Request For Grant Change Page 2

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Request for Change of Grant Budget
Original Budget
New Budget
(Proposed)
Salaries
Fringe (Benefits and Payroll Taxes)
Consultant Costs
Supplies
Equipment
(not to exceed $5,000 of direct costs)
Travel
Patient Care Costs
Screening
Diagnostics
Treatment
Sub-contracts
Other (itemize below)
Subtotal - Direct Costs
Indirect Costs
(not to exceed 15% of direct costs)
Total
The new total may not exceed the total for
the original budget. Budget increases are
not allowed.

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