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Task Number Task! Activity/Description Ie Report actual expenditures for January 1, 2015 through September 30,2015. If Complete 2016-2017 MCHBG Budget Workbook for October 1,2016 through September 30, 2017 using DOH-provided template. Ig Report actual expenditures for October 1, 2015 through September 30,2016. Ih Report actual expenditures for OctoberI, 2016 through March 31, 2017. Ii Complete 2017-2018 MCHBG Budget Workbook for October 1,2017 through September 30, 2018 using DOH-provided template MCHBG Assessment and Evaluation 2a Participate in statewide capacity and needs assessment activities in preparation for next statewide 5 year plan, as requested. 2b Participate in project evaluation activities developed and coordinated by DOH, as requested. 2c Report program level strategy measure data MCHBG Implementation 3a Develop 2015-2016 MCHBG Action Plan for October 1,2015 through September 30, 2016 using DOH provided template. 3b Report activities and outcomes of2014-2015 MCHBG Action Plan using DOH provided template. Exhibit A, Statements of Work Revised as of November 15, 2016 *May Support PHAB StandardsIMeasures Deliverables/Outcomes (Sections A and B only) to contract manager. Submit actual expenditures using the MCHBG Budget Workbook to DOH contract manager. Submit completed MCHBG Budget Workbook to DOH contract manager. Submit actual expenditures using the MCHBG Budget Workbook to DOH contract manager. Submit actual expenditures using the MCHBG Budget Workbook to DOH contract manager. Submit completed MCHBG Budget Workbook to DOH contract manager. Documentation using report template provided by DOH. Documentation using report template provided by DOH. Documentation using Action Plan Quarterly Report and MCHBG Budget Workbook Submit MCHBG Action Plan to DOH contract manager. Submit Action Plan quarterly reports to DOH contract manager . Page 4 of21 AMENDMENT #10 Payment Due Date/Time Frame Information and/or Amount See Program Specific Requirements and November 30,2015 Special Billing Requirements. September 2,2016 November 30,2016 May 26,2017 September 1, 2017 May 1,2015 Reimbursement for actual costs, not to exceed total funding September 30, 2017 consideration. See Program Specific Requirements and January 15,2017 Special Billing April 15, 2017 Requirements. July 15,2017 Draft -August 21, 2015 Reimbursement for Final -September 4, 2015 actual costs, not to exceed total funding January 15,2015 consideration. Action April 15,2015 Plan and Progress July 15,2015 Reports must only October 15,2015 reflect activities paid for with funds provided in this statement of work for I Contract Number C 171 14-10