CDC’s Center for State, Tribal, Local, and Territorial Support

CDC/ATSDR Funding and Technical Assistance: 

Overview for the CDC/ATSDR Tribal Advisory 

Committee

Center for State, Tribal, Local, and Territorial Support

Centers for Disease Control and Prevention

January 2020

1
 Mission: CDC protects America from health, safety and security threats, 

both foreign and in the United States 

2
Centers for Disease Control and Prevention (CDC) 

Mission

 CDC carries out its mission and fulfills its unique public health role by

– Turning science into action to protect people from public health threats

– Collecting mission critical data to inform decision-making about health threats

– Being prepared to combat any threat to the health and safety of Americans citizens, no 

matter where in the world it might first arise

– Using data to evaluate and implement the best science-based programs to improve health

– Sharing information with the public, telling them what we know, when we know it, so 

people can decide how best to protect themselves and their families

3 CDC FY2020 Congressional Justification - www.cdc.gov/budget/documents/fy2020/fy-2020-

cdc-congressional-justification.pdf
Agency for Toxic Substances and Disease Registry 

(ATSDR) Mission

 Created by Congress in 1980 to implement health-related 

sections of laws that protect the public from hazardous 

wastes and environmental spills of hazardous substances 

(www.atsdr.cdc.gov/about/congress.html)

 ATSDR protects communities from harmful health effects 

related to exposure to natural and man-made hazardous 

substances (www.atsdr.cdc.gov/about/mission_vision_goals.html)

4
Agency for Toxic Substances and Disease Registry 

(ATSDR) Mission, Cont.

 ATSDR carries out its mission and fulfills its unique public health role by

– Responding to environmental health emergencies

– Investigating emerging environmental health threats

– Conducting research on the health impacts of hazardous waste sites

– Building capabilities of and providing actionable guidance to state and local 

health partners

5
6

Comparison of CDC and IHS Characteristics 

Characteristic CDC Indian Health Service (IHS)

Mission Protect America from 

health, safety, and security 

threats, both foreign and 

in the US

Raise the health status of 

American Indian and 

Alaska Native people to 

the highest possible level

Provides or Funds Health 

Care Services 

Rarely — not CDC’s 

mission

Yes — IHS’s mission

Has Regional Service Areas 

and Regional Offices

No Yes

Population Served All US (includes US 

territories and freely 

associated states) 

American Indians and 

Alaska Natives

FY20 Program Level 

Budget

$7.97 billion $6.04 billion 
7

Comparison of CDC and IHS Characteristics, Cont. 

Characteristic CDC IHS

No. of Congressional Budget 

Lines

Hundreds Fewer than 50

Basis for Budget Structure Focus on disease and risk 

factors

Focus on direct medical care 

services, medical facilities, and 

other direct services

Stability of Budget Structure Less stable More stable

Statutory Authorities Specific 

to Tribes/Tribal Orgs

Few Many 

Funding Mechanisms for 

Tribes/Tribal Orgs

Cooperative agreements, 

grants, contracts

Cooperative agreements, grants, 

contracts, compacts 

Formal Budget Consultation No centralized/formal 

process; participate in 

annual HHS tribal budget 

consultations 

Formal structure and process as 

required by the Indian Health Care 

Improvement Act 
Informing CDC Program and Resource Strategies for 

Tribal Health

8

 CDC/ATSDR and Health and Human Services (HHS) Secretary 

Tribal Advisory Committees

 HHS budget consultations

 Other CDC consultations 

 Tribal testimony

 Listening sessions

 Federal Register Notices soliciting input

 Grantee/project input, feedback, and results

 Health data
Informing CDC Program and Resource Strategies for 

Tribal Health, Cont.

9

 Funding opportunity forecasts—talk to CDC contact

 Requests for and results of technical assistance

 National partner and other stakeholder input and feedback

 Notice of Funding Opportunity (NOFO) feedback—forecast 

phase, applicant technical assistance calls

 Tip sheet for CDC staff for writing funding opportunities that 

support tribal health and other CSTLTS technical assistance 

to do so
10

Help Wanted and Appreciated

 Continue to help CDC understand—using specific funding 

notice examples when possible—how we could have written 

the opportunity to better fit the tribal public health system 

and needs

− In terms of how eligibility written

− Programmatic approach or other content
The Federal Fiscal Year (FY)

 Timeframe

– Starts October 1 of each year

– Ends September 30 of the next year

– FY 2020 is October 1, 2019, through September 30, 2020 

 State, tribal, local, and territorial governments and other 

types of recipients have their own fiscal cycles

11
Example of Budget Formulation Timeline

 February 2020 

– President releases FY2021 budget proposal to Congress

 ~March 2020

– Federal agencies begin planning budget proposal for FY2022 and continue 

through ~January 2021

 ~February — September 30, 2020

– Congress works to develop and pass FY2021 appropriations bills by the Sept. 

