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Attachment D Activity-Based Plan and Budget Form |
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Dates |
Budgeted Expenditures | ||||||||
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Start |
Finish |
Total Personnel (Salary & Fringe Benefits) |
Travel |
Equipment |
Supplies & Materials |
Contracts |
Total Direct |
Indirect |
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| Short-term or Intermediate Outcome 1: | |||||||||
| Activity 1.1 | |||||||||
| Activity 1.2 | |||||||||
| Activity 1.3 | |||||||||
| Activity 1.4 | |||||||||
| Etc. | |||||||||
| Short-term or Intermediate Outcome 2: | |||||||||
| Activity 2.1 | |||||||||
| Activity 2.2 | |||||||||
| Activity 2.3 | |||||||||
| Activity 2.4 | |||||||||
| Etc. | |||||||||
| Short-term or Intermediate Outcome 3: | |||||||||
| Activity 3.1 | |||||||||
| Activity 3.2 | |||||||||
| Activity 3.3 | |||||||||
| Activity 3.4 | |||||||||
| Etc. | |||||||||
| Additional Short-term or Intermediate Outcomes and Activities | |||||||||
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U.S. Department of Health and Human Services |
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