OD2A: LOCAL – Frequently Asked Questions and Answers

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  1. Is there a webpage dedicated to previous awardees / spotlight of previous OD2A awardees?
  2. Is CDC prioritizing initiating new programs or sustaining programs (e.g., those started with OD2A CDC-RFA-CE19-1904 funds)?
    • CDC will evaluate applications on their scores based on the criteria outlined in the phase II review section of the NOFO, responsiveness to requirements, and based on their overdose burden. Details on how points may be allocated are provided in the phase II section of the NOFO. Prior overdose prevention funding will not affect selection for funding under this NOFO.
  3. Will research be allowed?
    • No research may be funded under this NOFO.
  4. Do applicants need to include anything in their submissions related to the Pilot Program for Enhancement of Employee Whistle Blowers Protections listed under terms and conditions?
    • Recipients funded under OD2A: LOCAL will be protected under the Pilot Program for Enhancement of Employee Whistle Blowers Protections term. There is nothing needed in the application or to do once funded.
  5. Under this opportunity, are activities allowed to cross components (i.e., can a proposed activity be funded under component A as well as be potentially supplemented by component B or C if it fits the proposed approach)? 
    • Yes, activities are allowed to cross more than one component, but the unique contributions of the surveillance and prevention funding should be clearly specified and consistent with the requirements in the OD2A: LOCAL NOFO. For instance, Component A may fund a drug checking activity that sends a subset of drug samples for comprehensive testing by a laboratory supported under Component B. This activity would both support high quality point-of-care drug testing and provide critical surveillance data on the illicit drug supply. In another example, Component C may fund case management systems for or data entry by staff working on linkage to care programs funded under Component A. This support would enable the collection of linkage to care surveillance data that directly informs and improves programmatic work funded through Component A.
    • Finally, some activities under Component A/Strategy 6A: Overdose Surveillance Infrastructure may supplement surveillance activities under Component B and/or Component C. For example, surveillance staff hired using Strategy 6A funding can also support data management, analysis, and dissemination efforts required as part of Components B and/or C. Except for Component B, Component C, or collaborations with state health departments, applicants are not allowed to propose new data collections using Surveillance Strategy 6A funding.
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  1. What is required to apply?
    • Applicants must submit a project narrative. The project narrative has a limit of 25 pages in 12-point font for Component A and up to 10 additional pages for each competitive strategy (Component B and Component C).
    • The optional application checklists for Component A (named, Optional Checklist for Component A Core Requirements_final_30 MAR 2023.docx), Component B (named, Optional Checklist for Component B Core Requirements_final_30 MAR 2023.docx), and Component C (named, Optional Checklist for Component C Core Requirements_final_30 MAR 2023.docx) can be found at https://ftp.cdc.gov/pub/OD2a-local/. These checklists provide a brief overview of what should be included with each application.
    • Applicants must submit a budget narrative. The budget narrative has a maximum of 5 pages for Component A and up to 3 additional pages for each competitive strategy (Component B and Component C).
    • Applicants also should submit an Evaluation and Performance Measurement Plan, which has a limit of 20 pages. The Evaluation and Performance Measurement Plan should describe the applicant’s approach to conducting all required evaluation activities presented in the NOFO.
  2. Will applications need to be reviewed every year if accepted?
    • The application is a one-time process to determine who is funded for the 5-year period. Funded jurisdictions will submit their workplan each year, which be reviewed and approved by CDC.
  3. Is the letter of intent required? When is it due?
    • A letter of intent is requested and strongly encouraged but not required. Letters of intent are due by 11:59 p.m. ET on April 6, 2023.
  4. Will the PowerPoint presentations from the informational webinars held on March 13 and March 14, 2023, and recordings of the presentations be made available?
  5. There is a stated requirement through Components A, B and C to submit memoranda of understanding (MOU) and data use agreements (DUA), however there is a reference on page 54 that states “Recipients can use the award’s first year to develop their data sharing agreements.” Please clarify.
    • An indication of a partnership, including a memorandum of understanding, letter of support or data use agreement should be included with the application. Data sharing agreements may be developed in the first year of the program.
  6. What if the local health department and state health departments have the same DUNS or UEI number (i.e., centralized health department structure)?
    • According to the NOFO’s Additional Information on Eligibility, eligible applicants are city or county local health departments or bona fide agents. A local health department could apply under their legal entity name and their assigned UEI (Unique Entity ID). Please also see the NOFO’s section on required registrations. Before applying for funding, all applicant organizations must obtain a UEI, obtain a current SAM registration, and register on grants.gov. To meet the application deadline, it is recommended that all required registrations be completed as soon as possible.
  7. Is it possible for a recipient to be awarded funding for all three components (Component A, Component B, and Component C)?
    • Yes, it is possible for a recipient to be awarded funding for all three components (A, B, and C).
  8. Would a low-diversity county with high health disparities be likely to be awarded?
    • All county, city, special district government, or territorial health departments, or their bona fide agents, are eligible to apply for OD2A: LOCAL Component B and Component C. All applicants for Component B and Component C must also apply for Component A. Applications are evaluated and selected for funding based on Phase II and Phase III evaluation criteria listed in the NOFO.
  9. Can the local health department apply but contract the implementation of activities to non-profits or other agencies?
    • Yes.
  10. Can applicants use other data sources to calculate the unintentional or undetermined intent drug overdose deaths (i.e., county coroner’s office)?
    • No. Applicants must use the data sources described in Appendix 1.
  11. The number of resident unintentional and undetermined drug overdose (UUDO) deaths that CDC shows in Table 1 of the Description of Applicant’s Service Catchment Area is lower than the number our medical examiners have. This would change our funding significantly. What do we do in this case?
    • Applicants must use the definitions in Appendix 1 in the NOFO when calculating number of resident UUDO deaths in 2021.
  12. Several local health departments that work together in a regional effort across state lines are interested in working together on this issue and application. Will an application that offers a bi-state proposal with collaborating health departments on both sides of a state line be reviewed favorably? Would CDC be willing to consider a bi-state consortium of local health agencies for this grant?
