Information Collection

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

IC 7655 under ICR 200612-0930-001 · OMB 0930-0242.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0242 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form 3 Regulations to Implement SAMHSA's Charitable Choice Statutory Provisions: 42 CFR Parts 54 and 54a	Form
Form 3 Form 3 Form 3 Funding Agreements and Certifications.doc	Form
finalSAMHSA_ccregs.pdf Charitable Choice Regulations	IC Document

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: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form 3	Form 3	Form 3 Funding Agreements and Certifications.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,686

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,360	187	-317,733	319,906
Annual IC Time Burden (Hours)	2,360	2,354	-16,202	16,208
Annual IC Cost Burden (Dollars)	0	0	-56,000	56,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Charitable Choice Regulations	finalSAMHSA_ccregs.pdf	12/08/2006

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