Notice of Funding Opportunity (NOFO) – FY2022

What happens if a recipient does not, or chooses not to, acknowledge receipt of the Ukraine supplemental funds?

The Ukraine supplemental funding will be made available to each recipient on or around August 15, 2022. Within five business days of receipt of this guidance, the Principal Investigator (PI) or Authorized Official for each respective recipient is required to acknowledge receipt of this guidance as a Grant Note in GrantSolutions. The acknowledgment must be submitted on official letterhead and utilize the attached “Acknowledgment Letter for CDC-RFA-PS20-2001– Uniting for Ukraine Supplemental Funds” template.

Should the acknowledgement of receipt of Announcement be submitted by the Authorizing Official (AO) or the Principal Investigator?

Acknowledgement of receipt of Announcement in GrantSolutions may be made by the Principal Investigator (PI) or the Authorizing Official (AO).

Do Program and Laboratory submit a common acknowledgement letter, or do they need to send two separate letters?

The Program will submit one letter on behalf of the recipient(s).

Is the CFDA number for the supplement the same as the CFDA number for the core TB program, 93.116?

Yes, it is the same.

Has the playbook been published and made available online?

You may ignore this. The inclusion of language in the supplement announcement regarding the playbook was an error.

When are the acknowledgment of receipt and application deadlines? Are the Work Plan, SF-424A, Budget Narrative, Project Narrative, and SF-424 due 60 days after the Ukraine supplemental funding announcement is released -or- 60 days after the Ukraine supplemental award is received?  Can you confirm the actual calendar due date?

Recipients must acknowledge receipt in GrantSolutions within 5 days of the announcement. The acknowledgement letter must be on the grantees’ official letterhead. The acknowledgement letter clock may start on 7/28/22 if the information call provided additional clarity on submission. Work with your project officer on its submission. The budget/narrative and work plan must be submitted within 60 days from receiving the award, in GrantSolutions.

CDC anticipates this to be mid to late October since the award should be out on or around 8/15/22.

Are there any page limits for the Project Narrative or Work Plan?

No page limits are specified in the guidance.

How were the program and laboratory Ukraine supplemental funds calculated for distribution?

Program funding: The total amount for program use in the initial Ukraine supplemental funding cycle is $7,200,000. CDC distributed funding to all 61 recipients of CDC-RFA-PS20-2001 utilizing a formula based on the estimated number of Ukrainian arrivals (70%) and average TB morbidity (30%) for each jurisdiction. Base arrivals funding for each jurisdiction was $10,000. The number of Ukrainian arrivals was estimated using the number of registered Uniting for Ukraine sponsors as a surrogate. These data were provided by the Department of Homeland Security (DHS) on July 15, 2022. Average TB morbidity was calculated using National TB Indicators Program (NTIP) data on TB cases reported over a three-year period (2017-2019).

Laboratory funding: The total amount for laboratory use in the initial Ukraine supplemental funding cycle is $800,000. CDC distributed funding to all 58 recipients of CDC-RFA-PS20-2001 utilizing a formula based on the estimated number of Ukrainian arrivals (70%) and average TB morbidity (30%) for each jurisdiction. Base arrivals funding for each jurisdiction was $7,500. The number of Ukrainian arrivals was estimated using the number of registered Uniting for Ukraine sponsors as a surrogate. These data were provided by the Department of Homeland Security (DHS) on July 15, 2022. Average TB morbidity was calculated using NTIP data on TB cases reported over a three-year period (2017-2019).

If the funding is not directly used for the Uniting for Ukraine program as there were fewer than expected Ukrainian arrivals in the jurisdiction, will any funds need to be returned to CDC or may the funds be used for other purposes? If this happens, what documentation will be required?

The Ukraine supplemental funds may be used to purchase any personnel time, materials or services that can be used for TB screening, testing, diagnostic, treatment, and other patient management activities (e.g., directly observed therapy (DOT)).

For purposes of the Ukraine supplemental funding only, medications may be purchased (the restriction against purchasing medications using funding from the parent cooperative agreement remains in place).

CDC realizes it is impossible to predict with certainty the capacity of personnel time, materials, or services that will be needed for the Uniting for Ukraine response. Therefore, when possible, it is preferable to purchase excess capacity rather than insufficient capacity. Any excess capacity may be used for TB prevention and control activities for persons who are not part of the Ukrainian resettlement. In particular, single use items such as medications and testing materials should not be allowed to expire if they can be used in persons who are not part of the Ukrainian resettlement.

