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Centers for Disease Control and Prevention (CDC)

CDC-RFA-CE23-0005 Essentials for Childhood (EfC): Preventing Adverse 

Childhood Experiences through Data to Action

Notice of Funding Opportunity (NOFO)

Frequently Asked Questions

Questions received during the informational call

1. Question: Can the applicant only apply to base funding?

Answer: Yes, the applicant may only apply for base funding. Enhanced funding activities are optional 

under this cooperative agreement. 

2. Question: Can the applicant only apply for enhanced funding?

Answer: No. All applicants must apply for base funding. Applicants will only be considered for enhanced 

funding after Phase II review. Enhanced funding is for additional activities only.

3. Question: Can the applicant apply for based funding and only one of the activities within the enhanced 

funding criteria?

Answer: Yes, the applicant may apply for one, two, or three additional activities listed within each goal of 

the award (see Strategies and Activities Section of the NOFO; page 9). Funding for enhanced activities will 

be considered up to $85,000 during Phase II review. 

4. Question: For this NOFO, are we limited to the common list of adverse childhood experiences (ACEs), 

or can we go beyond that to additional forms of ACE? 

Answer: Applicants may consider including other ACEs beyond the traditional measure of ACEs. For 

example, historical traumas, experiences of racism, bullying, teen dating violence, peer-to-peer violence, 

witnessing violence in a community or school, homelessness, and the death of a parent, are some 

experiences not included in the traditional measure of ACEs. While applicants may go beyond the 

traditional measurement of ACEs, applicants must include the core ACEs items as part of their youthbased surveillance efforts no later than 2025, as noted in the NOFO, pages 10-11.

5. Question: What if our State does not conduct the Youth Risk Behavior Survey (YRBS)? Do we still 

qualify? 

Answer: Yes, another equivalent state-representative survey of adolescents will be accepted and 

considered if YRBS is not implemented in your State, or another adolescent statewide survey is available.

6. Question: There were mainly references to adolescents and the use of the YRBS. Is this the scope of the 

target for this award? 

Answer: To date, it has been challenging to assess the incidence and prevalence of ACEs experienced by 

youth and adolescents –because the best surveillance data currently available for ACEs are collected 

retrospectively among adults. Therefore, one of the goals of this NOFO is to get a better understanding 

of ACEs prevalence among youth. As such, the NOFO calls for ACEs data collection through YRBS or

other statewide youth surveys. Additional methods of data collection are also part of the cooperative 

agreement (see pages 9-11) 
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7. Question: If YRBS is administered in my state/community, should I leverage this surveillance system?

Answer: Contingent upon funding, the Division of Violence Prevention and the Division of Adolescent 

and School Health within the CDC intend to continue offering financial incentives to YRBS sites that

include ACE questions on their surveys. We encourage recipients to inquire about how this YRBS 

information on ACEs may help them to leverage resources to advance the goals of the NOFO. States 

may also leverage the YRBS by including items about ACEs and Positive Childhood Experiences (PCEs) 

without additional supplemental funding from CDC if they wish to do so. Applicants should work with 

the YRBS coordinator in their State to leverage this surveillance system.

8. Question: What youth-based surveillance data can be used to link to social determinants of health data 

as part of the optional enhanced activity? 

Answer: Recipients who apply for enhanced funding to link youth-based surveillance data on ACEs and 

PCEs with data on the social determinants of health must have data on the core ACEs (as listed on pages 

10-11 of the NOFO) included in their state-representative youth-based surveillance system in a data 

collection cycle that occurred during or prior to 2023. Data must be from a youth-based surveillance 

system that provides information on the core ACEs described in the NOFO. PCEs do not have to be 

included in the youth-based surveillance system prior to 2023 to be eligible for enhanced funding. 

Recipients should work with their jurisdiction's administrator for the YRBS or other youth-based 

surveillance system that includes data on ACEs to determine how to conduct the linkage and the 

feasibility of doing so. Recipients who request this funding should provide information about their 

capacity and ability to conduct this work in the application. 

9. Question: Are city agencies eligible? 

Answer: The following organizations are eligible to apply:

• State, county, and city or township governments

• Native American tribal governments (federally recognized) 

• Native American tribal organizations (other than federally recognized tribal governments) 

• Public housing authorities and Indian housing authorities

• Public and state-controlled institutions of higher education 

• Private institutions of higher education

• Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education

• Nonprofits without 501(c)(3) status with the IRS, other than institutions of higher education

• Small businesses

More information can be found in the notice of funding announcement (NOFO) under the section 

Additional Information on Eligibility.

10. Question: Is the State Action Plan required to be submitted as a part of the application? What type of 

info is usually included in the state action plans?

Answer: A state action plan is a required document that must meet the requirements of the NOFO. It 

must be an existing statewide plan that expresses a shared vision to promote safe, stable, nurturing 

relationships and environments for children with strong cross-sector public and private commitments. 

11. Question: Is data collection and analysis expected, or just assistance with building a data collection 

system? 
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Answer: This NOFO has three required foci, one being to enhance or build the infrastructure for the 

state-level data collection, analysis, and application of ACE-related surveillance data that can be used to 

inform and tailor ACE prevention activities. The work of these foci, and the infrastructure and expertise 

exerted to accomplish that work, should be interdependent and planned and implemented as part of a 

comprehensive and coordinated ACE prevention dynamic system.

12. Question: It is limited to 12 awards, and will that be 12 different recipients, or could one recipient be 

awarded all 12 cooperative agreements?

Answer: The expected number of awards is up to twelve recipients. Funding will be determined in 

accordance with the information described in the Phase II Review section of the NOFO. CDC will fund 

recipients based on the evaluation scores of complete, eligible applications in accordance with the criteria 

indicated throughout the NOFO.

13. Question: Is there a specific format or set of questions that must be answered in the Letter of Intent? 

Answer: The Letter of Intent is a notice to the funding agency that the recipient intends to apply for the 

NOFO. There is not a specific format for this letter, and it is optional.

14. Question: Evidence-based and best available evidence is used in the NOFO. Is the requirement that the 

programs, policies, and practices implemented are evidence-based or that they be based on the best 

available evidence? 

Answer: Funded recipients are required to implement at least two out of the five core prevention 

strategies identified: 

1. Strengthen Economic Supports to Families 

2. Promote Social Norms that Protect Against Violence and Adversity

3. Enusre a Strong Start for Children

4. Teach Skills

5. Connect Youth to Care Adults and Activities

The definition of best available evidence described in this NOFO refers to the list of policies, programs, 

and practices outlined in 'CDC's ACEs Resource document entitled, ”Preventing Adverse Childhood 

Experiences: Leveraging the Best Available Evidence". CDC will provide oversight and guidance to 

recipients regarding the appropriateness of specific policies, programs, and practices selected within each 

strategy. While we encourage innovative approaches to preventing ACEs, these approaches must be 

evidence-informed and have demonstrated efficacy. 

15. Question: Can recipients use the funding to expand a prevention program NOT included in the 

technical package? 

Answer: Yes. If an alternate prevention program not included in the technical package is preferred, 

recipients may implement and evaluate this program. However, funded recipients are required to 

implement at least two core prevention strategies that have the potential to achieve population-level 

impact as implemented. Specific policies, programs, and practices selected for implementation within 

each strategy must be evidence-based. CDC will provide oversight and guidance to recipients regarding 

the appropriateness of specific policies, programs, and practices selected within each strategy. 

16. Question: NOFO indicates a local-state data infrastructure for sharing and using data for prevention 

strategies. Should evaluation focus on the two required prevention strategies and progress on the data 

infrastructure?
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Answer: The evaluation should focus on assessing the process and outcomes of the collective activities 

of the NOFO initiative. This includes identifying and tracking indicators related to the implementation of 

ACE surveillance infrastructure and prevention strategies selected by the recipients. It also includes 

identifying and tracking indicators that measure the outcomes of the selected prevention strategies and 

other outcomes specified in the NOFO logic model. Please refer to the Performance and Evaluation 

Measurement Strategy section of the NOFO for more information about the evaluation. 

17. Question: Can you explain a bit more about what you want to see in outcomes? 

Answer: Applicants must clearly identify the outcomes they expect to achieve by the end of the project 

period. Once funded, recipients are expected to achieve short- and intermediate outcomes by the end of 

the project period, as identified in the logic model in the Approach section of the CDC Project 

Description. Outcomes are the results the program intends to achieve and usually indicate the intended 

direction of change (e.g., increase or decrease).

18. Question: On page 13 the NOFO states “An essential part of implementing a comprehensive approach 

to preventing ACEs involves the funded entity serving as a convener and coordinator of multi-sector 

partnerships focused on ACE prevention. As such, recipients are expected to build partnerships with 

other relevant stakeholders within the State (e.g., data managers, education sector partners, tribal 

healthcare workers, non-governmental youth-serving and family-serving organizations, policymakers, 

healthcare providers, local health departments, statewide domestic violence coalitions) to successfully 

execute the requirements of this funding announcement." Can you elaborate on the role of convener and 

coordinator?

