Attachment F - Budget Forms (Instructions and Forms) UPDATED 3/21/2014

Illinois Department of Human Services
Division of Family and Community Services
Bureau of Domestic Violence and Sexual Assault

Domestic Violence Shelter & Services RFA

Released March 12, 2014


  1. Complete the budget summary page; this page should show the total cost from all sources of providing the program or service; this total is then allocated to "Applicant and Other" fund sources and the amount requested through this Application. The lower part of this page will identify the source and amounts of the funds shown in the "Applicant and Other" column above; this amount is further broken down to required "match or cost participation" and "Other".
  2. Personal Services - instructions are printed on the back of the page. Please pay close attention to the formula for calculating the Personal Services amount for each position - the proper procedure is the monthly salary in column (1) times the number of months this position will work on this program as shown in column (2) times the percent of time this position spends on this program as shown in column (3) equals the total budgeted amount applicable to this program. This total is then allocated among funds from this grant (Amount Assistance Requested) and all other fund sources (Applicant and Other). Insert proper codes to identify source(s) of other funds.
    • Fringe Benefits - a total percentage rate is acceptable for this budget process; however, you must show actual individual expenditure amounts when requesting reimbursement from the Department. It is desirable that you indicate the items and applicable rates which are included in your fringe benefits claim.
  3. Contractual services - itemize and be as specific as possible. All personal services contracts and sub-grants must be identified and explained. Registration fees, repairs and maintenance costs are shown here.
  4. Supplies - itemize and be as specific as possible. Show all printing and paper costs in this line.
  5. Travel - Indicate mileage rate for your agency; show estimated cost for mileage, lodging, etc. as indicated.
  6. Patient Care - complete if applicable.
  7. Equipment - itemize and be as specific as possible. All equipment purchases require program approval either through this Application and approval process or specific approval during the award period. Equipment purchases should be completed during the early months of the award period.

Budget justification - as instructed, provide additional information or justification for specific items listed in the detailed budget for which the need is not self-evident. Personal Services contracts and all sub-grants are to be explained and justified in this section.



The budget for this Application is to reflect the total cost of the project from all sources. The Budget Summary provides a one-page compilation of these costs. Individual line-items are to be itemized in detail on the following pages. Additional information and justification are to be shown on the Budget Justification page(s).

The budget must comply with the allowable costs for the program, the applicable Administrative Rules and Regulations, the laws of the State of Illinois and any applicable federal guidelines or requirements.

All amounts are to be expressed in whole dollars; each line-item is to be rounded to the nearest one-hundred dollar amount.

If additional pages are required, please note applicant agency name and program name on each additional page and number all additional pages as appropriate using the following sequence: Page 1a, Page 1b, Page 2a, Page 2b, and so on. Applications are disassembled and copied by the Department and these page number references will assist reassembly and help to ensure all copies are complete.


Enter the totals from each detail line-item section and sum these amounts to show the TOTAL, Direct Costs for the program.

SOURCES OF FUNDS columns: The total estimated cost for each line-item of the program is to be broken out by funds to be provided from sources other than this RFA (Applicant and Other) and by the amount requested in this Application (Requested from IDHS).

IDHS Components (specify): The amount requested in this Application (Requested from IDHS) is to be further broken out by program component(s) as instructed in the Program Description section of the RFA.

SOURCES OF FUNDS - Applicant and Other

Identify the source and amount of all funds shown in the Applicant and Other column of the Budget Summary. Enter the amounts proposed to meet the program's matching or cost participation requirements in the Required Match column; enter all other program support costs in the Other Support column. The total of the Required Match and Other Support columns must equal the total of the Applicant and Other column of the Budget Summary.

Examples of Applicant and Other fund sources include Applicant funds such as tax revenues; fees or other program income; donations; other corporate funds; and other program support such as other state and or federal grant awards (i.e. WIC, Title X, Title XIX, and Title XX) both from the IDHS and from other agencies.



