ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS000663700012 HEALTH AND HUMAN SERVICES COMMISSION XXXX XXXX HOME, INC Xxxxx Ita Associate Commissioner Name: Title: Xxxxxx Xxxxx Chief Executive Officer Date of execution: _July 22, 2020 Date of execution: July 22, 2020 THE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO. HHS000663700012 ARE HEREBY INCORPORATED BY REFERENCE: ATTACHMENT A STATEMENT OF WORK ATTACHMENT A-1 STATEMENT OF WORK SUPPLEMENTAL ATTACHMENT A-2 SUBSTANCE ABUSE PREVENTION AND TREATMENT (SAPT) BLOCK GRANT CONTRACT SUPPLEMENTAL ATTACHMENT B PROGRAM SERVICES & UNIT RATES ATTACHMENT C GENERAL AFFIRMATIONS ATTACHMENT D UNIFORM TERMS AND CONDITIONS-GRANTEE ATTACHMENT E SPECIAL CONDITIONS VERSION 1.2 ATTACHMENT F FEDERAL ASSURANCES AND CERTIFICATIONS ATTACHMENT G DATA USE AGREEMENT VERSION 8.5 ATTACHMENT H FISCAL FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA) FORM ATTACHMENT I SYSTEM AGENCY SOLICITATION NO. HHS0006637 INCLUDING ANY CLARIFICATIONS OR MODIFICATIONS MADE IN RESPONSE TO QUESTIONS SUBMITTED DURING POSTING AND ANY ADDENDUM ATTACHMENT X XXXXXXX’S PROPOSAL FOR SOLICITATION NO. HHS0006637 ATTACHMENTS FOLLOW ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.
ADDITIONAL GRANT INFORMATION. A. Grantee Data Universal Numbering System (DUNS) Number: 806781373
ADDITIONAL GRANT INFORMATION. DSHS Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NU50CK000501 Catalog of Federal Domestic Assistance (CFDA) Name and Number (list all that apply): Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) – 93.323 Federal Award Date: April 23, 2020 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xxxxxxx Xxxxxxxx-Xxxx, Grants Management Officer 0000 Xxxxxxx Xxxx – Mailstop TV2 Atlanta, GA 00000-0000 Phone: 000-000-0000 SIGNATURE PAGE FOLLOWS SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS000812700039 SYSTEM AGENCY GRANTEE Signature Printed Name: Xxxxxxxx Xxxx Printed Name: Signature Emi1y Everekke Title: _Deputy Commissioner Title: Program Direckor Date of Execution: September 3, 2020 Date of Execution: Augusk 31, 2020 THE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO. HHS000812700039 ARE INCORPORATED BY REFERENCE: ATTACHMENT A - STATEMENT OF WORK ATTACHMENT B - BUDGET ATTACHMENT C - UNIFORM TERMS AND CONDITIONS - GRANT ATTACHMENT D - SUPPLEMENTAL AND SPECIAL CONDITIONS ATTACHMENT E - FEDERAL ASSURANCES NON-CONSTRUCTION ATTACHMENT F - CERTIFICATION REGARDING LOBBYING ATTACHMENT G - FFATA ATTACHMENT H - HHS DATA USE AGREEMENT ATTACHMENT I - SECURITY AND PRIVACY INQUIRY (SPI) ATTACHMENTS FOLLOW ATTACHMENT A STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES Grantee will:
ADDITIONAL GRANT INFORMATION. In accordance with 2 CFR 200.331(A), if any of the following information is not available at time of contract execution, then it will be provided to the Grantee by a Technical Guidance Letter. Federal Award Identification Number (XXXX): NU90TP922165 Federal Award Date: 5/20/2021 Name of Federal Awarding Agency: Centers for Disease Control and Prevention CFDA Name and Number: Federal, 93.354 Awarding Official Contact Information: Xx. Xxxxxx Xxxxxx, 000-000-0000, xxx0@xxx.xxx DUNS: 807391511 Signature Page for System Agency Contract No. HHS001075600002 The Department of State Health Services Xxxxxxxxxx County Public Health District _____________________ ______________________ Signature Signature Xxxxx Xxxxxx Xxxxx Xxxxxxx, CEO Printed Name Printed Name Associate Commissioner for RLHS Executive Director Title Title September 9, 2021 September 8, 2021 Date Date THE FOLLOWING ATTACHMENTS TO THIS CONTRACT ARE HEREBY INCORPORATED BY REFERENCE AND MADE PART OF THIS CONTRACT: Attachment A – Statement of Work Attachment B – Budget Attachment C – Fiscal Federal Accountability and Transparency Act (FFATA) Certificate Attachment D – HHS Uniform Terms and Conditions – Governmental Entity, Version 3.0 Attachment E – Data Use Agreement Attachment F – Federal Assurances and Certifications Attachment G – Contract Affirmations 1.8 ATTACHMENT A STATEMENT OF WORK COVID-19 – Public Health Workforce Expansion
ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): B08TI083054-01 Federal Award Date: 10/01/2019 Name of Federal Awarding Agency: Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) CFDA Name and Number: 93.959 Awarding Official Contact Information: Xxxxxx Xxxxxxx, Grants Management Officer, Point of Contact is Xxxxx Xxxx, Grants Specialist, Contact Number: (000) 000-0000, Facsimile: (000) 000-0000, Email: Xxxxx.Xxxx@xxxxxx.xxx.xxx Signature Page for System Agency Contract No. HHS000663700051 Health and Human Services Commission The Montrose Center Xxxxx Ita Associate Commissioner Xxx X. Xxxxxxx Executive Director Date of execution: July 20, 2020 Date of execution: July 17, 2020 The following attachments to System Agency Contract No. HHS000663700051 are hereby incorporated