Regardless, programs receiving Ukraine supplemental funds are expected to meet all the needs of TB screening, testing, diagnostic, treatment, and other patient management activities required in their respective jurisdictions for the Uniting for Ukraine initiative. Programs receiving Ukraine supplemental funds must also report data related to these activities as indicated in the Ukraine supplemental funding guidance.

Can grantees carry over Year 1 of the Ukraine supplemental funds for use in Year 2 of the Ukraine supplemental funds?

Under the terms of Expanded Authority, Year 1 of the Ukraine supplemental funds can be carried over to Year 2, if this is outlined in the Federal Financial Report due 90 days after the Budget Period (or March 31, 2023).

Can programs use Ukraine supplemental funds for program and laboratory interchangeably?

There are associated costs allocated to program and laboratory based on a pre-determined formula. The Ukraine supplemental funds are not meant to be used interchangeably. However, transfer of funds may be considered after consultation with the CDC Laboratory Consultant and CDC Project Officer. Of note: if grantees wish to subcontract with a commercial laboratory, then they can do that with the programmatic or laboratory funding.

Can grantees use Ukraine supplemental funds to pay for IGRA testing at a commercial laboratory as referred by the public health department?

Yes.

There is a paragraph on fiscal reports that mentions the “Emergency Funding Suffix” on page 8 of the guidance. What is the Emergency Funding Suffix?

You may ignore this. There is no Emergency Funding Suffix.  The inclusion of language in the Ukraine supplement funding announcement regarding Emergency Funding Suffix was not applicable.

What is the time-period to use Year 1 Ukraine supplemental funds?

You can fund activities that began on or after May 21, 2022. The Ukraine supplemental funds will remain available until 9/30/2023.

Do Ukraine supplemental funds awarded in Year 1 need to be spent by 12/31/2022?

The Terms and Conditions of the parent NOFO (CDC-RFA-PS20-2001) stipulate that the funds need to be spent by the end of the Budget Year, or 12/31/2022. However, if funds are unspent, Expanded Authority can be utilized whereby unspent funds from Year 1 of the Ukraine supplemental funds can be carried forward to Year 2 of Ukraine supplemental funds (Fiscal Year 2023). Recipients will outline this in the Federal Financial Report that is due 90 days after the end of the Budget Period, on March 31, 2023.

Is this acknowledgment and application just for Year 1 of Ukraine supplemental funds? Will we have to “recompete” (complete another acknowledgment of funding and application) for Year 2 of Ukraine supplemental funds? 

Funding for Year 1 of Ukraine supplemental funds goes through December 31, 2022.  For the second round of Ukraine supplemental funds (Year 2), applicants will have to accept or decline the funding again in Fiscal Year 2023 when the notice of availability of the second round of Uniting for Ukraine supplemental funds is released, and complete all application requirements again as specified

If a program declines Year 1 of Ukraine supplemental funding can the program apply for Year 2 of Ukraine supplemental funding?

Yes, programs not applying for Year 1 Ukraine supplemental funding may apply for Year 2 Ukraine supplemental funding in Fiscal Year 2023. Programs that decline Year 1 Ukraine supplemental funding will not have access to Year 1 Ukraine supplemental funding in 2023.

What if you accept Year 1 of the Ukraine supplemental funds and use the funds for broader TB elimination activities and do not have anything to report on the Uniting for Ukraine Aggregate Reports of TB Program Evaluation (ARPE) form – does that affect your standing for Year 2 of the Ukraine supplemental funding?

The formula for the second round of Ukraine supplemental funding will be similar to the one used in the first round of Ukraine supplemental funding – it will be weighted heavily toward the number of Ukrainian arrivals in a jurisdiction. Funding will not be based on the Aggregate Reports of TB Program Evaluation (ARPE) report.

May grantees use Ukraine supplemental funds for services provided to Ukrainian Humanitarian Parolees who arrived prior to the implementation of Uniting for Ukraine?

Yes, Ukraine supplemental funds may be used for services provided after the Public Health Law authorizing these funds was signed on May 21, 2022. These funds may be applied retroactively for costs incurred for services to persons who were paroled into the United States under the terms of the Uniting for Ukraine program on or after that date.

Eligible persons under the terms of this supplement are (A) Ukrainian persons who were paroled into the United States between February 24, 2022, and September 30, 2023; or (B) any person who was –paroled into the United States after September 30, 2023, and —

• is the spouse or child of an individual described in subparagraph (A); or
• is the parent, legal guardian, or primary caregiver of an individual described in subparagraph (A) who is determined to be an unaccompanied child under section 462(g)(2) of the Homeland Security Act of 2002 (6 U.S.C. 279(g)(2)) or section 412(d)(2)(B) of the Immigration and Nationality Act (8 U.S.C. 1522(d)(2)(B)); and
• such individual’s parole (under subparagraph A) has not been terminated by the Secretary of Homeland Security.

