Federal Communications Commission

FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants

Release Date: 11/21/2022

AFFORDABLE CONNECTIVITY OUTREACH GRANT PROGRAM - PILOT PROGRAM GRANTS

DETAILED BUDGET WORKSHEET AND NARRATIVE

Worksheet Instructions
The Federal Communications Commission (FCC) has established the Affordable Connectivity Outreach Grant Program - Pilot Program
Grants (Pilot Program Outreach Grants), which provides eligible partners grant funds to facilitate promotion of the ACP to increase
awareness of and participation among eligible households by providing assistance with the completion and submission of the ACP
application. To be considered for funding, applicants must submit the required forms listed in the Pilot Program Outreach Grants Notice of
Funding Opportunity (NOFO). Required forms include a Pilot Program Outreach Grants Application using the USAC application portal,
several Grants Standard Forms (SFs) to be submitted in Grants.gov, and this Detailed Budget Worksheet and Narrative Template to be
submitted in Grants.gov.

Applicants must submit this budget worksheet as part of their overall application submission through Grants.gov no later than January 9,
2023, at 9:00 PM Eastern Standard Time (EST). Note there are separate tabs (worksheets) for funding requested from Your Home, Your
Internet Pilot Program (YHYI) Outreach Grants and the Navigator Pilot Program (NPP) Outreach Grants.

Helpful Tips When Navigating the Pilot Program Detailed Budget Worksheet and Narrative Template

Naming Convention When Submitting Completed Templates:

Applicants must use the following file naming convention when submitting the Detailed Budget Worksheet and Narrative Template:
• Government and Nongovernmental Entities: <State Abbreviation>_FY23_Pilot Grant Budget _< Applicant Name>
• Tribal Nations: FY23_Pilot Grant Budget_< Applicant Name>

Data Entry Fields:

All fields highlighted in yellow are the only fields allowed for data entry. However, if an applicant is not requesting federal funds from the
highlighted fields, the applicant can leave it blank. The applicant may not reformat the spreadsheet and may only enter data into cells
highlighted in yellow. All other cells are to be left unaltered. All total costs will be rounded to nearest whole dollar.

Character Count:
The data entry fields included in this Detailed budget Worksheet and Narrative Template allow for the maximum number of characters (700
including spaces) for each section, including spaces. Once that limit has been reached, applicants will not be able to include any additional
text.

Spell Check:
It is suggested that applicants use MS Word to ensure that the entered information is spelled correctly. To use Spell Check in MS Word
(2007 or newer):
• Click on the [Review] menu
• Select [Spelling & Grammar] and all spelling issues will be displayed.
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

I. APPLICANT INFORMATION
Applicant/Recipient Name Pilot Program Application Number
Enter the legal name of the applicant that will undertake the assistance Enter the information
activity. This is the organization that has registered with the System for Award collection report number
Management (SAM). Information on registering with SAM may be obtained provided when application
by visiting SAM.gov. is successfully submitted
in USAC Portal. Please
include both letters and
numbers.

YHYI Outreach Grants

Applicant Type Applicant's SAM.gov Unique Entity Identifier (UEI) Number
Select one applicant type from the drop down menu. Enter the organization’s UEI received from SAM. The UEI is a unique 12
character organization identifier. Information on registering with System for
Award Management (SAM.gov) may be obtained by visiting the Grants.gov
website.

If "Other" selected, please describe the eligible entity type. Otherwise, leave blank.

II. DETAILED BUDGET AND NARRATIVE

A. Personnel
Include only costs requested for key personnel employed by applicant. Do not include the personnel costs of consultants, contractors and
subrecipients under this category. Personnel expenditures should be broken out by each position, name, hourly rate, number of hours, annual
salary, level of effort (do not exceed 100%). Salaries included as indirect costs (e.g., administrative and clerical staff) should be excluded from
this category.

Line Position Name Hourly # of Annual % Level Personnel

Item # Rate Hours Salary of Effort Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0

Line Personnel Narrative:

Item #
Explain how personnel funding will be used. This section should include compensation for personnel whose time was spent exclusively conducting
ACP outreach activities and/or in-person ACP application assistance either in a part-time or full-time capacity. Please provide salary and computation
methods. Must comply with 2 CFR 200.430.

Page 3 of 47
 2
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

B. Fringe Benefits
Choose the provided fringe components using the drop-down menu. Provide fringe benefit rate for each component. Positions, staff names, and
personnel costs will pre-populate from the Personnel table above. Based on the provision of specific fringe components for each position, enter
the total fringe rate for each position.

Fringe Components for Devoted Staff Rate (%)

Total Fringe Rate 0.00%

Line Position Name Personnel Total Fringe Rate Fringe

Item # Cost Per Position (%) Benefits Cost
1 0 0 $0 $0
2 0 0 $0 $0
3 0 0 $0 $0
4 0 0 $0 $0
5 0 0 $0 $0
6 0 0 $0 $0
TOTAL $0

Fringe Benefits Narrative:

Validate the computations in the table above, and applicant compliance with written policies per 2 CFR Part 200.431. If "Other" was chosen as
a fringe component, explain the fringe benefit being provided.

