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Financial lnformation <br />Bu lnformation <br />Pass Thro lnformation <br />Prosecutor Review <br />TotalAmount State Funds S Federal Funds S <br />Percentage County Funds Matching Funds S CFDA# <br />1n-Kind S <br />Explain <br />ls 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 />Bud.get Amendment Needed?No n why notYes ! attach budgetform <br />New Division Created? <br />\Lx) <br />1.L6 - 672.94.333. 10.s6 (SNAP Ed) <br />1-16 - 612.88.3.333.93069 (PHEPR) <br />L76 - 6L2.32.t.333.93268 (VFC lmmz) <br />L1"6 - 6L2.39.24.333.93.268 (Covid Vaccine) <br />u"L6 - 612,22. 10.333.93.994 ( MCH BG ) <br />Revenue Code <br />Agency to Pass Through <br />Amount to Pass Through Expense Code: <br />Date:Sub-Contract Approved <br />Has the Prosecutor reviewed this agreement?Yes No <br />Cou De rtments lmpacted <br />BOCC roval Needed? <br />Assignment of Tracking lnformation <br />Auditor's Office <br />Human Resource <br />Prosecutor's Office <br />Who Signed the grant application <br />Facilities MaintenanceAuditor <br />Human Resourcelnformation Services <br />TreasurerProsecutor <br />NoEYes I <br />Staff Member Presenting <br />Reviewer Date <br />Grant/Contract Review Page 2