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U.S. Department of Health and Human Services

Federal Support to State, Tribal, and Jurisdiction Management (Tier 6)

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Federal Support to State, Tribal, and Jurisdiction Management(Tier 6)

Tier 6 consists of Federal public health and medical assets (e.g., supplies, equipment, facilities, and personnel) organized under Emergency Support Function (ESF) #8 of the National Response Plan (NRP). The U.S. Department of Health and Human Services (HHS) is the Primary Agency for ESF #8 and coordinates Federal public health and medical assistance in support of State, Tribal, and jurisdictional response efforts.[1] 

Key Points of the Chapter

The Federal Government may provide public health and medical assistance during an emergency or disaster under ESF #8 of the NRP. This assistance can be activated by a Presidential declaration of a major disaster or emergency, declaration of an Incident of National Significance by the Secretary of the Department of Homeland Security (DHS), or at the request of another Federal department or agency. HHS can also provide public health and medical assistance during an emergency or disaster under the independent authority of the Secretary of HHS.

The primary role of Federal resources in providing medical surge capacity and capability (MSCC) is to support, not supplant, State, Tribal, and jurisdictional response efforts. When the NRP is triggered by a Presidential declaration of a major disaster or emergency under the Stafford Act, Federal assistance generally is provided at the request of the Governor (or his/her designee) of an affected State. In a catastrophic event,[2] however, Federal assets may be mobilized and deployed to Federal installations in advance of a formal request for assistance. The Catastrophic Incident Supplement of the NRP establishes the policies, procedures, and mechanisms by which this may occur. The Federal Government closely coordinates this proactive mobilization with affected States, Tribal Nations, and jurisdictions.

On behalf of the Secretary of HHS, the Assistant Secretary for Preparedness and Response (ASPR) coordinates all aspects of Federal public health and medical assistance under ESF #8. The HHS Secretary's Operations Center (SOC) is the hub of information management and strategic-level command and control for ESF #8. During an emergency, the HHS Emergency Management Group (EMG) operates out of the SOC to coordinate the ESF #8 response. The ASPR may request that liaisons from the ESF #8 support agencies[3] and HHS Operating Divisions (OPDIVs)[4] be provided to the SOC to ensure a coordinated ESF #8 response. () Similarly, HHS may provide liaisons to other Federal, State, Tribal, and jurisdictional Emergency Operations Centers (EOCs) to promote response coordination. The SOC also provides liaisons to appropriate Federal command and control posts identified in the NRP, such as the National Response Coordination Center or the National Operations Center. 

The HHS Incident Response Coordination Team (IRCT), which is mobilized by the ASPR, coordinates all deployed ESF #8 assets. All field communications to the SOC flow through the IRCT, which is typically led by an HHS Regional Emergency Coordinator. The IRCT team leader is accountable for executing field activities for the ASPR. In a large-scale or complex incident, the Secretary of HHS may also deploy a Senior Health Official (SHO) to be his/her direct representative in the field. When deployed, the SHO is responsible for overarching coordination of deployed ESF #8 assets and provides guidance and leadership to the IRCT. The SHO serves as the senior-level ESF #8 liaison to State, Tribal, jurisdictional, and other Federal officials, including the DHS-appointed Principal Federal Official. The SHO operates at the strategic level and reports to the EMG. Typically, the SHO is part of the PFO Coordination Cell and coordinates with the IRCT leadership.

To promote an effective ESF #8 response, preparedness activities should examine and clearly delineate the processes for requesting, receiving, and managing Federal assistance. State, Tribal, and jurisdictional public health and medical planners must precisely determine their response capability, when they might need Federal support, how to develop and submit a request, and how they would integrate Federal assets into their incident command system. 


  1. In the context of this document, jurisdiction refers to a geographic area's local government, which usually has the primary role in emergency response. A definition of local government is provided in Appendix D.
  2. The NRP definition of a catastrophic event is provided in Appendix D.
  3. ESF #8 support agencies are identified in the ESF #8 annex of the NRP.
  4. HHS OPDIVs include the Centers for Disease Control and Prevention (CDC); Centers for Medicare and Medicaid Services (CMS); Food and Drug Administration (FDA); Indian Health Service (IHS); Health Resources and Services Administration (HRSA); Substance Abuse and Mental Health Services Administration (SAMHSA); National Institutes of Health (NIH); Agency for Healthcare Research and Quality (AHRQ); Administration for Children and Families (ACF); and Administration on Aging (AoA).

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  • This page last reviewed: May 08, 2015