Page 4 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

C. Travel
Choose types of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
ACP Outreach Local Travel (POV Mile$0.59 Mile 5 200 2 2 $1,180

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
TOTAL $0

Type of Travel Narrative:

Page 5 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022
Travel Narrative:
Event
For each type of event, list the locations of planned events. Justify costs requested, including reasoning for number of personnel traveling, and
particular positions attending event. If "Other" item was chosen, provide details and justify request (e.g., parking costs). All travel requests
must comply with 2 CFR Part 200.475.
ACP Outreach

In-person App. Assistance

Other

D. Equipment
N/A - not allowable.

E. Supplies
For each item of supplies requested by applicant, list the item and the type of outreach activity that necessitates the supply. Enter unit cost of
each item and quantity requested. Total supply costs requested may not exceed $5,000, including supply costs requested by contractors
(captured below). All supplies requested must be used exclusively for ACP outreach and/or ACP application assistance.

Line Item Type of Outreach Unit Cost Quantity Supplies

Item # Activity Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
7 $0
TOTAL $0

Line Supplies Narrative:

Item #
Explain necessity of supplies requested and computation method used for estimated unit cost.
1

Page 6 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

F. Contractual
Enter legal name of contractor, vendor, or subrecipient and specify which type of contractual agreement is planned, using the drop-down menu.
Enter the total contractual costs requested for each agreement. For each agreement in the first table, provide details in the second table next to
the corresponding agreement number. Describe the services and/or deliverables the contractor will provide. Itemize consultant costs, and
describe how the consultant was selected. If contractors plan to further subaward funds, include subcontractor information in the Contractual
Details.

Agree- Name of Contractor, Vendor, or SAM.gov Unique Entity Type of Agreement Period of Contractual
ment # Subrecipient Identifier (UEI) Number Performance Cost
1

TOTAL $0

Agree- Contractual Details/Services and Deliverables Provided

ment #
1

Page 7 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
1 Date: 11/21/2022
Release

Agree- Scope of Work

ment #
1

0
Contractual Personnel
Include only costs requested for key personnel employed by contractor/vendor/subrecipient. Personnel expenditures should be broken out by
each position, name, hourly rate, number of hours, annual salary, level of effort (do not exceed 100%). Salaries included as indirect costs (e.g.,
administrative and clerical staff) should be excluded from this category.
Line Position Name Hourly # of Annual % Level Personnel
Item # Rate Hours Salary of Effort Cost
1 $0
2 $0
3 $0
TOTAL $0

Line Personnel Narrative:

Item #
Explain how contractual personnel funding will be used. This section should include compensation for personnel whose time was spent exclusively
conducting ACP outreach activities and/or in-person ACP application assistance either in a part-time or full-time capacity. Please provide salary and
computation methods. Must comply with 2 CFR Part 200.430.

Page 8 of 47
Federal
1 Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Contractual Fringe Benefits

Choose the provided fringe components for contractor personnel using the drop-down menu. Provide fringe benefit rate for each component.
Positions, staff names, and personnel costs will pre-populate from the Contractual Personnel table above. Based on the provision of specific
fringe components for each position, enter the total fringe rate for each position.
Fringe Component for Contractual Staff Rate (%)

Total Fringe Rate 0.00%

Line Position Name Personnel Total Fringe Rate Fringe

Item # Cost Per Position (%) Benefits Cost
1 0 0 $0 $0
2 0 0 $0 $0
3 0 0 $0 $0
TOTAL $0

Contractual Fringe Benefits Narrative:

Validate the computations in the table above, and contractor compliance with written policies per 2 CFR Part 200.431. If "Other" was chosen as
a fringe component, explain the fringe benefit being provided.

Contractual Travel
Choose types of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.
See Example below (numbers will be based on actuals):

Page 9 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Choose types
Release Date: of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
11/21/2022
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.
See Example below (numbers will be based on actuals):

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
ACP Outreach Local Travel (POV Mile$0.59 Mile 5 200 2 2 $1,180

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
TOTAL $0

Line Contractual Travel Narrative:

Item #
For each type of event, list the locations of planned events. Justify costs requested, including reasoning for number of personnel traveling, and
particular positions attending event. If "Other" item was chosen, provide details and justify request (e.g., parking costs). All travel requests
must comply with 2 CFR Part 200.475.
ACP Outreach

Page 10 of 47
ACP Outreach
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

In-person App. Assistance

Other

Contractual Supplies
For each item of supplies requested by contractor, list the item and the type of outreach activity that necessitates the supply. Enter unit cost of
each item and quantity requested. Total supply costs requested may not exceed $5,000, including supply costs requested by primary
applicant captured as Supplies (above). All supplies requested must be used exclusively for ACP outreach and/or ACP application assistance.

