Common use of Programmatic Reporting Requirements Clause in Contracts

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 $7,725.00 $36,355.00 Fringe Benefits $6,485.00 $0.00 $6,485.00 Travel $0.00 $0.00 0.00 Equipment $0.00 $0.00 0.00 Supplies $0.00 $0.00 0.00 Contractual $0.00 $0.00 0.00 Other $0.00 $0.00 0.00 Total Direct Costs $35,115.00 $7,725.00 $42,840.00 Indirect Costs $3,511.00 0.00 $3,511.00 Totals: $38,626.00 $7,725.00 $46,351.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date FY20 Annual Progress Narrative Report Annually Sept. Jan. 1, 2024 August 2020 Dec. 31, 2025 2020 April 1, 2025 2021 FY21 Annual Narrative Report Annually Jan. 1, 2021 Dec. 31, 2021 April 1, 2022 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-& Match Reimbursement / Reimbursement/Certification Form (“Form B-13A”) Annually June Quarterly Jan. 1, 2025 August 2021 Mar. 31, 2025 September 2021 April 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 2021 FSR & Form B-13A Quarterly April 1, 2021 June 30, 2021 July 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun , 2021 FSR & Form B-13A Quarterly July 1, 2021 Sept. 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec , 2021 Oct. 31) current year Dec 31 of the following year , 2021 FSR & Form X-00X Xxxxxxxxx Xxx. 0, 0000 Xxx. 31, 2021 Feb. 15, 2022 Annual Report Submission Instructions: Annual Report: Submit program reports to the TB Reporting MailboxMailbox at XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. The DSHS TB Program will provide the form and format for the Annual Narrative Report. The Annual Narrative Report will be a separate report for the Grantee and must not be included with reports for the Region. ATTACHMENT B-1 FY2021 BUDGET Grantee: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Collin County Health Care Services Claims Processing Unit, MC 0000 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000Program ID: TB/PC-0000 FaxFederal Contract Number: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 HHS000686100011 Budget Budget FY25 Budget Category Categories DSHS Funds Cash Match Category Total Personnel $28,630.00 57,902.00 $7,725.00 16,785.00 $36,355.00 74,687.00 Fringe Benefits $6,485.00 25,228.00 $6,092.00 $31,320.00 Travel $5,498.00 $0.00 $6,485.00 Travel $0.00 $0.00 0.00 5,498.00 Equipment $0.00 $0.00 $0.00 Supplies $9,767.00 $0.00 $9,767.00 Contractual $4,650.00 $0.00 $4,650.00 Other $11,341.00 $0.00 $11,341.00 Total Direct Costs $114,386.00 $22,877.00 $137,263.00 Indirect Costs $.00 $0.00 $0.00 0.00 Contractual $0.00 $0.00 0.00 Other $0.00 $0.00 0.00 Total Direct Costs $35,115.00 $7,725.00 $42,840.00 Indirect Costs $3,511.00 0.00 $3,511.00 Totals: $38,626.00 114,386.00 $7,725.00 22,877.00 $46,351.00 137,263.00 Page 8 of 8 Certificate Of Completion Envelope Id: DCBAF86FA4E94DE6B743B09610E02ACD Status: Sent Subject: Amending $274,526; HHS000686100011; Collin County Health and Human Care Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible OfficeA-1; DSHS/LIDS/TB-FED Source Envelope: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Document Pages: 12 Signatures: 0 Envelope Originator: Certificate Pages: 2 Initials: 0 Texas Health and Human Services Commission AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (HHSCUTC-06:00) Central Time (US & Canada) 0000 X. 00xx Xx. Xxxxxx, XX 00000 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx IP Address: 167.137.1.15 Record Tracking Status: Original 9/30/2020 2:32:00 PM Holder: Texas Health and the Department of State Health Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx Location: DocuSign Signer Events Signature Timestamp Xxxxx Xxxx xxxxx@xx.xxxxxx.xx.xx Security Level: Email, Account Authentication (DSHS). These requirements None) Electronic Record and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms Signature Disclosure: Not Offered via DocuSign Xxxxxx Xxxxxx XxxxxxX.