    • CDC will not fund two applicants who serve the same county or city under this announcement. Applicants who serve the same county, city, or other contiguous geographic area are encouraged to coordinate to determine which single entity is appropriate to apply and can use Appendix I in calculating resident population and drug overdose deaths for an applicant’s catchment area. Nearby localities may choose to share resources with other organizations, including those across state lines, but should not apply as a consortium.
    • Applications should clearly specify there is not overlap in populations served but can describe collaboration among entities where appropriate. Please submit Letters of Support or Memoranda of Understanding/Agreement for any required collaborations, as outlined in the Notice of Funding Opportunity. Further, applicants are encouraged to provide Letters of Support or Memoranda of Understanding/Agreement to demonstrate recommended collaborations, which will be considered during Phase II evaluations.
  13. Page 46 of the NOFO outlines the requirement for all applications to include signed data use agreements/memoranda of commitment to share data from a minimum of 3 partners representing each of the settings in which strategies will take place: the community, public safety, and health systems. If the community partners are represented by the same entity (i.e., programs of our public health department), how should we document that data use agreements are not needed?
    • Please include a memorandum of commitment to share data even if a formal data use agreement will not be necessary. The memorandum should explicitly describe the existing relationship and why a data use agreement will not be needed.
  14. Does CDC have example Letters of Support and Memoranda of Understandings that are used by OD2A recipients.
    • CDC does not have examples of these documents. The PHAST toolkit includes content on developing memoranda of agreement that may be helpful. Your legal office may also have recommended language to include in such a letter.
  15. Do applicants need to specify all components for which they plan to apply in the letter of intent?
    • Yes, applicants should list all the components for which they intend to apply in the letter of intent.
  16. Are the application components reviewed separately or as a whole?  Will the base narrative of A be reviewed along with B and C? How much narrative needs to be repeated in B and C if it was included in A?
    • Applications for each of the components will be reviewed and scored separately and by different committees in accordance with the Phase II review criteria. For example, reviewers assigned to evaluate Component B applications will focus on the sections and attachments of the application specifically related to Component B. Similarly, reviewers assigned to evaluate Component C applications will focus on the sections and attachments of the application specifically related to Component C. Therefore, if text in Component A relates to or supports Component B and/or Component C, the applicant should clearly reference these Component A sections in their Component B and/or Component C text.
  17. If an applicant is partnering with an organization that will be participating in both Component A and Component B, will they be required to submit two letters of support from them, or can the same letter be submitted for Component A and Component B?
    • The same letter can be used for multiple components, but it would need to be submitted multiple times with the proper labels (naming which component it is for) and must clearly outline how the partnership contributes to activities under that component.
  18. Will CDC provide a workplan template to use?
  19. How detailed should workplans be in the application? Will recipients submit more detailed workplans after funding is awarded?
    • Year 1 workplans should be as detailed as possible, given application page limits. More detailed workplans can be developed in coordination with CDC after funding is awarded.
  20. Page 46 lists that applicants must include data use agreements/memoranda of commitment to share data from a minimum of 3 partners representing each of the settings. Is this 3 per setting or 3 overall for the settings?
    • A minimum of 3 data use agreements/memoranda of commitment representing the three settings are needed, for a total of 3 letters.
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  1. Under eligibility, what is meant by a “special district health department”?
    • A special district health department (e.g., health districts, authorities, boards, commissions) is a formal structure designated by law or regulation to serve a population that may reach more than one city or county. CDC encourages applicants who are considering applying as a special district health department to consult with local counsel to verify their status. For this application, a special district health department must be pre-existing prior to submission of application.
  2. Can two local health departments in the same county apply separately as long as there is no overlap in jurisdictions? For example, can one health department oversee the city jurisdiction and the other oversee the suburban jurisdiction?
    • CDC will not fund two applicants who serve the same county or city under this announcement. Applicants who serve the same county, city, or other contiguous geographic area, are encouraged to coordinate to determine which single entity is appropriate to apply. Phase III criteria, as stated in the NOFO, will consider geographic diversity given the limited number of awards. Applications should clearly specify there is not overlap in populations served.
  3. Will a regional grant impact local grants already in place?
    • It depends on the funding that you are currently receiving. Please contact us at OD2A_LOCAL@cdc.gov if you have specific questions about your current funding and how it might be affected if funded through this program.
  4. Can a county be permitted to apply for this opportunity if they are a current recipient of the ‘Implementing Overdose Prevention Strategies at the Local Level’ (IOPSLL) grant through the National Association of City and County Health Officials (NACCHO)?
    • Yes, counties that are current recipients of ‘Implementing Overdose Prevention Strategies at the Local Level’ funding may apply for OD2A: LOCAL funding.
  5. Does the state have to be an OD2A in States (OD2A-S) recipient for a locality within it to be awarded this funding?
    • No, the state does not have to be a recipient of Overdose Data to Action in States (OD2A-S: RFA-23-0002) for a locality within it to be awarded funding via OD2A: LOCAL.
  6. Can local law enforcement agencies, correctional services or community organizations apply? Or would the local health department need to be the applicant?
    • Only local health departments, special district health departments (e.g., special health districts), territories, and their bona fide agents may apply. We encourage law enforcement agencies, community-based organizations, and public health to partner on this effort.
  7. The NOFO refers to “duplication of efforts.” If a state applies for OD2A-S which also impacts a local program, can the local health department still apply for OD2A: LOCAL, and have both state AND local funding under this?
    • Yes, funding of localities within OD2A-funded states is allowed. Recipients are encouraged to collaborate to ensure no duplication of activities occurs across OD2A: LOCAL and OD2A-S. Braiding funding from multiple federal funding sources is allowed to the extent that the funding source permits, but the unique contribution of funding from OD2A: LOCAL is clearly described.
  8. Can a local health department receive the OD2A: LOCAL and OD2A-S funds? Or does it have to be one or the other?
    • A local health department needs to apply to the OD2A: LOCAL NOFO. The state health department may also apply to OD2A-S (RFA-23-0002). A local health department can receive funding via OD2A: LOCAL and still collaborate with a state in order to receive funds via the state program, as long as there is no duplication of programmatic activities or supplanting of funds. Recipients will collaborate to ensure no duplication of activities occurs across OD2A: LOCAL and OD2A-S. Braiding funding from multiple federal funding sources is allowed to the extent that the funding source permits, but the unique contribution of funding from OD2A: LOCAL should be clearly described.