30, 2020, deadline, or pass a continuing resolution, mini- or omnibus bills, or 

unfunded agencies shut down

 February 2021

– President releases FY2022 budget proposal to Congress 

• [Repeat Rest of Cycle] 12


Examples of CDC Strategic Framework Measures of 

Success

 Opioids – Reduce US drug overdose mortality by at least 15% by 2021

 Opioid Data – Reduce data delay from 3 months to 1 week for nonfatal 

opioid overdoses

 Influenza – By 2021, increase flu vaccination coverage rates among 

children to 65% and among pregnant women to 55%

 HIV/AIDS – Eliminate new HIV infections in 10 years

 Vaccine-preventable – Increase by 10% up-to-date HPV vaccination 

coverage rate in 2021 compared to 2017 (48.6%)

 Rapid Response – By 2022, triple the number of CDC rapid response 

teams and trained incident managers

www.cdc.gov/about/organization/strategic 15 -framework/index.html
Examples of CDC Measures of Success

 Vector-borne – Reduce by 75% cases of Rocky Mountain spotted fever in 

US tribal communities

 Hepatitis C – Reduce hepatitis C-related deaths by 65% in 10 targeted 

states by 2024, as a first step to a national program

 Antibiotics – Reduce by 50% inappropriate antibiotic use in outpatient 

settings by 2020

 Global – Zero countries with wild poliovirus

 Diabetes – Reduce the number of new diabetes diagnoses from 1.4M in 

2018 to 1.1M cases per year by 2025

 AMD – Increase the routine use of Advanced Molecular Detection from 

37 states (2017) to all states (2019)

www.cdc.gov/about/organization/strategic 16 -framework/index.html
Congress, May I . . . ? (Authorizing Legislation)

 Gives federal agencies the authority to operate

 Defines activities federal programs are authorized to 

perform

 Can be time-limited

 Can receive new authorities from Congress at anytime

Public health authorities are listed in the Public Health 

Service Act (Title 42 of USC)

Cited in agencies’ annual budget proposals, notices of 

funding opportunities (NOFOs), etc.

 May or may not also have appropriated funding

17
 Statement of priorities, strategies, and resource needs for upcoming 

year

 Justifies resources: How much, how will be used, how will manage, 

how will measure effectiveness; past fiscal year accomplishments

 Is a request; not necessarily what finally received 

18

CDC’s and ATSDR’s Annual Budget Request

www.cdc.gov/Budget/
FY 2020 Congressional Justification 

www.cdc.gov/budget/fy2020/congressional-justification.html
FY 2020 CDC and ATSDR Final Appropriations

 H.R. 1865 (Further Consolidated Appropriations Act, 2020)

− https://docs.house.gov/billsthisweek/20191216/BILLS-116HR1865SA-RCP116-44.PDF

− Joint Explanatory Statement (Division A) funding CDC

− https://docs.house.gov/billsthisweek/20191216/BILLS-116HR1865SA-JESDIVISION-A.pdf

− Joint Explanatory Statement (Division D) funding ATSDR

− https://docs.house.gov/billsthisweek/20191216/BILLS-116HR1865SA-JESDIVISION-D.pdf

20
FY 2020 CDC and ATSDR Final Appropriations

 Report of the Committee on Appropriations, House of 

Representatives on FY 2020 LHHS Funding Bill (HR 116-62) 

(HHS [page 36]; CDC [page 56])

− www.congress.gov/116/crpt/hrpt62/CRPT-116hrpt62.pdf

21
FY 2020 CDC Appropriations

 Total program level: $7.97 billion (increase of $636.81 million compared to FY2019)

 Major increases

− +$140 million to reduce new HIV infections

− +$85 million for the Infectious Disease Rapid Response Fund

− +$75 million for global health security

− +$50 million for the first year of a multi-year effort to support modernization of public 

health data and analytics at CDC and state and local health departments

Further Consolidated Appropriations Act, 2020 - https://docs.house.gov/billsthisweek/20191216/BILLS-116HR1865SARCP116-44.PDF and Joint Explanatory Statement (Division A) funding CDC -

https://docs.house.gov/billsthisweek/20191216/BILLS-116HR1865SA-JES-DIVISION-A.pdf

22
FY 2020 CDC Appropriations, Cont. 

 Major increases, Cont. 