Line Item Type of Outreach Unit Cost Quantity Supplies

Item # Activity Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
7 $0
TOTAL $0

Line Contractual Supplies Narrative:

Item #
Explain necessity of supplies requested and computation method used for estimated unit cost.
1

Page 11 of 47
Federal
4 Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Contractual Other - Non-Management and Administrative (M&A)

Itemize any other contractual expenses, and associate them with a project activity using the drop-down menu. Do not include expenses that fall
into the "Management & Administrative" category. For each item, provide the unit cost, and quantity requested.
Line Item Project Activity Unit Cost Quantity Contractual Other
Item # Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0

Line Other - Non-Management and Administrative (M&A) Narrative:

Item #
Justify costs requested, including reasoning for number of contractual items, project activity, and unit cost. If "Other" item was chosen, provide
details and justify request.
1

Page 12 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022
4

Agree- Name of Contractor, Vendor, or Type of Agreement Total Direct

ment # Subrecipient Charges
1 0 0 $0

0
Contractual Personnel
Include only costs requested for key personnel employed by contractor/vendor/subrecipient. Personnel expenditures should be broken out by
each position, name, hourly rate, number of hours, annual salary, level of effort (do not exceed 100%). Salaries included as indirect costs (e.g.,
administrative and clerical staff) should be excluded from this category.
Line Position Name Hourly # of Annual % Level Personnel
Item # Rate Hours Salary of Effort Cost
1 $0
2 $0
3 $0
TOTAL $0

Line Personnel Narrative:

Item #
Explain how contractual personnel funding will be used. This section should include compensation for personnel whose time was spent exclusively
conducting ACP outreach activities and/or in-person ACP application assistance either in a part-time or full-time capacity. Please provide salary and
computation methods. Must comply with 2 CFR Part 200.430.

Page 13 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Contractual Fringe Benefits

Choose the provided fringe components for contractor personnel using the drop-down menu. Provide fringe benefit rate for each component.
Positions, staff names, and personnel costs will pre-populate from the Contractual Personnel table above. Based on the provision of specific
fringe components for each position, enter the total fringe rate for each position.
Fringe Component for Contractual Staff Rate (%)

Total Fringe Rate 0.00%

Line Position Name Personnel Total Fringe Fringe

Item # Cost Rate (%) Benefits Cost
1 0 0 $0 $0
2 0 0 $0 $0
3 0 0 $0 $0
TOTAL $0

Contractual Fringe Benefits Narrative:

Validate the computations in the table above, and contractor compliance with written policies per 2 CFR Part 200.431. If "Other" was chosen as
a fringe component, explain the fringe benefit being provided.

Contractual Travel
Choose types of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.
See Example below (numbers will be based on actuals):

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
ACP Outreach Local Travel (POV Mile$0.59 Mile 5 200 2 2 $1,180

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0

Page 14 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
TOTAL $0

Line Contractual Travel Narrative:

Item #
For each type of event, list the locations of planned events. Justify costs requested, including reasoning for number of personnel traveling, and
particular positions attending event. If "Other" item was chosen, provide details and justify request (e.g., parking costs). All travel requests
must comply with 2 CFR Part 200.475.
ACP Outreach

In-person App. Assistance

Other

Contractual Supplies

Page 15 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

For each item of supplies requested by contractor, list the item and the type of outreach activity that necessitates the supply. Enter unit cost of
each item and quantity requested. Total supply costs requested may not exceed $5,000, including supply costs requested by primary applicant
captured as Supplies (above). All supplies requested must be used exclusively for ACP outreach and/or ACP application assistance.

Line Item Type of Outreach Unit Cost Quantity Supplies

Item # Activity Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
7 $0
TOTAL $0

Line Contractual Supplies Narrative:

Item #
Explain necessity of supplies requested and computation method used for estimated unit cost.
1

Page 16 of 47
Federal
7 Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Contractual Other - Non-Management and Administrative (M&A)

Itemize any other contractual expenses, and associate them with a project activity using the drop-down menu. Do not include expenses that fall
into the "Management & Administrative" category. For each item, provide the unit cost, and quantity requested.
Line Item Project Activity Unit Cost Quantity Contractual Other
Item # Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0
Line Other - Non-Management and Administrative (M&A) Narrative:
Item #
Justify costs requested, including reasoning for number of contractual items, project activity, and unit cost. If "Other" item was chosen, provide
details and justify request.
1

Agree- Name of Contractor, Vendor, or Type of Agreement Total Direct

Page 17 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

ment # Subrecipient Charges

2 0 0 $0

0
Contractual Personnel
Include only costs requested for key personnel employed by contractor/vendor/subrecipient. Personnel expenditures should be broken out by
each position, name, hourly rate, number of hours, annual salary, level of effort (do not exceed 100%). Salaries included as indirect costs (e.g.,
administrative and clerical staff) should be excluded from this category.
Line Position Name Hourly # of Annual % Level Personnel
Item # Rate Hours Salary of Effort Cost
1 $0
2 $0
3 $0
TOTAL $0

Line Personnel Narrative:

Item #
Explain how contractual personnel funding will be used. This section should include compensation for personnel whose time was spent
exclusively conducting ACP outreach activities and/or in-person ACP application assistance either in a part-time or full-time capacity. Please
provide salary and computation methods. Must comply with 2 CFR Part 200.430.
1

