Budget Example for Expanded Services (ES) Funding Request: Example Grantee: DFG Health Center receives 50% of its section 330 grant to serve the general population (330(e) funding) and 50% of its section 330 grant to serve the homeless population (330(h) funding). DFG Health Center is eligible to request a maximum of $270,000. Example Proposal: • Expanded Medical Capacity (EMC) Project 80000-01: Primary Care Expansion o DFG is requesting 67% of its maximum allowable amount: $180,000 • Service Expansion – Behavioral Health (SE-BH) Project 80000-02: Behavioral Health Expansion to Homeless Patients o DFG is requesting the remaining 33% of its maximum allowable amount: $90,000 Forms/Documents included in this example: • SF424 Face Page Budget Summary (EHB Standard Form) • Budget Details Form (EHB Program Specific Application Level Form) • Line Item Budget (EHB Program Specific Project Level Form) o EMC Project o SE-BH Project • Budget Justifications (these would be uploaded as Word documents into the appropriate sections in the application in EHB) o EMC Project o SE-BH Project
BUDGET INFORMATION - NON CONSTRUCTION Section A - Budget Summary Estimated Grant Unobligated Program CFDA Funds Select Function or Number NonActivity Federal Federal Community Health Centers Health Care for the Homeless 93.224
New or Revised Budget Federal NonFederal Total
$135,000.00 $198,225.00 $333,225.00
$135,000.00 $198,224.00 $333,224.00 $270,000.00 $396,449.00 $666,449.00
DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration BUDGET DETAILS Applicant Name Grant Number
FOR HRSA USE ONLY DFG Health Center H80CS00000 Application 80000 Tracking # Federal Funding Target Requested Federal Funding1 Enabling Total % Services $135,000 0
% Federal Service Expansion Expande Type of Health Funding d Medical Center/Program Currently Oral Behavioral Vision Capacity Pharmacy Received Health Health Care Community...