Answer: As part of the convener and coordinator role, funded entities are expected to engage and 

coordinate with public and private sector partners in implementing these strategies within the State. Cross

multi-sector partnerships and resources are required to support the implementation and sustainability of 

comprehensive ACE prevention efforts. The multi-sector collaborative entity should seek to prevent 

ACEs and include representation from sectors that support work in the community, including, but not 

limited to, education and youth-serving agencies, family and social services, civic, public safety and 

juvenile justice, mental health, labor, faith-based, healthcare, government, media, and business 

organizations.

19. Question: What is a comprehensive approach to preventing adverse childhood experiences (ACEs)? 

Answer: For the purposes of this NOFO, a comprehensive approach to ACEs prevention is 

characterized by the following activities: 

1) Prioritizing data to build/enhance an ACEs surveillance infrastructure that will support access to 

and analysis of ACEs surveillance and indicator data within the State to inform primary prevention 

activities/efforts and assess the impact of such activities/efforts.

2) Implementing ACEs primary prevention strategies.

3) Conducting foundational activities that promote data to action. 

4) Collaborating with other CDC programs, CDC-funded programs and organizations, and 

organizations not funded by CDC. 

20. Question: Will late applications be accepted due to COVID-19? 

Answer: You will find guidance about COVID-19-related delays on the CDC grants website: 

https://www.cdc.gov/grants/public-health-emergencies/covid-19/faqs/index.html. 
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The website states that when a delay occurs because the applicant or recipient is directly impacted by 

COVID-19, CDC will consider extending the application due date beyond the date specified in the 

NOFO on a case-by-case basis, in accordance with the Department of Health and Human Services 

(HHS) Grants Policy Statement on submitting application page I 25 and 26. Please submit your request 

to extend the NOFO deadline to the assigned grants management specialist/program official noted in the 

Notice of Funding Opportunity under Agency Contacts before the NOFO closing date. Your request 

should include enough detail about the delay so that CDC can determine whether circumstances justify 

extending the NOFO application submission deadline. 

21. Question: What does the word "complementary" mean in focus two? 

• Complementary to each other? 

• complementary to existing initiatives? 

• other? 

Answer: Complementary in the NOFO refers to the two strategies or approaches complementing each 

other. For example, if an applicant chooses the strategy ”Strengthening Economic Supports" by assuring 

that eligible families are enrolled in Supplemental Nutrition Assistance Program (SNAP), their other 

chosen strategy, "Promote Social Norms Change" may address destigmatizing seeking help from

assistance programs. 

22. Question: If you are contracting with an entity to conduct a specific function, is a memorandum of 

understanding (MOU) still required?

Answer: The applicant determines the agreement type in accordance with its organizational policy. The 

agreement should explicitly articulate each party's role, function, and responsibility as it relates to the 

CDC-RFA-CE23-0005 NOFO. 

23. Question: Do we need to submit a certain number of MOUs/letters? 

Answer: There is no definite number of MOUs/letters that must be submitted (refer to NOFO 12, b. 

With organizations not funded by CDC). 

24. Question: Is CDC assistance with logic models intended for after funding is awarded?

Answer: Yes, CDC will be providing guidance materials about refining the logic model after funding is 

awarded. You can also find additional resources in the NOFO. 

25. Question: If our organization is the administrator of our youth-based surveillance system that includes 

ACEs, do we still need to submit a MOU/MOA? 

Answer: Yes, if the applicant is the administrator for the Youth Risk Behavior Survey (YRBS) or 

intended surveillance equivalent in the jurisdiction, please submit a letter of evidence stating this. Please 

see question 26 below for the additional content that should be provided in the letter of evidence.

26. Question: What should be included within the MOU/MOA with the youth-based surveillance system 

partner?

Answer: The following information should be included in the MOU/MOA:

• A description of the youth-based surveillance system, including survey name, data collection cycle, 

and age of respondents. 
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• Describe, if any, adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) 

that were included in previous survey cycles. Please identify data elements that are outlined in 

Table 1 of the Strategies and Activities section of the NOFO. Inclusion of additional optional 

ACEs and PCEs elements may be described but should be distinguished from the core ACEs data 

elements. If data are not available, please describe this. Note: youth-based surveillance data on ACEs and 

PCEs are not required to be collected prior to 2025; this information is requested to understand available data at 

time of award. However, applicants without these previous data will still be considered responsive to the NOFO 

requirements and are eligible for potential award.

• A description of the core ACEs to be included in the youth-based surveillance system no later than 

the 2025 data collection cycle. Please explicitly identify data elements that are outlined in Table 1 of 

the Strategies and Activities section of the NOFO. Inclusion of additional optional ACEs elements 

may be described but should clearly be distinguished from the core ACEs data elements.

• Plans for continued monitoring of the core ACEs in ongoing data collection cycles throughout the 

period of performance. Please explicitly identify data elements that are outlined in Table 1 of the 

Strategies and Activities section of the NOFO. Inclusion of additional optional ACEs elements 

may be described but should clearly be distinguished from the core ACEs data elements.

• Plans to include at least one new PCE item in data collection cycles throughout the period of 

performance. Please explicitly identify data elements that are outlined in Table 1 of the Strategies 

and Activities section of the NOFO. Inclusion of additional optional PCEs elements may be 

described but should clearly be distinguished from the core PCEs data elements.

• Agreement to share youth-based surveillance data with CDC's Division of Violence Prevention 

throughout the period of performance. Data should be shared at the time of data availability to 

best inform technical assistance and data to action planning for the cooperative agreement. 

27. Question: One State that we are looking to partner with participated in the 2021 Middle School Youth 

Risk Behavior Survey (YRBS) and is denoted as having conducted a representative state survey on the 

YRBSS website. If the State continues to conduct this same survey, would this count as an eligible statelevel, jurisdiction-wide survey of adolescent for purposes of this RFA?

Answer: To be eligible for NOFO funding, recipients will use a state, territorial or tribal Youth Risk 

Behavior Survey (YRBS) or equivalent state-level jurisdiction-wide survey of adolescents to collect ACEs 

and PCEs data (see page 11). The hallmark Youth Risk Behavior Surveillance System (YRBSS), which is a 

set of Youth Risk Behavior Surveys, tracks behaviors that can lead to poor health in students grades 9 

through 12. The inquirer is correct that states, districts, territories, and tribes (collectively referred to as 

’sites" ) that conduct YRBS at the high school level have the option of also conducting the survey at the 

middle school level. However, to be eligible for the EFC funding, recipients must use a state-level 

jurisdiction wide-survey of adolescents. While there is not one definition of adolescent, this period is 

often thought of, including those aged 12 or 13 years to up to 18 years of age. Given that many middle 

school students are pre-adolescent and the use of surveys focusing on this age range alone would not 

include most of the adolescent age range, using only a jurisdiction-wide survey of middle school students 

would not meet eligibility criteria. The use of data on adolescents is critical given that experience of 

adversities increases with age, and that cognitive testing has demonstrated that there may be 

comprehension issues with asking ACEs items among middle school-aged children. However, if the 

recipient would like to use jurisdiction-wide surveys that include information on children and adolescents 

(i.e., data are collected from middle and high school students), this would be an eligible data collection 

strategy. 
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28. Question: Do all the core ACEs listed in the cooperative agreement have to be assessed using a youth 

report or can a combination of official records and youth report be used to assess ACEs?

Answer: All the core ACEs included on pages 10-11 should be included in a jurisdiction-wide youthbased surveillance system by the 2025 data collection cycle as part of the cooperative agreement. While 

recipients can use additional data from official records as part of the cooperative agreement to bolster 

their data collection efforts, administrative records cannot be used instead of youth-based surveillance. 

29. Question: What factors are assessed when determining if a survey is "equivalent" to YRBS?

Answer: The survey itself, and its data collection features, will vary on a state-by-state basis. There are 

three components to consider. First, data must be collected from children or adolescents (i.e., a focus on 

collecting data from those <18 years of age but including information on adolescents). Please note that 

we are aware that many surveys of high school students include adolescents who are aged 18 (i.e., high 

school seniors); this is acceptable given that the focus of these data collection is on adolescents (i.e., the 

focus is not on young adults). This is the most critical requirement. Second, it should be a statewide 

representative survey. For example, I'm in the State of Georgia. A YRBS-equivalent survey here should 

collect data from across the State, and not focus specifically on Atlanta, as that would not represent the 

entire jurisdiction. Recipients may use additional region-specific data collection as part of the cooperative 

agreement, but this must be in addition to and not instead of jurisdiction-wide youth-based surveillance 

data. Third, the survey should be able to be used to monitor trends in ACEs over time. That is, it should 

have data collection features that allow for it to be used to generate statistics about the prevalence of 

ACEs in the State and whether ACEs are stable or change year over year. 