  9. In the NOFO, it is stated that priority for funding will be given to areas with larger populations. Some rural counties have high rates of overdose but may not require the average award amount of $2 million per year — $500,000 might be a more realistic budget. Should counties like this apply?
    • Because of the rapid increases in drug overdose deaths, the national goal of reducing the number and rate of drug overdose deaths, and the desire to maximize the reach of OD2A programming, funding for this NOFO will be prioritized for recipients in jurisdictions with a higher burden of unintentional or undetermined drug overdose deaths and a larger population. Potential applicants are encouraged to use Appendices 1 and 2a for assistance in calculating resident population and drug overdose deaths. CDC has a broad portfolio and will continue to collaborate with national partners to support jurisdictions to address drug overdose prevention in all communities.
  10. What is considered a “larger population” area? My jurisdiction has approximately 500,000 people, but it looks like past awards have been in areas with greater than 1 million people. Is there a cutoff?
    • Because of the rapid increases in drug overdose deaths, the national goal of reducing the number and rate of drug overdose deaths, and the desire to maximize the reach of the funding, funding for this component will be prioritized for recipients in jurisdictions with a higher burden of unintentional or undetermined drug overdose deaths and a larger population. Potential applicants are encouraged to use Appendices 1 and 2a for assistance in calculating resident population and drug overdose deaths. The table below shows the maximum funding available based on population size and overdose deaths in 2021.

      UUDO Deaths 2021
      Population size of service catchment area Unintentional or undetermined intent drug overdose (UUDO) deaths during 2021
      Less than 300 deaths 300 deaths – 749 deaths 750 deaths or more
      Less than 600,000 $1,000,000 $1,500,000 $2,000,000
      600,000 – 799,999 $1,000,000 $1,750,000 $2,500,000
      800,000 or more $1,000,000 $2,500,000 $3,250,000

       

  11. Is the population size relative to the death rate considered? For instance, we are a small county (about 300,000) but have a death rate higher than our state average.
    • See answer to question #35.
  12. If multiple local public health departments are working together and have a 501c3 formed by multiple local public health departments, could they be an applicant, or does it have to be one local public health department?
    • The applicant must be a local public health department, a special health district designated by law or regulation, a territory or a bona fide agent that serves a local public health department. Bona fide agents and fiscal intermediaries are organizations designated by the health department as eligible to submit a grant application in lieu of the health department. These organizations may apply for the cooperative agreement and transfer money to the health department, or may undertake more of the cooperative activities, depending on the local situation.
  13. If an applicant lives in a state that does not have county-wide health departments but works with another county-entity that has helped secure grant resources to address addiction regionally, would they qualify to apply under the “other” eligibility category?
    • You may wish to check with state general counsel on whether the outside entity qualifies as a designated bona fide agent; alternatively, the county may apply and continue collaborating with the entity.
  14. Can multiple independent departments/districts apply on the same grant?
    • No, an applicant must be a single city or county or territorial health department, or a special health district. A special district health department (e.g., special health district) is a formal structure designated by law or regulation to serve a population that may reach more than one city or county. CDC encourages applicants considering applying as special health districts to consult with local counsel to verify their status. For this application, a special health district must be pre-existing prior to submission of application.
  15. Are organizations such as the National Association of City and County Health Officials (NACCHO) or the Council of State and Territorial Epidemiologists (CSTE) or state departments of public health eligible for this opportunity?
    • No, eligibility is limited to city and county health departments, special district health departments (e.g., special health district) and territories, or their bona fide agents. A state health department is NOT eligible to apply for OD2A: LOCAL. There is a separate funding opportunity dedicated to state health departments and Washington, DC called Overdose Data to Action in States (CDC-RFA-CE23-0002).
  16. If the focus of this NOFO is on disproportionate impact, why are funding strata being decided by counts of unintentional or undetermined intent drug overdose deaths and not by rates?
    • The primary goal of this NOFO is to reduce the number of Americans dying from overdose as quickly as possible. With limited funds and the growing severity of the crisis, we are prioritizing those jurisdictions with the highest death count.
  17. Does an applicant have to apply for and be funded for the base Component B activities to apply for the optional Medical Examiner/Coroner funding?
    • Yes, to apply for and conduct activities using the extra, optional Medical Examiner/Coroner funding, applicants must apply for the base Component B and be selected for funding under Component B.
  18. I noticed that this year the NOFO is split into two funding opportunities – one for state health departments and one for local health departments. Is there any opportunity for other types of local organizations to apply for the second NOFO if a state does not have any local health departments but has other designations, such as health equity zones?
    • Only local health departments, special district health departments (e.g., special health districts), territories, and their bona fide agents may apply. Health equity zones are not eligible for this cooperative agreement. Local community organizations or health equity zones may want to explore collaborations with the state health department through Overdose Data to Action in States.
    • In addition to funding through direct cooperative agreements like Overdose Data to Action, CDC will also continue to support health departments through other mechanisms, such as our Staffing Support program, which may be another area for local communities to collaborate with the state.
  19. In communities with an existing overdose prevention community coalition in place, can a nonprofit apply in lieu of the local health district if the municipality designates the nonprofit to apply on their behalf?
    • Nonprofit organizations that are bona fide agents of the health department can apply. If the nonprofit is not a bona fide agent, the local health district will need to apply and can subcontract with the nonprofit to conduct the activities.
  20. We are unable to locate and download the 2021 Excel file for calculating the resident population for our county. The only file available to download includes the 2022 data. Please advise how to proceed. 
    • The census website, https://www.census.gov/data/datasets/time-series/demo/popest/2020s-counties-total.html, has been updated to include county population data for 2022. Please continue to use the instructions in Appendix 2a but use the “co-est2022-pop-XX.xlsx” instead of “co-est2021-pop-XX.xlsx” file when calculating your 2021 county population. Please report your 2021 population instead of 2022 as this is what is requested in the OD2A: LOCAL NOFO. City and territorial files do not appear to be affected by this change.
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  1. Will CDC reduce the funding for an individual applicant OR simply decline to fund? For instance, if an applicant applies for $2 million, and CDC reviews the budget and decides that $1.5 million in funding is more appropriate, will that amount be funded, or none at all?