Contractual Fringe Benefits

Choose the provided fringe components for contractor personnel using the drop-down menu. Provide fringe benefit rate for each component.
Positions, staff names, and personnel costs will pre-populate from the Contractual Personnel table above. Based on the provision of specific
fringe components for each position, enter the total fringe rate for each position.
Fringe Component for Contractual Staff Rate (%)

Total Fringe Rate 0.00%

Line Position Name Personnel Total Fringe Fringe

Page 18 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Item # Cost Rate (%) Benefits Cost

1 0 0 $0 $0
2 0 0 $0 $0
3 0 0 $0 $0
TOTAL $0

Contractual Fringe Benefits Narrative:

Validate the computations in the table above, and contractor compliance with written policies per 2 CFR Part 200.431. If "Other" was chosen as
a fringe component, explain the fringe benefit being provided.

Contractual Travel
Choose types of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.
See Example below (numbers will be based on actuals):

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
ACP Outreach Local Travel (POV Mile$0.59 Mile 5 200 2 2 $1,180

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0

Page 19 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
TOTAL $0

Line Contractual Travel Narrative:

Item #
For each type of event, list the locations of planned events. Justify costs requested, including reasoning for number of personnel traveling, and
particular positions attending event. If "Other" item was chosen, provide details and justify request (e.g., parking costs). All travel requests
must comply with 2 CFR Part 200.475.
ACP Outreach

In-person App. Assistance

Other

Contractual Supplies
For each item of supplies requested by contractor, list the item and the type of outreach activity that necessitates the supply. Enter unit cost of
each item and quantity requested. Total supply costs requested may not exceed $5,000, including supply costs requested by primary applicant
captured as Supplies (above). All supplies requested must be used exclusively for ACP outreach and/or ACP application assistance.

Line Item Type of Outreach Unit Cost Quantity Supplies

Item # Activity Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
7 $0
TOTAL $0

Line Contractual Supplies Narrative:

Item #

Page 20 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Explain necessity of supplies requested and computation method used for estimated unit cost.
1

Contractual Other - Non-Management and Administrative (M&A)

Itemize any other contractual expenses, and associate them with a project activity using the drop-down menu. Do not include expenses that fall
into the "Management & Administrative" category. For each item, provide the unit cost, and quantity requested.
Line Item Project Activity Unit Cost Quantity Contractual Other
Item # Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0

Line Other - Non-Management and Administrative (M&A) Narrative:

Item #

Page 21 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Justify costs requested, including reasoning for number of items, project activity, and unit cost. If "Other" item was chosen, provide details and
justify request.
1

Agree- Name of Contractor, Vendor, or Type of Agreement Total Direct

ment # Subrecipient Charges
3 0 0 $0

Total Contractual
Cost
$0

G. Construction
N/A - not allowable

H. Other - Non-Management and Administrative (M&A)

Itemize any other expenses, and associate them with a project activity using the drop-down menu. Do not include expenses that fall into the
"Management & Administrative" category, as there is a separate table below for them. For each item, provide the unit cost, and quantity
requested.
Line Item Project Activity Unit Cost Quantity Other - Non M&A
Item # Cost

Page 22 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0

Line Other - Non-Management and Administrative (M&A) Narrative:

Item #
Justify costs requested, including reasoning for number of contractual items, project activity, and unit cost. If "Other" item was chosen, provide
details and justify request.
1

H. Other - Management and Administrative (M&A)

This section should include costs incurred in support of grant administration that are not included in the organization’s indirect cost pool (e.g.,
preparing and submitting programmatic and financial reports, establishing and/or maintaining inventory, responding to official information
requests such as audits, monitoring pass-through recipients). Include any M&A costs for subrecipients, contractors, or vendors below. The
M&A cost is capped at 5% of awarded funds.

Total
M&A Costs

Page 23 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Other - Management and Administrative (M&A) Narrative:

Explain Other expenses, only including Management and Administrative (M&A). If M&A is being requested by subrecipients, contractors, or
vendors, indicate this in the narrative.

I. Total Direct Charges

Total Federal Request
Total Direct Charges
$0

J. Indirect Charges
Indirect charges/costs (IDC) or Facilities and Administration (F&A) are those costs incurred for common or joint objectives which cannot be
readily identified with an individual project or program but are necessary for the operations of the organization.

IDC (F&A) is classified into two broad categories: "Facilities" and "Administration." "Facilities" is defined as depreciation on debt associated
with buildings, equipment and captial improvement, interest on debt associated with certain buildings, equipment and capital improvements,
and operations and maintenance expenses. "Administration" is defined as general administration expenses as the director's office, accounting,
personnel, and all other types of expenditures not listed specifically under one of the subcategories of "Facilities."

As described in 2 CFR part 200.403, costs must be consistently charged as either indirect or direct costs, but may not be double charged or
inconsistently charged as both.

For more guidance on IDC or F&A costs, refer to the 2 CFR Part 200.414 - Indirect (F&A) costs.

