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DocuSign Envelope ID: 262ABA18-5354-4F41-9508-9B13C8ACBA6D <br />Attachment 3 <br />Federal Award Identification for Subrecipients (reference 2 CFR 200.331) <br />(i) <br />Subrecipient name (which must match the name <br />Kittitas County Health Department <br />associated with its unique entity identifier); <br />(ii) <br />Subrecipient's Data Universal Numbering <br />System (DUNS@) unique entity identifier <br />(iii) <br />Federal Award Identification Number (FAIN); <br />21-05WA5ADM <br />(iv) <br />Federal Award Date (see §200.39 Federal <br />10/01/2020 <br />award date); <br />(v) <br />Subaward Period of Performance Start and End <br />01/01/2021 — 12/31/2021 <br />Date; <br />(vi) <br />Amount of Federal Funds Obligated by this <br />No Maximum — Reimbursement based on <br />action; <br />percentages. <br />(vii) <br />Total Amount of Federal Funds Obligated to the <br />No Maximum — Reimbursement based on <br />Subrecipient; <br />percentages. <br />(viii) <br />Total Amount of the initial Federal Award; <br />$2,622,877,000. <br />(ix) <br />Federal award project description, as required to <br />be responsive to the Federal Funding <br />Accountability and Transparency Act (FFATA); <br />(x) <br />Name of Federal awarding agency, pass- <br />CMS <br />through entity, and contact information for <br />WA State Health Care Authority <br />awarding official <br />Jon Brogger, HCA Contract Manager <br />626 8th Ave SE; Olympia, WA 98504-5330 <br />jon.brogger@hca.wa.gov <br />(xi) <br />Catalog of Federal Domestic Assistance (CFDA) <br />Number and Name; the pass-through entity <br />93.778 <br />must identify the dollar amount made available <br />under each Federal award and the CFDA <br />Medical Assistance Program <br />number at time of disbursement; <br />(xii) <br />Identification of whether the award is Research <br />❑ Yes ® No <br />& Development; and <br />(xiii) <br />Indirect Cost Rate for the Federal award, <br />including if the de minimis rate is charged per <br />§200.414 Indirect (Facilities & Administrative) <br />costs. <br />Washington State Page 32 of 53 HCA IAA K4649 <br />Health Care Authority Revised 10/2020 <br />