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and conditions in this document are in addition to all requirements listed in the RFASignature Disclosure: Not Offered via DocuSign Sent: 9/30/2020 2:40:00 PM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp CMS inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, if anyAccount Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxx Xxxxxx Xxxxxx.Xxxxxx@xxxx.xxxxx.xxx CMS Branch Manager Security Level: Email, under which applications for this grant award are acceptedAccount Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 9/30/2020 2:40:00 PM Sent: 9/30/2020 2:39:59 PM Viewed: 10/1/2020 7:39:18 AM Carbon Copy Events Status Timestamp Xxxxx Xxxxxx xxxxxxxx@xx.xxxxxx.xx.xx Security Level: Email, as well as all applicable federal Account Authentication (None) Electronic Record and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited toSignature Disclosure: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrumentNot Offered via DocuSign Sent: 9/30/2020 2:40:00 PM Viewed: 10/26/2020 8:24:16 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSEncrypted 9/30/2020 2:40:01 PM

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) - Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 118,833.00 $7,725.00 17,042.00 $36,355.00 135,875.00 Fringe Benefits $6,485.00 21,654.00 $0.00 3,174.00 $6,485.00 24,828.00 Travel $0.00 186.00 $0.00 0.00 2,874.00 $3,060.00 Equipment $0.00 $0.00 $0.00 Supplies $0.00 2,244.00 $0.00 0.00 631.00 $2,875.00 Contractual $16,740.00 $0.00 $0.00 0.00 16,740.00 Other $2,855.00 $0.00 $0.00 0.00 2,855.00 Total Direct Costs $35,115.00 162,512.00 $7,725.00 23,721.00 $42,840.00 186,233.00 Indirect Costs $3,511.00 0.00 4,005.00 $3,511.00 9,582.00 $13,587.00 Totals: $38,626.00 166,517.00 $7,725.00 33,303.00 $46,351.00 199,820.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) - Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 1940 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 54,999.00 $7,725.00 9,078.00 $36,355.00 64,077.00 Fringe Benefits $6,485.00 15,485.00 $0.00 2,979.00 $6,485.00 18,464.00 Travel $0.00 3,047.00 $0.00 0.00 1,103.00 $4,150.00 Equipment $0.00 $0.00 $0.00 Supplies $0.00 690.00 $0.00 0.00 479.00 $1,169.00 Contractual $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 Total Direct Costs $35,115.00 74,221.00 $7,725.00 13,639.00 $42,840.00 87,860.00 Indirect Costs $3,511.00 0.00 7,421.00 $3,511.00 2,689.00 $10,110.00 Totals: $38,626.00 81,642.00 $7,725.00 16,328.00 $46,351.00 97,970.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) - Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 1940 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 35,007.00 $7,725.00 5,152.00 $36,355.00 40,159.00 Fringe Benefits $6,485.00 16,381.00 $0.00 2,343.00 $6,485.00 18,724.00 Travel $0.00 3,394.00 $0.00 0.00 2,731.00 $6,125.00 Equipment $0.00 $0.00 $0.00 Supplies $1,989.00 $1,113.00 $3,102.00 Contractual $600.00 $0.00 $600.00 Other $1,127.00 $359.00 $1,486.00 Total Direct Costs $58,498.00 $11,698.00 $70,196.00 Indirect Costs $0.00 $0.00 0.00 Contractual $0.00 $0.00 0.00 Other $0.00 $0.00 0.00 Total Direct Costs $35,115.00 $7,725.00 $42,840.00 Indirect Costs $3,511.00 0.00 $3,511.00 Totals: $38,626.00 58,498.00 $7,725.00 11,698.00 $46,351.00 70,196.