FY2024 Outreach Partner Budget Template (Apr-Sep) - Copy — File 24-1655

Agency Name and Address: City of Somerville, MA *Required Department of Health and Human Services - Community Health Workers Division *Required 50 Evergreen Ave, Somerville, MA 02145 *Required FTE's 0.70 0.53 0.17 Salaries 42,862.25 32,451.12 10,411.13 Fringe Benefits 2,856.99 2,163.01 693.98 Operating Costs 2,400.00 2,050.00 350.00 Building Expenses - - - Equipment - - - Travel 67.00 50.25 16.75 Other Costs - - - Indirect Costs 4,818.61 3,671.43 1,147.18 $ 26,502.43 SNAP Outreach Partner Annual Budget FFY 2024: October 1, 2024 – September 30, 2025 Budget Summary Table Total Reimbursement Amount: Entries made in detail tables will automatically update this table TOTAL 53,004.85 40,385.81 12,619.04 Application Goal: BUDGET CATEGORY TOTAL FUNDS APPLICATION ACTIVITY FUNDS OUTREACH ACTIVITY FUNDS

Agency Name and Address: City of Somerville, MA *Required Department of Health and Human Services - Community Health Workers Division *Required 50 Evergreen Ave, Somerville, MA 02145 *Required Application Activity Recertification Activity FEDERAL FUNDS (CDBG) FTE's 0.53 Salaries 32,451.12 32,451.12 - - Fringe Benefits 2,163.01 2,163.01 - - Operating Costs 2,050.00 2,050.00 - - Building Expenses - - - - Equipment - - - - Travel 50.25 50.25 - - Other Costs - - - - Indirect Costs 3,671.43 3,671.43 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) City of Somerville, MA 40,385.81 40,385.81 - - - - - - - - - - - - - - TOTAL 40,385.81 40,385.81 - - % OF TOTAL LOCAL STATE FEDERAL LOCATION FTE FUNDS FUNDS FUNDS FUNDS (CDBG) Community Health Worker Manager Somerville 8.00% 6,088.68 6,088.68 - - Community Health Worker Somerville 15.00% 8,787.48 8,787.48 - - Community Health Worker Somerville 15.00% 8,787.48 8,787.48 - - Community Health Worker Somerville 15.00% 8,787.48 8,787.48 - - 0.00% - - - - 0.00% - - - - TOTAL 53% 32,451.12 32,451.12 - - - - SOURCE OF APPLICATION ASSISTANCE FUNDING Please list anticipated funding sources TOTAL 40,385.81 40,385.81 STATE FUNDS This budget must only represent 75% of your overall budget amount Budget Summary Table (Application Assistance Activity) Entries made in detail tables will automatically update this table FUNDING SOURCE TITLE OF POSITION DESCRIPTION Schedule of Personnel Expenses (Salary) ◊ HHS CHW Division Operating Fund Non-Reimbursable Activity BUDGET CATEGORY TOTAL FUNDS LOCAL FUNDS SNAP Outreach Partner Annual Budget SNAP Application Assistance Activity Budget FFY 2024: October 1, 2024 – September 30, 2025 SNAP Eligibility Screening Assisting with SNAP Application Helping with Verification Gathering Conducting application assistance where low income people gather Translation of SNAP materials and bilingual accommodation Application Interview Assistance Recertification Activities Placement of advertisements on radio, television, print or electronic media

