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TotalAmount S 155,495 State Funds $Federal Funds S i.55,495 <br />Percentage County Funds Matching Funds 5 CFDA# 10.56L; 93.069; 93.439; <br />93.994 93.26893.268 <br />ln-Kind S <br />ut ent bei urchased?ls Who owns uipment? <br />New Personnel being hired?Contact HR hiri - reportin uirements <br />Future impacts or liability to Kittitas County <br />Financial lnformation <br />Bu lnformation <br />Pass Through lnformation <br />Agency to Pass Through <br />Amount to Pass Through <br />Sub-Contract Approved Date: <br />Prosecutor Review <br />Budget Amendment Needed ? <br />New Division Created? <br />Yes ! attach budgetform No n why not <br />Revenue Code: LL6.612.94.333.10.561 52a,oqa Snap-Ed <br />LL6.672.88. 3. 3 33. 93. 069 <br />716.6L2.3r.333.93.439 <br />11"6.612.22. 10. 333. 93. 994 <br />776.612.32. 1. 333. 93. 268 <br />1,L6.612.32. 3. 3 33. 93. 268 <br />S19,653 <br />S6o,ooo <br />544,196 <br />s 2,800 <br />s 2,800 <br />PHEP <br />LSPAN <br />MCHBG <br />lmmz Enhanced Flu <br />lmmz VFC Ops lm prove Rates <br />Has the Prosecutor reviewed this a ment?Yes No <br />County De rtments lmpacted <br />Submitted <br />Signature:Date: <br />De rtment <br />Assignment of Tracki ng lnformation <br />Grant/Contract Review page 2 <br />Auditor Facilities Maintenance <br />lnformation Services Human Resource <br />Prosecutor Treasurer <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office L\0/ <br />Who Signed the grant application ) <br />Reviewer Date