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New Personnel being hired? NO I Contact HR hiring — reporting requirements <br />Future impacts or liability to Kittitas County: <br />Budget Information <br />Budget Amendment Needed? Yes E] attach budget form <br />. ......... . <br />New Division Created? <br />Revenue Code 116.612.47 Behavorial Health <br />Expense Code 116.612.47.54101 <br />Pass Throueh Information <br />NO ❑ Why not <br />Professional Services <br />Agency to Pass Through <br />Amount to Pass Through <br />$ <br />Sub -Contract Approved <br />Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <br />Signature: Date: <br />Department: <br />mssignment or i racKing inrormaiion <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer I Date <br />Grant/Contract Review Page 2 <br />