Minnesota Department of Health
HIV Prevention Projects
January 1, 2016
BUDGET PLAN INSTRUCTIONS
Budget Period
Jan. 1, 2013 - December 31, 2013
Jan. 1, 2014 - December 31, 2014
Jan. 1, 2015 – December 31, 2015
Jan. 1, 2016 – December 31, 2016
Budget Plan Due
Jan 30, 2013
Dec. 6, 2014
Dec. 5, 2015
Dec. 4, 2016
Instructions for filling out the Budget Plan 2016 form and the Budget Narrative 2016 form
Grantee
Your agency’s name
Address
Your agency’s address (if the agency has more than one location, write the
address of the fiscal office)
Telephone
The phone number of the person responsible for completing the budget plan
Email
The email address of the person responsible for completing the budget plan
Budget Plan Period
January1, 2016 through December 31, 2016
1. Salaries:
For each position indicate the name, title, the full time equivalent on this project and the total
amount for the budget period.
 Funds can be used for salary of staff members directly involved in the proposed project
(planning, developing, delivering or supporting).
2. Fringe Benefits:
All other costs, except for compensation, for full- or part-time employees listed in “Salaries”
above.
These may, but are not required to, include: employer portion of FICA and Medicare, medical and
dental insurance, long-term disability insurance, life and accidental death and dismemberment
insurance, workers compensation insurance, and unemployment insurance.
 State each staff person’s fringe per year.
 State total fringe amount and percent for the budget period.
3. Travel and Subsistence:
All costs related to the in-state and out-of-state transportation of project employees for approved
project activities. Client travel is reported under Other Expenses.
 Both in-state and out of state travel (mileage & parking) should be calculated here. Mileage
should be calculated at a maximum of the current IRS allowable amount.
 If applicable, in-state travel subsistence (meals, hotel) is listed separately as sub-line item.
 Out of state travel should be listed as a sub-line item under travel line item.
4. Supplies:
All project costs related to the purchase of items with a cost of less than $5,000 must be itemized.
Examples: condoms & lube, client incentives, office supplies, copying costs, brochures &
educational material, computer, software, client incentives, etc.

Note: All Track 1, 2, and 3 projects MUST have a budgeted line item for condoms & lube.
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Minnesota Department of Health
HIV Prevention Projects
January 1, 2016
If you provide incentives such as gift cards, list the value of each incentive, the number to
be distributed, and the total value. The maximum value of an incentive instrument is limited
to $50.00 with one instrument disbursed per individual per occurrence.
 If you are not using funds from this grant agreement to cover this expense (i.e.; condoms
are paid for out of other funding sources or through the MDH condom distribution
program), list the dollar amount as "in kind" in the Budget Narrative only.
Note: Do not include HIV testing kits nor laboratory processing costs if you are a community
based testing site.
Do include HIV testing kits and laboratory processing costs if you are a clinic.
5. Contractual:
If you plan to hire independent contractors for specific services on a fee basis, please indicate:
(1) the name(s) of the contractor(s) or consultant(s); (2) the dollar amount(s); (3) the specific
expense line items; and (4) the service(s) being provided.
 Contract states, “GRANTEE shall develop documentation of subcontracts and any other
documents that includes, but is not limited to: 1) description of the contracted activities;
2) budget; and, 3) signatures of appropriate staff from both the GRANTEE and the
subcontractor.”
Note: Sub-contracts require prior written approval by the MDH.
6. Equipment:
All equipment with a purchase price greater than $5,000, that is tangible, and has a useful life of
more than one year must be itemized.
Note: These costs must be approved by MDH prior to purchase.
7. Other Expenses:
All project cost items, not included in the previous definitions must be specified.
Examples: office phone, cell phone, internet access, postage, refreshments (e.g. food for client
group sessions), advertising, translation/interpretation costs, costs associated with staff training
(fees and travel).
 Costs for staff trainings out-of-state (fees, hotel, meals) go in this line item, not “Travel
and Subsistence”.
 Out of state travel will require prior approval by the State’s Authorized Representative on
a case by case basis during the contract period and pending availability of contract funds.
 Online costs such as website fees, banner ads, Facebook pushes, etc.
8. SUBTOTAL:
Total items 1- 7 above.
9. Administrative Costs:
MDH will accept up to the grantee’s current federally approved indirect cost rate. Grantee must
submit proof of their federally approved rate. If a grantee does not have a federally approved
indirect cost rate, MDH will allow up to 10% of the total grant award for indirect cost on both
federal and state funded program.