How will a TB clinic know that a Ukrainian person who came to their clinic requesting TB screening came through the Uniting for Ukraine program? Will they have documents that prove they are part of the Uniting for Ukraine program?

The Ukrainian persons who are eligible for services as funded by this supplement should have documentation, but there may be different scenarios where documents are not available. In general, we suggest that practitioners can work under the assumption that anyone claiming to be a Uniting for Ukraine parolee is eligible for services. The Ukrainian persons who were not admitted specifically under the Uniting for Ukraine program, including those who were paroled into the United States before the Uniting for Ukraine program began, are not required to undergo TB screening. Your Project Officer for PS20-2001 will not be auditing the eligibility of persons receiving services funded by this supplement.

Other Ukrainian persons ineligible for the services funded under the Ukraine supplement might be identified because of a need for diagnosis and treatment of latent TB infection or TB disease. Within reason, we ask you to distinguish the services provided to these persons and include them in reporting of routine activities of the Tuberculosis Elimination and Laboratory Cooperative Agreement (CDC-RFA-PS20-2001), rather than account for them in budget or other reporting requirements under this supplement.

Attorneys for some health departments have issued guidance regarding asking persons seeking care about their immigration status in a healthcare setting. We suggest that you confirm the policies, rules, or laws within your jurisdiction.

Are the estimated 20,000 people who were admitted as Ukrainian Humanitarian parolees outside of the Uniting for Ukraine program eligible to receive services under the Ukraine supplemental funds?

Ukrainian persons who were paroled into the United States before the Uniting for Ukraine program was launched are eligible for services that are funded under this supplement. No Ukrainian persons were paroled into the United States outside of the Uniting for Ukraine program after the program was launched.

Ukrainian persons who were paroled into the United States under the terms of the Uniting for Ukraine program do have documentation. However, they might seek services without their documents or might be uncertain about the conditions of their parole status. CDC is not seeking distinctions for these situations. Program managers should consider the efficiency of clinic workflow, for example, when determining how closely to check on patient eligibility for services being provided under this supplement. Some states have policies, rules, or laws governing whether persons can be asked about immigration status in a healthcare setting.

There may be non-Ukrainian born persons who last habitually lived in Ukraine coming through Uniting for Ukraine. How should TB programs document those persons?

Any persons coming to the United States as part of the Uniting for Ukraine program may be counted for this activity.

Can grantees use Ukraine supplemental funds to support TB services for clients who have sponsors or reported addresses outside of a grantees’ typical geographic catchment area?

It is anticipated that people will show up at clinics outside of a grantee’s geographic catchment area. Funds should be used to support TB services for anyone arriving under the Uniting for Ukraine program. Keeping track of the activity will be an important step to report how appropriated funds were used.

Will Uniting for Ukraine parolees be included in the Electronic Disease Notification (EDN) system for TB programs?

No. Persons who were paroled into the United States under the terms of the Uniting for Ukraine program are not examined by overseas panel physicians and are not entered in the EDN system. If requirements under the Uniting for Ukraine program are revised, we will update TB programs about any role for EDN.

TB screening and documentation requirements for Uniting for Ukraine were addressed in a Dear Colleague Letter.

Can you please share the expected numbers of Ukrainian arrivals/number of sponsors per each state?

The Department of Homeland Security reports the data on sponsorship by state and local jurisdiction to state refugee coordinators. Please inquire with these officials in your state.

I understand CDC has limited information from the Department of Homeland Security (DHS) regarding the sponsors and their parolees. Any possibilities in the future that DHS could provide or work with CDC to provide local jurisdictions with notifications or information (addresses or phone numbers) so that we can reach out to those parolees? Like the process we have with the Electronic Disease Notification system and immigrants.

TB control officials will not receive personal information about persons who were paroled into the United States under the terms of the Uniting for Ukraine program, or their sponsors from DHS. Please collaborate with your local colleagues in refugee health or refugee coordination to learn what information may be available for your jurisdiction. Under the activities funded by the CDC TB Ukraine supplement, TB control officials are asked to assist the Uniting for Ukraine parolees with completing the TB screening for attestation. The parolees must meet this requirement as a condition of their stay in the United States.

The NOFO states, “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.”

Can you please explain more about the meaning of this statement? Many state TB programs do not provide direct clinical services. The state TB program may reimburse local health departments for IGRAs, chest x-rays and TB medications and/or provide funds to the local health department for the TB clinical services they provide.

