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Division of Public Health <br />Agreement Addendum <br />FY 16-17 <br />Lee County Health Department <br />Local Health Department Legal Name <br />403 WIC <br />Activity Number and Description <br />06/01/2016 — 05/31/2017 <br />Service Period <br />07/01/2016 — 06/30/2017 <br />Payment Period <br />OOn58 <br />Page 1 of 2 <br />Women's and Children's Health Section <br />Nutrition Services Branch <br />DPH Section/Branch Name <br />Sheila J. Hirt, (919) 707-5793 <br />Sheila.Hirt@dhhs.nc.gov <br />DPH Program Contact <br />(name, telephone number with area code, and email) <br />DPH Program Signature Date <br />(only required for a negotiable agreement addendum) <br />❑ Original Agreement Addendum <br />® Agreement Addendum Revision # 1 (Please do not put the Budgetary Estimate revision # here.) <br />I. Background: <br />No change. <br />II. Purpose: <br />This Agreement Addendum Revision #1 provides additional funding to the Local Health Department as <br />described in Section IV Performance Measures/Reporting Requirements below. This additional funding <br />allows the Local Health Department to further enhance its ability to continue with the objective of the <br />Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which is to provide <br />supplemental nutritious foods, nutrition education, and referrals to health care for low-income persons <br />during critical periods of growth and development. <br />III. Scope of Work and Deliverables: <br />No change. <br />IV. Performance Measures/Reporting Requirements: <br />As of February 1, 2017, this Agreement Addendum Revision #1 adds Subparagraph 2 to Paragraph A. <br />Performance Measures as follows: <br />2. Budget additional annual funds among the four WIC activities to include the increased rate of <br />$0.50 per participant, per month, for the remainder of the Service Period. The current participant <br />rate has been increased from $15.25 to $15.75 per participant per month. <br />Health Director Signature (use blue ink) <br />Local Health Department to complete: LHD program contact name: <br />(If follow-up information is needed by DPH) Phone number with area code: <br />Email address: <br />Date <br />Signature on this nage signifies you have read and accepted all pages of this document. <br />Revised July 2015 <br />