and Wages funded by Diabetes

Salary and Wages funded by SH

Total Fringe Planned

Fringe funded by HDSP

Fringe funded by Diabetes

Fringe funded by SH

TOTAL:

$-

$-

$-

$-

$-

$-

$-

$-

Consultant Costs

Totaled from Consultants tab (click to view)

Total Amount Planned

Amount funded by HDSP

Amount funded by Diabetes

Amount funded by SH

TOTAL:

$-

$-

$-

$-

Contractual Costs

Totaled from Contracts tab (click to view)

Total Amount Planned

Amount funded by HDSP

Amount funded by Diabetes

Amount funded by SH

TOTAL:

$-

$-

$-

$-

Equipment

In most cases, awardees may not use funds from this grant for the purchase of furniture or equipment. Select "Yes" at right if you plan to purchase equipment.

Select

Item Requested

Number Needed

Unit Cost

Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to Diabetes activities

Amount funded by Diabetes

% allocated to SH activities

Amount funded by SH

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

Supplies

Item Requested

Type (if appropriate)

Number Needed

Unit Cost

Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to Diabetes activities

Amount funded by Diabetes

% allocated to SH activities

Amount funded by SH

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

Travel

Description and Number of People

Cost of Airfare or Mileage

Cost of Per Diem or Lodging

Cost of Ground Transportation

Other Costs

Total Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to Diabetes activities

Amount funded by Diabetes

% allocated to SH activities

Amount funded by SH

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

$-

$-

$-

$-

Other

Item Requested

Number Needed

Unit Cost

Amount Planned

% allocated to HDSP activities

Amount funded by HDSP

% allocated to Diabetes activities

Amount funded by Diabetes

% allocated to SH activities

Amount funded by SH

Justification

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

$-

TOTAL:

$-

$-

$-

$-

---

Sheet 9: Budget Reports

Budget Reports
PPHF Budget
Target versus Planned Budget by Domain and Funding Category
	Funding Category	Heart Disease and Stroke Prevention	Diabetes	Nutrition, Physical Activity, and Obesity	School Health	TOTAL
Target Funding	Basic	$-	$-	$-	$-	$-
	Enhanced	$-	$-	$-	$-	$-
	Domain 2	$-	$-	$-	$-	$-
	Domain 3	$-	$-	$-	$-	$-
	Domain 4	$-	$-	$-	$-	$-
	TOTAL TARGET	$-	$-	$-	$-	$-
Planned Budget	Basic	$-	$-	$-	$-	$-
	Enhanced	$-	$-	$-	$-	$-
	Domain 2	$-	$-	$-	$-	$-
	Domain 3	$-	$-	$-	$-	$-
	Domain 4	$-	$-	$-	$-	$-
	TOTAL PLANNED	$-	$-	$-	$-	$-
Balance (Not Yet Planned)	Basic	$-	$-	$-	$-	$-
	Enhanced	$-	$-	$-	$-	$-
	Domain 2	$-	$-	$-	$-	$-
	Domain 3	$-	$-	$-	$-	$-
	Domain 4	$-	$-	$-	$-	$-
	NET BALANCE	$-	$-	$-	$-	$-
Planned Budget by Object Class and Funding Category
	Basic Component
	Funding Category
	Object Class	HDSP	Diabetes	NPAO	SH	TOTAL
	Salary and Wages	$-	$-	$-	$-	$-
	Fringe Benefits	$-	$-	$-	$-	$-
	Consultant Costs	$-	$-	$-	$-	$-
	Equipment	$-	$-	$-	$-	$-
	Supplies	$-	$-	$-	$-	$-
	Travel	$-	$-	$-	$-	$-
	Other	$-	$-	$-	$-	$-
	Contractual Costs	$-	$-	$-	$-	$-
	Indirect Costs	$-	$-	$-	$-	$-
	TOTAL	$-	$-	$-	$-	$-
	Enhanced Component
	Funding Category
	Object Class	HDSP	Diabetes	NPAO	SH	TOTAL
	Salary and Wages	$-	$-	$-	$-	$-
	Fringe Benefits	$-	$-	$-	$-	$-
	Consultant Costs	$-	$-	$-	$-	$-
	Equipment	$-	$-	$-	$-	$-
	Supplies	$-	$-	$-	$-	$-
	Travel	$-	$-	$-	$-	$-
	Other	$-	$-	$-	$-	$-
	Contractual Costs	$-	$-	$-	$-	$-
	Indirect Costs	$-	$-	$-	$-	$-
	TOTAL	$-	$-	$-	$-	$-

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Sheet 10: 424A-SectionB_PPHF

Form 424A, Section B
PPHF Funding
Object Class Categories	Funding Category			TOTAL Enhanced (sum of C-F)	TOTAL Award (Basic & Enhanced) (sum of B and G)
	Basic (HDSP, Diabetes, NPAO)	Enhanced Heart Disease & Stroke Prev	Enhanced Diabetes
a. Personnel	$-	$-	$-	$-	$-
b. Fringe Benefits	$-	$-	$-	$-	$-
c. Travel	$-	$-	$-	$-	$-
d. Equipment	$-	$-	$-	$-	$-
e. Supplies	$-	$-	$-	$-	$-
f. Contractual	$-	$-	$-	$-	$-
g. Construction	$-	$-	$-	$-	$-
h. Other	$-	$-	$-	$-	$-
i. Total Direct Charges (sum of a-h)	$-	$-	$-	$-	$-
j. Indirect Charges	$-	$-	$-	$-	$-
k. TOTALS (sum of i and j)	$-	$-	$-	$-	$-

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Sheet 11: 424A-SectionB_Non-PPHF

Form 424A, Section B
Non-PPHF Funding
Object Class Categories	Funding Category					TOTAL Enhanced (sum of C-F)	TOTAL Award (Basic & Enhanced) (sum of B and G)
	Basic (SH)	Enhanced Heart Disease & Stroke Prev	Enhanced Diabetes	Enhanced School Health	Enhanced Nutrition, PA & Obesity
a. Personnel	$-	$-	$-	$-	$-	$-	$-
b. Fringe Benefits	$-	$-	$-	$-	$-	$-	$-
c. Travel	$-	$-	$-	$-	$-	$-	$-
d. Equipment	$-	$-	$-	$-	$-	$-	$-
e. Supplies	$-	$-	$-	$-	$-	$-	$-
f. Contractual	$-	$-	$-	$-	$-	$-	$-
g. Construction	$-	$-	$-	$-	$-	$-	$-
h. Other	$-	$-	$-	$-	$-	$-	$-
i. Total Direct Charges (sum of a-h)	$-	$-	$-	$-	$-	$-	$-
j. Indirect Charges	$-	$-	$-	$-	$-	$-	$-
k. TOTALS (sum of i and j)	$-	$-	$-	$-	$-	$-	$-

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Sheet 12: In-Kind Funding (Optional)

In-Kind Funding (Optional)
Total non-Federal Funds (if not using table below)
Estimated In-Kind Funding
Object Class	Applicant Funds	State Funds	Local Funds	Other	Program Income	TOTAL
Salary and Wages						$-
Fringe Benefits						$-
Consultant Costs						$-
Equipment						$-
Supplies						$-
Travel						$-
Other						$-
Contractual Costs						$-
TOTAL	$-	$-	$-	$-	$-	$-
You may use the space below to provide additional detail on in-kind and matching funds provided.