Form 1 GABI Instrument and Instruction 2016

OMB Control No: 0970-0207
Expiration date: XX/XX/XX

GABI
2016
Re-Approval

THE PAPERWORK REDUCTION ACT OF 1995 (PUB. L. 104-13)
Public reporting burden for this collection of information is estimated to average 33 hours per
response, including the time for reviewing instructions, gathering and maintaining the data
needed, and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number.

OMB Control No: 0970-0207
Expiration date: 12/31/13

Program Approach Form- Grantee/Delegate Number

Agency Name

_

I. Enrollment bl: Pro :;ram Oution
This section should be filled out and submitted for each grantee a nd delegate agency.
1. Funded child enrollment by program option 1 :

2. Number of pregnant women enrolled for EHS:

Center-based enrollment
Home-based enrollment
Combination option enrollment
Family child care enrollment
Other option enrollment
Total Child Enrollment
II. Pro :;ram Schedule
This section should be filled out for each group of children servedfor different hours of service each year.
Complete #1-3 for all groups of children
1.

I 2.
3.

Program schedule number

I

1

I

2

I

3

I

4

I

5

Program option identification
Funded enrollment

Complete #4-9 for center-based, family child care, combination, and other options
4a. Number of classes/groups/family child care settings
4b. Double session, enter D
5.

Number of hours of classes/groups/FCC settings per child, per day

6.

Number of days of classes/groups/FCC settings per child, per week

7.

Number of days of classes/groups/FCC settings per child, per year

8.

Number of home visits per child, per year

9.

Number of hours per home visit

Complete # 10-13 for home-based options
10. Number of home visits per child, per year
11. Number of hours per home visit
12. Number of hours per home-based socialization experience
13. Number of home-based socialization experiences per child, per year
Notes:
ltem I: 1f more than 5 different schedules, photocopy form and write in 6, 7, 8, etc.
ltem 2: Identify each program schedule as center-based (CB), home-based (HB), combination program (CO), family child care (FC), or other program option (OT). For
combination options (CO and other options (OT), the items on the form that more appropriately describe the services provided by these options should be filled out

1

Funded enrollment by program option must equal the total number of children supported through the budget contained on the SF 424A and the Line-Item Budget.

LINE-ITEM BUDGET FOR HEAD START AND EARLY HEAD START

Position

HS/EHS Cost for
Program Operations
a. PERSONNEL (Object class 6a)
Child Health and Developmental Services Personnel

HS/EHS Cost for
Training &
Technical Assistance

Non-Federal Share
(Cash and in-kind)

Number of People
Employed

1. Program Managers &
Content Area Experts
2. Teachers/Infant
Toddler Teachers
3. Family Child Care
Personnel
4. Home Visitors
5. Teacher Aides & Other
Education Personnel
6. Health/Mental Health
Services Personnel
7. Disabilities Services
Personnel
8. Nutrition Services
Personnel
9. Other Child Services
Personnel
a1.

Include program managers, supervisors, and content experts in child development, health, mental health,
nutrition, and disabilities services. Include home-based and family child care supervisors.

a2.

Include all teachers, including infant and toddler teachers.

a3.

Include family child care staff, if they are agency employees. If providers are not agency employees, enter
costs under item (f)(6) or (h)(10).

a6.

Include nurses, health services aides, speech therapists, mental health staff and other health services personnel.

a8.

Include nutritionists, cooks, and other food services staff.

a9.

Include any personnel that provide services to children that cannot be reported in any other category.

2

LINE-ITEM BUDGET FOR HEAD START AND EARLY HEAD START

HS/EHS Cost for
Program Operations
Family and Community Partnerships Personnel

Position

HS/EHS Cost for
Training &
Technical Assistance

Non-Federal Share
(Cash and in-kind)

Number of People
Employed

10. Program Managers &
Content Area Experts
11. Other Family &
Community
Partnerships Personnel
Program Design and Management Personnel
12. Managers
13. Staff Development
14. Clerical Personnel
15. Fiscal Personnel
16. Other Program Design
Personnel
Other Personnel
17. Maintenance Personnel
18. Transportation
Personnel
19. Other Personnel
TOTAL PERSONNEL (6a)
a10. Include program managers, coordinators, supervisors, and content experts in parent involvement, social
services, volunteer coordination, or other family and community partnership activities.
a11. Include social workers, family service workers, social services aides, parent involvement aides, and other
family and community partnerships staff.
a12. Include executive directors, Head Start or Early Head Start directors, deputy or assistant directors, and other
administrators.
a13. Include staff responsible for coordinating staff development and training. (Note: Report any salaries paid by
T&TA funds in the second column.)
a19. Include any personnel that cannot be reported in any other category.

3

LINE-ITEM BUDGET FOR HEAD START AND EARLY HEAD START

Position

HS/EHS Cost for
Program Operations

HS/EHS Cost for
Training & Technical
Assistance

Non-Federal Share
(Cash and in-kind)

b. FRINGE BENEFITS (Object Class 6b)
1. Social Security (FICA), State
Disability, Unemployment (FUTA),
Workers Compensation
2. Health/Dental/Life Insurance
3. Retirement
4. Other Fringe
TOTAL FRINGE (6b)
c. TRAVEL (Object Class 6c)
1.

Staff Out-of-Town Travel
TOTAL TRAVEL (6c)

d. EQUIPMENT (Object Class 6d)
1.

Office Equipment

2.

Classroom/Outdoor/Homebased/FCC

3.

Vehicle Purchase

4.

