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Fx <br />J <br />Attachment I <br />PMMgRNIW CAS iL uEaNATICK (fir <br />STATE1ENr of AssuR iii <br />The <br />(name Of agency) agrees to the following requirements <br />as a condition for receiving maternity care coordination grant funds from the <br />Division of Maternal and Child Health: <br />(1) 'Ib use grant funds to establish new maternity care coordination <br />Position(s) and/or increase the page time of existing part -time <br />care coordination positions, and <br />(2) To use the revenue generated by maternity rare coord]r <br />ot,on staff to <br />support their salaries and fringe benefits in the current and <br />subsequent fiscal years. <br />Signature of Agency Director <br />W71;M <br />Signature of Agency Finance Officer Da " <br />Date <br />