Budget Spreadsheet 33454 | Tbcb Spm Bud Base Award Invoice Fy21 22

472x Filetype XLSX File size 0.05 MB Source: www.cdph.ca.gov

File: Budget Spreadsheet 33454 | Tbcb Spm Bud Base Award Invoice Fy21 22

sheet 1 base invoice summary blank cell fy 20212022 base award invoice summary blank cell end of row invoice number blank cell blank cell blank cell blank cell end of ...

Filetype Excel XLSX | Posted on 10 Aug 2022 | 3 years ago

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Sheet 1: Base Invoice Summary

	
	
	
	
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		        FY 2021-2022 BASE AWARD INVOICE SUMMARY
		

		

		

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		Invoice Number:
		

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		Invoice to be submitted on Local Health Jurisdiction letterhead.
		

		

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		Billing Period:  
		

		Award Number:
		

		Amount Due:
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Category
		Award Budget Amount
		Prior Invoiced
		Current Quarter
		Year-to-Date
		Balance Remaining
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Personnel
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Personnel (Non-benefits)
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Fringe Benefits
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Travel
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Equipment
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Supplies
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Anti-TB Medications
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Subcontracts
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Other Direct
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		Indirect Cost
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		TOTAL
		 $- 
		 $-   
		 $-   
		 $-   
		 $-   
		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		CERTIFICATION:
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		This reimbursement (invoice) request is certified to be correct and is supported by accounting information and documentation 
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		held available for the California Department of Public Health Tuberculosis Control Branch to review upon request.
		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

		

	
	
		AUTHORIZED SIGNER:
		

		

		

		

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		SIGNER's TITLE:
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		AUTHORIZED SIGNATURE:
		

		

		

		

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		DATE SIGNED:
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		Bill to:
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		Remit to:
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		California Department of Public Health  
		

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		Tuberculosis Control Branch  
		

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		Marina Bay Parkway, Bldg. P, 2nd Floor
		

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		Richmond, CA 94804
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		Attention: Fiscal Analyst
		

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Sheet 2: Base Invoice Detail

	
	
	
	
	
		                                 FY 2021-2022 BASE AWARD INVOICE DETAIL
		

		

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		PERSONNEL
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		List and identify those personnel funded by TBCB housing dollars by placing an “H” next to their name.
		

		

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		Name and Title
		Salary
		Benefits
		TOTAL
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		

		 $-   
		 $-   
		 $-   
		

	
	
		TOTAL PERSONNEL
		 $-   
		 $-   
		 $-   
		

	
	
		EQUIPMENT
		Blank cell.
		Blank cell.
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		Make and Model
		Cost per Unit
		Number of Units
		TOTAL
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		TOTAL EQUIPMENT
		

		

		 $-   
		

	
	
		ANTI-TB MEDICATION
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		Medication
		Cost per Unit
		Number of Units
		TOTAL
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		TOTAL ANTI-TB MEDICATION
		

		

		 $-   
		

	
	
		OTHER DIRECT
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		Item
		Cost per Unit
		Number of Units
		TOTAL
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		

		 $-   
		0
		 $-   
		

	
	
		TOTAL OTHER DIRECT
		

		

		 $-

The words contained in this file might help you see if this file matches what you are looking for:

...Sheet base invoice summary blank cell fy award end of row number to be submitted on local health jurisdiction letterhead billing period amount due category budget prior invoiced current quarter yeartodate balance remaining personnel nonbenefits fringe benefits travel equipment supplies antitb medications subcontracts other direct indirect cost total certification this reimbursement request is certified correct and supported by accounting information documentation held available for the california department public tuberculosis control branch review upon authorized signer s title signature date signed bill remit marina bay parkway bldg p nd floor richmond ca attention fiscal analyst page detail list identify those funded tbcb housing dollars placing an ldquo h rdquo next their name salary make model per unit units medication item...

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FY 2021-2022 BASE AWARD INVOICE DETAIL			Blank cell. End of row.
PERSONNEL	Blank cell	Blank cell	Blank cell. End of row.
List and identify those personnel funded by TBCB housing dollars by placing an “H” next to their name.			Blank cell. End of row.
Name and Title	Salary	Benefits	TOTAL
	$-	$-	$-
	$-	$-	$-
	$-	$-	$-
	$-	$-	$-
	$-	$-	$-
	$-	$-	$-
	$-	$-	$-
	$-	$-	$-
	$-	$-	$-
	$-	$-	$-
	$-	$-	$-
TOTAL PERSONNEL	$-	$-	$-
EQUIPMENT	Blank cell.	Blank cell.	Blank cell. End of row.
Make and Model	Cost per Unit	Number of Units	TOTAL
	$-	0	$-
	$-	0	$-
	$-	0	$-
	$-	0	$-
TOTAL EQUIPMENT			$-
ANTI-TB MEDICATION	Blank cell.	Blank cell.	Blank cell. End of row.
Medication	Cost per Unit	Number of Units	TOTAL
	$-	0	$-
	$-	0	$-
	$-	0	$-
	$-	0	$-
TOTAL ANTI-TB MEDICATION			$-
OTHER DIRECT	Blank cell.	Blank cell.	Blank cell. End of row.
Item	Cost per Unit	Number of Units	TOTAL
	$-	0	$-
	$-	0	$-
	$-	0	$-
	$-	0	$-
TOTAL OTHER DIRECT			$-

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