30. Question: Does our State's youth survey need to include all 8 ACE's questions indicated by YRBS or is 

there flexibility on question wording and how the ACE's scale is constructed?

Answer: All the core ACEs included on pages 10-11 of the NOFO should be included in a jurisdictionwide youth-based surveillance system by the 2025 data collection cycle as part of the cooperative 

agreement. While we recommend aligning your question wording with that from the YRBS, as these 

items have been cognitively tested to ensure that they capture the intended ACE and are well-understood 

by adolescents, you do not have to use the exact wording in your surveillance system. We have included 

the wording in the cooperative agreement from YRBS to help you identify the concepts of interest, but if 

you have specific questions about individual items, please request assistance from CDC. Please note, 

however, that if your jurisdiction receives supplemental funding from the Division of Violence 

Prevention (DVP) via the Division of Adolescent and School Health’s YRBS cooperative agreement to 

add ACEs and/or PCE items to the YRBS, then the exact wording of the YRBS items as noted in the 

NOFO must be used unless changed or otherwise noted by ' 'CDC's DVP. 

31. Question: The NOFO says "monitor indicators of ACEs using near real time data" and "utilize state 

level youth-based ACEs and PCEs surveillance infrastructure". What do you consider to be near real time 

data and what types or limitations on "surveillance infrastructure" are expected?

Answer: There is not one specific definition of near-real time. We typically consider it to be anything that 

has a data lag of less than 6 months. For the purposes of the cooperative agreement, near-real time data 

needs to be a data source that provides more timely information than what we have from surveys (i.e., 

data that are available 1-2 years following data collection). Some types of data sources could be
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emergency department syndromic surveillance or hotline data, or from other type of data collection

where data are routinely available from <6 months prior. 

Please see NOFO page 10-11 for a description of youth-based surveillance infrastructure as well as Q&A 

specific to youth-based surveillance data.

All data sources have limitations. Some near-real-time data may just be indicators of adversities. For

example, syndromic surveillance data are typically chief complaint and discharge diagnosis-coded data 

from emergency department visits. With hotline data, these are data about people seeking or requesting 

help. In both instances, this is the tip of the iceberg in terms of the experience of ACEs, but they are 

much timely than other data sources. This is why we pair these data with more traditional, self-report 

approaches that collect data from children and adolescents. As part of the fourth strategy under Goal 1 

of the NOFO (see page 11), we encourage recipients to use a triangulated data approach that uses 

statewide youth-based surveillance data and then builds on these data by incorporating additional types of 

data from near-real-time sources, administrative sources, or other surveys to help build a more 

comprehensive picture of ACEs and PCEs in your jurisdiction. No one data source can give us 

everything we need to inform our prevention strategy planning. We encourage recipients to think

carefully about multiple data sources that they can use to help build and support their surveillance 

infrastructure with this in mind. 

32. Question: Is a combination of the YRBS for state level ACEs with a smaller number of ACEs being 

collected at the more micro-regional level for targeted prevention be an acceptable strategy. 

Answer: All core ACEs listed on pages 10-11 of the NOFO that are required as part of youth-based 

surveillance efforts must be included in the same survey; the core ACEs items cannot be split across 

multiple surveys. Please note that the requirement for the NOFO is to collect the core ACEs in the 

YRBS or a youth-based equivalent. States that have a YRBS may utilize either the YRBS or another 

similar survey (see the response to FAQ regarding what characteristics define an equivalent survey). If a 

recipient has a youth-based survey in their jurisdiction that provides macro jurisdiction-wide estimates 

and estimates for micro-regional level efforts, they are welcome to include the core ACEs in this survey 

to satisfy the youth-based surveillance requirement. Recipients may include ACEs items in other surveys 

at their interest, beyond the NOFO requirement to include the core ACEs in a jurisdiction-wide youthbased surveillance system.

33. Question: If you are a primarily online-national organization, which YRBS do you best recommend? Or 

is it best to collaborate with a specific partner state to localize data?

Answer: Please utilize the State where your organization resides (i.e., the State you file taxes in). 

34. Question: Can CDC provide an exemption to the 99-question maximum in the YRBS web-based 

questionnaire to accommodate the ACEs items and other program questions?

Answer: The YRBS is funded by ' 'CDC's Division of Adolescent and School Health (DASH). ' 'CDC's 

Division of Violence Prevention, which administers the EFC program, are very close collaborators with 

DASH. While it is not possible to request a global exemption to the 99-question maximum, there are 

several options that jurisdictions may consider obtaining an exemption to the 'YRBS' 99-question 

maximum. Since 2019, DASH has allowed state and local YRBS coordinators to administer their survey 

electronically (e.g., on school laptops) if they are approved through an application process. Sites that use 
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electronic data collection are allowed to exceed 99 questions on their YRBS. In addition, sites that 

administer their surveys on paper can exceed 99 questions if they use their own answer sheets and scan 

their own data. Sites using electronic data collection with paper backup must also use their own answer 

sheets and scan their own data. Recipients of EFC should work with their 'jurisdictions' YRBS 

coordinator to consider the feasibility of these options and whether an exemption to the 99-question 

maximum is necessary to incorporate ACEs and PCE items. Funding from DVP through EFC or via 

YRBS supplemental funds to add ACEs/PCEs items may be used, if available within the requested 

budget, to support the costs incurred by these exemptions. 

35. Question: What do you consider a "comprehensive ACEs and PCEs surveillance system" as identified in 

Goal 1?

Answer: In terms of this cooperative agreement, the first core component is having a base of a youthbased surveillance system that includes data on the core ACEs and PCE(s). From there, how we define a 

comprehensive system is flexible, but it is one that layers in additional forms of data, such as local-level 

survey data, administrative data, and/or near-real-time data. These triangulated data should help your 

jurisdiction understand the complex picture of ACEs and PCEs among children and adolescents in your 

jurisdiction and use these data to inform prevention strategies. There is no a specific requirement about 

the number of data sources you must use to be considered comprehensive. We encourage you to think 

strategically about what data sources are available to you within your jurisdiction, and which may be 

useful for you to incorporate to inform your prevention strategy implementation. 

36. Question: Would CDC conduct IRT analysis on the YRBS items to create an ACES score excluding 

sensitive questions like sexual abuse?

Answer: The ACEs items were first included in the 2021 YRBS in selected states. These data very 

recently became available, and CDC intends to conduct methodological and empirical research to better 

understand item response and scale construction for the ACEs items in the youth population. Extensive 

prior work has been undertaken by CDC and the scientific community to understand ACEs scale 

construction among adults, which has informed ongoing work in applying the science of ACEs to data 

collected among youth. 

37. Question: How will youth-based surveillance data be shared with CDC?

Answer: For recipients that use the State or local YRBS as their ACEs and PCEs youth-based 

surveillance system, data will be shared internally within CDC without additional data sharing needed by 

the EfC recipient or their partners. This is made possible through a combination of existing data-sharing 

agreements and the requested MOU/MOA/LOS for the EfC NOFO between the EfC recipient and the 

agency conducting YRBS in that jurisdiction. More specifically, CDC's Division of Adolescent and 

School Health (DASH) has a data management plan in place as part of cooperative agreement PS18-

1807, which runs through July 31, 2024, that supports data sharing and governance between CDC and 

each agency conducting YRBS. CDC's DASH and Division of Violence Prevention (DVP) will 

collaborate under subsequent YRBS cooperative agreements during the duration of EfC to ensure 

processes for the appropriate and allowable sharing of YRBS data are in place. By further providing an 

MOU/MOA/LOS as part of the EfC NOFO application that specifies YRBS data can be shared 

between the EfC recipient and jurisdictional YRBS administrator, this collectively allows for data sharing 

between the three engaged entities: CDC, the EfC recipient, and jurisdictional YRBS administrator. 

CDC's DASH and DVP will collaborate to ensure appropriate data governance and access in accordance 
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with all applicable DASH YRBS policies and will provide additional information about these processes 

upon funding. 

For recipients that do not elect to use the YRBS or do not have a YRBS in their jurisdiction, CDC will 

collaborate with EfC recipients upon funding to obtain the necessary data-sharing agreements and 

determine appropriate data-sharing processes. Recipients in this category should still include an 

MOU/MOA/LOS with the administrator of their chosen youth-based surveillance system that specifies 

ability to share data when it is available by the administering agency for use. Additional discussion will 

occur upon funding regarding data sharing timelines and protocols.

38. Question: Are individuals able to apply?

Answer: The list the eligible applicants can be found on page 35 of the NOFO. 

39. Question: Page 19 of the NOFO says to upload a PDF attachment to the application with the file name 

MOUs/MOAs/letters of support but Page 30 instructs to name the attachments Letter of Support with 

the 'partner's name and upload as a PDF file." Can you confirm if this should be one or multiple files and 

what the file’s name should be?