Please select from the drop down the type of IDC Rate or Cost Allocation Plan you will use to charge IDC to the award.

Type of IDC Rate/Cost Allocation Plan

Indirect Cost Rate/ Base Indirect Cost

Approved IDC Rate
$0

Indirect Charges Narrative:

Explain how you determined the base. If selecting to use approved Negotiated Indirect Cost Rate Agreement (NICRA), indicate the end date of
the effective period of the approved NICRA.

Cost Sharing/Match
Cost Sharing/Match % of FEDERAL
Total REQUEST
#DIV/0!

Page 24 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Cost Sharing/Match Narrative:

Matching funds (whether cash or in-kind) must meet the same test of allowability as the FEDERAL REQUEST in that the costs must be
reasonable, allocable, and necessary for the accomplishment of the project objectives and allowable under the cost principles (2 CFR Part
200.29) Cost sharing or matching. Please include amount per subrecipient and per cost category.

BUDGET SUMMARY

BUDGET FEDERAL
CATEGORY REQUEST
A. Personnel
$0
B. Fringe Benefits
$0
C. Travel
$0
D. Equipment (N/A)
$0
E. Supplies
$0
F. Contractual
$0
G. Construction (N/A)
$0
H. Other - Non M&A $0
H. Other - M&A $0 More than 5%? No
H. Total Other $0
I. Total Direct Charge
$0
(sum of A to H)
J. Indirect Charges $0
K. Total Project Costs
$0
(sum of I and J)

Page 25 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

I. APPLICANT INFORMATION
Applicant/Recipient Name Pilot Program Application Number
Enter the legal name of the applicant that will undertake the assistance Enter the information
activity. This is the organization that has registered with the System for Award collection report number
Management (SAM). Information on registering with SAM may be obtained provided when application
by visiting SAM.gov. is successfully submitted
in USAC Portal. Please
include both letters and
numbers.

NPP Outreach Grants

Applicant Type Applicant's SAM.gov Unique Entity Identifier (UEI) Number
Select one applicant type from the drop down menu. Enter the organization’s UEI received from SAM. The UEI is a unique 12
character organization identifier. Information on registering with System for
Award Management (SAM.gov) may be obtained by visiting the Grants.gov
website.

If "Other" selected, please describe the eligible entity type. Otherwise, leave blank.

II. DETAILED BUDGET AND NARRATIVE

A. Personnel
Include only costs requested for key personnel employed by applicant. Do not include the personnel costs of consultants, contractors and
subrecipients under this category. Personnel expenditures should be broken out by each position, name, hourly rate, number of hours, annual
salary, level of effort (do not exceed 100%). Salaries included as indirect costs (e.g., administrative and clerical staff) should be excluded from
this category.

Line Position Name Hourly # of Annual % Level Personnel

Item # Rate Hours Salary of Effort Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0

Line Personnel Narrative:

Item #
Explain how personnel funding will be used. This section should include compensation for personnel whose time was spent exclusively conducting
ACP outreach activities and/or in-person ACP application assistance either in a part-time or full-time capacity. Please provide salary and computation
methods. Must comply with 2 CFR 200.430.

Page 26 of 47
 2
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

B. Fringe Benefits
Choose the provided fringe components using the drop-down menu. Provide fringe benefit rate for each component. Positions, staff names, and
personnel costs will pre-populate from the Personnel table above. Based on the provision of specific fringe components for each position, enter
the total fringe rate for each position.

Fringe Components for Devoted Staff Rate (%)

Total Fringe Rate 0.00%

Line Position Name Personnel Total Fringe Rate Fringe

Item # Cost Per Position (%) Benefits Cost
1 0 0 $0 $0
2 0 0 $0 $0
3 0 0 $0 $0
4 0 0 $0 $0
5 0 0 $0 $0
6 0 0 $0 $0
TOTAL $0

Fringe Benefits Narrative:

Validate the computations in the table above, and applicant compliance with written policies per 2 CFR Part 200.431. If "Other" was chosen as
a fringe component, explain the fringe benefit being provided.

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Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

C. Travel
Choose types of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
ACP Outreach Local Travel (POV Mile$0.59 Mile 5 200 2 2 $1,180

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
TOTAL $0

Type of Travel Narrative:

Page 28 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022
Travel Narrative:
Event
For each type of event, list the locations of planned events. Justify costs requested, including reasoning for number of personnel traveling, and
particular positions attending event. If "Other" item was chosen, provide details and justify request (e.g., parking costs). All travel requests
must comply with 2 CFR Part 200.475.
ACP Outreach

In-person App. Assistance

Other

D. Equipment
N/A - not allowable.

E. Supplies
For each item of supplies requested by applicant, list the item and the type of outreach activity that necessitates the supply. Enter unit cost of
each item and quantity requested. Total supply costs requested may not exceed $5,000, including supply costs requested by contractors
(captured below). All supplies requested must be used exclusively for ACP outreach and/or ACP application assistance.