− +$20 million to combat the increase in youth e-cigarette use and continue momentum 

toward reducing tobacco use among all populations

− +$12.5 million for Firearm Injury and Mortality Prevention Research

− +$10 million for addressing the Infectious Diseases and the Opioid Epidemic

− +5 million for the Section 317 Immunization Program

Further Consolidated Appropriations Act, 2020 - https://docs.house.gov/billsthisweek/20191216/BILLS-116HR1865SARCP116-44.PDF and Joint Explanatory Statement (Division A) funding CDC -

https://docs.house.gov/billsthisweek/20191216/BILLS-116HR1865SA-JES-DIVISION-A.pdf

23
FY 2020 CDC Appropriations — Tribal Highlights

 Racial and Ethnic Approaches to Community Health — The Committee includes an 

increase of $16,000,000 for Racial and Ethnic Approaches to Community Health for 

additional approved but unfunded organizations for the first year of a three-year 

cooperative agreement, with at least two additional grantees from each of the racial and 

ethnic target populations described in the funding announcement CDC–RFA–DP18–1813. 

The Committee continues funding for Good Health and Wellness in Indian Country at the 

fiscal year 2019 enacted level. (Note: $21 million) (Committee report 116-62 on HR2740) 

24

Further Consolidated Appropriations Act, 2020 - https://docs.house.gov/billsthisweek/20191216/BILLS -

116HR1865SA-RCP116-44.PDFand Joint Explanatory Statement (Division A) funding CDC -

https://docs.house.gov/billsthisweek/20191216/BILLS -116HR1865SA-JES-DIVISION-A.pdf
FY 2020 CDC Appropriations — Tribal Highlights

 Tribal Advisory Committee — The agreement encourages the [CDC] Director, with guidance 

from Tribal Advisory Committee, to develop best practices around delivery of Tribal technical 

assistance and provide an update on written guidelines in the fiscal year 2021 Congressional 

Justification. (Joint Explanatory Statement, Division A, to HR1865)

25

Further Consolidated Appropriations Act, 2020 - https://docs.house.gov/billsthisweek/20191216/BILLS -

116HR1865SA-RCP116-44.PDFand Joint Explanatory Statement (Division A) funding CDC -

https://docs.house.gov/billsthisweek/20191216/BILLS -116HR1865SA-JES-DIVISION-A.pdf
CDC Budget Structure (It’s Complicated)

www.cdc.gov/budget/fy2019/operating-plans.html 26

FY18 FY19 +/-18

Dollar 

amounts 

are in 

millions.
CDC Grant Funding Profiles

27

Dollars rounded to nearest million

www.cdc.gov/FundingProfiles
CDC Tribal Health Budget, Grants, and Funding Site

www.cdc.gov/tribal/consultation-support/funding/index.html 28
CDC Resources for Public Health Agencies

 Funding

 Assignees

 Data for action

 Workforce development resources

 Direct Assistance

 Short-Term Technical Assistance

 Communication Products 

29

www.cdc.gov/publichealthgateway/docs/healthdepartmentresources/stlt-agency-resources.pdf

www.cdc.gov/publichealthgateway/healthdepartmentresources/health-official-support.html

Don’t forget: Direct 

funding isn’t the only 

resource CDC offers to 

affect public health.
CDC Short-Term Technical Assistance

 Epi-Aid, Lab-Aid, Informatics-Aid, and Econ-Aid

 Opioid Rapid Response Teams 

 Health Hazard Evaluation

 Community Assessment for Public Health Emergency 

Response 

 Assessment of Chemical Exposures

 Public Health Law Technical Assistance

 Center for State, Tribal, Local, and Territorial Support

30 https://www.cdc.gov/publichealthgateway/healthdepartmentresources/health-official-support.html
Examples of Factors CDC Considers in Budget and 

Program Planning

 Congressional legislation, appropriations, directives, and 

priorities

 Guidance and directives including priorities and funding 

levels−from White House (through the Office of 

Management and Budget or OMB), HHS, and CDC Director 

and other CDC leaders

31
Examples of Factors CDC Considers in Budget and 

Program Planning, Cont.