Answer: Please submit multiple files and include the partner's name. For example, Letters of Support

YRBS

40. Question: Can you please confirm if a "Data Management Plan" needs to be included with the drafted 

Evaluation & Performance Measurement Plan?

Answer: Yes, the Evaluation and Performance Management Plan includes a Data Management Plan.

Data Management Plans are living documents and may be updated throughout the cooperative 

agreement as data sources and plans for analysis and storage evolve.

41. Question: Will the slide set be available after the zoom meeting for participants and applicants?

Answer: Yes, the recording, slides, and FAQ document will be available after the call. The following 

webpage will have this information Essentials for Childhood (EfC): Preventing Adverse Childhood 

Experiences through Data to Action |Violence Prevention|Injury Center|CDC

42. Question: Many areas talk about specific activities can be done with technical assistance from CDC. So 

you can simply state in the application we will decide the best route in collaboration with CDC?

Answer: CDC will provide technical assistance to all recipients post-award. However, please submit a 

work plan inclusive of your planned activities for surveillance, prevention strategy implementation, and 

data to action. 

43. Question: The word "can" ise being used for several goals. What is mandatory versus optional in terms 

of the goals?

Answer: Yes, goals one, two, and three are required. The optional enhanced activities we discussed under 

each goal are optional. The goals, strategies, and activities listed in the logic model are required unless it 

has an asterisk next to it. And so those are the optional enhanced activities.
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44. Question: The scope of our current PACE:D2A activities had to be scaled back due to the impact of the 

pandemic and staff turnover. Because of these challenges, we have modified our current workplan, logic 

model, and evaluation plan. If, as part of our application under this NOFO, we wanted to propose to do 

some of the activities that we originally proposed under the PACE:D2A cooperative agreement, but had 

to discontinue, would that be acceptable?

Answer: Yes. However, you must explicitly state in your application that these are new activities under a 

current strategy already being implemented. that were not completed. Current Preventing ACEs: Data to 

Action (CE20-2006) recipients must demonstrate that they are 1) implementing new strategies that are 

not currently being funded by CDC CE18-1803 or CE20- 2006 funds; 2) implementing new approaches 

under the strategies they are already implementing, or 3) substantially expanding a strategy already being 

implemented under current funding (e.g., expanding reach within the State, implementing in different 

locales, and/or targeting a new population with high burden of ACEs).

45. Question: The material that I was introduced to in 2020 as an intro to ACES and on which I have built 

my content, the definition and age range says ACES happen between 0 and 18 years of age, but in the 

NOFO document it says 17. It appears this could be a discrepancy that might cause problems in planning 

and execution. Can you tell me for sure the latter age and maybe when it changed from 18 to 17?

Answer: CDC defines ACEs as preventable, potentially traumatic events that occur in childhood and 

adolescence (aged 0-17 years). Please note that in terms of the youth-based surveillance components of 

the award, we are aware that many surveys of high school students include adolescents who are aged 18 

(i.e., high school seniors); this is acceptable given that the focus of these data collection is on children and 

adolescents (i.e., the focus is not on young adults).

46. Question: Can you clarify whether the budget ceiling is inclusive of indirect costs?

Answer: Yes, the budget ceiling is inclusive of indirect cost. Please see page 43 of the NOFO for more 

information on how to develop your budget narrative.

47. Question: When you say focused on health equity it assumes you need to identify areas that do not have 

health equity not at the state level. Moreover, goal 1 will not be completed in time to get a statewide 

intervention running with fidelity. What is the expectation here?

Answer: Our intent is to focus on health equity and for you to include health, equity within your work 

and within the prevention strategies and approaches you're implementing. We want you to use the data 

you collect in goal one to inform your prevention strategies and how you can be intentional about your 

health equity work. Again. This is a 5-year cooperative agreement. We know there are limitations to this 

program as there are any programs, especially if we're trying to implement societal and community-level 

change. The hope is to move the needle forward in preventing ACES and be intentional about what we 

do to implement data to action. We must focus on using our data to action and being very intentional 

about our health equity work.

48. Question: How does mentoring and socioemotional learning prevent kids from experiencing ACES? It 

is more of a mitigating factor which you say is not part of this proposal? The CDC's Preventing Adverse 

Childhood Experiences: Leveraging the Best Available Evidence document includes detailed information 

on the ACEs strategies and approaches (see page 13).
12

Answer: You need to do both two statewide implementation strategies and two local strategies if you 

already have data to do targeted and more economically efficient interventions. As part of the 

requirements of the cooperative agreement you are to implement 2 strategies and approaches that are

outlined in the CDC's Preventing ACEs Best Available Evidence document on a Statewide 

Implementation. If you choose to apply for additional funding or additional enhanced activities, you will 

also be required to provide 2 implementation strategies and approaches. If you choose to do local level 

implementation, you can choose not to do local level implementation, but you can choose not to apply 

for those additional activities. Maybe 2 or 3 years into the cooperative agreement, you decide that you 

have the resources and capacity to try to implement something at the local level. That's fine, and you are 

allowed to do that if you're meeting the minimum requirements of the cooperative agreement. However, 

in terms of the application, you only have to do the 2 required state level implementation of the strategies 

in approaches. If you have the capacity now and your organization decides to apply for those additional 

funds to do local level implementation you can do so. 

49. Question: The intervention has to be across the State as defined by what? Every county? There are not 

enough funds to support a true statewide implementation.

Answer: If you reference the ACEs best available evidence document, it lists all the activities under 

strategies and approaches on how states can do that. These are not necessarily interventions. These are 

strategies and approaches that we know based on the best available evidence that has the bandwidth to 

really reach more statewide targeted populations. We encourage you to utilize that document to inform 

your applications. 

50. Question: Do applicants need to propose a project that addresses all three goals? Or can we propose a 

project that addresses individual goals?

Answer: All three goals will need to be addressed with this cooperative agreement. More information on 

the goals can be found under the Strategies and Activities section starting on page 9. 

51. Question: ACES are diverse. Is it acceptable to do prevention activities to target specific ACES? Also, 

how do PCEs fit into the intervention goals? 

Answer: We encourage you to do prevention activities to target specific ACEs. Current recipients used 

their specific information about individual types of ACEs to inform their prevention strategies. It's one 

of the reasons that we include the core ACEs in the cooperative agreement, and then recommend that 

recipients use that the specific type of basis as well as the key middle of a score to drive there are 

prevention, strategy implementation, because, as you mentioned, there may be specific needs depending 

on the type of ACEs that are most common within your jurisdiction. We do encourage folks to think 

about whether there are specific prevention strategies that align with the best available evidence, tool 

based on the data that you have available. Also recognize that many prevention strategies for ACEs do 

have universal impact, and they are custom. In terms of the PCEs data, we know that PCEs are 

specifically aligned with the number of the prevention strategies. Oftentimes monitoring of PCEs can 

help us better understand the impact of the prevention strategies that we're having, because they can 

directly align with creating a strong start for children or creating positive relationships and by monitoring 

PCEs, we can also understand whether those prevention strategies are supporting and improved in those 

relationships for children and families. You can think creatively and critically about how you use your 

PCEs data. For example, really promoting those positive social norms, understanding, maybe where 
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those positive norms within your PCEs, each data are not being. You know, the data is low prevalence of 

that PCEs. You can utilize a public education campaign to promote positive social norms about help 

seeking behaviors that support relationship building and the importance of having a strong connection 

with an adult. We encourage you to think creatively about that and we can help you post-award to ensure

that you're targeting your messaging and making sure that you're implementing the strategies and 

approaches effectively.

52. Question: If applying for enhanced, do all optional activities need to be completed? If we can choose 

which activities, what is the budget breakdown?

Answer: You can apply for 1, 2, or all 3 of the optional enhanced activities and if you apply and receive 

funding for the one, then that would have to be completed. If you apply for 2, receive funding for 2, then 

both of those would need to be included and completed.

53. Question: The NOFO states “Applicants applying for the enhanced activities must have core youthbased ACEs surveillance data (as defined by CDC) in a survey administered during or prior to 2023.” Are 

core ACEs surveillance data the 8 core ACE questions on YRBS? Do you need to also have the specific 

PCE data collected prior to 2023? 

Answer: Applicants applying for the enhanced activities must have youth-based surveillance data on 

ACEs in a survey administered during or prior to 2023. The core ACEs as defined by CDC for youthbased surveillance are the 8 questions included on pages 10-11 of the NOFO. Recipients do not have to 

have youth-based PCE(s) data collected during or prior to 2023 to apply for enhanced funding. 

54. Question: How much additional funding is available for doing each of the optional activities? The

cooperative agreement provides a 400k floor and 480k ceiling without specific discussion of what is 

available for supplemental activities.

Answer: The award ceiling is $485,000. Page 44 of the NOFO states that “the budget should include the 

requested funding amount for each enhanced activity.”

