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Financial Information <br />Total Amount State Funds $ <br />Percentage County Funds Matching Funds $ <br />In -Kind $ <br />Federal Fun. <br />CFDA# <br />Is Equipment being purchased? Who owns equipment? <br />New Personnel being hired? Contact HR hiring — reporting requirements <br />Future impacts or liability to Kittitas County: <br />t Information <br />Amendment Needed? <br />New Division Created? <br />Revenue Code <br />Yes ❑ attach budget form No ❑ Why not <br />116 — 612.94.333.10.56 (SNAP Ed) <br />116 — 612.88.3.333.93069 (PHEPR) <br />116 — 612.32.1.333.93268 (VFC Immz) <br />116 — 612.39.24.333.93.268 (Covid Vaccine) <br />-116 — 612.22.10.333.93.994 (MCHBG) <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? <br />County Departments Impacted <br />Auditor <br />Information Services <br />Prosecutor <br />BOCC Approval Needed? <br />Yes ❑ <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 />Expense Code: <br />Yes ❑ No <br />Facilities Maintenance <br />Human Resource <br />Treasurer <br />Reviewer Date <br />Grant/Contract Review Page 2 <br />