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By signing this document, the Contractor Authorized Representative attests to the information. <br />Signature of Contractor Authorized Representative Date <br />HCA will not endorse the Contractor's subaward until this form is completed and returned. <br />FOR HEALTH CARE AUTHORITY USE ONLY <br />HCA Contract Number: <br />Sub -award Project Description (see instructions and examples below) <br />Instructions for Sub -award Project Description: <br />In the first line of the description provide a title for the sub -award that captures the main purpose of the <br />subrecipients work. Then, indicate the name of the subrecipient and provide a brief description that captures <br />the overall purpose of the sub -award, how the funds will be used, and what will be accomplished. <br />Example of a Sub -award Project Description: <br />Increase Healthy Behaviors: Educational Services District XYZ will provide training and technical assistance to <br />chemical dependency centers to assist the centers to integrate tobacco use into their existing addiction <br />treatment programs. Funds will also be used to assist centers in creating tobacco free treatment environments. <br />Local Health Jurisdiction Page 43 of 59 Medicaid Administrative Claiming <br />Washington State Health Care Authority Contract # K3069 <br />