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pdfOMB Control Number 3095-0013
Expiration Date: 09/30/2021
NATIONAL HISTORICAL PUBLICATIONS AND RECORDS COMMISSION (NHPRC) BUDGET FORM & INSTRUCTIONS
__________
Project Director:
Organization:
_
Requested Grant Period From: (MM/DD/YYYY)
Thru: (MM/DD/YYYY)
If this is a revised budget, indicate NHPRC grant number: ______________________ New End Date (MM/DD/YYYY) ______________________
The method of cost computation should clearly indicate how the total charge for each budget item was determined. If more space is required for any budget
Category, please follow the budget format on a separate sheet of paper. Click HERE to see the detailed instructions.
1. Salaries and Wages
Provide the names and title of the principal project personnel. For support staff, include the title of each position and indicate in the number column the number
of persons who will be employed in that capacity. For persons employed on an academic year basis, list separately any salary for work done outside the academic
year.
Name/Title or Position
Method of Cost
No Computation
Subtotal
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
Year 1
NHPRC
Cost
Funds
Share
0
Year 2
NHPRC
Funds
0
Page 1 of 9
0
Year 3
NHPRC
Cost
Funds
Share
Cost
Share
0
0
NHPRC
Funds
0
Total
Cost
Share
Grand
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NA Form 17001 (12-14)
SAVE
OMB Control Number 3095-0013
Expiration Date: 09/30/2021
2. Fringe Benefits
If more than one rate is used, list each rate and salary base.
Rate
( % OF )
Salary
Base
Subtotal
NHPRC
Funds
Year 1
Cost
Share
0
NHPRC
Funds
Year 2
Cost
Share
0
NHPRC
Funds
0
Year 3
Cost
Share
0
Total
Cost
Share
NHPRC
Funds
0
0
Grand
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3. Consultant Fees
Include payments for professional and technical consultants and honoraria.
Name or type of consultant
No of
Daily Rate of
Year 1
Days on Compensation NHPRC
Cost
Project
Funds
Share
Subtotal
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
0
NHPRC
Funds
0
0
Page 2 of 9
Year 2
Cost
Share
0
Year 3
NHPRC
Funds
0
Cost
Share
0
NHPRC
Fund
Total
Cost
Grand
Share
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NA Form 17001 (12-14)
SAVE
OMB Control Number 3095-0013
Expiration Date: 09/30/2021
4. Travel
For each trip, indicate the number of persons traveling, the total days they will be in travel status, and the total subsistence and transportation costs for that trip.
When a project will involve the travel of a number of people to conference, institutes, etc., these costs may be summarized on one line by Indicating the point of origin
as “various”, ALL foreign travel must be listed separately.
From/To and Purpose
#
*
Year 1
Subsistence &
Transportation NHPRC Cost
Funds
Share
Costs
Subtotal
# - Number of persons
0
Year 2
NHPRC
Cost
Funds
Share
0
0
Year 3
NHPRC
Cost
Funds
Share
0
Total
NHPRC
Fund
0
0
Cost
Share
Grand
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
* - Total travel days
5. Supplies and Materials
Include consumable supplies, materials to be used in the project and items of expendable equipment (i.e., equipment items costing less than $5,000 and with an
estimated useful life of less than a year)
Item
Basis/Method
of Cost
Computation
Subtotal
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
Year 1
NHPRC
Funds
0
Cost
Share
0
Year 2
NHPRC
Cost
Funds
Share
0
Page 3 of 9
0
Year 3
NHPRC
Cost
Funds
Share
0
0
Total
NHPRC
Funds
Cost
Share
Grand
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NA Form 17001 (12-14)
SAVE
OMB Control Number 3095-0013
Expiration Date: 09/30/2021
6. Services
Include the cost of duplication and printing, long distance telephone calls, equipment rental, postage, and other service related to project objectives – not included
under other budget categories. For subcontracts, provide an itemization of subcontract costs as an attachment.
Item
Basis/Method
of Cost
Computation
Year 1
NHPRC
Funds
Subtotal
Year 2
NHPRC
Cost
Funds
Share
Cost
Share
0
0
0
Year 3
NHPRC
Cost
Funds
Share
0
0
Total
NHPRC
Cost
Funds
Share
0
Grand
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7. Other Costs
Include participant stipends and room and board, equipment purchases, and other items not previously listed. Please note that “miscellaneous” and “contingency” are not
acceptable budget categories. Refer to the budget instructions for the restriction on the purchase of permanent equipment.
Item
Basis/Method of
Cost Computation
Subtotal
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
Year 1
NHPRC
Funds
0
Cost
Share
Year 2
NHPRC
Funds
0
0
Page 4 of 9
Cost
Share
0
Year 3
NHPRC
Cost
Funds
Share
0
0
Total
NHPRC
Cost
Funds
Share
0
Grand
Total
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NA Form 17001 (12-14)
SAVE
OMB Control Number 3095-0013
Expiration Date: 09/30/2021
8. Total Project Costs
Add totals of items 1 to 7.
