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Task <br />Number Task/ Activityillescription <br />Id Report actual expenditures for October 1, 2018 <br />through March 31, 2019 <br />le Develop 2019-2020 MCHBG Budget Workbook <br />for October 1, 2019 through September 30, 2020 <br />using DOH provided template. <br />If Report actual expenditures for October 1, 2017 <br />through September 30, 2018 <br />MCHBG Assessment and Evaluation <br />2a Participate in project evaluation activities <br />developed and coordinated by DOH, as <br />requested. <br />2b Report program level strategy measure data <br />(CSHCN, UDS, ACEs). <br />2c Conduct a Maternal and Child Health (MCH) <br />Needs Assessment. <br />MCHBG Implementation <br />3a Develop 2018-2019 MCHBG Action Plan for <br />October 1, 2018 through September 30, 2019 <br />using DOH-provided template. <br />3b Report activities and outcomes of2017-2018 <br />MCHBG Action Plan using DOH-provided <br />temJJlate. <br />Exhibit A, Statements of Work <br />Revised as of July 16, 2018 <br />*May Support PHAB <br />Standards/Measures Deliverables/Outcomes <br />Submit actual expenditures using <br />the MCHBG Budget Workbook to <br />DOH contract manager. <br />Submit MCHBG Budget Workbook <br />to DOH contract manager <br />Submit actual expenditures using <br />the MCHBG Budget Workbook to <br />DOH contract manager. <br />Documentation using report <br />template provided by DOH <br />Documentation using report <br />template provided by DOH <br />Submit Needs Assessment <br />documentation to DOH contract <br />manager using templates provided <br />byDOH <br />Submit MCHBG Action Plan to <br />DOH contract manager <br />Submit Action Plan monthly <br />reports to DOH contract manager <br />Page 8 of32 <br />AMENDMENT #4 <br />Payment <br />Due Date/Time Frame Information and/or <br />Amount <br />May 24, 2019 period. <br />See Program <br />Specific <br />Requirements and <br />September 5, 2019 Special Billing <br />Requirements. <br />November 30, 2018 <br />September 30, 2018 Reimbursement for <br />September 30, 2019 actual costs, not to <br />exceed total funding <br />January 15, 2018 consideration. <br />April15,2018 <br />July 15, 2018 See Program <br />October 15, 2018 Specific <br />January 15, 2019 Requirements and <br />April 15, 2019 Special Billing <br />July 15, 2019 Requirements. <br />May 24, 2019 <br />Draft August 17, 2018 Reimbursement for <br />Final September 5, 2018 actual costs, not to <br />exceed total funding <br />Monthly, on or before consideration. <br />the 15th of the following Action Plan and <br />month Progress Reports <br />Contract Number CLH18249-4