55. Question: Regarding Goal 2: On page 14 of the NOFO, recipients are instructed to select two strategies 

and approaches from Table 2 in the CDC's Preventing Adverse Childhood Experiences: Leveraging Best 

Available Evidence. The tables and figures are not labeled by number in this document. Can you please 

confirm that the table we should be selecting these strategies and approaches from is a table on page 9 

titled "Preventing ACEs"? 

 

Answer: Yes, Table 2 is on page 9 and where you should be selecting strategies and approaches from.

56. Question: Is the Enhanced $80,000 total of $85,000? The NOFO says $85,000 but I thought I heard 

$80,000 today?

Answer: The funding for optional enhanced activities is $85,000 and not $80,000.

57. Question: What is a statewide approach? And what is a local approach? 

Answer: One statewide example could be a public education campaign on positive social norms. The 

public education campaign would take into consideration that help-seeking among parents is something 
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that communities may need assistance with. The campaign would be conducted across the State in 

multiple cities. A local approach would focus, based on the highest need, on specific towns or 

communities. 

58. Question: If we had a statewide campaign around helping behaviors but then we had community 

members modify the campaign, making sure that it really speaks to the diverse communities in different 

areas. Would we still consider that statewide?

Answer: Yes, it would be considered statewide (and a good example of utilizing data for action). It would 

also be helpful to make clear that the campaign is both statewide and also focuses on specific diverse 

communities. 

Questions received after the informational call

59. Question: We are hoping to apply for CDC-RFA-CE-23-0005, Essentials for Childhood (EfC): 

Preventing Adverse Childhood Experiences through Data to Action which is due on 06/12/2023. The 

date for submission of Letter of Intent (LoI) has passed. Are we therefore precluded from applying 

without having submitted the LoI? 

Answer: The letter of intent (LOI) was requested, but not required as part of the application for this 

NOFO (see page 40).

60. Question: For the CDC-RFA-CE-23-0005 Essentials for Childhood (EfC): Preventing Adverse 

Childhood Experiences through Data to Action, the due date for the optional Letter of Intent (LOI) is 

listed as May 9, 2023, in the NOFO and on your website. In the slides from the informational webinar, 

the due date for the optional LOI is listed as May 22, 2023. Does this reflect a change in the due date 

allowing us to send in an optional currently?

Answer: The due date for the LOI was May 9, 2023 (see slide 49). EfC NOFO Informational Call 

Presentation (cdc.gov)

61. Question: In the slides for the webinar the due date for proposal submission is listed as June 13, 2023. 

Does this reflect a change in the due date for submission? The NOFO and website State the due date for 

submission is June 12. 

Answer: The due date for the NOFO is June 12, 2023, 11:59pm EST (see slide 49). EfC NOFO 

Informational Call Presentation (cdc.gov) 

62. Question: May we use a font size smaller than 12-point for the workplan? 

Answer: The font size should be 12-point font as stated on page 40 of the NOFO. “Unless specified in 

the "H. Other Information" section, maximum of 20 pages, single spaced, 12-point font, 1-inch margins, 

number all pages. This includes the work plan. Content beyond the specified page number will not be 

reviewed.”

63. Question: Do references/citations count towards the narrative page limit?

Answer: Reference/citations do not count towards the narrative page limit.
15

64. Question: We wanted also to check on page limits for the application. Page 40 describes a 20-page limit 

for the Project Narrative. Are there additional page limits for the overall application, sections, or 

attachments? 

Answer: Page 40 of the NOFO and slide 50 of the EfC NOFO Informational Call Presentation 

(cdc.gov), includes more information. The project narrative has a 20-page limit, which includes the 

background, approach, evaluation and performance management plan (including data management plan), 

organizational capacity description, and work plan. The Table of Contents has no page limit, and the 

project abstract summary has a maximum of 1 page. 

65. Question: Is the evaluation and performance management plan included in the 20-page project narrative 

page limit? Does the page limit also include the DMP (since that’ is a part of the evaluation plan)?

Answer: Page 40 of the NOFO includes the project narrative information, and page 42 includes the 

minimal requirement information for the Applicant Evaluation and Performance Measurement Plan. The 

data management plan (DMP) is included in the page limit total. 

66. Question: Should we include CVs/Resumes for the finance and administrative support staff that are 

included in our budget?

Answer: Page 28 of the NOFO states, “applicants must provide (as attachments) CVs orresumes for 

assigned NOFO-funded personnel only and an overall organizational chart for their organization. 

Applicants must name the attachments CVs or resumes” and organizational charts and upload them as 

PDF files under other Attachment Forms at www.grants.gov.” 

“Applicants should have demonstrated expertise in analyzing complex data sources, and expertise in 

tracking surveillance data over time by providing relevant CVs/resumes for proposed NOFO-funded 

personnel and organizational accomplishments. Applicants must name the attachments “CVs/Resumes” 

and “Organizational Surveillance Accomplishments” and upload them as PDF files under “Other 

Attachment Forms” at www.grants.gov. If applicants have applied for enhanced funding, they must 

describe the ability to link data on ACEs and PCEs with the social determinants of health, capacity to link 

data (i.e., availability of indicators necessary to link data) as well as expertise in data linkage should be 

described by providing relevant CVs/resumes for proposed NOFO-funded personnel and organizational 

accomplishments.”

67. Question: As a UK-based organization, are we eligible to apply for funding under the scheme above?

Answer: Eligibility information can be found on page 35 of the NOFO.

68. Question: How can we collaborate on the application? 

Answer: This NOFO builds on the findings and lessons learned in the previous NOFOs CE18-1803: 

Childhood Essentials and CE20-2006: Preventing ACEs: Data to Action (page 4). A list of these 

recipients can be found here: CE18-1803: Childhood Essentials and CE20-2006: Preventing ACEs: Data 

to Action. 

69. Question: I am reaching out in regard to an attachment described on page 28 of the CDC-RFA-CE-23-

0005 Essentials for Childhood (EfC): Preventing Adverse Childhood Experiences through Data to 

Action NOFO (attached). On page 28, it describes a request to please submit a document titled, 

“Organizational Surveillance Accomplishments.” However, on page 62 of the NOFO which provides a 

list of all acceptable documents which an applicant may upload, “Organizational Surveillance 
16

Accomplishments” is not included. Will Grants.gov allow us to upload this document or would it be best 

to not include it in our submission package?

Answer: Please ignore the boilerplate language and instead follow the criteria in the NOFO for the 

required documentation and upload the necessary documents. 

70. Question: We understand it can be between 12 months and 5 years, based on the yearly and total 

funding budget provided in the documents. Is this correct? 

Answer: Please see page 3 of the NOFO for the total period of performance (see below), and page 34 

for the budget period length (see below). f. Total Period of Performance Length: 5 year(s) 12. Budget 

Period Length: 12 month(s). 

71. Question: Will we have to propose a time period for our project, or will CDC determine the project 

length? 

Answer: CDC determines the period of performance, which is five years. Each budget period of the total 

period of performance is 12 months. 

 

72. Question: Can applicants propose the State we work in or will the CDC decide that?

Answer: Applicants will propose the State to work with.

73. Question: The NOFO states an average of $400,000 per budget period with a maximum request of 

$485,000 per budget period. Does the maximum of $485,000 apply to all applications, or is does this 

apply only to applicants pursuing Enhanced Activities?

Answer: The award ceiling is $485,000, which includes applicants applying for and receiving funding for 

the optional enhanced activities. 

74. Question: Regarding the one meeting to be attended annually: Is there a specific meeting we should be 

budgeting for or will this be an annual meeting of the applicant’s choosing. Are there any certain amount 

of days we should be using to calculate expense in the budget for each year?

Answer: Page 27 of the NOFO states that “recipients are expected to participate in CDC’s annual 

meeting or site visits, monthly monitoring meetings or conference calls...” The specific details will be 

discussed with funded recipients. 

75. Question: Under the review section of the NOFO, it is stated that no more than one application per 

State will be funded. Is that state agencies only, or does that include tribal applications from a state also? 

Is it possible for a state application and a tribal application from that same State to be awarded if the 

applications show a close and productive working relationship with cooperative project goals?

Answer: Eligibility information can be found on page 35 of the NOFO. Phase III Review (see page 52) 

states that the following: 

• Applications will be reviewed and scored using the following criteria: 

o Applications will be reviewed and scored in accordance with the Phase II Review 

Criteria. 

o Applications for the optional enhanced activities will be reviewed and scored separately 

in accordance with the Phase II Review Criteria. 
17

o Applications may be funded out of rank order to ensure maximum U.S. coverage, no 

more than one application per State will be funded. 

o If multiple applicants from the same State apply under this NOFO, only the highestscoring applicant from that State will be selected for funding. 

76. Question: We were told during the information session that since we are a national organization, we will 

need to focus on delivery in the State where we’re registered (i.e., California). American SPCC’s 

connections with community-based organizations that will enable delivery of the program is strongest in 

Texas, and we would prefer to select Texas. Do we need to provide additional rational for why we are 

selecting Texas and not California?