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) - Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 1940 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 41,122.00 $7,725.00 0.00 $36,355.00 41,122.00 Fringe Benefits $6,485.00 13,499.00 $0.00 $6,485.00 13,499.00 Travel $2,463.00 $0.00 $0.00 0.00 2,463.00 Equipment $0.00 $0.00 $0.00 Supplies $0.00 $0.00 0.00 Contractual 1,626.00 $0.00 $0.00 0.00 Other 1,626.00 Contractual $1,250.00 $0.00 $1,250.00 Other $14,383.00 $0.00 0.00 $14,383.00 Total Direct Costs $35,115.00 74,343.00 $ .00 $7,725.00 $42,840.00 74,343.00 Indirect Costs $3,511.00 0.00 $ .00 $3,511.00 14,868.00 Totals: $38,626.00 74,343.00 $7,725.00 14,868.00 $46,351.00 89,211.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 1940 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 256,816.00 $7,725.00 54,232.00 $36,355.00 311,048.00 Fringe Benefits $6,485.00 123,182.00 $22,631.00 $145,813.00 Travel $2,687.00 $0.00 $6,485.00 Travel $0.00 $0.00 0.00 2,687.00 Equipment $0.00 $0.00 $0.00 Supplies $1,164.00 $0.00 $0.00 0.00 1,164.00 Contractual $0.00 $0.00 $0.00 Other $470.00 $0.00 $470.00 Total Direct Costs $384,319.00 $76,863.00 $461,182.00 Indirect Costs $0.00 $0.00 $0.00 Total Direct Costs $35,115.00 $7,725.00 $42,840.00 Indirect Costs $3,511.00 0.00 $3,511.00 Totals: $38,626.00 384,319.00 $7,725.00 76,863.00 $46,351.00 461,182.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current t year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 1940 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 38,622.00 $7,725.00 9,055.00 $36,355.00 47,677.00 Fringe Benefits $6,485.00 11,586.00 $0.00 $6,485.00 11,586.00 Travel $6,833.00 $0.00 $0.00 0.00 6,833.00 Equipment $0.00 $0.00 $0.00 Supplies $0.00 $0.00 $0.00 Contractual $0.00 $0.00 0.00 Other 14,159.00 $0.00 $14,159.00 Other $1,940.00 $0.00 0.00 $1,940.00 Total Direct Costs $35,115.00 73,140.00 $7,725.00 9,055.00 $42,840.00 82,195.00 Indirect Costs $3,511.00 0.00 $3,511.00 5,573.00 $5,573.00 Totals: $38,626.00 73,140.00 $7,725.00 14,628.00 $46,351.00 87,768.00 ATTACHMENT C Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) - Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 783,506.00 $7,725.00 161,954.00 $36,355.00 945,460.00 Fringe Benefits $6,485.00 355,746.00 $67,496.00 $423,242.00 Travel $2,000.00 $0.00 $6,485.00 Travel $0.00 $0.00 0.00 2,000.00 Equipment $0.00 $0.00 $0.00 Supplies $2,000.00 $0.00 $2,000.00 Contractual $2,000.00 $0.00 $2,000.00 Other $2,000.00 $0.00 $2,000.00 Total Direct Costs $1,147,252.00 $229,450.00 $1,376,702.00 Indirect Costs $0.00 $0.00 0.00 Contractual $0.00 $0.00 0.00 Other $0.00 $0.00 0.00 Total Direct Costs $35,115.00 $7,725.00 $42,840.00 Indirect Costs $3,511.00 0.00 $3,511.00 Totals: $38,626.00 1,147,252.00 $7,725.00 229,450.00 $46,351.00 1,376,702.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) B- Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 594,415.00 $7,725.00 110,635.00 $36,355.00 705,050.00 Fringe Benefits $6,485.00 193,378.00 $0.00 42,740.00 $6,485.00 236,118.00 Travel $0.00 $0.00 $0.00 Equipment $0.00 $0.00 $0.00 Supplies $0.00 $0.00 $0.00 Contractual $0.00 3,707.00 $0.00 0.00 4,925.00 $8,632.00 Other $0.00 $0.00 $0.00 Total Direct Costs $35,115.00 791,500.00 $7,725.00 158,300.00 $42,840.00 949,800.00 Indirect Costs $3,511.00 0.00 $3,511.00 Totals: 0.00 $38,626.00 $7,725.00 $46,351.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS0.00