 Evidence base 

– Health statistics

– Research and program results

– Known best practices and practice-based evidence

– Results of surveys of public health system

 National strategies and action plans

 Input from stakeholders (e.g., health departments, grantees, 

national organizations)

32
Communicate with CDC (and Others) Early and Often

 Community and health department status, needs, barriers, 

ideas, and success stories

 How federal (and even state and local) priorities, proposals, 

bills/legislation/regulation, and resource decisions will 

affect, or are affecting, your health department and the 

public’s health

 How CDC can improve its public health programs, activities, 

services, processes, and resourcing

33
Some Key Points in Time to Pay Attention

(“Which Way Is the Wind Blowing?” Moments)

 Release of President’s budget and federal agency budget 

materials (usually 1st Monday in February)

 Release of House and Senate budget resolutions (statements 

of priorities and intent)

 Release and markups of House and Senate bills

 Congressional press conferences

 Congressional appropriations hearings (usually webcast from 

House and Senate websites)

34
Some Key Points in Time to Pay Attention

(“Which Way Is the Wind Blowing?” Moments)

 Passage and content of final appropriations, including 

committee reports

 Release of funding opportunity announcements from federal 

agencies that put the appropriations into action

− Technical assistance webinars for potential applicants

 Initiation of accountability activities and release of those 

results

35
Communication and Collaboration

 Subscribe to CDC’s email subscription service for news and 

updates (www.cdc.gov/other/emailupdates/), Facebook 

page, or Twitter feed

– What sources of tribal information would you recommend CDC staff 

subscribe to?

 Subscribe to Grants.gov alerts for grant and cooperative 

agreement funding opportunities and FedBizOpps.gov for 

contract opportunities

36
Communication and Collaboration, Cont.

 Serve on and/or attend meetings of CDC’s advisory 

committees, provide input to committee members 

representing you, provide written statement or testimony 

(when applicable)

– CDC federal advisory committees

• www.cdc.gov/maso/facmcommitteeinformation.html

 Share lessons learned with CDC and the field

37
Communication and Collaboration, Cont.

 Communicate challenges and needs at anytime to CDC

– CSTLTS can connect you to the right person or source at CDC to help 

address your issue

– If you are a current CDC funding recipient, tell your project officer 

about any specific challenges or issues that might be improved in the 

current or funding cycle

38
www.grants.gov/web/grants/view-opportunity.html?oppId=315086 39

Forecasted NOFO
 

 

 

 

 

 

 

 

 

 

 

 

Full Eligibility for Funding 

 Applicants must meet both basic and additional eligibility requirements 

− Title: CDC-RFA-TP18-1802 - Cooperative Agreement for Emergency Response: Public 

Health Crisis Response 

− Purpose: Enhance the nation’s ability to rapidly mobilize and respond to specific public 

health emergencies 

− Eligible applicants: County governments, state governments, city or township 

governments, Native American tribal governments (federally recognized) 

− Additional information on eligibility 

− Governmental public health departments constitutionally empowered to protect 

health and welfare of their communities 

− Functional public health emergency management programs, legal authority, and 

already existing public health emergency management capacity 

− For tribal governments meeting these requirements, must serve through their own 

infrastructure a population at least 50,000 people 

www.grants.gov/web/grants/view-opportunity.html?oppId=297939 40 
Funding Application Tips

 Grant writing guidance and tips: 

www.cdc.gov/publichealthgateway/grantsfunding/grant-writing.html

 Direct assistance for assigning CDC staff to state, tribal, local, 

and territorial health agencies:

www.cdc.gov/publichealthgateway/grantsfunding/direct_assistance.html

 Expediting the federal grant process with an administrative 

partner:

www.cdc.gov/publichealthgateway/grantsfunding/expediting.html

41
Information continued at www.cdc.gov/stltpublichealth/grantsfunding/alerts.html

42
Connect with CSTLTS

 Visit Us

– www.cdc.gov/publichealthgateway

 Email Us 

– CSTLTSfeedback@cdc.gov

 Subscribe to Our Email Updates

– www.cdc.gov/publichealthgateway/news-alerts

 Like Us on Facebook 

– www.facebook.com/CDCSTLTConnection

43
For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.

Thank you!