This statement is not intended to address the clinical aspects of the program operations, rather it addresses the administrative. Community or contractual involvement for patient care is reasonable and justified. Key personnel identified in the cooperative agreement must have substantial involvement in “carrying out program outcomes” or managing program operations. The Principal Investigator (PI) or key staff identified in the cooperative agreement should be involved in the management of these activities, if not directly involved in primary care activities. For example, State X ensures that County Y is screening new arrivals and provides outcome data for surveillance purposes and for the targeted testing (TT) Aggregate Reports for TB Program Evaluation (ARPE). It is up to the PI to determine who receives the Ukraine supplemental funds for activities described in the announcement.

This language is directly from the parent COAG PS20-2001 and represents the same funding conditions under which grantees currently operate.

It will be very difficult to capture testing and treatment data for all Ukrainian arrivals under Uniting for Ukraine since a) not all will seek services at a public health department clinic, and b) no list of arrivals to local jurisdictions exists. How do you suggest providing targeted testing in this situation?

Work with your community outreach partners to capture the data for your state or local jurisdiction. Otherwise, count the Ukrainian persons that come through public health departments.

We have tested the same Ukrainian National twice with a QFT and both have been indeterminate. Should we keep trying?

Persons completing the Uniting for Ukraine U.S. Citizenship and Immigration Services attestation form can select indeterminate IGRA results as an option. They are required to retain documentation that the indeterminate results have been followed up by public health officials.

Please see recommendations about the interpretation of indeterminate IGRA results in Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection and Diagnosis of Tuberculosis in Adults and Children Guidelines, and take into consideration the test manufacturer’s instructions in the FDA-approved product labeling.

Consult with your state TB medical consultant or the TB Center of Excellence serving your jurisdiction if needed.

If Ukraine has a higher incidence of multidrug-resistant (MDR) TB disease than the United States, what medication regimen is recommended for latent TB infection diagnosed under Uniting for Ukraine?

The Division of Tuberculosis Elimination advised that Ukrainian arrivals with latent TB infection should be treated in accordance with current guidelines from the National Tuberculosis Controllers Association (NTCA) and CDC, unless drug susceptibility test results for the presumed source case support a conclusion of drug-resistant latent TB infection. If drug-resistant latent TB infection is suspected, clinical consultation should be obtained for assistance in selecting drugs in an empirical latent TB infection treatment regimen. TB disease must be excluded before any regimen for treating latent TB infection is started.

For specific situations when drug resistance seems more likely, please consult with your state TB medical consultant or the TB Center of Excellence serving your jurisdiction.

Will there be a standard format for data collection?

Recipients should use their own surveillance systems for data collection, tracking data outlined in the Deliverables section of the Announcement. It is strongly encouraged that program and laboratory staff collaborate on data findings (for example, chest x-rays, IGRA testing, sputum results for smear and culture) and discuss how the laboratory will capture which specimens are part of the Uniting for Ukraine program. Laboratory data should be reported using the Laboratory Performance Progress and Monitoring Report: Uniting for Ukraine Workload Volume Data form.

All verified cases of TB should be reported to CDC’s National TB Surveillance System as soon as possible after verification of the diagnosis using the Report of a Verified Case of Tuberculosis (RVCT). For TB cases diagnosed among persons who recently arrived in the United States through the Uniting for Ukraine Program, enter “U4UKRAINE” in the “Other, specify” free text field under Additional/Other TB Risk Factors (item 16 of the 2020 RVCT; item 34 of the 2009 RVCT). Targeted testing data should be reported to CDC’s National Tuberculosis Indicators Project (NTIP), using the standard Targeted Testing (TT) Aggregate Reports of TB Program Evaluation (ARPE) form. A ‘Targeted Testing, Uniting for Ukraine’ radio button will be developed in NTIP to capture the aggregate data. Note that the Uniting for Ukraine TT ARPE should start on the “Evaluated” row of the report. The three rows above “Evaluated” do not need to be completed, and in many settings the data for those three rows will not be readily available.

When are the reporting deadlines?

The Targeted Testing Aggregate Reports of TB Program Evaluation (ARPE) form report must be filed by 12/31/22, 6/30/23, and 12/31/23 in the National TB Indicators Project (NTIP) portal, with accompanying narrative in GrantSolutions. The Laboratory Performance Monitoring Report must also be submitted in GrantSolutions at the same intervals.

If we chose not to apply for supplemental funding because our state refugee numbers are low, do we still have to do separate reporting of Ukrainian parolees coming in for testing?