Answer: Yes, please provide rationale in your application on why Texas and its associated partners are 

your chosen communities. Please see page 35 of the NOFO for eligibility categories.

77. Question: Can you provide any examples of successful past collaborations between recipients and CDC 

to aggregate, synthesize, translate, and disseminate findings from their projects?

Answer: CDC and recipients will collaborate throughout the period of performance to ensure best 

practices in ACEs and PCEs data collection, analysis, synthesis, translation, and dissemination. Page 27 

includes a list of examples, including peer-reviewed publications, brief reports, aggregated reports, and 

success stories.

78. Question: Can you provide more information on the rapid feedback process provided by the CDC and 

how recipients should incorporate this feedback into their ongoing project implementation and 

evaluation efforts?

Answer: Pages 9 and 14 of the NOFO include a list of example partners for surveillance and prevention, 

respectively. There is no preference or priority for the types of partners engaged; however, the recipient 

should identify the appropriate partners needed to support their surveillance, prevention, and data-toaction goals and meet the requirements of the cooperative agreement. 

79. Question: Does the CDC have any recommendations for addressing the unique needs of different 

populations (e.g., rural vs. urban communities) when designing and implementing prevention strategies 

for ACEs?

Answer: CDC does not define specific target populations. However, applicants should use their 

surveillance and other available data to identify the target populations and communities to be served 

based on data collected. Specific target populations may vary by applicant (see page 20).

80. Question: Can you provide any examples of innovative or unique approaches that past recipients have 

used to engage local communities and stakeholders in their projects to prevent ACEs and promote 

PCEs? 

Answer: Please see CE18-1803: Childhood Essentials and CE20-2006: Preventing ACEs: Data to Action

for a list of prevention strategies and approaches.

81. Question: Are there any specific considerations or requirements related to the use of digital and online 

learning resources when developing and implementing projects supported by the CDC grant?
18

Answer: The use of digital and online learning resources is not explicitly acknowledged within the 

NOFO. However, CDC will provide support through collaboration, technical assistance, and information 

sharing to ensure appropriate implementation of strategies and approaches are executed. 

82. Question: How does the CDC define “community-based organizations” within the context of this grant, 

and what role are they expected to play in the proposed projects? For context, the American SPCC will 

heavily rely on community-based organizations to support local-level outreach and promotion, as well as 

development of the course materials.

Answer: Please see page 35 of the NOFO for a list of eligible applicants. Roles of specific partner 

organizations are determined by the applicant based on requirements of the NOFO. 

83. Question: Is there a preference for projects that focus on specific age groups or developmental stages of 

children? 

Answer: Page 20 of the NOFO includes information on the target population. CDC does not define 

specific target populations. However, applicants should use data to identify the target populations and 

communities to be served. Specific target populations may vary by applicant.

 

84. Question: Are there any expectations for recipients to engage with other organizations or initiatives 

(outside of the organizations identified as collaborators in the grant application) working on similar 

issues, either regionally or nationally?

Answer: Cross multi-sector partnerships and resources to support the implementation and sustainability 

of comprehensive ACEs surveillance and prevention efforts are required. Recipients should identify, 

sustain, and support collaborations with the surveillance, prevention, and data to action partners needed 

to implement the goals of the cooperative agreement. 

Recipients are required to foster and sustain a national-level dialogue and collaboration on primary 

prevention with non-CDC-funded state health departments (SHDs), national partners, and other partners 

including but not limited to those in the business community, emergency management, hospitals, media, 

non-government organizations, nonprofit agencies, other federal, State, or local government agencies, the 

public health community and tribes or tribal organizations (see page 19). There is not a requirement to 

engage with other organizations or initiatives outside of the above requirements. 

85. Question: Are there any restrictions on the use of grant funds for marketing, outreach, or promotional 

activities related to the proposed project?

Answer: Please see page 45 of the NOFO for a list of funding restrictions. 

86. Question: Can you provide more information on the rapid feedback process provided by the CDC and 

how recipients should incorporate this feedback into their ongoing project implementation and 

evaluation efforts?

Answer: CDC will provide feedback in a timely manner to recipients (e.g., conference calls, and emails), 

which will include how to incorporate the feedback. 

87. Question: We understand we must provide a detailed budget justification for selected enhanced 

activities. Do we need to separate the Enhanced Activities costs from the overall budget? If so, do we 

need to break out those costs on the SF-424. The form only has one line for total cost and does not allow 

for a breakout of the “Enhanced Activities Budget”.
19

Answer: No, the applicant can include up to $85,000 for enhanced activities. Please see page 34 for 

award ceiling information.

88. Question: We understand recipients must comply with the administrative and public policy requirements 

outlined in 45 CFR Part 75 and the HHS Grants Policy Statement, as appropriate. Can you please identify 

those Administrative Requirements (AR’s) that are appropriate so that we can ensure compliance?

Answer: All Administrative Requirements listed on page 54 of the award are appropriate. Brief 

descriptions of relevant provisions are available at https://www.cdc.gov/grants/additionalrequirements/index.html

89. Question: On p. 18 of the NOFO, it says we need to have an MOU or MOA for data systems such as 

YRBS (Minnesota has the Minnesota Student Survey). We just wanted to clarify what an MOU or MOA 

is in this context—can it be in a letter format but contain elements of an MOA? We typically have gotten 

letters of support from our partners and weren’t sure how different this is from that.

Answer: If the applicant is the administrator for the youth-based surveillance system (in this case, as you 

note, the Minnesota Student Survey), please submit a letter of evidence stating this. If the applicant is not 

the administrator, then a MOU/MOA with the administrator of the survey is required. Letter format 

would be acceptable if it clearly documents the information requested and data sharing agreements 

between the applicant and partner. Page 19 of the NOFO states, “Applicants must provide evidence of 

partnership with the state entity who administers the Youth Risk Behavior Survey (YRBS) or similar 

jurisdiction-wide survey of adolescents. A MOU/MOA and LOS stating the requested information 

should be provided. If applicants are the YRBS administrator, a LOS within information outlined below 

is required.” Please see pages 19-20 of the NOFO on the information that should be included as part of 

the letter of evidence. Please see question 26 above for the information that should be included within 

the MOU/MOA with the youth-based surveillance system partner. 

90. Question: For the enhanced option of linking youth data to social determinants of health data, could you 

explain more about what kind of linkage is meant? For example, if we have SDOH data at the county 

level and ‘link’ that to county-level youth data on ACEs and PCEs, is that adequate? Or is this meaning 

linking individual socioeconomic status, for example, to individual level ACEs/PCE data?

Answer: Data on the social determinants of health (SDOH) are typically considered to be data on the 

“conditions in the environments in which people are born, live, learn, work, play, worship, and age that 

affects a wide range of health, functioning, and quality-of-life outcomes” (see page 67). Within the 

context of this cooperative agreement, data on the social determinants of health are considered data at 

the county or other similar geographic areas that provide context to the social and structural inequities 

within which people live (see page 11 for examples of SDOH data sources and indices). Data on 

individual risk and protective factors, such as the individual socio-economic status of families, may be 

helpful to the broader surveillance system but will not be considered social determinants of health within 

the context of this cooperative agreement.

91. Question: In the NOFO section for ‘Additional Activities Supported by Enhanced Funding’, it states 

that recipients will “Link social determinants of health data with youth-based ACEs and PCEs data.” Just 

wanting to make sure we understand this concept correctly. At the CDC Reverse Site Visit last summer, 

Dr. Swedo presented on layering/linking data in a way that combines SDOH and ACE data together 

(slide attached and copy/pasted below). Would this be an appropriate example for how to link these 

types of data together? Thank you for your help.

Answer: As part of the cooperative agreement application, the applicant should describe their capacity 

and ability to conduct linkage between data on the social determinants of health and data from a youthbased surveillance system on ACEs and PCEs. This should include a proposed description of the types 
20

of SDOH data and a description of the youth-based surveillance system with ACEs and PCEs data that 

may be linked, as well as documentation that this linkage is feasible and allowable given data governance 

processes. Technical assistance on how to structure data files to conduct data linkage will be provided by 

CDC following award.

92. Question: The NOFO says to include MOUs for partners who will be participating in the state plan 

update but letters of support for partners who are committing to the planning, implementation, and 

evaluation process. If partners are committing to all those things, can we submit just MOUs for those 

entities – or do they need to provide both an MOU and separate letter of support.

Answer: Applicants must describe any key state-level partners who would likely participate in the state 

action plan update process or collaborate in any substantial way, including signed MOUs indicating the 

organization's commitment and willingness to participate. Applicants must submit the MOU, MOA 

and/or letters of support, as appropriate, name the file MOUs/MOAs/letters of support, and upload it 

as a PDF file at www.grants.gov (see page 19). 