    • CDC may decide to fund at the full amount, a reduced amount, or decline to fund for this NOFO.
  2. If part of a staff person’s salary is funded by OD2A-S, can part of their salary be covered by OD2A: LOCAL funding as well?
    • Braided funding is encouraged. If a jurisdiction is covered by both state and local OD2A funds, they should work for each cooperative agreement proportionate to their salary. Recipients will collaborate to ensure no duplication of activities occurs across OD2A: LOCAL and OD2A-S. Braiding funding from multiple federal funding sources is allowed to the extent that the funding source permits, but the unique contribution of funding from OD2A: LOCAL should be clearly described.
  3. Will current OD2A recipients of CDC-RFA-CE19-1904 have the option to request no cost extensions should they not be awarded funds from OD2A: LOCAL or OD2A-S, CDC-RFA-CE-23-002?
    • No, current OD2A recipients of CDC-RFA-CE19-1904 will not have the option to request no cost extensions should they not be awarded funds from OD2A: LOCAL or OD2A-S, CDC-RFA-CA-23-002.
  4. Is the $2,000,000 indicated for Component A the average for one year award for one recipient?
    • Yes, $2,000,000 is the average award for year one for one recipient.
  5. Can OD2A: LOCAL funds be used for building out space for laboratory or administrative purposes to fulfill NOFO requirements?
    • Construction expenses are generally not allowed; however, in some cases CDC will approve them. If an applicant is proposing such expenses, they must be clearly identified in the budget, and they will be subject to CDC approval.
  6. If we aren’t ready to apply at this time, are additional future funding opportunities expected to be available?
    • This is a 5-year award. Future funding opportunities are dependent upon availability of funds.
  7. Should applicants be using the Excel document in appendix 2B to calculate total possible funding?
    • If applicants are using the optional Excel document in Appendix 2b, they will need to calculate the maximum funding for Component A and plug it in to Table 2: Maximum Funding Worksheet. The table will automatically calculate funding for Components B and C using the selections in the first row, which should be determined based on population size.
  8. Can OD2A: LOCAL funds be used for a detox center to link to outpatient substance use treatment?
    • Funds must be used to link from community, public safety, or healthcare settings to evidence-based care, which can include medications for opioid use disorder (MOUD), cognitive behavioral therapy and/or contingency management.
  9. As part of the harm reduction approach, are we able to purchase naloxone and/or fentanyl test strips to distribute?
    • Purchase of fentanyl test strips is allowable under this NOFO. However, naloxone purchase is NOT allowable with OD2A: LOCAL funds. Funds can be used to distribute naloxone, store it, provide staffing, support, education, etc. A complete list of allowable activities under the harm reduction strategy is in Appendix 3.
  10. Why can’t naloxone be purchased through this NOFO? I thought it was allowed in the current OD2A program.
    • Naloxone purchase in the current OD2A funding (CDC-RFA-CE19-1904) was a one-time exception. Other federal resources are available for the purchase of naloxone.
  11. Are syringes an allowable cost?
    • Syringes are an allowable cost when they are purchased for the purpose of injecting intramuscular naloxone or for the purpose of adapting for nasal atomizer administration. Syringes for the purpose of illicit drug injection may NOT be purchased under this NOFO.
  12. Can funds be used for participant incentives (e.g., incentives to participate in syringe service programs)?
    • No, participant incentives may not be funded under this NOFO.
  13. Does the funding allow for the purchase of clinical services?
    • No, this funding does not allow for the purchase of clinical services.
  14. Is the three-page budget narrative limit for a 5-year budget or one-year budget?
    • The budget narrative should describe funding for the first year of the award.
  15. Should a Year 1 budget alone be submitted with the application, or a total budget for the entire 5-year term?  Should the request be only for Year 1, the total project, or both?
    • Submitted budgets should cover the first year of all components to which you are applying.
  16. Can recipients use OD2A funding to support programs that serve both their county and surrounding rural areas, or must funding apply strictly to programs within county lines?
    • Funding does not need to be constrained by county lines. Funding, however, must only be spent in geographic areas that meet two conditions:
      • The geographic area is served by the applicant, served by collaborating health departments that provide letters of support in the OD2A: LOCAL application, or served by a collaborating health department that is approved by CDC after funding.
      • For geographic areas outside the applicant’s service or catchment area, the applicant must provide a clear justification why OD2A: LOCAL funding is being spent outside the applicant’s service area (e.g., a city collaborating with surrounding suburban or rural areas because their drug overdose epidemic is interconnected).
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  1. Are external partners required for all parts of the Component A?
    • Applications will be evaluated in part on demonstrated partnerships, including the extent to which the application has the partnerships, as evidenced by letters of commitment, to implement activities in all settings upon receipt of funding. Partnerships must include those that support the recipient in ensuring access to naloxone for distribution activities, access to populations disproportionately affected by overdose and/or historically underserved by prevention and treatment programs, ensuring low-barrier access to evidence-based treatment for opioid use disorder and stimulant use disorder, and increasing capacity to engage and support a cadre of navigators familiar with the local public health infrastructure.
  2. Partnering is mentioned many times in this NOFO. How important is it compared to developing programs not already in existence in the public health department?
    • Partnerships will be critical to successful program implementation across settings and reaching populations disproportionately impacted by overdose and those historically underserved by prevention programs. See question 45 for more detail about expectations related to partnerships.
  3. Are different activities needed for each setting for prevention activities 1A and 2A?
    • Please refer to pages 20-29 of the NOFO that give detailed descriptions of the required activities for 1A and 2A for each setting (community, public safety, health systems). Activities in one strategy that have touchpoints in all settings can be leveraged to advance unique efforts in another strategy by encouraging linkage to care and retention in care and harm reduction.
  4. Under letter B it states, “Recipients will need to conduct at least one additional prevention activity apart from the required activities in each of several required strategies.” Does this mean one additional activity per setting per each strategy?
    • Recipients will need to conduct at least one additional prevention activity apart from the required activities in each of several required strategies (i.e., naloxone distribution, linkage to care or harm reduction with navigators, training on guideline-concordant care). Recipients also will have the opportunity to conduct additional interventions in required and optional strategies. Additional prevention activities do not need to take place in all settings.
