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Is Equipment being purchased? no Who owns equipment? <br />New Personnel being hired? no Contact HR hiring -reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed? Yes D attach budget form No • Why not amended funding <br />New Division Created? no <br />Revenue Code 612.22.333.93.99 MCHBG $ 893 <br />612.88.3.333.93.06 PHER $ 565 <br />612.94.333.10.56 SNAP ED $11,025 <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub-Contract Approved Date: <br />Prosecutor Review I Has the Prosecutor reviewed this agreement? j Yes • No D <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted I: Siitn atu re: <br />Department: <br />I Date: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />I Reviewer I Date <br />Grant/Contract Review Page 2