FEDERAL FUNDS (CDBG) Community Health Worker Manager Somerville 7.00% 405.51 405.51 - - Community Health Worker Somerville 10.00% 878.75 878.75 - - Community Health Worker Somerville 10.00% 878.75 878.75 - - - - - 0.00% - - - - 0.00% - - - - TOTAL 27% 2,163.01 2,163.01 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Office Supplies Notebooks, pens, paper, etc. 375.00 375.00 - - Postage - - - Printing Instructions on next steps, visual graphics of application process 375.00 375.00 - - Telephone Tablet and Hotspot usage 150.00 150.00 - - Advertising Promotional Content; social media posts, PDFs, paper fliers 150.00 150.00 - - Purchased Services - - - - Training SNAP application/program training 1,000.00 1,000.00 - - - - - - - - - - - - - - TOTAL 2,050.00 2,050.00 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Space- Lease/Rent SQ FT= - - - - Utilities - - - - Depreciation - - - - Maintenance - - - - - - - - - - - - TOTAL - - - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Equipment-Rental/Lease - - - - Equipment-Maintenance - - - - Computer & Software - Purchase - - - - Computer & Software - License - - - - - - - - - - - - - - - - - - - - TOTAL - - - - Operating Costs ◊ LOCAL FUNDS STATE FUNDS TITLE OF POSITION LOCATION DESCRIPTION If item is not listed below please add to the bottom of the list ('misc' or 'other' is not acceptable). % OF FTE Personal Benefits (Fringe) ◊ If item is not listed below please add to the bottom of the list ('misc' or 'other' is not acceptable). ITEM NAME DESCRIPTION TOTAL BENEFITS Building Expenses ◊ Equipment ◊ If item is not listed below please add to the bottom of the list ('misc' or 'other' is not acceptable). ITEM NAME DESCRIPTION ITEM NAME

TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Mileage Rate Per Mile = .67 75 Staff travel for App Assist. 50.25 50.25 - - - - - - - - - - TOTAL 50.25 50.25 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Audit Costs - - - - - - - - - - - - - - - - - - - - - - - - TOTAL - - - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Indirect Cost Rate 10.0% 3,671.43 3,671.43 - - TOTAL 3,671.43 3,671.43 - - Indirect Costs ◊ ITEM NAME DESCRIPTION Travel ◊ ITEM NAME DESCRIPTION Other Costs ◊ ITEM NAME DESCRIPTION If item is not listed below please add to the bottom of the list ('misc' or 'other' is not acceptable).

Agency Name and Address: City of Somerville, MA *Required Department of Health and Human Services - Community Health Workers Division *Required 50 Evergreen Ave, Somerville, MA 02145 *Required Outreach Activity BUDGET TOTAL LOCAL STATE FEDERAL CATEGORY FUNDS FUNDS FUNDS FUNDS (CDBG) FTE's 0.17 Salaries 10,411.13 10,411.13 - - Fringe Benefits 693.98 693.98 - - Operating Costs 350.00 350.00 - - Building Expenses - - - - Equipment - - - - Travel 16.75 16.75 - - Other Costs - - - - Indirect Costs 1,147.18 1,147.18 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) City of Somerville, MA 12,619.04 12,619.04 - - - - - - - - - - - - - - TOTAL 12,619.04 12,619.04 - - % OF TOTAL LOCAL STATE FEDERAL FTE FUNDS FUNDS FUNDS FUNDS (CDBG) Community Health Worker Manager Somerville 2.00% 1,623.65 1,623.65 - - Community Health Worker Somerville 5.00% 2,929.16 2,929.16 - - Community Health Worker Somerville 5.00% 2,929.16 2,929.16 - - Community Health Worker Somerville 5.00% 2,929.16 2,929.16 - - 0.00% - - - - 0.00% - - - - TOTAL 17% 10,411.13 10,411.13 - - Entries made in detail tables will automatically update this table HHS CHW Division Funds Please list anticipated funding sources FUNDING SOURCE COMMENT TOTAL 12,619.04 12,619.04 - LOCATION TITLE OF POSITION SNAP Outreach Partner Annual Budget SOURCE OF OUTREACH FUNDING* SNAP Outreach Activity Budget - Budget Summary Table (Outreach Activity) FFY 2024: October 1, 2024 – September 30, 2025 Schedule of Personnel Expenses (Salary) ◊ This budget should only represent up to 25% of your overall budget amount SNAP Information Dissemination Information on how to get SNAP benefits Training or Train-the-trainer for SNAP Outreach workers Disseminate information in other locations SNAP Gap Data Development of SNAP Outreach Materials (Creation of SNAP materials) Development of SNAP Outreach Material (Translation of outreach materials)

