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1. Salaries <br /> direct costs <br /> used to <br /> Grant= G calculate <br /> Hourly Cost Hours/wk. Total Gross or Indirect Cost? Admin. <br /> Salaries (Name/Position) $) * or% FTE = Salary($ match = M Y/N Cost? Y/N <br /> $ * _ $ <br /> Sub-Totals for Salaries Category $ <br /> 2. Fringe Benefits <br /> Approved % direct costs <br /> per Work Plan used to <br /> Amount or enter"N/A" Benefit# Benefit# Benefit# Grant= G calculate <br /> Name of Gross & provide 1 2 3 Total Fringe or Indirect Cost? Admin. Cost <br /> Employee Salary $) break-out &Cost &Cost &Cost Benefits ($) match = M Y/N Y/N <br /> $ $ $ $ $ <br /> Sub-Total of Fringe Benefits Category $ <br /> 3.Travel * Cannot exceed cost limitations described in Ch. 112.061, F.S. <br /> direct costs <br /> used to <br /> Period of Grant= G calculate <br /> Name of Trip (#of Amount or Indirect Cost? Admin. Cost <br /> Employee Destination days) Purpose of Trip Budgeted match = M Y/N Y/N <br /> $ <br /> Sub-Total of Travel Cate o $ <br /> Energy Efficiency and Conservation Block Grant Application <br /> Attachment A-Grant Application Form <br /> Page 9of13 <br />