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) - Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 1940 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 37,509.00 $7,725.00 1,103.00 $36,355.00 38,612.00 Fringe Benefits $6,485.00 15,257.00 $0.00 441.00 $6,485.00 15,698.00 Travel $0.00 402.00 $0.00 0.00 402.00 $804.00 Equipment $0.00 $0.00 $0.00 Supplies $0.00 346.00 $0.00 0.00 8,132.00 $8,478.00 Contractual $0.00 $0.00 $0.00 Other $0.00 $0.00 0.00 624.00 $624.00 Total Direct Costs $35,115.00 53,514.00 $7,725.00 10,702.00 $42,840.00 64,216.00 Indirect Costs $3,511.00 0.00 $3,511.00 0.00 $0.00 Totals: $38,626.00 53,514.00 $7,725.00 10,702.00 $46,351.00 64,216.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 65,508.00 $7,725.00 $36,355.00 13,176.00 78,684.00 Fringe Benefits $6,485.00 19,233.00 $0.00 $6,485.00 19,233.00 Travel $0.00 318.00 $0.00 0.00 988.00 1,306.00 Equipment $0.00 $0.00 0.00 Supplies $0.00 10.00 $0.00 0.00 10.00 Contractual $0.00 750.00 $0.00 0.00 3,000.00 3,750.00 Other $0.00 $0.00 0.00 Total Direct Costs $35,115.00 85,819.00 $7,725.00 17,164.00 $42,840.00 102,983.00 Indirect Costs $3,511.00 0.00 $3,511.00 0.00 0.00 Totals: $38,626.00 85,819.00 $7,725.00 17,164.00 $46,351.00 102,983.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 2023 August 31, 2025 2024 April 1, 2025 2024 Financial Status Report (FSR) Biannually Sept. 1, 2023 February 29, 2024 Feb. 28, 2025 March 31, 2025 2024 FSR Biannually March 1, 2025 2024 August 31, 2025 September 302024 October 15, 2025 2024 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) - Annually June 1, 2025 2024 August 31, 2025 September 302024 October 15, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year 2024 Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Status Reports: Department of State Health Services Claims Processing Unit, MC 0000 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 (September 1, 2023 August 31, 2024) Budget Budget FY25 Budget Category Categories DSHS Funds Cash Match Category Total Personnel $28,630.00 157,121.00 $7,725.00 32,687.00 $36,355.00 189,808.00 Fringe Benefits $6,485.00 69,626.00 $0.00 13,028.00 $6,485.00 82,654.00 Travel $0.00 $0.00 $0.00 Equipment $0.00 $0.00 $0.00 Supplies $1,827.00 $0.00 $0.00 0.00 1,827.00 Contractual $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 Total Direct Costs $35,115.00 228,574.00 $7,725.00 45,715.00 $42,840.00 274,289.00 Indirect Costs $3,511.00 0.00 $3,511.00 Totals0.00 $0.00 Totals $228,574.00 $45,715.00 $274,289.00 (Remainder of the page intentionally left blank) Certificate Of Completion Envelope Id: $38,626.00 $7,725.00 $46,351.00 Health D8CD84AF50F74FC2B680E378A5777B30 Status: Completed Subject: Please DocuSign: HHS001182200011; City of Laredo; A1; TB STATE Signature Packet Source Envelope: Document Pages: 7 Signatures: 2 Envelope Originator: Certificate Pages: 5 Initials: 0 CMS Internal Routing Mailbox AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-06:00) Central Time (US & Canada) 00000 Xxxxxx Xxxxx Xxxx #000 Reston, VA 20190 XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx IP Address: 167.137.1.18 Record Tracking Status: Original 3/30/2023 1:53:57 PM Holder: CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx Location: DocuSign Signer Events Signature Timestamp XXXXXXX XXXXXXX xxxxxxxx@xx.xxxxxx.xx.xx Deputy City Manager City of Laredo Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 174.197.2.156 Sent: 3/30/2023 1:58:18 PM Resent: 4/17/2023 8:05:26 AM Viewed: 4/17/2023 7:22:17 PM Signed: 4/17/2023 7:22:30 PM Electronic Record and Human Services Signature Disclosure: Accepted: 8/27/2021 11:52:50 AM ID: ac272163-b539-4ebe-a533-1e48e90fa365 Xxxxx Xxxxxxxxxxx xxxxx.xxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (HHSNone) Uniform Terms Completed Using IP Address: 167.137.1.17 Sent: 4/17/2023 7:22:32 PM Viewed: 4/18/2023 7:49:58 AM Signed: 4/18/2023 7:52:38 AM Electronic Record and Conditions - Grant Version 3.3 Published Signature Disclosure: Accepted: 4/18/2023 7:49:58 AM ID: 2214b694-3df8-4dc3-a732-44b857555a0a XXXXX XXXXXXXX Xxxxx.Xxxxxxxx@xxxx.xxxxx.xxx Director, DSHS CMS Security Level: Email, Account Authentication (None) Electronic Record and Effective – November 2023 Responsible OfficeSignature