AREA AGENCY ON AGING 1-B



AREA AGENCY ON AGING 1-B

BUDGET JUSTIFICATION FORM

NUTRITION SERVICES

|Applicant Name: |      |

|Service: |      |

EXPLANATION OF EXPENDITURES

Please briefly explain all costs listed in the budget by line item. An explanation for raw food, purchased meals, and nutrition supplements is not needed.

|Direct Cost Line Item: |Explanation: |

|Direct Labor Salary |      |

|Direct Labor Fringe |      |

|Direct Kitchen Expenses |      |

|Transportation |      |

|Indirect Cost Line Item: |Explanation: |

|Other |      |

|Indirect Labor Salary |      |

|Indirect Labor Fringe |      |

|Facilities (Rent / Utilities) |      |

|Equipment |      |

|Consultants |      |

|Completed by: | |Title: | |Phone: |

I certify that the information provided in this statement is accurate, that all resources received have been accounted for and that all costs reported herein have been incurred in accordance with the conditions of the contract.

| | |      |

|Signature (Required for Final Report): | |Title: |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download