Line Item Type of Outreach Unit Cost Quantity Supplies

Item # Activity Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
7 $0
TOTAL $0

Line Supplies Narrative:

Item #
Explain necessity of supplies requested and computation method used for estimated unit cost.
1

Page 29 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

F. Contractual
Enter legal name of contractor, vendor, or subrecipient and specify which type of contractual agreement is planned, using the drop-down menu.
Enter the total contractual costs requested for each agreement. For each agreement in the first table, provide details in the second table next to
the corresponding agreement number. Describe the services and/or deliverables the contractor will provide. Itemize consultant costs, and
describe how the consultant was selected. If contractors plan to further subaward funds, include subcontractor information in the Contractual
Details.

Agree- Name of Contractor, Vendor, or SAM.gov Unique Entity Type of Agreement Period of Contractual
ment # Subrecipient Identifier (UEI) Number Performance Cost
1

TOTAL $0

Agree- Contractual Details/Services and Deliverables Provided

ment #
1

Page 30 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
1 Date: 11/21/2022
Release

Agree- Scope of Work

ment #
1

0
Contractual Personnel
Include only costs requested for key personnel employed by contractor/vendor/subrecipient. Personnel expenditures should be broken out by
each position, name, hourly rate, number of hours, annual salary, level of effort (do not exceed 100%). Salaries included as indirect costs (e.g.,
administrative and clerical staff) should be excluded from this category.
Line Position Name Hourly # of Annual % Level Personnel
Item # Rate Hours Salary of Effort Cost
1 $0
2 $0
3 $0
TOTAL $0

Line Personnel Narrative:

Item #
Explain how contractual personnel funding will be used. This section should include compensation for personnel whose time was spent exclusively
conducting ACP outreach activities and/or in-person ACP application assistance either in a part-time or full-time capacity. Please provide salary and
computation methods. Must comply with 2 CFR Part 200.430.

Page 31 of 47
Federal
1 Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Contractual Fringe Benefits

Choose the provided fringe components for contractor personnel using the drop-down menu. Provide fringe benefit rate for each component.
Positions, staff names, and personnel costs will pre-populate from the Contractual Personnel table above. Based on the provision of specific
fringe components for each position, enter the total fringe rate for each position.
Fringe Component for Contractual Staff Rate (%)

Total Fringe Rate 0.00%

Line Position Name Personnel Total Fringe Rate Fringe

Item # Cost Per Position (%) Benefits Cost
1 0 0 $0 $0
2 0 0 $0 $0
3 0 0 $0 $0
TOTAL $0

Contractual Fringe Benefits Narrative:

Validate the computations in the table above, and contractor compliance with written policies per 2 CFR Part 200.431. If "Other" was chosen as
a fringe component, explain the fringe benefit being provided.

Contractual Travel
Choose types of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.
See Example below (numbers will be based on actuals):

Page 32 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Choose types
Release Date: of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
11/21/2022
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.
See Example below (numbers will be based on actuals):

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
ACP Outreach Local Travel (POV Mile$0.59 Mile 5 200 2 2 $1,180

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
TOTAL $0

Line Contractual Travel Narrative:

Item #
For each type of event, list the locations of planned events. Justify costs requested, including reasoning for number of personnel traveling, and
particular positions attending event. If "Other" item was chosen, provide details and justify request (e.g., parking costs). All travel requests
must comply with 2 CFR Part 200.475.
ACP Outreach

Page 33 of 47
ACP Outreach
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

In-person App. Assistance

Other

Contractual Supplies
For each item of supplies requested by contractor, list the item and the type of outreach activity that necessitates the supply. Enter unit cost of
each item and quantity requested. Total supply costs requested may not exceed $5,000, including supply costs requested by primary
applicant captured as Supplies (above). All supplies requested must be used exclusively for ACP outreach and/or ACP application assistance.

Line Item Type of Outreach Unit Cost Quantity Supplies

Item # Activity Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
7 $0
TOTAL $0

Line Contractual Supplies Narrative:

Item #
Explain necessity of supplies requested and computation method used for estimated unit cost.
1

Page 34 of 47
Federal
4 Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Contractual Other - Non-Management and Administrative (M&A)

Itemize any other contractual expenses, and associate them with a project activity using the drop-down menu. Do not include expenses that fall
into the "Management & Administrative" category. For each item, provide the unit cost, and quantity requested.
Line Item Project Activity Unit Cost Quantity Contractual Other
Item # Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0

Line Other - Non-Management and Administrative (M&A) Narrative:

Item #
Justify costs requested, including reasoning for number of contractual items, project activity, and unit cost. If "Other" item was chosen, provide
details and justify request.
1

Page 35 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022
4

Agree- Name of Contractor, Vendor, or Type of Agreement Total Direct

ment # Subrecipient Charges
1 0 0 $0

0
Contractual Personnel
Include only costs requested for key personnel employed by contractor/vendor/subrecipient. Personnel expenditures should be broken out by
each position, name, hourly rate, number of hours, annual salary, level of effort (do not exceed 100%). Salaries included as indirect costs (e.g.,
administrative and clerical staff) should be excluded from this category.
Line Position Name Hourly # of Annual % Level Personnel
Item # Rate Hours Salary of Effort Cost
1 $0
2 $0
3 $0
TOTAL $0

Line Personnel Narrative:

Item #
Explain how contractual personnel funding will be used. This section should include compensation for personnel whose time was spent exclusively
conducting ACP outreach activities and/or in-person ACP application assistance either in a part-time or full-time capacity. Please provide salary and
computation methods. Must comply with 2 CFR Part 200.430.