% OF TOTAL LOCAL STATE FEDERAL FTE FUNDS FUNDS FUNDS FUNDS (CDBG) Community Health Worker Manager Somerville 7.00% 108.14 108.14 - - Community Health Worker Somerville 10.00% 292.92 292.92 - - Community Health Worker Somerville 10.00% 292.92 292.92 - - - - - 0.00% - - - - 0.00% - - - - TOTAL 27% 693.98 693.98 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Office Supplies Notebooks, pens, paper, etc. 125.00 125.00 - - Postage - - - - Printing Instructions on next steps, visual graphics of application process 125.00 125.00 - - Telephone Tablet and Hotspot usage 50.00 50.00 - - Advertising Promotional Content; social media posts, PDFs, paper fliers 50.00 50.00 - - Purchased Services - - - - Training - - - - - - - - - - - - - - - TOTAL 350.00 350.00 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Space- Lease/Rent SQ FT= - - - - Utilities - - - - Depreciation - - - - Maintenance - - - - - - - - - - - - TOTAL - - - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Equipment-Rental/Lease - - - - Equipment-Maintenance - - - - Computer & Software - Purchase - - - - Computer & Software - License - - - - - - - - - - - - - - - - - - - - TOTAL - - - - ITEM NAME ITEM NAME DESCRIPTION DESCRIPTION ITEM NAME Equipment ◊ If item is not listed below please add to the bottom of the list ('misc' or 'other' is not acceptable). If item is not listed below please add to the bottom of the list ('misc' or 'other' is not acceptable). Operating Costs ◊ Building Expenses ◊ Personal Benefits (Fringe) ◊ If item is not listed below please add to the bottom of the list ('misc' or 'other' is not acceptable). DESCRIPTION TITLE OF POSITION LOCATION

TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Mileage Rate Per Mile = .67 25 Staff travel for outreach 16.75 16.75 - - - - - - - - - - - - - - - - - - TOTAL 16.75 16.75 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Audit Costs - - - - - - - - - - - - - - - - - - - - - - - - TOTAL - - - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Indirect Cost Rate 10.0% 1,147.18 1,147.18 - - TOTAL 1,147.18 1,147.18 - - If item is not listed below please add to the bottom of the list ('misc' or 'other' is not acceptable). ITEM NAME DESCRIPTION Indirect Costs ◊ ITEM NAME ITEM NAME DESCRIPTION DESCRIPTION Other Costs ◊ Travel ◊ If item is not listed below please add to the bottom of the list ('misc' or 'other' is not acceptable).

Title Name Annual Salary 6 month salary Community Health Worker Manager Andria Benvenuto $81,182.40 $40,591.20 Community Health Worker Han Hogan-Rigg $58,583.20 $29,291.60 Community Health Worker Emmanuel L. Charles $58,583.20 $29,291.60 Community Health Worker Cynthia Bonilla $58,583.20 $29,291.60 $0.00 $0.00 $0.00 Please note: Highlighted columns should autopopulate based on information entered in the oth

Total Hours Worked Per Week Hourly Rate Total % of SNAP Time (AA and OA) % of AA AA % of OA 40 $39.03 10 8% 6,088.68 $ 2% 40 $28.17 20 15% 8,787.48 $ 5% 40 $28.17 20 15% 8,787.48 $ 5% 40 $28.17 20 15% 8,787.48 $ 5% #DIV/0! 0 0% - $ 0% #DIV/0! 0 0% - $ 0% #DIV/0! 0 0% - $ 0% $32,451.12 17% her cells Application Assistance (AA) Outreach Ac