NHPRC
Funds
Subtotals (Items 1-7)
Year 1
Cost
Share
0
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
NHPRC
Funds
0
Year 2
Cost
Share
NHPRC
Funds
0
0
Page 5 of 9
Year 3
Cost
Share
0
Total
Cost
Share
NHPRC
Funds
0
0
Grand
Total
0
0
NA Form 17001 (12-14)
SAVE
OMB Control Number 3095-0013
Expiration Date: 09/30/2021
9. Indirect Costs
If indirect costs are to be charged to this project, CHECK THE APPROPRIATE BOX BELOW and provide the Information requested. Refer to the budget
instructions for explanations of these options.
Note: NHPRC only accepts indirect costs as cost share See 2 CFR 2600.1
Current indirect cost rate(s) has/have been negotiated with Federal agency (complete items A and B).
Indirect cost proposal has been submitted to a Federal agency, but not yet negotiated (indicate the name of the agency in Item A and show proposed rate(s)
and base(s) and the amount(s) of indirect costs in item B).
Applicant chooses to use a rate not to exceed 10% of direct costs, less distorting items (under item B, enter the proposed rate, the base against which
the rate will be changed, and the computation of indirect costs per year).
Item A.
Name of Federal agency: _
_
Date of agreement: _
Item B.
_
Rate(s)
_
_
Base(s)
_
Cost Sharing
Total
%
of
$
_
$
_
$_
_%
of
$_ _
_
$
_
$
_%
of
$_ _
_
$
_
$
TOTAL INDIRECT COSTS
$
_
$
_
$
0
10. Total Costs (Cost Sharing and Project).
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
0
$ __________________
Page 6 of 9
0
0
0
0
_
_
_
0
_____________
NA Form 17001 (12-14)
SAVE
OMB Control Number 3095-0013
Expiration Date: 09/30/2021
SUMMARY BUDGET
P
Enter the period of each year of the proposed grant.
Year 1
Budget Categories
Year 2
from:
thru:
Year 3
from:
thru:
TOTAL COSTS
FOR
ENTIRE GRANT
PERIOD
from:
thru:
1.) Salaries & Wages
$
0$
0 $
0 = $
0
2.) Fringe Benefits
$
0$
0 $
0 =$
0
3.) Consultant fees
$
0$
0 $
0 =$
0
4.) Travel
$
0$
0 $
0 =$
0
5.) Supplies & Materials
$
0$
0 $
0 =$
0
6.) Services
$
0$
0 $
0 =$
0
7.) Other Costs
$
0$
0 $
0 =$
0
8.) Total project costs
$
0$
0 $
0 =$
0
9.) Indirect Costs
$
0$
0 $
0 =$
0
10.) Total direct/indirect costs
$
0$
0 $
0 =$
0
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
Page 7 of 9
NA Form 17001 (12-14)
SAVE
OMB Control Number 3095-0013
Expiration Date: 09/30/2021
PROJECT FUNDING FOR ENTIRE GRANT PERIOD
1. Indicate the amount of outright and/or Federal matching funds that is requested from NHPRC.
2. Indicate the amount of cash contributions that will be made by the applicant and cash, and in-kind contributions made by third parties to support
project expenses that appear in the budget. Cash gift that will be raised to release Federal matching funds should be included under “Third-party
contributions”. (Consult the program guidelines for information on cost sharing requirements.) When a project will generate income that will be
used during the grant period to support expenses listed in the budget, indicate the amount of income that will be expended on budgeted project
activities. Indicate funding received from other agencies.
3. Total Project Funding should equal Total Project Costs.
Outright
1. REQUESTED
Federal
Matching
$
$
Applicant’s contribution
2. COST SHARING
TOTAL FUNDING
$
= $0
Third-party contributions
$
Project Income
$
Other Federal agencies
$
TOTAL COST SHARING
= $0
3. TOTAL PROJECT FUNDING (Total Funding + Total Cost sharing): = $ 0
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
Page 8 of 9
NA Form 17001 (12-14)
SAVE
OMB Control Number 3095-0013
Expiration Date: 09/30/2021
Submission of a revised budget
When submitting a revised budget, the Institutional Grant Administrator or Individual Applicant should provide the information
requested below. The signature of this person indicates approval of the budget submission and the agreement of the organization/
individual to cost share project expenses at the level under “Project Funding.”
Name/Title:
Telephone:
Email:
Signature:
Date:
PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT
A Federal agency may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for
this information collection is 3095-0013. Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to National
Archives and Records Administration (MP), Room 4100, 8601 Adelphi Road, College Park, MD 20740-6001. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS.
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION
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NA Form 17001 (12-14)
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| File Type | application/pdf |
| File Title | NHPRC Budget Form and Instructions, NA Form 17001 (12-14) |
| Subject | National Historical Publications and Records Commission (NHPRC), budget form, instructions, grant applications |
| Author | National Archives and Records Administration |
| File Modified | 2018-09-25 |
| File Created | 2015-02-13 |