Total | |||||||||||
Employee Total |
* This tool is for estimation of an individual budget and does not constitute an obligation on the part of GT Independence or Partners to fund or authorize services.
Authorized Start Date:
Authorized End Date:
Direct Costs | Units | Rate | Dollars | ||
---|---|---|---|---|---|
Indirect Costs | |||||
Total | |||||
*-These items are not subject to Payroll Tax | Total Authorized Dollars | ||||
Total Budgeted Dollars | |||||
Total Remaining for Future Use |
Hours | Total | |
---|---|---|
Self Directed Service Hours and Total Dollar Amount | ||
Supervisory/Training Hours | ||
Optional Benefit Hours, ex. Vacation, Sick | ||
Total Base Salary Hours |
The following expenses are proportionally allocated to the Cost Categories Above:
Payroll Taxes | |
Employee Benefits | |
Wage Premiums |
Employee Name | Hours | Total |
---|---|---|
Payroll Taxes (2) | |||
Worker's Compensation (3) | |||
Employee Benefits | |||
Retention Bonus (Included in Gross) | |||
Vacation (Optional) | |||
Mileage Reimbursement (Optional) | |||
Emergency/Back-up Staffing Hours | |||
Startup Training/Supervision Costs | |||
Supplies/Misc Costs | |||
Administrative Costs | |||
Other Costs (Include Invoiced Services) | |||
Reserved for other service related costs: | |||
Total Budget |
(1) | These hours are added for supervisory/training time spent with staff. Employees would be paid for the time supervised/trained, but the hours would not be billed to Medicaid. | |
(2) | Breakdown of Benefits % | |
Social Security and Medicare | 7.65% | |
SUTA (State Unemployement Tax Act) | 1.20% | |
FUTA (Federal Unemployement Tax Act) | 1.80% | |
(3) | Worker's Compensation is based on the rate set |
* This tool is for estimation of an individual budget and does not constitute an obligation on the part of GT Independence or Alliance to fund or authorize services.