Step 1 of 2 50% County:*BurlingtonCamdenCape MaryCumberlandEssexGloucesterHudsonMercerMiddlesexMorrisNJ State PolicePassaicSalemSomersetSussexWarrenType of Activity*ArrestKnock & TalkSurveillance DetailCommunity EventTraining/PresentationOutreachMobile Van OutreachCoordination MeetingLocation TypeAddressArea (Radius)Municipality/CityStart Date* Date Format: MM slash DD slash YYYY Start Time* : HH MM End Date* Date Format: MM slash DD slash YYYY End Time* : HH MM Activity Funder*FFY20SFY21FFY21Names of Law Enforcement/OHH Staff*Names of Recovery Support Staff*# of Contacts MadePlease enter a number greater than or equal to 0.Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Municipality/CityRadius Arrest DetailsAgency Type*StateCountyLocalAgency SpecificsCase #'sMaterial DistributionMaterials Distributed Select All Narcan Test Strips Written Materials Give Aways (branded items) Other If Other, please provide detailCount of Narcan*Please enter a number greater than or equal to 0.Count of Test Strips*Please enter a number greater than or equal to 0.Count of Written Materials*Please enter a number greater than or equal to 0.Count of Give Aways*Please enter a number greater than or equal to 0.Count of Other*Please enter a number greater than or equal to 0.
