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· 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 />Contract/Grant Information <br />II Agenda Date ILA .' I I '" I1IlYlI 1-,., ;;{)J VI <br />Contract /G rant Agency: Child Death Review Case Re portihg System Data Use Agreem ent <br />Period Begin Date: Date of Execution I I 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 />rJt.A -~ Department Head Signature .:~V ; Administrator <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED ~~ F~ , ,.J~ p <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />I Total Amount $ State Funds $ Federal Funds $ <br />I Percen tage County Funds Matching Funds $ CFDA# <br />Grant/Contract Review Page 1