93. Question: On Slide 11 of the NOFO PowerPoint slides, it discusses enhanced funding activities for 

Goals one and two as being an 'and/or' option; however, based on Slide 37, it mentions in red that Goal 

2 enhanced activities must be conducted to do Goal three enhanced activities. Does this mean that Goals 

1 and 2 optional enhanced activities can be 'pick and choose'? In other words, we can choose to do 

syndromic surveillance but not data linkage. Or we can choose to do local prevention strategies but not 

developing local partnerships, etc.

Answer: Yes, you may choose to select the syndromic surveillance optional activity and not other Goal 1 

optional activities. However, recipients conducting the optional activity of implementing comprehensive 

ACEs prevention strategies at the local level must also include local-level implementation efforts within 

the process and outcome evaluation plan for enhancing ACEs and PCEs surveillance and ACEs 

prevention strategies. Therefore, you must apply for Goal three optional activity in addition to this 

optional Goal 2 activity. 

94. Question: Can Goal 3 enhanced activities only be selected if Goal 2 enhanced activities were also 

chosen?

Answer: Goal 3 enhanced activities correspond to other optional activities within Goal 1 and Goal 2. 

Please see slides 37 and 38 from the informational call for more information. EfC NOFO Informational 

Call Presentation (cdc.gov)

95. Question: Regarding MOUs, the language in the NOFO states this regarding the YRBS: 

"A Memorandum of Understanding (MOU) or Memorandum of Agreement (MOA) is required for each

CDC-funded data source at the time of the application, even if the administrator of each data source is 

the same entity. If the recipient is the administrator, a letter of evidence should state this."

Could you clarify whether this language requires both an MOU and letter of evidence OR just a letter of 

evidence if our organization is the administrator for the YRBS? Unfortunately, our leadership discourages 

internal MOUs and requires a lengthy process for an exception to this rule, so I want to ensure we 

understand the requirements before embarking on this process.

Answer: Yes, if the applicant is the administrator for the Youth Risk Behavior Survey (YRBS) or 

intended surveillance equivalent in the jurisdiction, please submit a letter of evidence stating this. Page 18 

of the NOFO states “A Memorandum of Understanding (MOU) or Memorandum of Agreement (MOA) 

is required for each CDC-funded data source at the time of the application, even if the administrator of 

each data source is the same entity. If the recipient is the administrator, a letter of evidence should state 

this.” Page 19 of the NOFO states, “Applicants must provide evidence of partnership with the state 
21

entity who administers the Youth Risk Behavior Survey (YRBS) or similar jurisdiction-wide survey of 

adolescents. A MOU/MOA and LOS stating information below should be provided. If applicants are the 

YRBS administrator, a LOS within information outlined below is required.” Please see pages 19-20 of the 

NOFO on the information that should be included as part of the letter of evidence. 

96. Question: "Applicants must describe any key state-level partners who would likely participate in the state 

action plan update process or collaborate in any substantial way, including signed MOUs indicating the 

organization's commitment and willingness to participate."

Can you clarify in which cases an MOU would be needed vs an LOS from our state level partners? We 

have a state level coalition and executive committee and I want to understand what "collaborate in a 

substantial way" means in this example. Again, we are trying to reduce time in getting MOUs if they are 

not necessarily due to our lengthy internal processes, so any guidance you can provide is very much 

appreciated. Thank you in advance for your help. I look forward to hearing from you soon.

Answer: The recipient is required to collaborate with the CDC-funded entity that implements the State, 

territorial, or tribal Youth Risk Behavior Surveillance System (YRBS) as well as the CDC-funded entity 

that implements the syndromic surveillance program (if applying for enhanced activities). A 

Memorandum of Understanding (MOU) or Memorandum of Agreement (MOA) is required for each 

CDC-funded data source at the time of application, even if the administrator of each data source is the 

same entity. If the recipient is the administrator, a letter of evidence should state this. If the recipient is a 

jurisdiction that does not utilize the YRBS, or if this is not the intended youth-based surveillance system 

that will monitor ACEs and PCEs, the recipient is required to provide a similar MOA/MOU for the 

State, territorial, or tribal entity that administers the youth-based surveillance system (see page 18). 

Other cross/multi-sector partnerships and resources to support implementation and sustainability of 

comprehensive ACEs surveillance and prevention efforts are required (see page 19 for more details). 

However, these partnerships can be described and documented using a combination of MOU, MOAs, or 

letters of support, depending on which is most appropriate.

Applicants must submit the MOU, MOA and/or letters of support, as appropriate, name the file 

MOUs/MOAs/letters of support, and upload it as a PDF file at www.grants.gov (see page 19).

97. Question: Does a county government applying as the fiscal sponsor of a community collaborative 

qualify to apply for this funding to conduct their own local ACEs prevalence data collection and tie it to 

county-wide ACEs mitigation and prevention strategies. We do get some limited ACEs data from the 

State of California, but it is limited and combined with two other adjacent counties and this county would 

like more detailed data for their own county to target intervention strategies more effectively. 

Answer: Please see page 35 of the NOFO for a list of eligible applicants. If the county government is the 

primary applicant, please note that the direct and primary recipient in a cooperative agreement program 

must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an 

award to another party or provider who is ineligible (see page 46 under 16. Funding Restrictions of the 

NOFO).

98. Question: For the enhanced funding under Goal 1 for using syndromic surveillance data to monitor 

indicators, is sharing data with CDC a required component?

Answer: Data sharing within the NSSP ESSENCE platform is not required; however, it is encouraged to 

support more effective technical assistance in use, analysis, and dissemination of these data to inform 

prevention and intervention strategies. Page 12 of the NOFO states “For the purposes of providing 
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effective technical assistance that can facilitate the use of syndromic surveillance data to inform 

prevention activities, if recipients choose to share their data with CDC, surveillance reports will be 

provided by CDC highlighting the burden of ACEs-related ED visits within their State. CDC will work 

with recipients post award on the processes for sharing data.” 

99. Question: For Goal 2, page 13 of the NOFO states that "Recipients are required to select at least two 

strategies and two approaches from the table below..." Does this mean that recipients must choose at 

least two approaches from two strategies (equating to a total of 2 strategies with at least 4 approaches), or 

does this mean that recipients can choose at least two strategies with at least one approach from each of 

those strategies (equating to a total of 2 strategies with at least 2 approaches)?

Answer: Recipients are required to select at least two strategies and two approaches only (not four 

approaches). 

100.Question: On page 3 of the NOFO, ACEs are defined as preventable, potentially traumatic events that 

occur among children and adolescents aged 0-17 years. To confirm, is the 0-17 age group the age group 

of focus for data and surveillance and prevention activities? 

Answer: CDC defines ACEs as preventable, potentially traumatic events that occur in childhood and 

adolescence (aged 0-17 years). 

Please consult pages 9-11 of the NOFO for information on the multiple surveillance components of the 

award, which include youth-based surveillance of ACEs and PCEs, use of data on the social determinants 

of health (which are typically measured at the community and not individual levels), and other available 

data within the jurisdiction (including near-real-time data). For the youth-based surveillance data, 

recipients will “use state, territorial, or tribal Youth Risk Behavior Survey (YRBS) or equivalent state-level 

jurisdiction-wide survey of adolescents to collect ACEs and PCEs data” (see page 10). Data on other age 

ranges may be used to supplement these data. Please note that we are aware that many surveys of high 

school students include adolescents who are aged 18 (i.e., high school seniors); this is acceptable given 

that the focus of these data collection is on children and adolescents (i.e., the focus is not on young 

adults).

101. Question: In the NOFO on pages 21 (6 months), 24 (within 45 days), and 42 (in the application) it 

states that we are to provide an evaluation and performance measurement plan within 6 months of the 

grant award (final), within 45 days after the grant award (draft), and in the grant application (draft) due on 

6/12. Is that correct? 

Answer: The EfC NOFO Informational Call Presentation (cdc.gov) (slide 51) includes this information 

as well. The draft Evaluation and Performance Measurement Plan is due within 45 days of the award, and 

the final Evaluation and Performance Measurement Plan is due 6 months (180 days) after the award. The 

NOFO application is due on June 12, 2023, 11:59pm EST (slide 49).

102.Question: Are both Letters of Support and MOU/MOAs required at the time of submission. We will be 

partnering with our state departments of health and other agencies to access data sources. Are letters of 

support sufficient?

Answer: Page 18 of the NOFO states “A Memorandum of Understanding (MOU) or Memorandum of 

Agreement (MOA) is required for each CDC-funded data source at the time of the application, even if 

the administrator of each data source is the same entity. If the recipient is the administrator, a letter of 

evidence should state this.” Page 19 of the NOFO states, “Applicants must provide evidence of 

partnership with the state entity who administers the Youth Risk Behavior Survey (YRBS) or similar 
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jurisdiction-wide survey of adolescents. A MOU/MOA and LOS stating the information below should 

be provided. If applicants are the YRBS administrator, a LOS within the information outlined below is 

required.” Please see pages 19-20 of the NOFO on the information that should be included in the letter 

of evidence. 