  5. What does ‘linkage to care is required in all settings’ mean?
    • This means that linkage to care focused activities must be implemented in all settings described in the NOFO (community, public safety, and healthcare).
  6. Does the naloxone distribution requirement take state laws/regulations into account?
    • All activities funded under this NOFO need to be within the bounds of state and local laws and regulations.
  7. Where can jurisdictions find resources to apply for a determination of need for syringe services program?
  8. Currently, fentanyl test strips are illegal in our state, but many people are trying to change the laws around that. Does a funded county have to wait for the laws to change before we can work on that side of harm reduction?
    • CDC encourages you to consult with state or local counsel on matters pertaining to laws, policies, and regulations related to fentanyl test strips.
  9. For navigators, do those include certified peer support specialists with lived experience helping navigate substance use disorder resources virtually (i.e., text-based support, etc.)?
    • Yes, navigators may include certified peer support specialists with lived experience helping navigate substance use disorders resources virtually.
  10. As part of the clinical approach, does the education provided have to be through academic detailing or can it be done via targeted media campaigns or provider education?
    • We encourage applicants to consider the educational needs of their local clinical community and to tailor educational efforts in whatever way meets those needs.
  11. There is conflicting information in the NOFO regarding required strategies in each setting. Is strategy 4A only required in the healthcare setting or also in the community setting?
    • Strategy 4A is only required in the healthcare setting.
  12. Can recipients use OD2A: LOCAL funds for alternatives to incarceration/emergency departments?
    • As described in Appendix 5, examples of activities to be conducted in public safety/criminal justice settings for the prevention strategy linkage to and retention in care include law enforcement-assisted diversion or deflection and evidence-based treatment for substance use disorders (e.g., MOUD) during incarceration and upon release.
  13. Overdose fatality review activities were allowed under OD2A CDC-RFA-CE19-1904. Where do such activities fit under this NOFO?
    • Overdose fatality review activities are allowable under the prevention strategies in the community and public health/public safety settings.
  14. Are there suggested joint venture or partnership agreements?
  15. Is there additional information on what is and is not considered “clinical care”? We understand that OD2A: LOCAL funds cannot be used for clinical care but are wondering if occupational therapy used in combination with linkage to care navigators would fall under this category.
    • Occupational therapy is considered clinical care and cannot be funded through OD2A. OD2A funds could be used at a location offering occupational therapy to support navigators who link clients to evidence-based care for opioid use disorder and/or stimulant use disorder or to harm reduction programs.
  16. Can occupational therapists (OTs) be used to evaluate personal and environmental factors that can pose barriers to service engagement and design individualized interventions to facilitate that engagement?  
    • No, occupational therapists are considered clinical providers and are not an allowable cost under OD2A: LOCAL.
  17. If multiple settings will be used for prevention in the community (i.e., a syringe services program and a public health department) are each of the activities under the “Prevention in the Community” section required for each location, or will the project be able to divide the required activities between locations?
    • Jurisdictions may choose to divide activities between locations if all required activities are implemented in each required setting.
  18. Are contingency management / incentives, to enhance linkage to care and retention an allowable cost?
    • OD2A: LOCAL funds may not be used for contingency management. Funds may be used to link individuals to a program offering contingency management but not for the treatment itself.
  19. Is harm reduction nursing for health education, wound and abscess care, linkage to care or linkage to MOUD teleprescribers an allowable expense?
    • OD2A: LOCAL funds may not be used for clinical care, including for nurses providing wound care. A portion of a nurses’ salary could be supported with OD2A: LOCAL funds to provide education or linkage to care.
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  1. Is the surveillance strategy maximum amount per year or total for the entire project period?
    • The surveillance strategy maximum funding is for the first year, not for the entire project period.
  2. Could an activity, as part of the proposal, include wastewater monitoring to examine opioid analytes?
    • No, CDC is not funding wastewater testing as part of this NOFO.
  3. Overdose deaths were previously investigated by the coroner’s office; when a new coroner was hired, the investigations were put on hold. Our health department plans to move the investigations “in-house to be conducted by a public health staff member. Is this an example of an eligible partnership?
    • The optional “Improve medical examiner and coroner investigation of drug overdose deaths” activity is meant to support improvements of drug overdose death investigations being conducted by medicolegal death investigators for the purposes of accurate and comprehensive completion of death certificates and medical examiner/coroner reports for drug overdose deaths. Applicants applying for this optional activity must provide a brief description of how the funding will be used to improve drug overdose death investigations and the timeliness and/or quality of data sharing. The medical examiner/coroner agency must also participate in the State Unintentional Drug Overdose Reporting System funded by OD2A-S. A detailed description of the process used for drug overdose death investigation, since a system outside of the coroner system is being used, should be included in the application.
  4. Is it permitted to collect biospecimens for nonfatal overdose toxicology testing under Surveillance Component 6A?
    • Funds from Component A: Strategy 6 cannot be used to collect and test biospecimens collected from people who were treated for a nonfatal overdose unless the collection is part of a collaboration with their state health department on the project. Please see pages 31-32 of the NOFO for examples of how funds for this strategy can be used. The OD2A: LOCAL NOFO encourages applicants to collaborate with their state health departments. This collaboration can include braiding OD2A-LOCAL and OD2A-S funding, contingent on CDC approval. Allowable and optional collaborations include collecting and conducting comprehensive toxicologic testing of samples from patients treated for nonfatal overdose in hospitals in your jurisdiction as part of state led efforts to conduct biosurveillance funded through OD2A-S (RFA-23-0002). Please see pages 45-46 of the OD2A: LOCAL NOFO for a description of allowable collaborations of OD2A: LOCAL recipients with OD2A-S recipients.
    • Funding from OD2A: LOCAL Component B cannot be used to collect and test biospecimens collected from people who were treated for a nonfatal overdose.
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  1. Is there a list of the standard performance measures required to report on?
