Common use of For Information Only Clause in Contracts

For Information Only. Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: ▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf Guide for Public Health Case Management of Children with Elevated Blood Lead Levels ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇.▇▇▇/Portals/1/Documents/4000/334-414.pdf A Targeted Approach to Blood Lead Screening in Children, Washington State 2015 Expert Panel Recommendations ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇.▇▇▇/Portals/1/Documents/Pubs/334-383.pdf Laboratories are required to report to the Department of Health all Blood Lead test results (WAC 246-101-201). Elevated results (greater than or equal to 5 mcg/dL) must be reported within two (2) days; non-elevated results need to be reported within one (1) month. Telephone calls and/or in person meetings with contract manager on as as-needed basis. BLL – Blood Lead Level EBLL – Elevated Blood Lead Level PEHSU – Pediatric Environmental Health Specialty Units The average total amount expended for laboratory, interpreter, and translation services is suggested to be approximately $185 per home visit, per child. It is recognized that more complex cases may require a higher level of services, while simpler cases may require fewer services. Total reimbursements may not exceed total funding consideration. Please note WDRS event number(s) on invoice to allow DOH review of deliverables via WDRS. Payment to completely expend the “Total Consideration” for a specific funding period will not be processed until all deliverables are accepted and approved by DOH. Invoices may be submitted as needed within 60 days after home visit completion and must be based on actual direct program costs. Billing for services on a monthly fraction of the “Total Consideration” will not be accepted or approved. If needed, additional funding may be requested and upon DOH approval may be added if funds are available. Note: Blood Lead Case Management reimbursement excludes indirect costs. ▇▇▇ ▇▇▇▇▇▇▇▇, Health Services Consultant/Case Management Coordinator ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, Management Analyst 1 Office of Environmental Health Sciences Assistant Secretary’s Office Washington State Department of Health Telephone: ▇▇▇-▇▇▇-▇▇▇▇ Street Address: ▇▇▇ ▇▇▇▇▇▇ ▇▇ ▇▇, ▇▇▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇ Telephone: ▇▇▇-▇▇▇-▇▇▇▇ / Fax ▇▇▇-▇▇▇-▇▇▇▇ Email: ▇▇▇.▇▇▇▇▇▇▇▇@▇▇▇.▇▇.▇▇▇ SOW Type: Revision Revision # (for this SOW) 5 Period of Performance: January 1, 2018 through December 31, 2020 Funding Source Federal Contractor State Other Federal Compliance (check if applicable) FFATA (Transparency Act) Research & Development Type of Payment Reimbursement Fixed Price Yr 21 SRF - Local Asst (15%) (FS) SS N/A 346.26.64 24139221 01/01/18 06/30/19 3,750 0 3,750 Yr 21 SRF - Local Asst (15%) (FS) TA N/A 346.26.66 24139221 01/01/18 06/30/19 884 0 884 Yr 22 SRF - Local Asst (15%) (FO-SW) SS N/A 346.26.64 24239222 01/01/19 12/31/20 4,250 3,750 7,500 Yr 22 SRF - Local Asst (15%) (FO-SW) TA N/A 346.26.66 24239222 01/01/19 12/31/20 1,750 2,000 3,750 1 Trained LHJ staff will conduct sanitary surveys of small community and non-community Group A water systems identified by the DOH Office of Drinking Water (ODW) Regional Office. See Special Instructions for task activity. Provide Final* Sanitary Survey Reports to ODW Regional Office. Complete Sanitary Survey Reports shall include: 1. Cover letter identifying significant deficiencies, significant findings, observations, recommendations, and referrals for further ODW follow-up. Final Sanitary Survey Reports must be received by the ODW Regional Office within 30 calendar days of conducting the sanitary survey. Upon ODW acceptance of the Final Sanitary Survey Report, the LHJ shall be paid $250 for each sanitary survey of a non-community system with three or fewer connections. Upon ODW acceptance of the Final Sanitary Survey Report, the LHJ shall be paid $500 for each sanitary survey of a non-community system with four or more connections and each community system.

