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New Personnel being hired? no j Contact HR hirin <br />Future impacts or liability to Kittitas County: <br />— reporting requirements <br />Budget Information <br />Budget Amendment Needed? Yes ❑ attach budget form <br />New Division Created? <br />Revenue Code 116.612.47 Behavorial Health <br />Expense Code <br />No ❑ Why not <br />_.. . _ ........... _..... <br />116.612.47.54101 Professional Services <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through $ <br />Sub -Contract Approved Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes El No El <br />County IDenartments Immacted <br />Submitted <br />................... <br />Signature: Date: <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office r <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />ReviewerDate <br />_ ........... .... - <br />Grant/Contract Review Page 2 <br />Auditor <br />Facilities Maintenance <br />Information Services <br />Human Resource <br />Prosecutor <br />Treasurer <br />Submitted <br />................... <br />Signature: Date: <br />Department: <br />Assignment of Tracking Information <br />Auditor's Office r <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />ReviewerDate <br />_ ........... .... - <br />Grant/Contract Review Page 2 <br />