All Fringe Benefits Will Be Paid by Applicant Agency Additional Fringe Benefits Will Be Paid by Applicant Agency EMPLOYEES’ EMPLOYEES’ NAMES: (Continued) SOCIAL SECURITY RATE SALARY TOTAL SOCIAL SECURITY RATE SALARY TOTAL 1. 5. $0 $0 .062 .062 2. $0 6. $0 .062 .062 3. 7. .062 $0 .062 $0 4. 8. $0 $0 .062 .062 MEDICARE RATE SALARY TOTAL MEDICARE RATE SALARY TOTAL 1. $0 5. $0 .0145 .0145 2. 6. $0 $0 .0145 .0145 3. 7. $0 $0 .0145 .0145 4. 8. $0 $0 .0145 .0145 TIME TIME HEALTH/LIFE INSURANCE HEALTH/LIFE INSURANCE RATE MONTHS DEVOTED TO TOTAL RATE MONTHS DEVOTED TO TOTAL Provide monthly insurance rates Provide monthly insurance PROJECT PROJECT 1. 5. $0 $0 2. 6. $0 $0 3. 7. $0 $0 4. 8. $0 $0 WORKMAN’S COMPENSATION RATE SALARY TOTAL WORKMAN’S COMPENSATION RATE SALARY 1. 5. $0 $0 2. 6. $0 $0 3. 7. $0 $0 4. 8. $0 $0 UNEMPLOYMENT TAX UNEMPLOYMENT TAX RATE TYPE SALARY TOTAL RATE TYPE SALARY TOTAL Based on first $7,000 or Less Based on first $7,000 or Less 1. 5. $0 $0 check check type: type: 2. 6. $0 $0 3. 7. $0 $0 futa futa 4. 8. $0 $0 suta suta PUBLIC/PRIVATE RETIREMENT RATE SALARY TOTAL PUBLIC/PRIVATE RETIREMENT RATE SALARY TOTAL 1. 5. $0 $0 2. 6. $0 $0 3. 7. $0 $0 4. 8. $0 $0 OTHER: RATE SALARY TOTAL OTHER: RATE SALARY TOTAL 1. 5. $0 $0 2. $0 6. $0 3. 7. $0 $0 4. 8. $0 $0 $0 $0 FRINGE BENEFITS TOTAL (A): FRINGE BENEFITS (B): please note: if more than eight employees charged to this project, please complete an $0 200. Fringe Benefits (A+B): addendum page. SECTION 200. FRINGE BENEFITS SUMMARY FEDERAL CASH $0 TOTAL FRINGE BENEFITS
All Fringe Benefits Will Be Paid by Applicant Agency Additional Fringe Benefits Will Be Paid by Applicant Agency EMPLOYEES’ EMPLOYEES’ NAMES: (Continued) SOCIAL SECURITY RATE SALARY TOTAL SOCIAL SECURITY RATE SALARY TOTAL 1. .062 $0 5. .062 $0 2. .062 $0 6. .062 $0 3. .062 $0 7. .062 $0 4. .062 $0 8. .062 $0 MEDICARE RATE SALARY TOTAL MEDICARE RATE SALARY TOTAL 1. .0145 $0 5. .0145 $0 2. .0145 $0 6. .0145 $0 3. .0145 $0 7. .0145 $0 4. .0145 $0 8. .0145 $0 HEALTH/LIFE INSURANCE Provide monthly insurance rates RATE MONTHS TIME DEVOTED TO PROJECT TOTAL HEALTH/LIFE INSURANCE Provide monthly insurance RATE MONTHS TIME DEVOTED TO PROJECT TOTAL 1. $0 5. $0 2. $0 6. $0 3. $0 7. $0 4. $0 8. $0 WORKMAN’S COMPENSATION RATE SALARY TOTAL WORKMAN’S COMPENSATION RATE SALARY 1. $0 5. $0 2. $0 6. $0 3. $0 7. $0 4. $0 8. $0 UNEMPLOYMENT TAX Based on first $7,000 or Less RATE TYPE SALARY TOTAL UNEMPLOYMENT TAX Based on first $7,000 or Less RATE TYPE SALARY TOTAL 1. check type: $0 5. check type: $0 2. $0 6. $0 3. futa $0 7. futa $0 4. suta $0 8. suta $0 PUBLIC/PRIVATE RETIREMENT RATE SALARY TOTAL PUBLIC/PRIVATE RETIREMENT RATE SALARY TOTAL 1. $0 5. $0 2. $0 6. $0 3. $0 7. $0 4. $0 8. $0 OTHER: RATE SALARY TOTAL OTHER: RATE SALARY TOTAL 1. $0 5. $0 2. $0 6. $0 3. $0 7. $0 4. $0 8. $0 FRINGE BENEFITS TOTAL (A): $0 FRINGE BENEFITS (B): $0 please note: if more than eight employees charged to this project, please complete an addendum page. 200. Fringe Benefits (A+B): $0 SECTION 200. FRINGE BENEFITS SUMMARY FEDERAL CASH TOTAL FRINGE BENEFITS $0
Byrne_JAG_App_Word2010.docx