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Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Today's Date Agenda Date /tv: ~ q lp <br />01/27/2016 ! VlI 1)1)1· <br />Fund/Department <br />116-Public Health <br />Contract/Grant Information <br />Contract /Grant Agency: Child Death Review Case Reporting System Data Use Agreement <br />Period Begin Date: Date of Execution 1 I Period End Date: 12/31/2020 <br />Total Grant/Contract Amount: None <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The data use agreement is entered into by the Michigan Public Health Institute (MPHI) and Kittitas <br />County Public Health Department to establish terms and conditions for the collection, storage and use of <br />data obtained from the case reviews of child deaths submitted by Child Death Review teams in Kittitas <br />County and entrusted to the Michigan Public Health Institute as the Child Death Review Case Reporting <br />System. <br />Recommendation for Board of Health and Board of Health Review on <br />~ Department Head Signature V -;-Administrator <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount $ State Funds $ Federal Funds $ <br />Percentage County Funds Matching Funds $ CFDA# <br />Grant/Contract Review Page 1