    • Yes, there will be a list of standard performance measures that will be shared post-award, aligned with the logic model included in the NOFO. Performance measures will be linked to and will address the prevention strategy outcomes and measures related to partnerships and health equity/social determinants of health more broadly. Required activity (i.e., use of navigators, naloxone distribution, implementing guideline concordant care) performance measures primarily will address short-term outcomes associated with required activities and intermediate-term outcomes specified in the logic model. Some potential examples of required performance measures that recipients may be asked to report include: number of naloxone doses distributed, number of people utilizing OD2A-funded harm reduction services, number of available evidence-based OUD treatment programs, number of new health equity-focused overdose prevention interventions that address drivers of health disparities, number of partnerships mobilized to address overdose prevention health disparities and inequities, and number of prescribers who use a PDMP before prescribing opioids. CDC will provide more guidance and final measures upon award, and CDC will work with funded recipients to operationalize the performance measures and identify available and feasible data sources for the measures. CDC will develop specific reporting processes and templates and provide guidance on their function to facilitate and standardize data collection.
  2. We are currently working on needs assessments in our community and may have some preliminary data to incorporate into our application but possibly not enough to meet the requirements outlined in Appendix 9. How should we incorporate this preliminary information?
    • Applicants should describe in their applications the status of their ongoing needs assessments, available preliminary data, and timeline for completing their needs assessments and having data to inform how prevention strategies will address:
      • health equity and the needs of priority populations and people with lived experience.
      • how the needs of priority populations and people with lived experience will be addressed through navigation activities to link people to care and to harm reduction services.
    • Applicants that have preliminary data are encouraged to provide a summary of preliminary findings with their applications, and CDC will review the summary findings to determine whether the applicant is on track to meet the requirements of the community needs assessment. Funded jurisdictions that shared preliminary summary findings should plan to share updated findings and/or complete their needs assessments at the start of the cooperative agreement to address the community needs assessment requirement. CDC will work with a funded recipient to revise their workplan to include or build upon the jurisdiction’s prior/ongoing community needs assessment, if needed.
    • Applicants can use the optional evaluation and performance measurement plan template—either the 508-compliant or non-508-compliant optional template—to describe the status of their ongoing needs assessments or plan for completing the community needs assessment. These optional templates are available at ftp.cdc.gov/pub/OD2a-local/.
  3. Is the Evaluation Plan included in the total Project Narrative Length (45 pages if applying for all components) or separate?
    • The Evaluation and Performance Measurement Plan is separate from the Project Narrative. The Evaluation and Performance Measurement Plan has a limit of 20 pages and should describe the applicant’s approach to conducting all required evaluation activities presented in the NOFO, specific to Component A. Applicants can use the optional evaluation and performance measurement plan template—either the 508-compliant or non-508-compliant optional template—to submit their Evaluation and Performance Measurement Plan. These optional templates are available at https://ftp.cdc.gov/pub/OD2a-local/.
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  1. Are state public health laboratories allowed to perform the laboratory testing described in Component B with collaborators at the local health department level?
    • Yes, state public health laboratories are allowed to perform laboratory testing for local health departments funded to implement Component B. Local health departments funded for Component B have the freedom to select the laboratory they will partner with to meet Component B requirements.
  2. Will there be any guidance from the CDC on protocols and procedures for drug and paraphernalia sample collection?
    • CDC will not supply or require applicants to use specific protocols and procedures for drug and drug paraphernalia sample collection. Procedures and protocols should minimize safety risk while maximizing obtaining a sample that can be tested. Once funded, CDC will work with recipients to design and refine procedures for sample collection.
  3. What information needs to be submitted for samples tested under Component B?
    • CDC will provide recipients detailed guidance and a template that lists and describes the case-level data elements recipients must share with CDC about the test results for each sample. Required data elements will include, but not be limited to:
      • A sample ID
      • Recipient name (e.g., name of city or county health department submitting the samples)
      • A description of the specimen tested (e.g., drug product, syringe, bags that hold drugs, cooker, or other drug paraphernalia) using standardized categories provided by CDC
      • A list of drugs and metabolites detected in the sample
      • The date the sample was submitted for testing
  4. What type of testing instrumentation can be used? Fourier-Transform Infrared Spectroscopy (FTIR)? Substance-specific test strips? Gas Chromatography Mass Spectrometry (GCMS)?
    • Toxicology testing must include qualitative laboratory testing for a list of core drugs identified by CDC including but not limited to fentanyl, heroin, methamphetamine, and cocaine. Testing for fentanyl analogs such as carfentanil and other emerging substances of concern should also be included in toxicologic panels (See Appendix 8 for CDC draft guidance).
      • Examples of acceptable laboratory testing methodologies include Gas Chromatography Mass Spectrometry (GC-MS), Liquid Chromatography – Mass Spectrometry (LC-MS), Quadrupole Time of Flight LC/MS, and Direct Analysis in Real Time – Mass Spectrometry (DART-MS).
      • Near real-time drug testing or checking that occurs in the field outside a laboratory-like setting with portable devices or tests will not meet the requirements.
        • Examples of testing methodologies that will not meet the Component B requirements, include but are not limited to, fentanyl test strips (FTS), portable Fourier-Transform Infrared Spectrometer (FTIR) or portable high pressure mass spectrometers (HPMS).
  5. May recipients purchase instrumentation (e.g., Gas Chromatographer/Mass Spectrometer [GC/MS]) with Component B funding?
    • Recipients are allowed to purchase testing instrumentation when the purchase of the equipment is an essential part of a feasible plan to meet the requirements for Component B. Purchased equipment must be used to support Component B testing.
  6. Will CDC provide any guidance on how to protect individuals providing drug testing services from law enforcement?
    • Component B funds cannot be used to test samples obtained by law enforcement that are part of an investigation or criminal prosecution. Samples provided by individuals should be de-identified or anonymous to protect the identity of individuals using the services. Also, all acquisition of drug products and/or drug paraphernalia and testing procedures must be within the bounds of federal, state, and local laws and regulations.
  7. Can clinical samples such as urine samples from a clinical setting or from nonfatal overdose cases treated in a medical setting be tested as part of Component B?
    • Samples tested using OD2A: LOCAL Component B funding must be obtained from drug products and/or drug paraphernalia. Component B funding cannot be used to test clinical samples from nonfatal overdoses.
