Regulations to Implement SAMHSA's Charitable Choice Statutory Provisions: 42 CFR Parts 54 and 54a

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IC Title:	Regulations to Implement SAMHSA's Charitable Choice Statutory Provisions: 42 CFR Parts 54 and 54a	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SMA-170				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,256	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	319,906	319,906
Annual IC Time Burden (Hours)	16,208	16,208
Annual IC Cost Burden (Dollars)	56,000	56,000

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.