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Position Name Annual Salary/Rate Level of Effort SS/HS Costs Project LAUNCH Costs Grand Total TOTAL $310,500 $304,500 $615,000 JUSTIFICATION: Describe the role and responsibilities of each position. (1) The Project Director will provide daily oversight of the grant and will be considered key staff. (2) The TA Team Leads and TA Team Specialists will coordinate project services and project activities, including training, communication and information dissemination. (3) The Evaluation Specialist will provide necessary evaluation direction and oversight under this project. Key staff positions require prior approval by SAMHSA after review of credentials of resume and job description. FEDERAL REQUEST (enter in Section B column 1 line 6a of form S-424A) $615,000 B. Fringe Benefits: List all components that make up the fringe benefits rate FEDERAL REQUEST Component Rate Wage SS/HS Cost Project LAUNCH Cost Grand Total FICA 7.65% $615,000 $23,754 $23,294 $ 47,048 Workers Compensation 2.5% $615,000 $ 7,764 $ 7,613 $ 15,377 Insurance 10.5% $615,000 $32,603 $31,973 $ 64,576 TOTAL $64,121 $62,880 $127,001 JUSTIFICATION: Fringe reflects current rate for agency. FEDERAL REQUEST (enter in Section B column 1 line 6b of form SF-424A) $127,001 C. Travel: Explain need for all travel other than that required by this application. Local travel policies prevail. 46
FEDERAL REQUEST Purpose of Travel Location Item Rate SS/HS Costs Project LAUNCH Costs Grand Total (1) Grantee Conference Washington, DC Airfare $200/flight x 2 persons $20 $20 0 $400 Hotel $180/night x 2 persons x 2 nights $360 $360 $72 Per Diem (meals and incidentals) $46/day x 2 persons x 2 days $92 $92 $184 (2) Local travel SS/HS Mileage 1,500 miles@.38/mile $570 $570 (2) Local Travel Project LAUNCH 1,500 miles @ .38/mile $570 $570 (3) TA Site Visit SS/HS Airfare $200/flight x 2 persons $400 $400 Hotel $180/night x 2 persons x 2 nights $720 $720 Perdiem (Meals and Incidentals) $46/day x 2 persons x 2 days $184 $184 (3) TA Site Visit Project LAUNCH Airfare $300/flight x 2 persons $600 $600 Hotel $185/night x 2 persons x 2 nights $740 $740 Perdiem (Meals and Incidentals) $46/day x 2 persons x 2 days $184 $184 47
Page 1 and 2: Department of Health and Human Serv
Page 3 and 4: Appendix B - Guidance for Electroni
Page 5 and 6: Cost Sharing/Match Required: No Len
Page 7 and 8: programming and policies will be ac
Page 9 and 10: • Assist grantees with developing
Page 11 and 12: • Participate in state, regional,
Page 13 and 14: Freedom (OIF), and Operation New Da
Page 15 and 16: and performance assessment, e.g., a
Page 17 and 18: Tribal organization means the recog
Page 19 and 20: (demographics and clinical characte
Page 21 and 22: Your application must be received b
Page 23 and 24: Section B: Proposed Approach (35 po
Page 25 and 26: • Demographics - race, ethnicity,
Page 27 and 28: Note: There should be separate colu
Page 29 and 30: termination of the grant award, or
Page 31 and 32: Appendix A - Checklist for Formatti
Page 33 and 34: Appendix B - Guidance for Electroni
Page 35 and 36: that these issues will be resolved
Page 37 and 38: • Name, telephone number, and e-m
Page 39 and 40: o Documentation of nonprofit status
Page 41 and 42: grant applications submitted by com
Page 43 and 44: prevention provider may also provid
Page 45: Appendix F - Sample Budget and Just
Page 49 and 50: Item(s) Rate SS/HS Costs Project LA
Page 51 and 52: (2) Consultant is needed to provide
Page 53 and 54: FEDERAL REQUEST - (enter in Section
Page 55 and 56: Appendix G - Confidentiality and SA
Page 57 and 58: Appendix H- Addressing Behavioral H
Page 59 and 60: You can learn more about the CLAS m
Page 61 and 62: Appendix I - Sample Logic Model A l
Page 63 and 64: Sample Logic Model 63

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