Other Equipment
TOTAL EQUIPMENT (6d)
c1. Enter the total costs of travel outside of the grantee service area for employees of the project, including per diem
expenses. Do not include costs for consultant travel, parent travel, or local transportation. [A brief explanation
of travel costs should be included in the budget justification.]
d. “Equipment” means an article of tangible, non expendable, personal property having a useful life of more than
one year and an acquisition cost of $5,000, or more, per unit. Include leased equipment only if costs are $5,000
or more per unit; costs for other leased equipment may be reported in object class (h). [An itemized list of
equipment should be included in the budget justification.]
d2. Includes equipment used for classrooms, group settings for infants and toddlers, family child care settings,
playgrounds, home-based programs, and family and community partnerships.

4

LINE-ITEM BUDGET FOR HEAD START AND EARLY HEAD START

Position

HS/EHS Cost
for Program
Operations

HS/EHS Cost for
Training and Technical
Assistance

Non-Federal Share
(cash and in-kind)

e. SUPPLIES (Object Class 6e)
1. Office Supplies
2. Child and Family Services Supplies
3. Food Services Supplies
4. Other Supplies
TOTAL SUPPLIES (6e)

f. CONTRACTUAL (Object Class 6f)
1.

Administrative Services (e.g.,
Legal, Accounting)

2.

Health/Disabilities Services

3.

Food Services

4.

Child Transportation Services

5.

Training & Technical Assistance

6.

Family Child Care

7.

Delegate Agency Costs

8.

Other Contracts
TOTAL CONTRACTUAL (6f)
f.

Enter the costs of contracts for services and goods, except those belonging in other categories, such as
equipment, supplies, construction, etc. Include contracts with organizations for the provision of training or
technical assistance. Do not include payments to individuals in this category; services of individuals (other
than employees) should be reported in object class (h). Do no include service contracts; such maintenance
agreements also may be reported in object class (h). [An itemized list of contracts should be included in the
budget justification.]

f6. Include contracts with umbrella organizations. Contracts with individuals should be included in line (h)(10).

5

LINE-ITEM BUDGET FOR HEAD START AND EARLY HEAD START

Position

HS/EHS Cost
for Program
Operations

HS/EHS Cost for
Training and Technical
Assistance

Non-Federal Share
(cash and in-kind)

g. CONSTRUCTION (Object Class 6g)
1.

New Construction

2.

Major Renovation

3.

Acquisition of Buildings/Modular
Units
TOTAL CONSTRUCTION (6g)

h. OTHER (Object Class 6h)
1.

Depreciation/Use Allowance

2.

Rent

3.

Mortgage

4.

Utilities, Telephone

5.

Building & Child Liability
Insurance

6.

Building Maintenance/Repair and
Other Occupancy

7.

Incidental Alterations/Renovations

8.

Local Travel

9.

Nutrition Services

10. Child Services Consultants
h1. Enter proposed occupancy expenses. Rent may be charged only when the applicant does not own or have
substantial interest in the real property. Depreciation/Use Allowances should be charged when the building is
owned by or has been donated to the applicant or there is a less-than-arms-length lease agreement. See OMB
Circular A-122, Cost Principles for Non-Profit Organizations or OMB Circular A-87, Cost Principles for State
and Local Governments.
h8. List proposed costs associated with transporting children to and from the center, on field trips, etc. Include all
costs of maintaining, repairing, operating, and insuring vehicles that transport children.
h10. If individuals who provide direct service to children are paid as consultants rather than as staff, the cost should
be included in this category. Include consultants providing education and child development services, medical
or dental exams, screening care, mental health services, nutrition services, speech therapy, disability services,
family child care services, or other child services.

6

LINE-ITEM BUDGET FOR HEAD START AND EARLY HEAD START

Position

HS/EHS Cost
for Program
Operations

HS/EHS Cost for
Training and Technical
Assistance

Non-Federal Share
(cash and in-kind)

h. OTHER (Object Class 6h)
11. Volunteers
12. Substitutes (if not paid benefits)
13. Parent Services
14. Accounting & Legal Services
15. Publications/Advertising/Printing
16. Training or Staff Development
17. Other
TOTAL OTHER (6h)
i.

TOTAL DIRECT CHARGES
Sum of Line 6a-6h

j.

INDIRECT COSTS
Enter Costs Not Reflected in i
above

k. TOTALS
ALL BUDGET CATEGORIES
h11. Enter the in-kind value of volunteers (parents or others) who participate in program activities in the nonFederal share column.
h13. Include parent activities, parent local and out-of-town travel, and other parent services.

7

LINE-ITEM BUDGET FOR HEAD START AND EARLY HEAD START

The Federal and non-Federal costs proposed in the SF 424A and the Line-Item Budget are the
costs that, when agreed upon, will be included in the Head Start grant award. There may be
other cash or in-kind resources that are necessary to support the services that will be
provided to Head Start children and their families. Applicants are asked to explain these
resources in Part 3 of the Budget and Budget Justification. The value of these resources
should be shown below. (Resources that the applicant uses to serve children who are not
enrolled in Head Start should not be included.)
Federal Funding
1.

Federal Child Development and Child Care funds

2.

USDA Funds for Nutrition Services

3.

Other Federal Funding
(

)

State Funding
4.

State Preschool Programs

5.

Other State Funding
(

)

Local Government Funding
6.

School District Funding

7.

Other Local Government Funding
(

)

Other Funding
8.

Tribal Government Funding

9.

Fund-raising Activities

10.

Other
(

)

TOTAL

8

Value