OA Fringe Rate Fringe AA (%) Fringe OA (%) 1,623.65 $ 7% $405.51 $108.14 2,929.16 $ 10% $878.75 $292.92 2,929.16 $ 0% $0.00 $0.00 2,929.16 $ 10% $878.75 $292.92 - $ 0% $0.00 $0.00 - $ 0% $0.00 $0.00 - $ 0% $0.00 $0.00 $10,411.13 $2,163.01 $693.98 ctivities (OA) Fringe

SNAP Outreach Partner Annual Budget FFY 2024: April 1, 2024 – September 30, 2024 Agency Name and Address: ABC Corporation *Required 1 Smith Street *Required Exampleville, MA 01234 *Required BUDGET TOTAL LOCAL STATE FEDERAL CATEGORY FUNDS FUNDS FUNDS FUNDS FTE's 0.55 Salaries 16,111.00 13,611.00 2,500.00 - Fringe Benefits 5,861.07 - 5,861.07 - Operating Costs 650.00 650.00 - - Building Expenses 847.00 847.00 - - Equipment 350.00 350.00 - - Travel 54.00 54.00 - - Other Costs - - - - Indirect Costs 2,207.00 2,207.00 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) State Funding 17,719.00 17,719.00 United Way Funds 8,361.07 8,361.07 - - TOTAL 26,080.07 17,719.00 8,361.07 - Schedule of Personnel Expenses (Salary) % OF TOTAL LOCAL STATE FEDERAL FTE SALARY FUNDS FUNDS FUNDS (CDBG) Director Worcester 10% 5,000.00 2,500.00 2,500.00 SNAP Coordinator Worcester 45% 11,111.00 11,111.00 - - TOTAL 55% 16,111.00 13,611.00 2,500.00 - Personal Benefits (Fringe) % OF TOTAL LOCAL STATE FEDERAL FTE BENEFITS FUNDS FUNDS FUNDS (CDBG) Director Worcester 10% 1,850.00 1,750.00 SNAP Coordinator Worcester 45% 4,111.07 4,111.07 - - - - TOTAL 55% 5,961.07 - 5,861.07 - Operating Costs TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Office Supplies 100.00 100.00 Postage 200.00 200.00 Printing 100.00 100.00 Telephone 50.00 50.00 Advertising - - Purchased Services 100.00 100.00 Training 100.00 100.00 - - - TOTAL 650.00 650.00 - - If item is not listed below please add to the bottom of the list. Budget Summary Table Entries made in detail tables will automatically update this table SOURCE OF FUNDING Please list anticipated funding sources FUNDING SOURCE COMMENT 17,719.00 8,361.07 - TOTAL 26,080.07 LOCATION TITLE OF POSITION ITEM NAME COMMENT TITLE OF POSITION LOCATION Enter all of the funding sources for the SNAP project funds in these sections. Potential funding sources: Any non-federal funding including State or local government funding, Private contributions (foundations or corporate grants, individual donations), Social enterprise revenue, and community development block grants (federal, but accepted) The total from all of the funding sources for the outreach and application assistance tabs should equal the total budget. Important: Do not enter information directly into these sections on any of the tabs; they will auto-populate based on entries in the sections below and calculate based on all tabs. Enter the percentage of FTE and salary for each employee spending time on SNAP outreach application/recert assistance activities for both sections (75% Application assistance/25% Outreach). Enter the monies under the funding sources for each line item accordingly. If you have foundation money, allowable state monies and CDBG, then if must be broken down accordingly. Enter the fringe total (if applicable) for the percentage of fringe benefits included for the employee spending time on SNAP outreach/application assistance activities accordingly. All of the funding source columns should equal the total funds column. Instructions below are for both budget tabs: Allowable administrative costs are operational costs for outreach, including all administrative expenses that are reasonable and necessary to operate approved outreach activities. All information listed on the project budget should only be reflective of the time and resources for SNAP outreach application assistance activities. Back up documentation for all items listed must be retained for 7 years and may be requested for review at any time. This budget item consists of costs associated with operating, and maintaining the facility such as: office supplies (general supplies), postage (SNAP outreach mailings), printing (client documentation and informational SNAP materials for clients), telephone (mobile and telephone lines), Advertising (development and production of outreach materials when no other appropriate materials exist. Outreach materials can include contact cards also known as business cards. To be allowable, the term “SNAP” or applicable State program name must be included on the contact card), and training (staff). *Production and distribution of public service announcements to radio, television, print or electric media are NOT REIMBURSEABLE ITEMS. Costs must be entered based on available funding in the appropriate columns based on that funding source. For items that are not listed, please add and provide an explanation. Calculation for Outreach budget (maximum at 25%): 1. Overall budget available 34,909.76, 25, divide this by 4 = $8,726.69 OR 2. Divide Application Acitivity Budget by 3. $26,180.07/3 = $8,726.69 A budget of up the 25% can be created for Outreach activities.

