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Total Amount $ State Funds $ Federal Funds $ <br />Percentage County Funds Matching Funds $ CFDA# <br />In -Kind $ <br />Is Equipment being purchased? No Who owns equipment? <br />New Personnel being hired? No 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 />Time extension only <br />New Division Created? <br />Revenue Code <br />116.612.95.333.93.778 <br />Expense Code <br />116.612.95.51001/52001/50098 <br />Pass Through Information <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Sub -Contract Approved Date: <br />Prosecutor Review <br />Has the Prosecutor reviewed this agreement? Yes ❑ No ❑ <br />_County Departments Impactecd <br />Auditor Facilities Maintenance <br />Information Services Human Resource <br />Prosecutor Treasurer <br />BOCC <br />Yes <br />roval Needed? <br />Staff Member Presenting: <br />Assignment of Tracking Information <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Reviewer <br />Date <br />Grant/Contract Review Page 2 <br />