For Information Only. Funding is not tied to the revised Standards/Measures listed here. This information may be helpful in discussions of how program activities might contribute to meeting a Standard/Measure. More detail on these and/or other Public Health Accreditation Board (PHAB) Standards/Measures that may apply can be found at: ▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇.▇▇▇/wp-content/uploads/PHAB-Standards-and-Measures-Version-1.0.pdf Guide for Public Health Case Management of Children with Elevated Blood Lead Levels ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇.▇▇▇/Portals/1/Documents/4000/334-414.pdf A Targeted Approach to Blood Lead Screening in Children, Washington State 2015 Expert Panel Recommendations ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇.▇▇▇/Portals/1/Documents/Pubs/334-383.pdf Laboratories are required to report to the Department of Health all Blood Lead test results (WAC 246-101-201). Elevated results (greater than or equal to 5 mcg/dL) must be reported within two (2) days; non-elevated results need to be reported within one (1) month. Telephone calls and/or in person meetings with contract manager on as as-needed basis. BLL – Blood Lead Level EBLL – Elevated Blood Lead Level PEHSU – Pediatric Environmental Health Specialty Units The average total amount expended for laboratory, interpreter, and translation services is suggested to be approximately $185 per home visit, per child. It is recognized that more complex cases may require a higher level of services, while simpler cases may require fewer services. Total reimbursements may not exceed total funding consideration. Please note WDRS event number(s) on invoice to allow DOH review of deliverables via WDRS. Payment to completely expend the “Total Consideration” for a specific funding period will not be processed until all deliverables are accepted and approved by DOH. Invoices may be submitted as needed within 60 days after home visit completion and must be based on actual direct program costs. Billing for services on a monthly fraction of the “Total Consideration” will not be accepted or approved. If needed, additional funding may be requested and upon DOH approval may be added if funds are available. Note: Blood Lead Case Management reimbursement excludes indirect costs. ▇▇▇ ▇▇▇▇▇▇▇▇, Health Services Consultant/Case Management Coordinator ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, Management Analyst 1 Office of Environmental Health Sciences Assistant Secretary’s Office Washington State Department of Health Telephone: ▇▇▇-▇▇▇-▇▇▇▇ Street Address: ▇▇▇ ▇▇▇▇▇▇ ▇▇ ▇▇, ▇▇▇▇▇▇▇▇ ▇▇ ▇▇▇▇▇ Telephone: ▇▇▇-▇▇▇-▇▇▇▇ / Fax ▇▇▇-▇▇▇-▇▇▇▇ Email: ▇▇▇.▇▇▇▇▇▇▇▇@▇▇▇.▇▇.▇▇▇ SOW Type: Revision Revision # (for this SOW) 5 6 Period of Performance: January 1, 2018 through December 31, 2020 Funding Source Federal Contractor State Other Federal Compliance (check if applicable) FFATA (Transparency Act) Research & Development Type of Payment Reimbursement Fixed Price Yr 20 SRF - Prog Mgmt (10%) (FS) TA N/A 346.26.66 24137220 01/01/18 12/31/18 1,268 0 1,268 Yr 21 SRF - Local Asst (15%) (FS) SS N/A 346.26.64 24139221 01/01/18 06/30/19 3,750 14,250 0 3,750 14,250 Yr 21 SRF - Local Asst (15%) (FS) TA N/A 346.26.66 24139221 01/01/18 06/30/19 884 1,900 0 884 1,900 Yr 22 SRF - Local Asst (15%) (FO-SW) SS N/A 346.26.64 24239222 01/01/19 12/31/20 4,250 3,750 7,500 21,250 500 21,750 Yr 22 SRF - Local Asst (15%) (FO-SW) TA N/A 346.26.66 24239222 01/01/19 12/31/20 1,750 2,000 3,750 4,249 0 4,249 1 Trained LHJ staff will conduct sanitary surveys of small community and non-community Group A water systems identified by the DOH Office of Drinking Water (ODW) Regional Office. See Special Instructions for task activity. Provide Final* Sanitary Survey Reports to ODW Regional Office. Complete Sanitary Survey Reports shall include: 1. Cover letter identifying significant deficiencies, significant findings, observations, recommendations, and referrals for further ODW follow-up. Final Sanitary Survey Reports must be received by the ODW Regional Office within 30 calendar days of conducting the sanitary survey. Upon ODW acceptance of the Final Sanitary Survey Report, the LHJ shall be paid $250 for each sanitary survey of a non-community system with three or fewer connections. Upon ODW acceptance of the Final Sanitary Survey Report, the LHJ shall be paid $500 for each sanitary survey of a non-community system with four or more connections and each community system.