Disclosure: Chief Counsel ABOUT THIS DOCUMENT Accepted: 5/5/2022 12:43:08 PM ID: f01589da-43a7-481e-996a-7c50409e5d48 Completed Using IP Address: 167.137.1.7 Sent: 4/18/2023 7:52:41 AM Viewed: 4/18/2023 8:02:58 AM Signed: 4/18/2023 8:03:09 AM Xxxx Xxxx Xxxx.Xxxx@xxxx.xxxxx.xxx Deputy Commissioner Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 167.137.1.18 Sent: 4/18/2023 8:03:11 AM Viewed: 4/18/2023 8:24:26 AM Signed: 4/18/2023 8:25:32 AM Electronic Record and Signature Disclosure: Accepted: 4/18/2023 8:24:26 AM ID: aa567c9b-2a55-4155-8afa-9c23fb9be9af In this documentPerson Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Xxxx Xxxxxxxxx xxxx.xxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, Grantees Account Authentication (also referred None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxxx X. Xxxxxxx xxxxxxxxx@xx.xxxxxx.xx.xx Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign CMS Internal Routing Mailbox XXX.XxxxxxxxXxxxxxx@xxxx.xxxxx.xxx DSHS Contract Management Section Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Sent: 3/30/2023 1:58:17 PM Viewed: 3/30/2023 1:58:42 PM Sent: 3/30/2023 1:58:17 PM Sent: 4/18/2023 8:25:33 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 3/30/2023 1:58:17 PM Certified Delivered Security Checked 4/18/2023 8:24:26 AM Signing Complete Security Checked 4/18/2023 8:25:32 AM Completed Security Checked 4/18/2023 8:25:33 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to in this document as subrecipients time, DSHS Contract Management Section (we, us or contractorsCompany) will find requirements and conditions applicable may be required by law to grant funds administered and passed through by both provide to you certain written notices or disclosures. Described below are the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to DocuSign system. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period of time (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per-page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this document are process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact DSHS Contract Management Section: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx To advise DSHS Contract Management Section of your new email address To let us know of a change in addition your email address where we should send notices and disclosures electronically to all requirements listed you, you must send an email message to us at xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the RFAbody of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from DSHS Contract Management Section To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to xxxxxx.xxxxxxxx@xxxx.xxxxx.xx.xx and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any, under which applications for this grant award are accepted, as well as all applicable federal . To withdraw your consent with DSHS Contract Management Section To inform us that you no longer wish to receive future notices and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth disclosures in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSelectronic format you may:

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date FY20 Annual Progress Narrative Report Annually Sept. Jan. 1, 2024 August 2020 Dec. 31, 2025 2020 April 1, 2025 2021 FY21 Annual Narrative Report Annually Jan. 1, 2021 Dec. 31, 2021 April 1, 2022 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-& Match Reimbursement / Reimbursement/Certification Form (“Form B-13A”) Annually June Quarterly Jan. 1, 2025 August 2021 Mar. 31, 2025 September 2021 April 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 2021 FSR & Form B-13A Quarterly April 1, 2021 June 30, 2021 July 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun , 2021 FSR & Form B-13A Quarterly July 1, 2021 Sept. 