103. Question: If a state participates in CDC’s BioSense Platform and must commit to using standard CDC 

syndrome definitions to track selected ACEs indicators (Goal 1 page 12 of NOFO), will technical 

assistance provided by CDC to states mean that there will be no cost to the State to add this ACEs set of 

indicators and definitions to BioSense?

Answer: The National Syndromic Surveillance Program includes information on all Emergency 

Department (ED) visits for participating facilities, regardless of the type of indicator. The CDC-funded 

entity that implements the syndromic surveillance program in each jurisdiction manages access to the 

data for the jurisdiction; recipients should collaborate with the CDC-funded entity in their State if they 

apply for this optional enhanced funding (see pages 12 and 18). There are already indicators available 

within the system that identify types of ACEs, such as suspected child abuse and neglect; childhood 

sexual violence; mental health; suicide ideation and attempts; nonfatal overdose or substance use; and 

intimate partner violence. Recipients will be asked to commit to leveraging indicators as specified by 

CDC to align with national and other state standards and technical assistance will be provided to support 

the use of these indicators. There is no cost to leveraging these indicators within the NSSP system as they 

are already available to users.

104.Question: Does the CDC plan to continue the 8 or 16-question ACEs module funding in 2025 and 2027 

as they provided in 2023 to support fulfilling the new grant requirements? For 2023, we opted in for the 

8-question ACEs module and therefore had funding assistance for a swap and a new ACEs question on 

our YRBS. If there is a chance you do not plan to provide that funding in 2025 and 2027, we need to 

appropriately budget for the 2 ACEs and the new PCE required by the NOFO in the years we plan for 

the next YRBS survey (and to ensure we are asking all the required questions).

Answer: “Contingent upon funding, the Division of Violence Prevention and the Division of Adolescent 

and School Health within CDC intend to continue offering financial incentives to YRBS sites who 

choose to include ACE questions on their surveys. We encourage recipients to inquire about how this 

YRBS information on ACEs may help them to leverage resources to advance the goals of the NOFO. 

States may also leverage the YRBS by including items about ACEs and PCEs without additional 

supplemental funding from CDC, if they wish to do so. Applicants should work with the YRBS 

coordinator in their State to leverage this surveillance system.” 

105.Question: How does this grant define “evidence-based” prevention program? Are they only the ones 

included in the ACEs prevention technical packet?

Answer: The NOFO states on page 13 that “Recipients will: implement data-driven, comprehensive, 

evidence-based ACEs primary prevention strategies and approaches, particularly with a focus on health 

equity. Recipients are required to select at least two strategies and two approaches from the table below, 

derived from the CDC’s Preventing Adverse Childhood Experiences: Leveraging the Best Available 

Evidence.” See Table 2: ACEs Prevention Strategies and Approaches (page 13-14).

106.Question: How does this grant define “state-level collection of data” and “state-level action plan”? 

Answer: State-level refers to statewide. The NOFO states the following on page 22 (Process Evaluation): 

“In what ways has the recipient enhanced their statewide action plan to implement complementary ACEs 
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prevention strategies (additional funding for implementation at the local level)? The NOFO states on 

page 28 that the applicant must provide a current version of their State’s action plan that outlines primary 

prevention of ACEs with the application as a PDF file named “State Action Plan" at www.grants.gov.”

107.Question: Does the applicant have to have an MOU/MOA from the YRBS or will a LOS be sufficient? 

The division collecting YRBS data is also located within the same health department.

Answer: Page 18 of the NOFO states “A Memorandum of Understanding (MOU) or Memorandum of 

Agreement (MOA) is required for each CDC-funded data source at the time of the application, even if 

the administrator of each data source is the same entity. If the recipient is the administrator, a letter of 

evidence should state this.”

Page 19 of the NOFO states, “Applicants must provide evidence of partnership with the state entity who 

administers the Youth Risk Behavior Survey (YRBS) or similar jurisdiction-wide survey of adolescents. A 

MOU/MOA and LOS stating the information below should be provided. If applicants are the YRBS 

administrator, a LOS within the information outlined below is required.”

108.Question: We noticed that the RFP is more focused on state-level infrastructure so have determined not 

to move forward with applying at this time. Please advise if we misinterpreted that focus. 

Answer: This NOFO will support the implementation of data-driven, comprehensive, evidence-based 

ACEs primary prevention strategies and approaches, with a particular focus on health equity, to prevent 

ACEs and ensure safe, stable nurturing relationships and environments for all children. Recipients will 

enhance a state-level surveillance infrastructure that ensures the capacity to collect, analyze, and use 

ACEs and PCEs data among youth; and conduct data-to-action activities to inform changes or 

adaptations to existing strategies or selection and implementation of additional prevention strategies” (see 

page 7).

109.Question: Can you please explain the eligibility and dollar amounts available for the Enhanced Funding 

in the NOFO? Our project team wants to ensure we understand the activities and funding available in 

this category. 

Answer: The applicant can apply for enhanced funding to conduct one or more of the additional 

activities: (1) collect ACEs data using syndromic surveillance approaches, (2) implement ACEs primary 

prevention strategies at the local level; and/or (3) link state and local data on the social determinants of 

health to youth-based ACEs data. The Strategies and Activities section (starting on page 9) includes the 

specific details and requirements for the three additional activities. 

The award ceiling is $485,000. Page 44 of the NOFO states that “the budget should include the requested 

funding amount for each enhanced activity.” 

110.Question: Given our work on adverse childhood experiences (ACEs), we have been asked to support 

two separate states on this opportunity. We are an Eligible Applicant as per Section C.1 of the request for 

applications (RFA). We are interested in supporting both states, but do not want to hamper either State’s 

opportunity for award selection: Would it be permissible for us to submit two separate applications for 

the CDC’s consideration (one for each State), with our organization serving as the prime on both, or 

would we have to apply as the prime on one application or a sub on the other?

Answer: Response: The NOFO states on page 46 (under 16. Funding Restrictions) that the direct and 

primary recipient in a cooperative agreement program must perform a substantial role in carrying out 
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project outcomes and not merely serve as a conduit for an award to another party or provider who is 

ineligible. 

111. Question: Would the CDC consider a joint award for a project in which we are proposing to work with 

two states?

Answer: The NOFO states on page 3 (under G. Executive Summary) that approximately 12 awards will 

be made at an average one year amount of $400,000. 

112.Question: One State that we are looking to partner with participated in the 2021 Middle School Youth 

Risk Behavior Survey (YRBS) and is denoted as having conducted a representative state survey on 

the YRBSS website. If the State continues to conduct this same survey, would this count as an eligible 

state-level, jurisdiction-wide survey of adolescents for purposes of this RFA?

Answer: To be eligible for NOFO funding, recipients will use a state, territorial or tribal Youth Risk 

Behavior Survey (YRBS) or equivalent state-level jurisdiction-wide survey of adolescents to collect ACEs 

and PCEs data (see page 11). The hallmark Youth Risk Behavior Surveillance System (YRBSS), which is a 

set of Youth Risk Behavior Surveys, track behaviors that can lead to poor health in students grades 9 

through 12. The inquirer is correct that states, districts, territories, and tribes (collectively referred to as 

“sites”) that conduct YRBS at the high school level have the option of also conducting the survey at the 

middle school level. However, to be eligible for the EFC funding, recipients must use a state-level 

jurisdiction wide-survey of adolescents. While there is not one definition of “adolescent,” this period is 

often thought of including those aged 12 or 13 years to up to 18 years of age. Given that many middle 

school students are pre-adolescent and use of surveys focusing on this age range alone would not include 

the majority of the adolescent age range, use of only a jurisdiction-wide survey of middle school students 

would not meet eligibility criteria. The use of data on adolescents is critical given that experience of 

adversities increases with age, and that cognitive testing has demonstrated that there may be 

comprehension issues with asking ACEs items among middle school-aged children. However, if the 

recipient would like to use jurisdiction-wide surveys that include information on both children and

adolescents (i.e., data are collected from middle and high school students), this would be an eligible data 

collection strategy. 

113.Question: On page 4 of the NOFO, it state “Applicants applying for the enhanced activities must have 

core youth-based ACEs surveillance data (as defined by CDC) in a survey administered during or prior to 

2023.” We want to clarify that in order to apply for any of the enhanced activities, applicants must have 

included the 8 core ACEs questions and 1 PCE question on the YRBS during or prior to 2023. Is this 

correct? 

Answer: Applicants applying for the enhanced activities must have youth-based surveillance data on 

ACEs in a survey administered during or prior to 2023. The core ACEs as defined by CDC for youthbased surveillance are the 8 questions included on pages 10-11 of the NOFO. Recipients do not have to 

have youth-based PCE(s) data collected during or prior to 2023 to apply for enhanced funding.