Recipients who decide not to accept the funding need to provide a letter on official state/local letterhead to notify CDC they are declining receipt of Ukraine supplemental funds. Submit the letter as a Grant Note in GrantSolutions. Recipients who decline the Ukraine supplemental funds are not required to submit separate reports for persons who were paroled into the United States under the terms of the Uniting for Ukraine program. Routine TB reporting to CDC should include persons from this population.

All verified cases of TB should be reported to CDC’s National TB Surveillance System as soon as possible after verification of the diagnosis using the Report of a Verified Case of Tuberculosis (RVCT). For TB cases diagnosed among persons who recently arrived in the United States through the Uniting for Ukraine Program, enter “U4UKRAINE” in the “Other, specify” free text field under Additional/Other TB Risk Factors (item 16 of the 2020 RVCT; item 34 of the 2009 RVCT). Targeted testing data should be reported to CDC’s National Tuberculosis Indicators Project (NTIP), using the standard Targeted Testing Aggregate Reports of TB Program Evaluation (ARPE) form.

My state or big city program does not report 150 cases of tuberculosis annually. Do I need to submit a Targeted Testing (TT) Aggregate Reports of TB Program Evaluation (ARPE) form for the Uniting for Ukraine activity?

Yes, all recipients of Ukraine supplemental funds must submit a TT ARPE at intervals listed in the announcement (12/31/22, 6/30/23, and 12/31/23). There will be a separate radio button in the ARPE options that identifies Targeted Testing, United for Ukraine. States/jurisdictions that are required to submit a TT ARPE in March 2023 as part of the Terms and Conditions of 20-2001 (150 cases or more) will still complete that form, but the United for Ukraine activity should be reported separately.

Can you clarify if the Targeted Testing Aggregate Reports of TB Program Evaluation (ARPE) form is directly tied to the use of Ukraine supplemental funds? That is, if IGRA cost was not covered with these funds, should results be reported to CDC?

Targeted testing is tied to the use of the Ukraine supplemental funds. If IGRA costs were paid for by other means, reporting for testing activities should still be captured in the ARPE if testing involved persons who were paroled into the United States under the terms of the Uniting for Ukraine program.

Will the optional Aggregate Reports of TB Program Evaluation (ARPE) form fields (i.e., IGRA tests, treatment regimens) also be optional on the Uniting for Ukraine report?

There will be a radio button for uploading ARPE data for targeted testing (TT) Uniting for Ukraine activities. The form will be the same as with the standard TT ARPE form, with the same instructions. Therefore, the optional fields still apply.

However, the TT ARPE for persons who seek TB testing for the Uniting for Ukraine U.S. Citizenship and Immigration Services attestation form should start on the “Evaluated” row of the report. The three rows above “Evaluated” do not need to be completed, and in many settings the data for those three rows will not be readily available.

What if you have already been screening and testing prior to receiving this award and do not need to go back and retroactively pay for anything – do you still report these numbers in the Uniting for Ukraine targeted testing Aggregate Reports of TB Program Evaluation (ARPE) form or is the targeted testing ARPE related to this population for which funding was used?

Recipients can decide whether to collect and report the aggregate data on Uniting for Ukraine activities prior to accepting and applying the Uniting for Ukraine supplemental funding. Ideally, all Uniting for Ukraine activity should be collected and reported.

The feasibility and the reasonableness of the data collection should be considered. One reason for collecting the data is accountability. If the new funds are not being used for recouping the costs of the previous work, then the data are not needed.

Another reason for collecting the data is to document how health departments are directly contributing to the national Uniting for Ukraine response. Data for previous work are helpful for showing the workload that is added by the Uniting for Ukraine response. Some of the burden from the previous work may carry over into the current workload. Please work with your project officer on the best solution

Recipients can retroactively apply/reimburse Uniting for Ukraine activity costs back to May 21, 2022, when the Public Health Law authorizing this funding was signed by President Biden.

There have been and will be Ukrainian persons arriving or staying in the United States outside of the Uniting for Ukraine program. Even though they may not be required to have TB testing, they may be tested, evaluated, and treated. What guidance do you have regarding documenting services for the Ukrainian population not included in Uniting for Ukraine program?

The guidance in the Ukraine supplemental funding announcement indicates documenting TB screening and treatment only for persons who were paroled into the United States under the terms of the Uniting for Ukraine program. State or local programs should document other targeted testing or treatment efforts in accordance with protocols under routine activities of the Tuberculosis Elimination and Laboratory Cooperative Agreement (CDC-RFA-PS20-2001).

How should grantees track funds spent on medications?

Only Ukraine supplemental funds can be used for purchasing medications. Funds from the parent NOFO (CDC-RFA-PS20-2001) cannot be used to purchase medications. Keep a separate account of spending for this activity.