Amendment 4 - Laserfiche WebLink

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Task Number Task/ Activityillescription 0 Race/ethnicity 0 Gender 0 Age • % SNAP eligible per site • Setting type -school, church, etc . • Top Key Messages delivered per project LHJs are required to submit data electronically or within the template provided by DOH. 2.2 Evaluation Data and Reports The following evaluation activities* and information is required for all projects based on your approved project/plan • Formative • Process • PSE • Outcome • Qualitative *Please Note: the deliverables may change based on state evaluation team requirements. Exhibit A, Statements of Work Revised as ofJuly 16, 2018 AMENDMENT #4 *May Support PHAB Payment Standards/Measures Deliverables/Outcomes Due Date/Time Frame Information and/or Amount week after data is collected. I 1. Collect and report any 1. Due: Submit within See payment formative and process data Quarterly reporting listed information as completed based on above in task 2.0. referenced in task approved project plan. number 1.0. 2. Submit PSE progress and 2. Due: quarterly outcomes based on approved • 2nd quarter due by project plan. 04/06/18 • 3rd quarter due by 07/06/18 • Final report for all other work due 09/21/18. 3. Conduct and submit/mail 3. Due: Within 30 days after pretest surveys for each completed. Submit all project class series. pretests surveys/data when they are completed for a specific project. 4. Conduct and submit/mail 4. Due: Within 30 days after posttest surveys for each completed. Submit all project class series. posttest surveys/data when they are completed for a specific project. 5. Capture and submit 5. Due: Submit within qualitative (success stories, Quarterly reporting listed pictures) information per above in task 2.0 along with your approved work plan. photo releases. Page 20 of32 Contract Number CLH18249-4