 Administrative Costs percentage must match the cost allocations of the HIV Prevention
projects in relationship with other programs in the agency.
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Minnesota Department of Health
HIV Prevention Projects
January 1, 2016
Administrative Costs are defined as costs that represent the expenses of doing business
that are not easily identified with a particular grant, contract, project, function, or activity
but are necessary for the general operation of the organization and the conduct of
activities it performs.
Note: Administrative expenses will not be provided to other government agencies or universities.
10. TOTAL:
Total of 8 + 9 above.
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Minnesota Department of Health
HIV Prevention Projects
January 1, 2016
BUDGET PLANNING NOTES AND TIPS:
1. Submit your budget plan on Budget Plan 2016 form and your Budget Narrative on the
Budget Narrative 2016 form. Categories in the budget must correspond to the categories
listed in the narrative.
Both forms can be downloaded from the online Grantee Portal.
2. If project expenses differ from your budget plan as the budget period progresses and you
want to make adjustments:
 You may shift 10% or less from a line item (but not the Administrate Cost rate)
without approval. Inform MDH of the change promptly via email.
 To shift more than 10% from a line item requires prior written approval from
MDH.
3. When planning, take into account possible startup costs in the first budget period (if
applicable) and cost of living and salary increases in the subsequent budget periods.
4. Your award letter listed the amount awarded for one year of the grant agreement time
frame. Though the grant agreement is written for 4 years, only 2 years are currently
budgeted for.
5. When multiple people are listed in the Salary section, it is helpful to list each person’s
name so as to avoid confusion (Note: not required but helpful). (Shouldn’t it just be
position title in case the person changes?)
6. All Track 1, 2, and 3 programs must have funds allocated for condoms and lube under the
“Supplies” line item.
7. You may submit a draft of your budget plan to MDH for feedback and discussion before
the final due date.
8. The “Administrative / Indirect Cost Allocation for HIV Prevention Projects” form is only
submitted with your first-year Budget Plan and is not required in the 2nd, 3rd or 4th year of
the contract.
 However, if your Administrative Cost percentage is changing from last year’s
budget, submit a new form along with the new Budget Plan.
9. If your project has unspent funds at the end of a budget period (e.g. due to unfilled staff
positions) these funds may not be carried over into the next budget period. We will be in
contact with you close to the end of each budget period to discuss balances and expected
expenses.
When in doubt – DON’T HESITATE TO CONTACT US!
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Minnesota Department of Health
HIV Prevention Projects
January 1, 2016
EXAMPLE OF A COMPLETED BUDGET
* Do not use this page for your Budget Plan.
* Use the Budget Plan 2016 form on the Grantee Portal
Grantee:
Address:
Telephone:
Email:
Budget Plan Period:
Acme Prevention of Minnesota
123 Main St.
Minneapolis, MN 55408
612-555-4528
pat.money@acme.org
January 1, 2016 – December 31, 2016
Budget Categories
Amounts
1. Salaries
Detail
a. Prog. Manager
.20 FTE John Jones
b. Health Educator
.50 FTE Paul Smith
c. Health Educator
.50 FTE George Hemple
d. HIV Tester
.25 FTE Ringo Jackson
2. Fringe
(21.7%)
3. Travel – Mileage ($ per mile)
4. Supplies
a. Printing
b. Brochures and ed materials
c. Office supplies
d. Condoms & lube
e. HIV Testing Kits
f. HIV Lab costs
Name of Lab
5.
6.
7.
8.
9.
10.
Salary total
John’s salary
Paul’s salary
George’s salary
Ringo’s salary
Fringe total
Travel total
Supplies Total
Print costs
Material cost
Office costs
Condom costs
Kit costs
Lab costs
Contractual
Contractual
Total
a. ABC accounting
Accounting
costs
Monthly accounting
Equipment
Other
Other Total
a. Office Phone
Phone costs
b. Cell Phone
Cell costs
c. Postage
Postage costs
d. Staff development/training
Training costs
e. Advertising
Advert. costs
f. Copies
Copy costs
g. Refreshments
Refresh. costs
h. Other (requires prior approval)
Other costs
Subtotal
Total of above
15.61% of
Administrative Costs (15.61%)
subtotal
Total of
Subtotal plus
Total
Admin. costs
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