BOX 14.1

Budget Justification

Agency Name:

Proposal Name:

Submitted by:

Date:

Costs:

Year Total General fund Federal funds State funds Other funds

Budget year $ $ $ $ $

Year2 $ $ $ $ $

Year3 $ $ $ $ $

Introductory Summary:

Statement of Need:

Program Description:

Benefits:

Performance Measurement:

Measurements: Target

Measure

Budget Year Year 2 Year 3

Input: (beneficiaries not $)

Output: (completing)

Outcome: (achieving goal)

Cost Efficiency: ($/output)

Efficiency: (complete/input)

Cost Effectiveness: ($/outcome)

Effectiveness: (achieve/input)

Quality of process

Equity: Don't put anything here

Costs:

Staffing Impact:

Options:

Budget allocation: Object codes Budget year Year 2 Year 3

Personnel services (PS), Total:

Full-time personnel services costs

Other personnel costs

Nonpersonnel services (OTPS), Total:

Supplies 100-199

Equipment 300-399

Contracts, services, travel benefits 400-499

Social services 500-599

Contractual services objects 600-699

Charges, awards, grants, and subsidies 700-801

Bonds and other 810-870

Fund, Total:

General funds

Federal funds

State funds

Other funds:

Employees, (not dollars):

Full-time, permanent

Part-time, temporary, contract

Accompanying Legislation:

This Template Intentionally Left Blank

Refer to the case and your cost estimate in Module 13, assignment 1. budget justification

using the format of Box 14.