Tuberculosis Elimination and Laboratory Cooperative Agreement - The New Jersey Department of Health (NJDOH) Tuberculosis (TB) Program conducts statewide surveillance by housing and maintaining the state TB disease registry. Additionally, the program provides financial assistance, direct assistance, material support, technical assistance, and education to strengthen TB prevention and control activities at local health departments throughout the state. The NJDOH TB Program ensures continuity of care by tracking TB case-patients migrating in to and out of New Jersey and the United States. The program also provides health service grant funding to partially fund eight regional TB clinics. Local TB programs are funded through a combination of sources unique to each site: levies, general revenue funds, private hospitals, and endowments from corporate or community groups. Where needed, the NJDOH TB Program provides on-site expert guidance for the investigation of TB cases, clusters and outbreaks, and conducts regional trainings to address specific needs. Expert TB medical consultation for complex cases is provided by the Global TB Institute and the TB Medical Advisory Board. The Global TB Institute in Newark has been designated a TB Center of Excellence by the CDC and serves as a federally funded regional training and medical consultation consortia, providing trainings and webinars for public health nurses and TB clinicians throughout New Jersey and the Northeastern United States. New Jersey is the fourth smallest and most densely populated state, with more than 1,200 people per square mile. In 2023, the population was 9.2 million; 51.0 percent females and 49.0 percent males. Regarding race/ethnicity, the largest segment of the population is White (52.0%) followed by Hispanic (22.7%), Black (15.5%), and Asian (10.6%). In 2023, foreign-born persons accounted for 23.2 percent of the population or approximately 2.1 million people. There has been a 65.1 percent decrease in tuberculosis (TB) morbidity in New Jersey since 1992 (The peak of TB resurgence in the US). Following two decades of steadily decreasing incidence, the rate of decline began to slow, or level off, between 2012—2019. However, since 2020, TB case counts and rates have increased each year, culminating in 343 cases in 2023, with a corresponding incidence rate of 3.7 cases per 100,000 population. Although the incidence of TB has been generally declining since 1992, both in the US and New Jersey, the incidence rate of TB in New Jersey remains higher than the national rate of 2.9, and the 343 cases counted in 2023 represents the largest number of newly diagnosed cases of TB in New Jersey since 2010 (N= 405). Aside from the recent increases in incidence and prevalence, TB remains a disease of major public health importance in New Jersey due to its airborne mode of transmission and the emergence of drug resistant strains of the bacterium.