by reference: Attachment A Statement of Work Attachment A-1 Statement of Work Supplemental Attachment A-2 Substance Abuse Prevention and Treatment (SAPT) Block Grant Contract Supplemental Attachment B Program Services & Unit Rates Attachment C General Affirmations Attachment D Uniform Terms and Conditions-Grantee Attachment E Special Conditions Version 1.2 Attachment F Federal Assurances and certifications Attachment G Data Use Agreement Version 8.5 Attachment H Fiscal Federal Funding Accountability and Transparency Act (FFATA) Form Attachment I System Agency Solicitation No. HHS0006637 including any clarifications or modifications made in response to questions submitted During posting and any addendum Attachment X Xxxxxxx’s proposal for Solicitation No. HHS0006637 Attachments Follow ATTACHMENT A: STATEMENT OF WORK TREATMENT FOR ADULTS SECTION I: PURPOSE Grantee shall provide substance use disorder treatment services to the target population at one or more of the following service types/levels of care. The below service types/levels of care are based on Texas Administrative Code (TAC) requirements, as referenced in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines, located at the following link: xxxxx://xxx.xxxxx.xxx/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers, and American Society of Addiction Medicine (ASAM) criteria located at the following link: xxx.xxxx.xxx, which is a collection of objective guidelines that give clinicians a standardized approach to admission and treatment planning.
ADDITIONAL GRANT INFORMATION. System Agency Data Universal Numbering System (DUNS) Number: 807391511 Federal Award Identification Number (XXXX): NH75OT000045 Assistance Listing Name and Number: Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crises; 93.391 Federal Award Date: May 26, 2021 Federal Award Project Period through May 31, 2023 Name of Federal Awarding Agency: Centers for Disease Control and Prevention Awarding Official Contact Information: Xx. Xxxxxxxxx Xxxxx Email: xxx0@xxx.xxx SIGNATURE PAGE FOLLOWS SIGNATURE PAGE FOR SYSTEM AGENCY CONTRACT NO. HHS001057600015 SYSTEM AGENCY GRANTEE Signature Signature Printed Name: Xxxx Co1e Printed Name: Xxxx Xxxxxxxxx Title: _Depuky Commissioner Title: Medica1 Direckor Date of Execution: Augusk 26, 2021 Date of Execution: Augusk 26, 2021 THE FOLLOWING ATTACHMENTS TO SYSTEM AGENCY CONTRACT NO. HHS001057600015 ARE INCORPORATED BY REFERENCE: ATTACHMENT A: STATEMENT OF WORK ATTACHMENT B: BUDGET ATTACHMENT C: HHS UNIFORM TERMS AND CONDITIONS - GRANT ATTACHMENT D: HHS CONTRACT AFFIRMATIONS ATTACHMENT E: FEDERAL ASSURANCES AND CERTIFICATIONS ATTACHMENT F: FFATA FORM ATTACHMENTS FOLLOW ATTACHMENT A: STATEMENT OF WORK I. GRANTEE RESPONSIBILITIES To ensure community engagement in targeted communities disproportionately impacted by COVID-19 and the building of sustainable relationships in those targeted communities, Grantee will conduct the following activities:
ADDITIONAL GRANT INFORMATION. In accordance with 2 CFR 200.332(A), any of the following information that is not available at time of Contract execution will be provided via email once available. Federal Award Identification Number (XXXX): To be determined Federal Award Date: To be determined Name of Federal Awarding Agency: Centers for Disease Control and Prevention CFDA Name and Number: 93.116 – Tuberculosis Elimination and Laboratory Cooperative Agreement – Prevention & Control Awarding Official Contact Information: To be determined DUNS: 081078891
ADDITIONAL GRANT INFORMATION. Federal Award Identification Number (XXXX): TBD Federal Award Date: TBD Name of Federal Awarding Agency: Centers for Disease Control and Prevention CFDA Name and Number: Immunizations and Vaccines for Children Program 93.268 Awarding Official Contact Information: TBD Signature Page Follows Signature Page for System Agency Contract No. HHS000119700005 System Agency Grantee Xxxxx Xxxxxxx Name: Xxxxxxx Xxxxxx, County Judge Associate Commissioner Title: Date of execution: Date of execution: DRAFT The following attachments to System Agency Contract No. HHS000119700005 are hereby incorporated by reference: Attachment A – Statement of Work Attachment B – Budget Attachment C – Uniform Terms and Conditions Attachment D – Supplemental and Special Conditions Attachment E – Federal Assurances and certifications Attachment F – FFATA Attachment G – Data Use Agreement Attachments Follow ATTACHMENT A STATEMENT OF WORK
ADDITIONAL GRANT INFORMATION. A. Federal Award Identification Number (XXXX): B08TI083545
ADDITIONAL GRANT INFORMATION. A. Grantee Data Universal Numbering System (DUNS) Number: 00-000-0000 B. Catalog of Federal Domestic Assistance (CFDA) Name and Number: • Name - Number: 10-557 Special Supplemental Nutrition Program for Women, Infants & Children (FOOD, ADMIN and PEER) • Name - Number: 10-561 Supplemental Nutrition Assistance Program