Page 36 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Contractual Fringe Benefits

Choose the provided fringe components for contractor personnel using the drop-down menu. Provide fringe benefit rate for each component.
Positions, staff names, and personnel costs will pre-populate from the Contractual Personnel table above. Based on the provision of specific
fringe components for each position, enter the total fringe rate for each position.
Fringe Component for Contractual Staff Rate (%)

Total Fringe Rate 0.00%

Line Position Name Personnel Total Fringe Fringe

Item # Cost Rate (%) Benefits Cost
1 0 0 $0 $0
2 0 0 $0 $0
3 0 0 $0 $0
TOTAL $0

Contractual Fringe Benefits Narrative:

Validate the computations in the table above, and contractor compliance with written policies per 2 CFR Part 200.431. If "Other" was chosen as
a fringe component, explain the fringe benefit being provided.

Contractual Travel
Choose types of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.
See Example below (numbers will be based on actuals):

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
ACP Outreach Local Travel (POV Mile$0.59 Mile 5 200 2 2 $1,180

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0

Page 37 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
TOTAL $0

Line Contractual Travel Narrative:

Item #
For each type of event, list the locations of planned events. Justify costs requested, including reasoning for number of personnel traveling, and
particular positions attending event. If "Other" item was chosen, provide details and justify request (e.g., parking costs). All travel requests
must comply with 2 CFR Part 200.475.
ACP Outreach

In-person App. Assistance

Other

Contractual Supplies

Page 38 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

For each item of supplies requested by contractor, list the item and the type of outreach activity that necessitates the supply. Enter unit cost of
each item and quantity requested. Total supply costs requested may not exceed $5,000, including supply costs requested by primary applicant
captured as Supplies (above). All supplies requested must be used exclusively for ACP outreach and/or ACP application assistance.

Line Item Type of Outreach Unit Cost Quantity Supplies

Item # Activity Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
7 $0
TOTAL $0

Line Contractual Supplies Narrative:

Item #
Explain necessity of supplies requested and computation method used for estimated unit cost.
1

Page 39 of 47
Federal
7 Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Contractual Other - Non-Management and Administrative (M&A)

Itemize any other contractual expenses, and associate them with a project activity using the drop-down menu. Do not include expenses that fall
into the "Management & Administrative" category. For each item, provide the unit cost, and quantity requested.
Line Item Project Activity Unit Cost Quantity Contractual Other
Item # Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0
Line Other - Non-Management and Administrative (M&A) Narrative:
Item #
Justify costs requested, including reasoning for number of contractual items, project activity, and unit cost. If "Other" item was chosen, provide
details and justify request.
1

Agree- Name of Contractor, Vendor, or Type of Agreement Total Direct

Page 40 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

ment # Subrecipient Charges

2 0 0 $0

0
Contractual Personnel
Include only costs requested for key personnel employed by contractor/vendor/subrecipient. Personnel expenditures should be broken out by
each position, name, hourly rate, number of hours, annual salary, level of effort (do not exceed 100%). Salaries included as indirect costs (e.g.,
administrative and clerical staff) should be excluded from this category.
Line Position Name Hourly # of Annual % Level Personnel
Item # Rate Hours Salary of Effort Cost
1 $0
2 $0
3 $0
TOTAL $0

Line Personnel Narrative:

Item #
Explain how contractual personnel funding will be used. This section should include compensation for personnel whose time was spent
exclusively conducting ACP outreach activities and/or in-person ACP application assistance either in a part-time or full-time capacity. Please
provide salary and computation methods. Must comply with 2 CFR Part 200.430.
1

Contractual Fringe Benefits

Choose the provided fringe components for contractor personnel using the drop-down menu. Provide fringe benefit rate for each component.
Positions, staff names, and personnel costs will pre-populate from the Contractual Personnel table above. Based on the provision of specific
fringe components for each position, enter the total fringe rate for each position.
Fringe Component for Contractual Staff Rate (%)

Total Fringe Rate 0.00%

Line Position Name Personnel Total Fringe Fringe

Page 41 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Item # Cost Rate (%) Benefits Cost

1 0 0 $0 $0
2 0 0 $0 $0
3 0 0 $0 $0
TOTAL $0

Contractual Fringe Benefits Narrative:

Validate the computations in the table above, and contractor compliance with written policies per 2 CFR Part 200.431. If "Other" was chosen as
a fringe component, explain the fringe benefit being provided.

