HomeMy WebLinkAboutMINUTES - 01261993 - 1.43A CONTRA COSTA COUNTY COUNTY/CITY
' (FISCAL YEAR 1993-94)
II. CERTIFICATION STATEMENT
This is to certify that: (1) The statements herein are true and
complete to the best of applicant's knowledge. (2) This community' s
CHDP program will comply with all federal and state legal requirements
pertaining to the CHDP program. (3) The applicant agrees to provide the.
Department of Health Services adequate periodic and final reports of the
program; reports of budgets, program, and personnel changes; and access
to all fiscal and program records by state and federal staff for
purposes of audit and review. (4) The county has an MCAH Board, the
membership and responsibilities of which meet the requirements of the
Health and Safety Code, Section 321.7. (5) This application becomes a
public document as prescribed by the California Public Records Act of
1968.
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Signature of CHDP Director Date
�✓ 00,
Signature of Health Officer Date
Signature and Title of Other Date
(Optional)
I certify that this plan has been I certify that this plan is
reviewed by the Community MCAH approved by the Local Governing
Advisory Board. Body.
MCAH AdvisoryBoard Chairperson Local Governing Body Chairperson
Date Date
-7-