  8. If the forensic science laboratory is under the purview of medical examiner, are all samples accepted eligible for this grant? Our local health department accepts samples from law enforcement for medical examiner cases as well.
    • Component B funds cannot be used to test samples obtained by law enforcement that are part of an investigation or criminal prosecution irrespective of the lab conducting the testing. Samples obtained by law enforcement that are not part of an investigation or criminal prosecution, referred to as noncriminal samples, may be tested using Component B funds. Results from tests must be de-identified.
    • Medical examiner and coroners may test and use findings from drug product and paraphernalia toxicologic tests as part of their investigations of suspected drug overdose deaths (e.g., testing drugs or drug paraphernalia found at the scene of a fatal drug overdose).
  9. Previously our county had overdose death investigations done primarily through the coroner’s office, but when that coroner left, the investigations stopped. Our county plans to move the investigations to being conducted by the health department. If selected, would our health department be eligible for the funding if the investigations are done concurrently with the coroner but “housed” at the public health department?
    • Please email OD2A_LOCAL@cdc.gov with more specific information to receive a complete answer to this question.
  10. How will CDC use and display data submitted by recipients of Component B?
    • By applying for and accepting this funding, the recipient agrees to CDC sharing aggregated results with the public through publications, reports, alerts, and dashboards. Applicants not able to share toxicologic test results with CDC and publicly should not apply. CDC will work closely with recipients to ensure any publicly reported data meets minimum data quality standards.
  11. If the local health department applies for the optional component supporting Medical Examiners/Coroners, is the $100,000 – $200,000 in addition to the previously stated maximum funding for component B, or is it included in those limits (i.e., greater than $325,000 if large population area)?
    • Yes, the $100,000 – $200,000 for supporting Medical Examiners/Coroners is in addition to the previously stated maximum funding for component B of $250,000 to $325,000.
  12. Could biological specimens for nonfatal overdose be part of component B toxicology testing?
    • Samples tested using OD2A: LOCAL Component B funding must be obtained from drug products and/or drug paraphernalia. Component B funding cannot be used to test biological specimens from nonfatal overdoses.
  13. We currently receive drug seizure data from the crime lab of our coroner’s office. The report received is the grand jury report used if the case goes to trial. The analysis of the drug seizures is independently funded through the crime lab If grant funding is not used for the testing of the criminal drug seizure samples, are we able to use the results? Are all criminal samples to be excluded or only those involved in an active investigation?
    • Component B funds cannot be used to test samples obtained by law enforcement that are part of an investigation or criminal prosecution, irrespective of whether the investigation is “active” and irrespective of the lab conducting the testing. Samples obtained by law enforcement that are not part of an investigation or criminal prosecution, referred to as noncriminal samples, may be tested using Component B funds. Results from tests must be de-identified.
    • In addition to conducting toxicological testing, recipients are allowed, but not required, to use funding to analyze existing toxicologic results obtained through routine testing of drug products submitted by law enforcement to forensic laboratories such as those participating in the National Forensic Laboratory System (NFLIS). Data must be acquired within three months of the laboratory testing of the drug product and include results for core drugs such as fentanyl, fentanyl analogs, heroin, methamphetamine, and cocaine. Please see pages 32-39 for a detailed list of the requirements for this component.
  14. Is purchasing analytical instrumentation to test paraphernalia allowable under this solicitation?
    • Recipients are allowed to purchase testing instrumentation when the purchase of the equipment is an essential part of a feasible plan to meet the requirements for Component B. Purchased equipment must be used to support Component B testing.
  15. A neighboring county is applying for OD2A: LOCAL. Their county is smaller than ours, and our coroner covers both counties. Would Component B be able to be a regional component that one of us could apply for, covering multiple counties if our coroner confirms the service area for expanding drug testing capabilities?
    • Yes, the optional activity “Improve medical examiner and coroner investigation of drug overdose deaths” provides additional funding to support improvements of drug overdose death investigations by medical examiner/coroner agencies serving the recipient’s jurisdiction. The medical examiner/coroner agency may serve multiple counties.
  16. Are there any examples of component B activities successfully happening across the United States?
    • Applicants may wish to check with other jurisdictions and/or peers to learn about potential processes and procedures related to testing of drug products and/or paraphernalia.
  17. Can funds for Component B be used for staff outside of the Medical Examiner’s office? For example, can the funds to be used to support a drug checking technician?
    • Optional funding to improve medical examiner and coroner investigation of drug overdose deaths must fund activities that either:
      • Support the medical examiner’s office to improve investigations of drug overdose deaths, or,
      • Increase collaboration and data sharing between you and your medical examiner’s office.
    • Funding could be used to support staff outside of the medical examiner’s office, such as a drug checking technician, only if the staff conducts work that directly supports or enhances the medical examiner’s investigation of drug overdose or increases collaboration and data sharing between you and your medical examiner’s office. For instance, funding could support more rapid or comprehensive toxicology testing.
  18. Can Component B funds be used to support staff that conduct community-based drug checking and/or sample collection for confirmatory testing?
    • Component B funding can be used to support staff that are collecting samples for confirmatory lab testing, including staff that are conducting community-based drug checking. Because Component A funds drug checking activities, applicants are encouraged to fund drug checking staff with Component A funding OR a combination of Component A and Component B funding. Component B funding should support Component B activities such as sample collection and shipping samples to the laboratory for confirmatory testing.
  19. In regard to purchasing lab equipment for testing, is there a preference between purchasing or leasing this equipment?
    • CDC does not have a preference between purchasing or leasing lab equipment. Irrespective of whether the equipment is leased or purchased, the equipment should only be purchased or leased if the equipment is an essential part of the recipient’s plan to meet Component B requirements. The equipment must be used to test samples collected as part of Component B.
  20. Would recipients be able to roll over unspent funds from one grant year into the next to be able to purchase this equipment?
    • In previous CDC cooperative agreements, recipients have been able to roll over unspent funds from one grant year into the next to purchase equipment. For this to occur, the recipient would need to receive approval from CDC and the purchase and use of the equipment would have to directly support the recipient meeting Component B requirements. Recipients of Component B funding must start testing drug and/or drug paraphernalia samples at the beginning of Year 2 of funding.