Enter the position title and name of the current incumbent; if the position is new or currently not filled, enter "Vacant".

  • Example:
    • Counselor -Mary Jones
      Pgrm Coord - Joyce Johnson

Enter the monthly salary for each position that will be filled for all or any part of the period. Enter the number of months the position will be filled by an incumbent working on the program. Enter the percent of time the incumbent will devote to the program during the months shown. Enter the total amount of support to be provided for the program, as computed from the information shown, using the following formula:

  • [Monthly Salary] times [Number of Months Budgeted] times [Percent of time on Program] = [Total for the Program].

The Total for the Program is then broken out by the amount to be provided from sources other than this Application (Applicant and Other) and the amount requested as part of this Application (Requested from IDHS). The amount Requested from IDHS is further broken out by the various program components (IDHS Components) if the Program Description section of the RFA requests that program components be identified separately.


The components included in the applicant agency's fringe benefit rate are to be itemized (listed by component and rate) in the Budget Justification section. The total fringe benefits rate is entered on the Fringe Benefits line; this rate is then applied to the Personal Services, Subtotal shown as Total for the Program. If the applicant agency includes fringe benefits in the amount Requested from IDHS and the various IDHS Components, the amounts for fringe benefits may not exceed the fringe benefits rate times the Personal Services, Subtotal for those columns.



List the costs directly attributable the program estimated to be incurred during the period covered by this Application. Examples of Contractual Services include conference registration fees; repair and maintenance of furniture and equipment; postage; UPS or other carrier costs; software; subscriptions; training and education costs; and telecommunications costs. See also the Allowable Costs section of the RFA.

Payments (or pass-through) to subcontractors or subgrantees are to be listed here. All subcontracts or subgrants require an attached detailed line-item budget supporting this contractual amount. The Department must approve, in writing, all subcontracts or subgrants.



List the costs, directly attributable to the program, estimated to be incurred during the period covered by this Application. Examples of Supplies include office supplies; medical supplies (consumable items such as syringes, tape and gauze, other than drugs); educational and instructional materials; cleaning supplies; copy paper and other paper supplies; and letterpress, offset printing, and other printing services. See also the Allowable Costs section of the RFA.


List the costs, directly attributable to the program, of applicant agency's employees' transportation, mileage, per diem, meals, etc. necessary for carrying out the activities described in the Application. Unless specifically stated in the budget, the mileage rate will be assumed to be the same as that authorized for state employees by the Governor's Travel Control Board. See also the Allowable Costs section of the RFA.

Travel costs for contractual consultants are to be included in the Contractual Services line.



List those items costing over $100.00 each, with a useful life of more than one year, that are required for the successful completion of the activities described in the Application. Equipment costs shall include all freight and installation charges. Equipment may include office furniture and equipment, such as desks, chairs, computers, printers and calculators; training materials; reference books; and films. All Equipment purchases must be approved by the Department, either through this budget or via specific request for items not included in the budget as submitted. See also the Allowable Costs section of the RFA.


List those patient care services necessary to the program which the applicant agency cannot provide through its own resources and which will be purchased from other agencies or individuals.

Patient Care includes laboratory tests or other diagnostic procedures; and transportation of patients or clients, including accompanying parents or guardians (or other escort).

Patient Care also includes services that the applicant agency will provide and be paid an established fee-for-service, such as family planning services, family case management; and primary care services.




PROGRAM:  Domestic Violence Shelter & Services

Show justification for specific items listed in the detailed budget for which the need is not self-evident.

Justifications should clearly indicate the items being requested are essential to the achievement of the state program objectives.

FICA (Social Security) %
Pension/Retirement %
Group Health Insurance %
Group Life Insurance %
Unemployment Insurance %
Workmen's Compensation %
(Name the Item) %
(Name the Item) %
(Name the Item) %
(Name the Item) %
TOTAL, Fringe Benefits Rate %

Other Budget Justification: