Department Program: Program name Program Manager: Budget Prepared by:

REVENUES Federal Program (Cost Center): Description Federal Award State & Other Award Tribal Award Program Revenue Wells Dam Columbia River Initiative Title XIX Sales Fees Other Revenues State

Period Covered From: 10/01/12 To: 09/30/13 Program:

Fund:
Other Tribal

50010 50020 50210 53020 56008 50077 50019 53160 53675 54090

SUB-TOTAL REVENUE 54515 Indirect Cost Revenue TOTAL REVENUE EXPENDITURES

$ $

Federal Program (Cost Center): Description SALARIES/FRINGE Salaries Fringe SUPPLIES AND MATERIALS 62110 Office Supplies 62510 Program Supplies PURCHASED AND CONTRACTED SERVICES 63001 Dues & Fees 63210 Consultant Service 63410 Sub Contracts/Contract Labor 63440 Drug Testing TELEPHONE/UTILITIES 64010 Telecommunications 64020 Utilities TRAVEL/TRAINING 65010 Travel 65210 Training VEHICLE EXPENSES 66015 Vehicle R&M 66050 Vehicle Fuel 66090 GSA 66095 Vehicle Insurance REPAIR & MAINTENANCE 67020 Bldg. R&M 67110 Equip R&M CAPITAL OUTLAYS 68010 Capital Assets 68090 Sensitive Assets 68210 Sensitive Equipment OTHER 69930 Property Insurance 69020 Lease MISCELLANEOUS 79980 Supportive Service

State

Other

Tribal

SUB-TOTAL EXPENDITURE 69805 Indirect Cost TOTAL EXPENDITURE

$ $

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Period Covered Salary/Fringe Worksheet for: Program name From: 01-Oct-12

Position

Emp No.

CII B N Code

Hourly Rate

Hours

Salary -

FICA -

Medicare -

Emp Sec

To: 30-Sep-13 CII Ind -

Total Fringe -

Salary Total This Sheet Total All Sheets 60010 60510 Total Worked Total Non-Worked Total This Sheet Total All Sheets -

FICA 61110 Med Ins -

Medicare 61115 Life Ins -

Emp Sec 61120 Den Ins -

CII Ind 61130 Vis Ins -

Total Fringe 401K -

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Program Narrative:

Mission Statement:

Goals and Objectives:

EXPENSE SUPPLIES AND MATERIALS Office Supplies Program Supplies PURCHASED AND CONTRACTED SERVICES Dues & Fees Consultant Service Sub Contracts/Contract Labor Drug Testing TELEPHONE/UTILITIES Telecommunications Utilities TRAVEL/TRAINING Travel Training VEHICLE EXPENSES Vehicle R&M Vehicle Fuel GSA Vehicle Insurance REPAIR & MAINTENANCE Bldg. R&M Equip R&M CAPITAL OUTLAYS Capital Assets Sensitive Assets Sensitive Equipment OTHER Property Insurance Lease MISCELLANEOUS

BUDGET $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ -

JUSTIFICATION

TOTAL

UNMET NEEDS
$ $ $ $ $ $ $ -

DESCRIPTION

TOTAL

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