Building Expenses TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Space- Lease/Rent SQ FT= 46 547.00 547.00 Utilities 100.00 100.00 Depreciation 100.00 100.00 Maintenance 100.00 100.00 - - TOTAL 847.00 847.00 - - TOTAL LOCAL STATE FEDERAL ITEM NAME FUNDS FUNDS FUNDS FUNDS (CDBG) Equipment-Rental/Lease 200.00 200.00 Equipment-Maintenance - Computer & Software - Purchase 100.00 100.00 Computer & Software - License 50.00 50.00 - - - - TOTAL 350.00 350.00 - - TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Mileage Rate Per Mile = 0.54 100 miles 54.00 54.00 - - - - TOTAL 54.00 54.00 - - Other Costs TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Audit Costs - Insurance Costs - - - - - TOTAL - - - - Indirect Costs TOTAL LOCAL STATE FEDERAL FUNDS FUNDS FUNDS FUNDS (CDBG) Indirect Costs Rate= 10% 2,207.00 2,207.00 TOTAL 2,207.00 2,207.00 - - ITEM NAME COMMENT ITEM NAME COMMENT COMMENT ITEM NAME COMMENT ITEM NAME COMMENT Please title and explain any costs listed in this category. Misc or Other is not acceptable. Please provide internal travel policies/procedures. Equipment Travel This budget line item includes: utilities (heat and electricity), building depreciation, and building maintenance (cleaning and security). Please provide a breakdown of space square footage calculations. Example: Project Budget Narrative for a Project Involving One Privately Rented Building: Here is an example assuming that 6 of the 10 staff in a rented building are involved with SNAP outreach. The 6 staff average 21% of their time on SNAP outreach. Note that staff salaries are not used in the calculation. • Total square feet occupied = 5,000 sq ft • Total staff = 10; SNAP Outreach staff = 6; 6 ÷ 10 = .6 • 5,000 sq ft × .6 staff= 3,000 sq ft If staff average only 21% of their time on SNAP Outreach, then 3,000 sq ft × .21 = 630 sq ft that can be charged to the SNAP Outreach program. 630 ÷ 5,000 = .126 If rent is $100,000 per year then $100,000 × .126 = $12,600 that can be budgeted for SNAP Outreach building space. Be sure to include the square footage of the percentage of space utilized for SNAP outreach/application assistance activities if this is being included This budget items consists of equipment lease and maintenance (copiers) and computer and/or software (purchase and/or license). if the purchase of equipment is not going to be used solely for this project then the cost will need to be proportioned accordingly. This budget item includes of mileage costs for staff travel for outreach in the service area and for SNAP Meetings, site visits, etc. Charges for travel for the purpose of fulfilling the approved outreach plan objectives based on official state, local, or university travel regulations. Be sure to send UMMS your organizations travel policy if travel is included on your budget. This budget item includes audit costs and/or insurance costs (if applicable) as they relate to SNAP Outreach. Any other costs listed, please provide and explanation. This budget item includes indirect costs. Indirect costs are costs incurred by a state agency or an outreach partner in support of allowable activities that are directly charged to sponsoring federal or state agencies. Please provide a federally approved indirect cost letter if the