Sample Format For Budget Request

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SAMPLE FORMAT for BUDGET REQUEST
(Name of Project, Date)
Proposed Budget
(Based on a 12-month budget)
A.
Direct Salaries and Wages
Personnel
Total $ XXXXXX
Position Title and Name
Annual
Time
Months
Amount
Salary
Requested
(Example--only for Direct Personnel)
XXX
20%
12 months
XXX
Director, Research & Development
Joe Smith
Justification
Director, Research & Development
Joe Smith
Joe Smith has been with NACCHO since 1993. He is responsible for oversight of the
cooperative agreement activities and ensures that all necessary reports/documentation are
submitted accordingly.
B.
Direct Staffing Fringe Benefits
Fringe Benefits
Total $ XXXXXX
23% of Total Direct Staff Salaries = Fringe Benefits

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