  21. Page 33-35 of the NOFO outlines required activities with respect to drug product/paraphernalia and toxicologic testing. Regarding drug product testing, the application states that “it is not allowable to support this type [drug products and paraphernalia obtained by law enforcement to support criminal prosecutions] with Component B funds.” What if an applicant’s county does direct drug product/paraphernalia testing by local law enforcement’s forensic center? Would providing funding to the forensic center be sufficient for this component? 
    • In addition to testing drug products, applicants can propose to test drug paraphernalia (e.g., used bags containing drugs, cookers, and/or syringes) or drug residual (e.g., wipes of used drug paraphernalia).
    • A forensic center can be funded to conduct testing of samples of drug paraphernalia and/or drugs that are noncriminal. Noncriminal is defined as a deidentified sample that is not currently or previously involved in a law enforcement investigation or prosecution. If OD2A: LOCAL funds support testing of noncriminal samples and the testing program meets the requirements of Component B, the applicant has the freedom to choose the laboratory that will be funded to conduct Component B testing, irrespective of whether that laboratory also conducts testing of samples involved in law enforcement investigations and prosecutions using other funding sources.
  22. How can drug product testing occur outside of law enforcement or portable devices at harm reduction agencies? 
    • Allowable approaches include, but are not limited to, conducting laboratory testing of:
      • Drug paraphernalia, drugs, or drug residual submitted by harm reduction organizations conducting drug checking to both verify field test results and detect emerging drugs.
      • Used syringes or other drug paraphernalia obtained from harm reduction organizations.
      • Wipes of used drug paraphernalia obtained by harm reduction organizations.
      • Drug paraphernalia or drugs obtained from suspected drug overdose scenes obtained by the medical examiner and coroner as part of their death investigation.
      • Noncriminal samples obtained by law enforcement that will be destroyed by law enforcement and are not part of an investigation or prosecution.
    • Because this is a competitive announcement, CDC cannot provide specific examples of drug and drug paraphernalia testing programs currently being implemented in the United States. CDC will work with recipients to implement allowable testing programs that meet Component B requirements after funding.
  23. Is the additional funding available in Component B (page 39) a one-time lump sum for the entire 5 years or is it an annual amount?
    • Under Component B, applicants have the option to receive $100,000 – $200,000 per year over five years to “…support improvements of drug overdose death investigations by the medical examiner and coroners (ME/C) agency(ies) serving their jurisdiction.” (See Appendix 2a and 2b for more information on the budget.) Only applicants for Component B are eligible to apply for this additional funding.
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  1. Can an applicant be funded for Component B or C with a great score if they aren’t funded for Component A? Does a score in component affect scoring for the other components?
    • An applicant must be awarded Component A funding to be considered for Component B and/or Component C. Component A Phase II evaluation scores do not affect Phase II evaluation scores for either Component B or Component C.
  2. Overdose deaths were previously investigated by the coroner’s office; when a new coroner was hired, the investigations were put on hold. The local public health department plans to move the investigations in-house to be conducted by a local public health staff member- would this be an eligible partnership?
    • The optional medical examiner and coroner (ME/C) funding in Component B supports medical examiners and coroners improve their investigation of suspected fatal drug overdoses and improve data sharing between the recipient and their ME/C agency. If the local public health department’s investigations of drug overdoses support the ME/C investigation and directly inform the certification of deaths as drug overdoses, this likely would qualify for optional medical examiner and coroner (ME/C) funding. If the investigations happen independent of the ME/C and do not directly inform certification of deaths or the ME/C report on the death, these investigations would unlikely qualify for optional ME/C funding under Component B.
    • More broadly, the unit in the local public health department that conducts the investigations may be a valuable collaborator in collecting, interpreting, and/or disseminating drug product and drug paraphernalia testing. If the unit is collaborating on the plan to implement Component B drug product and paraphernalia testing, we encourage the unit to submit a letter of intent for your application and explain their role in the Component B section of your application.
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  1. If the data set for Component C includes individuals who identify as American Indian/Alaska Native (and/or live on a reservation), can this data be disaggregated and/or masked?
    • Recipients will submit aggregate data to CDC to meet Component C requirements, not individual-level data. Aggregate indicators may be stratified by demographic characteristics, including race and ethnicity. CDC recognizes the critical importance of maintaining standards of data quality, upholding individual and institutional privacy and confidentiality, and ensuring impartiality in the sharing of public health data. Across all CDC dissemination products, data suppression rules will be used to prevent possible identification through publication of tables combining characteristics that could be used to identify an individual (e.g., age, sex, race/ethnicity, and geographic location). Please see Appendix 7 for more information on data dissemination and data sharing requirements.
  2. Are there expected measures available for Component C? Or some indication of what will be measured in Component C that applicants can use to help shape the work?
    • CDC will provide funded recipients with detailed guidance and a template that lists and describes the aggregate linkage to care surveillance indicators that must be submitted to CDC. These standardized indicators will assess the stages across the cascade of care (CoC) for SUD, with a primary focus on opioid use disorder and stimulant use disorder. Indicators will include but not be limited to 1) number of individuals identified as in need of treatment at each entry point to care (see Section IV under Strategies and Activities in the NOFO for a description of priority entry points), 2) number of individuals identified during the reporting period who engaged with linkage to care program staff, 3) number of individuals identified during the reporting period who were referred to treatment (e.g., MOUD and behavioral health treatment) and other support services (e.g., harm reduction services), 4) number of individuals identified during the reporting period who were linked to/initiated treatment, and 5) treatment status 6 months after initiation, including retention and treatment interruptions.
    • Recipients are encouraged to collect individual-level data or conduct individual-level data linkages across data sources to monitor indicators across stages of the CoC (e.g., identify whether individuals identified as in need of treatment during the reporting period were linked to and retained in treatment), instead of relying on aggregate, unlinked data for each indicator.
    • Indicators may be disaggregated by key characteristics, such as primary substance used, age, gender, race/ethnicity, and county of residence. Given current challenges to collecting substance use treatment data, it is anticipated that some indicators and disaggregates will be required while others will be optional. Some optional indicators and disaggregates may become required later in the funding period.
    • Recipients will also be required to submit metadata to CDC, which may include the number and type of agencies contributing data and the percent of treatment providers contributing data.
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