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec , 2021 Oct. 31) current year Dec 31 of the following year , 2021 FSR & Form X-00X Xxxxxxxxx Xxx. 0, 0000 Xxx. 31, 2021 Feb. 15, 2022 Annual Report Submission Instructions: Annual Report: Submit program reports to the TB Reporting MailboxMailbox at XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx. The DSHS TB Program will provide the form and format for the Annual Narrative Report. The Annual Narrative Report will be a separate report for the Grantee and must not be included with reports for the Region. ATTACHMENT B-1 FY2021 BUDGET Grantee: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000Fort Bend County Program ID: TB/PC-0000 FaxFederal Contract Number: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 HHS000686100015 Budget Budget FY25 Budget Category Categories DSHS Funds Cash Match Category Total Personnel $28,630.00 53,016.00 $7,725.00 0.00 $36,355.00 53,016.00 Fringe Benefits $6,485.00 26,397.00 $0.00 $6,485.00 26,397.00 Travel $2,546.00 $0.00 $0.00 0.00 2,546.00 Equipment $0.00 $0.00 $0.00 Supplies $0.00 2,500.00 $0.00 0.00 10.00 $2,510.00 Contractual $0.00 14,727.00 $0.00 0.00 19,827.00 $34,554.00 Other $0.00 $0.00 $0.00 Total Direct Costs $35,115.00 99,186.00 $7,725.00 19,837.00 $42,840.00 119,023.00 Indirect Costs $3,511.00 0.00 $3,511.00 0.00 $0.00 Totals: $38,626.00 99,186.00 $7,725.00 19,837.00 $46,351.00 Health and Human Services 119,023.00 (HHSRemainder of Page Intentionally Left Blank) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible OfficeXX Xxxxxx County Judge Certificate Of Completion Envelope Id: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the E14841AD14794219AC29F0E692B56127 Status: Sent Subject: Amending $238,046.00; HHS000686100015; Fort Bend County A-1; DSHS/LIDS/TB-FED Source Envelope: Document Pages: 18 Signatures: 0 Envelope Originator: Certificate Pages: 2 Initials: 0 Texas Health and Human Services Commission AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (HHSCUTC-06:00) Central Time (US & Canada) 0000 X. 00xx Xx. Xxxxxx, XX 00000 XXX_XxxxXxxx@xxxx.xxxxx.xx.xx IP Address: 167.137.1.18 Record Tracking Status: Original 10/1/2020 7:17:40 AM Holder: Texas Health and the Department of State Health Human Services Commission XXX_XxxxXxxx@xxxx.xxxxx.xx.xx Location: DocuSign Signer Events Signature Timestamp XX Xxxxxx xxxxxx.xxxxx@xxxxxxxxxxxxxxxx.xxx County Judge Fort Bend County Security Level: Email, Account Authentication (DSHS). These requirements None) Electronic Record and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms Signature Disclosure: Not Offered via DocuSign Xxxxxx Xxxxxx XxxxxxX.Xxxxxx@xxxx.xxxxx.xxx Security Level: Email, Account Authentication (None) Electronic Record and conditions in this document are in addition to all requirements listed in the RFASignature Disclosure: Not Offered via DocuSign Sent: 10/1/2020 7:23:57 AM Viewed: 10/1/2020 3:49:58 PM In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp CMS inbox xxxxxxxxxxxx@xxxx.xxxxx.xxx Security Level: Email, if anyAccount Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Xxxxxx Xxxxxx Xxxxxx.Xxxxxx@xxxx.xxxxx.xxx CMS Branch Manager Security Level: Email, under which applications for this grant award are acceptedAccount Authentication (None) Electronic Record and Signature Disclosure: Sent: 10/1/2020 7:23:57 AM Sent: 10/1/2020 7:23:57 AM Viewed: 10/13/2020 12:34:33 PM Carbon Copy Events Status Timestamp Not Offered via DocuSign Xxxx Xxxxxx Xxxx.Xxxxxx@xxxxxxxxxxxxxxxx.xxx Security Level: Email, as well as all applicable federal Account Authentication (None) Electronic Record and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited toSignature Disclosure: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrumentNot Offered via DocuSign Sent: 10/1/2020 7:23:58 AM Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTSEncrypted 10/1/2020 7:23:58 AM

