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AMENDMENT #14 <br />Payment , <br />Task *May Support PHAB Task! Activity illescription Deliverables/Outcomes Due Date/Time Frame Information and/or I Number StandardslMeasures Amount <br />4b Administer requested DOH Diagnostic and Submit completed Health 30 days after forms are <br />See Program Specific I Treatment funds for infants and children per Services Authorization forms and completed. <br />CSHCN Program Manual when funds are used. Central Treatment Fund requests Requirements and <br />directly to the CSHCN Program Special Billing <br />as needed. Requirements. <br />4c Participate in the CSHCN Regional System and Submit Action Plan quarterly January 15,2015 <br />quarterly meetings as described in the CSHCN reports including number of April 15,2015 <br />Program Manual. regional meetings attended to the July 15, 2015 <br />DOH contract manager. October 15,2015 <br />January 15, 2016 <br />April 15,2016 <br />July 15,2016 <br />October 15,2016 <br />January 15,2017 <br />April 15, 2017 . July 15, 2017 <br />October 15. 2017 <br />*For Information Only: <br />Funding is not tied to the revised StandardslMeasures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a <br />StandardlMeasure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: <br />hltp;/lwww.phaboal.d.orglwp-contenUuploadsIPHAB -Standards-and-Measul.es-Version-t.O .p df <br />Program Specific Reguirements/Narrative <br />Special Requirements <br />Federal F unding Accountability and Transparenc.v Act (FFATA) <br />This statement of work is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FF AT A or the Transparency Act). <br />The purpose of the Transparency Act is to make information available online so the public can see how the federal funds are spent. <br />To comply with this act and be eligible to perform the activities in this statement of work, the LHJ must have a Data Universal Numbering System (DUNS®) number. <br />Information about the LHJ and this statement of work will be made available on USASpending .gov by DOH as required by P.L. 109-282. <br />Program Manual, Handbook, Policy References <br />Children with Special Health Care Needs Manual-http://\l.'\vw .doh.wa .govlPortalS!1IDocumenWPubsl970 -209·CSHCN-Manual.pdf <br />Exhibit A, Statements of Work <br />Revised as of September 15, 2017 <br />Page 9 of 10 Contract Number C 17114-14