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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? <br />Yes ❑ attach budget form <br />No ❑ why not <br />New Division Created? <br />Revenue Code 116.612.47 Behavorial Health <br />Expense Code <br />116.612.47.54101 <br />Professional Services <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through <br />_$ <br />Date: <br />Sub -Contract Approved <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ <br />county uepartments impactea <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />Submitted <br />Signature: <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Date: <br />Reviewer Date <br />Grant/Contract Review Page 2 <br />