Programmatic Reporting Requirements. Report Name Frequency Period Begin Period End Due Date Annual Progress Report Annually Sept. 1, 2024 August 31, 2025 April 1, 2025 Financial Status Report (FSR) Biannually Sept. 1, 2024 Feb. 28, 2025 March 31, 2025 FSR Biannually March 1, 2025 August 31, 2025 September 30, 2025 Final Quarter-Match Reimbursement / Certification Form (“Form B-13A”) B- Annually June 1, 2025 August 31, 2025 September 30, 2025 Cohort Review Periods and Submission Schedule Cohort period cases counted in: Are reviewed and reported by: First quarter (Jan 1 – Mar 31) current year Mar 31 of the following year Second quarter (Apr 1 – Jun 30) current year Jun 30 of the following year Third quarter (Jul 1 – Sep 30) current year Sep 30 of the following year Fourth quarter (Oct 1 – Dec 31) current year Dec 31 of the following year Submission Instructions: Annual Report: Submit program reports to the TB Reporting Mailbox: XXXxxxxxxxXxxxxxxxx@xxxx.xxxxx.xxx Financial Reports (FSRs, B-13s, and B-13A) Department of State Health Services Claims Processing Unit, MC 0000 0000 Xxxx 00xx Xxxxxx X.X. Xxx 149347 Austin, Texas 00000-0000 Fax: (000) 000-0000 Email: xxxxxxxx@xxxx.xxxxx.xxx and XXXxxxxxxxx@xxxx.xxxxx.xxx Attachment B FY25 Budget Budget FY25 Budget Category DSHS Funds Cash Match Category Total Personnel $28,630.00 19,159.00 $7,725.00 4,719.00 $36,355.00 23,878.00 Fringe Benefits $6,485.00 4,566.00 $0.00 1,124.00 $6,485.00 5,690.00 Travel $0.00 $0.00 $0.00 Equipment $0.00 $0.00 $0.00 Supplies $0.00 $0.00 $0.00 Contractual $5,490.00 $0.00 $0.00 0.00 5,490.00 Other $0.00 $0.00 $0.00 Total Direct Costs $35,115.00 29,215.00 $7,725.00 5,843.00 $42,840.00 35,058.00 Indirect Costs $3,511.00 0.00 $3,511.00 0.00 $0.00 Totals: $38,626.00 29,215.00 $7,725.00 5,843.00 $46,351.00 35,058.00 Health and Human Services (HHS) Uniform Terms and Conditions - Grant Version 3.3 Published and Effective – November 2023 Responsible Office: Chief Counsel ABOUT THIS DOCUMENT In this document, Grantees (also referred to in this document as subrecipients or contractors) will find requirements and conditions applicable to grant funds administered and passed through by both the Texas Health and Human Services Commission (HHSC) and the Department of State Health Services (DSHS). These requirements and conditions are incorporated into the Grant Agreement through acceptance by Grantee of any funding award by HHSC or DSHS. The terms and conditions in this document are in addition to all requirements listed in the RFA, if any, under which applications for this grant award are accepted, as well as all applicable federal and state laws and regulations. Applicable federal and state laws and regulations may include, but are not limited to: 2 CFR Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards; requirements of the entity that awarded the funds to HHS; Chapter 783 of the Texas Government Code; Texas Comptroller of Public Accounts’ agency rules (including Uniform Grant and Contract Standards set forth in Title 34, Part 1, Chapter 20, Subchapter E, Division 4 of the Texas Administrative Code); the Texas Grant Management Standards (TxGMS) developed by the Texas Comptroller of Public Accounts; and the Funding Announcement, Solicitation, or other instrument/documentation under which HHS was awarded funds. HHS, in its sole discretion, reserves the right to add requirements, terms, or conditions. TABLE OF CONTENTS