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In-Kind$ <br />Explain <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? 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 []I Why not <br />New Division Created? Fund Neutral <br />Revenue Code 116.612.47 Behavioral Health & Recovery <br />612.47.1.333.93.959 SABG Substance Abuse Block Grant SFY-19 $71,553 -$2,956 = $68,597 <br />612.47.3.334.04.Gx GFS General Fund State Admin SFY-19 $ 3,009 + $2,956 = $ 5,965 <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? I Yes • No D <br />County Departments Impacted <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted I Signature : <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 <br />I <br />Page 2