Contractual Travel
Choose types of events planned from drop-down menu - ACP outreach, in-person ACP application assistance, or other. Enter the cost/rate per
item requested for each type of event. Items represent categories of travel costs allowable under 2 CFR 200.475. It is possible to enter as many
as ten cost categories for one type of event. Enter the number of each type of event planned, and the number of personnel requesting that cost
covered. If selecting "Local Travel (POV Mileage), please enter the number of miles under "# of Items Per Person". Exclude travel costs for
consultants/contractors/subrecipients and registration fees for organization staff.
See Example below (numbers will be based on actuals):

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
ACP Outreach Local Travel (POV Mile$0.59 Mile 5 200 2 2 $1,180

Type of Event Item Cost / Rate Basis # of # of Items # of # of Travel

Per Item Events Per Person Persons Travel Days Cost
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0

Page 42 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
#N/A $0
TOTAL $0

Line Contractual Travel Narrative:

Item #
For each type of event, list the locations of planned events. Justify costs requested, including reasoning for number of personnel traveling, and
particular positions attending event. If "Other" item was chosen, provide details and justify request (e.g., parking costs). All travel requests
must comply with 2 CFR Part 200.475.
ACP Outreach

In-person App. Assistance

Other

Contractual Supplies
For each item of supplies requested by contractor, list the item and the type of outreach activity that necessitates the supply. Enter unit cost of
each item and quantity requested. Total supply costs requested may not exceed $5,000, including supply costs requested by primary applicant
captured as Supplies (above). All supplies requested must be used exclusively for ACP outreach and/or ACP application assistance.

Line Item Type of Outreach Unit Cost Quantity Supplies

Item # Activity Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
7 $0
TOTAL $0

Line Contractual Supplies Narrative:

Item #

Page 43 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Explain necessity of supplies requested and computation method used for estimated unit cost.
1

Contractual Other - Non-Management and Administrative (M&A)

Itemize any other contractual expenses, and associate them with a project activity using the drop-down menu. Do not include expenses that fall
into the "Management & Administrative" category. For each item, provide the unit cost, and quantity requested.
Line Item Project Activity Unit Cost Quantity Contractual Other
Item # Cost
1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0

Line Other - Non-Management and Administrative (M&A) Narrative:

Item #

Page 44 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Justify costs requested, including reasoning for number of items, project activity, and unit cost. If "Other" item was chosen, provide details and
justify request.
1

Agree- Name of Contractor, Vendor, or Type of Agreement Total Direct

ment # Subrecipient Charges
3 0 0 $0

Total Contractual
Cost
$0

G. Construction
N/A - not allowable

H. Other - Non-Management and Administrative (M&A)

Itemize any other expenses, and associate them with a project activity using the drop-down menu. Do not include expenses that fall into the
"Management & Administrative" category, as there is a separate table below for them. For each item, provide the unit cost, and quantity
requested.
Line Item Project Activity Unit Cost Quantity Other - Non M&A
Item # Cost

Page 45 of 47
Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

1 $0
2 $0
3 $0
4 $0
5 $0
6 $0
TOTAL $0

Line Other - Non-Management and Administrative (M&A) Narrative:

Item #
Justify costs requested, including reasoning for number of contractual items, project activity, and unit cost. If "Other" item was chosen, provide
details and justify request.
1

H. Other - Management and Administrative (M&A)

This section should include costs incurred in support of grant administration that are not included in the organization’s indirect cost pool (e.g.,
preparing and submitting programmatic and financial reports, establishing and/or maintaining inventory, responding to official information
requests such as audits, monitoring pass-through recipients). Include any M&A costs for subrecipients, contractors, or vendors below. The
M&A cost is capped at 5% of awarded funds.

Total
M&A Costs

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Federal Communications Commission
FY 2023 Affordable Connectivity Outreach Grant Program - Pilot Program Grants
Release Date: 11/21/2022

Other - Management and Administrative (M&A) Narrative:

Explain Other expenses, only including Management and Administrative (M&A). If M&A is being requested by subrecipients, contractors, or
vendors, indicate this in the narrative.

I. Total Direct Charges

Total Federal Request
Total Direct Charges
$0

J. Indirect Charges
Indirect charges/costs (IDC) or Facilities and Administration (F&A) are those costs incurred for common or joint objectives which cannot be
readily identified with an individual project or program but are necessary for the operations of the organization.

IDC (F&A) is classified into two broad categories: "Facilities" and "Administration." "Facilities" is defined as depreciation on debt associated
with buildings, equipment and captial improvement, interest on debt associated with certain buildings, equipment and capital improvements,
and operations and maintenance expenses. "Administration" is defined as general administration expenses as the director's office, accounting,
personnel, and all other types of expenditures not listed specifically under one of the subcategories of "Facilities."

As described in 2 CFR part 200.403, costs must be consistently charged as either indirect or direct costs, but may not be double charged or
inconsistently charged as both.

For more guidance on IDC or F&A costs, refer to the 2 CFR Part 200.414 - Indirect (F&A) costs.

Please select from the drop down the type of IDC Rate or Cost Allocation Plan you will use to charge IDC to the award.

Type of IDC Rate/Cost Allocation Plan

Indirect Cost Rate/ Base Indirect Cost

Approved IDC Rate
$0

Indirect Charges Narrative:

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