Laserfiche WebLink
Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date <br />01/27/2016 <br />Fund/Department <br />116 -Public Health <br />nt Information <br />r <br />hE l ul i [!11 <br />(.3Z4 �;I <br />Agenda Date <br />n <br />Contract /Grant Agency: Child Death Review Case Reporting System Data Use Agreement i <br />Period Begin Date: Date of Execution Period End Date: 12/31/2020 <br />Total Grant/Contract Amount: None <br />Grant/Contract Number: -- <br />Contract/Grant Summary: -- — - <br />The data use agreement is entered into by the Michigan Public Health Institute (MPHI) and Kittitas <br />County Public Health Department to establish terms and conditions for the collection, storage and use of <br />data obtained from the case reviews of child deaths submitted by Child Death Review teams in Kittitas <br />County and entrusted to the Michigan Public Health Institute as the Child Death Review Case Reporting <br />System. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature Administrator Date: 3EQ <br />G <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: . <br />" J i <br />L <br />4gnatr <br />Prosecutor's Office DFte <br />uditor's Office Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ State Funds $ <br />Percentage County Funds Matching Funds $ <br />Federal Funds $ <br />CFDA# <br />Grant/Contract Review Page 1 <br />