Common use of OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE Clause in Contracts

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-58486E273622-405E3A1B-44C9-AE7A-FA1C26DEE6F0 AA3C-077881B99D41 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-5848810536CA-5E03-405E4D9F-AE7AB3E9-FA1C26DEE6F0 22D442ADCDCA Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-58481AF8BE11-405EF933-AE7A4C04-FA1C26DEE6F0 BCAC-A951488DD0C6 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-58481AF8BE11-405EF933-AE7A4C04-FA1C26DEE6F0 8A Employment BCAC-A951488DD0C6 OUTCOMES 1A Symptom Improvement - Obtain Depression YES N/A 8B Employment PHQ-9 1B Symptom Improvement - Maintain Anxiety YES N/A 9A Housing GAD-7 1D Symptom Improvement - Obtain PTSD YES N/A 9B Housing - Maintain PCL-5 3 Resiliency YES N/A CYRM-R 4 Quality of Life YES Q-LES-Q 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-58489CCA6DF9-405E90F1-AE7A40B7-FA1C26DEE6F0 BC50-C456F623BE27 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-5848AFA7D21D-405EABA6-AE7A4CD7-FA1C26DEE6F0 83B6-FC84E830BBB5 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848AFA7D21D-405EABA6-AE7A4CD7-FA1C26DEE6F0 8A Employment 83B6-FC84E830BBB5 1B Symptom Improvement - Obtain Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-C 3 Resiliency YES CYRM-R 6A Rate Reduction - Hospitalization YES N/A 8B Employment 6B Rate Reduction - Maintain Emergency Room Use YES N/A 9A Housing 10A Academic Progress - Obtain Attendance YES N/A 9B Housing 10B Academic Progress - Maintain Behavior YES N/A 1 To be completed and submitted as part of Q4 only.10C Academic Progress - Grades YES N/A

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-58483986959B-405EFB3A-4BFE-AE7A-FA1C26DEE6F0 A9FC-853E6176281D Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-58483986959B-405EFB3A-4BFE-AE7A-FA1C26DEE6F0 8A Employment A9FC-853E6176281D 1A Symptom Improvement - Obtain Depression YES PHQ-9 1B Symptom Improvement - Anxiety YES GAD-7 1D Symptom Improvement - PTSD YES PCL-5 10A Academic Progress - Attendance YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.A

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-5848AF78D2DC-48E5-405E4DA7-AE7A9B90-FA1C26DEE6F0 DACDFF72309A Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-5848E46E8EC8-405E66B8-AE7A493B-845F-FA1C26DEE6F0 CBA1E83E03BD Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-58483598EB6A-6332-405E4E64-AE7A-FA1C26DEE6F0 ACFB-083A68FF2420 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-584892D5E900-405E7744-AE7A4E6F-84D3-FA1C26DEE6F0 7894CFDCA226 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-584836E922F0-405EE70C-4001-AE7ABF58-FA1C26DEE6F0 35916C8A1F88 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-58484110F1C7-405EEA57-AE7A49F4-FA1C26DEE6F0 8645-68A48D20508D Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID1 Before starting, ensure cell C8 is set to filter for 'YES'. 2 Complete the Output and Outcomes measures that appear below by entering info white cells. If Outcome and/or Output measures appear that you were not negotia contact your contract manager. All Outputs and Outcomes must be reported cumu date. Shaded cells are locked and where applicable will fill in automatically. 3 Enter explanatory notes, if any, into the Performance Notes column(s). r Metric Selected for Reporting Performance Expectation or Target OUTPUTS 1 Unduplicated Number of Participants Receiving Services YES 428 2 Participant Retention YES Performance Expectation: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain 100% with an allowable variance of 10% OUTCOMES 3 Resiliency YES N/A 8B Employment - Maintain BRS 4 Quality of Life YES N/A 9A Housing - Obtain AQol 5 Social Supports YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.SSQ6 ▇▇▇▇▇▇ into the ▇▇▇ for reporting, latively, year to

OUTCOME IF GRANTEE CANNOT COMPLETE REQUIRED PERFORMANCE. Unless otherwise specified in this Statement of Work, if Grantee cannot complete or otherwise comply with a requirement included in this Statement of Work, System Agency, at its sole discretion, may impose remedies outlined under Grant Agreement Attachment D (Uniform Terms and Conditions) Section 9.1 (Remedies). 3 Grant Agreement Nbr Grant Agreement Number 4 State Fiscal Quarter EndDate State Fiscal Quarter End Date State Fiscal Quarter 5 Enter HHSC Share of the Grant Agreement 6 Enter Grantee's Share of the Grant Agreement 8 HHSC Percentage of the Grant Areement (Line 5 / Line 7) #DIV/0! 9 Grantee's Percentage of the Grant Areement (100% minus Line 8) #DIV/0! 10 Enter Total Cumulative Allowable Cash Expenditures (IMPORTANT - IF PROGRAM INCOME HAS BEEN COLLECTED, SEE INSTRUCTIONS) 11 Enter Total Cumulative Allowable In-kind Contributions 12 Total Cumulative Project Costs (Line 10 + Line 11) Thru "Period Covered" State Fiscal Quarter $0.00 14 HHSC Maximum Cumulative Share (% of total cumulative project costs from line 12) #DIV/0! #DIV/0! 15 The Lesser Amount From Line 10 and Line 14. This is the maximum amount of the cumulative project costs that HHSC may reimburse. #DIV/0! 16 Total of the previous Invoices/Reimbursement Requests (before reductions for advance repayment, if any - do not include the amount received as an advance) 17 Reconciliation - Payment Due To/From Grantee Thru "Period Covered" - If Line 15 is greater than Line 16, difference due to Grantee. If Line 15 is less than Line 16, difference due to DSHS. #DIV/0! 18 Advance Received (if any) 19 Enter Cumulative Amount of Advance Repaid (including amount repaid with this voucher) Docusign Envelope ID: 0B1260BD-5848D7DAB463-405E6790-AE7A4694-FA1C26DEE6F0 B95C-6CDAFCAACC54 Attachment A-2 Project Expenditure Report Grantee Name Grant Agreement # Project Name Project Category Report Month Fiscal Year Budget Category Approved HHSC Requested Funds Budgeted Match Funds Budgeted Cumulative HHSC Funds Expended Cumulative Match Utilized/Expended Total Cumulative Expenditures Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Personnel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Fringe Benefits $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Travel $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Supplies $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Contractual $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Other $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Equipment $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Indirect $0.00 $0.00 Grantee Name Grant Agreement Number [Project Name] Project Category SELECT MONTH FY Total $0.00 $0.00 $0.00 $0.00 $0.00 Docusign Envelope ID: 0B1260BD-5848-405E-AE7A-FA1C26DEE6F0 8A Employment - Obtain YES N/A 8B Employment - Maintain YES N/A 9A Housing - Obtain YES N/A 9B Housing - Maintain YES N/A 1 To be completed and submitted as part of Q4 only.