SABG_Funding_Agreements 4-29-13

I.

State Information

Chief Executive Officer’s Funding Agreements, Assurances Non-Construction Programs and
Certifications (Form 3)
Fiscal Year 2014

U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administrations
Funding Agreements
as required by
Substance Abuse Prevention and Treatment Block Grant Program
as authorized by
Title XIX, Part B, Subpart II and Subpart III of the Public Health Service Act
and
Tile 42, Chapter 6A, Subchapter XVII of the United States Code

Section
Section 1921
Section 1922
Section 1923
Section 1924
Section 1925
Section 1926
Section 1927
Section 1928
Section 1929
Section 1930
Section 1931
Section 1932
Section 1941
Section 1942
Section 1943
Section 1946
Section 1947
Section 1953
Section 1955
Section 1956

Title XIX, Part B, Subpart II of the Public Health Service Act
Title
Formula Grants to States
Certain Allocations
Intravenous Substance Abuse
Requirements Regarding Tuberculosis and Human Immunodeficiency Virus
Group Homes for Recovering Substance Abusers
State Law Regarding the Sale of Tobacco Products to Individuals Under Age 18
Treatment Services for Pregnant Women
Additional Agreements
Submission to Secretary of Statewide Assessment of Needs
Maintenance of Effort Regarding State Expenditures
Restrictions on Expenditure of Grant
Application for Grant; Approval of State Plan
Title XIX, Part B, Subpart III of the Public Health Service Act
Opportunity for Public Comment on State Plans
Requirement of Reports and Audits by States
Additional Requirements
Prohibition Regarding Receipt of Funds
Nondiscrimination
Continuation of Certain Programs
Services Provided by Nongovernmental Organizations
Services for Individuals with Co-Occurring Disorders

Chapter
42 USC § 300x-21
42 USC § 300x-22
42 USC § 300x-23
42 USC § 300x-24
42 USC § 300x-25
42 USC § 300x-26
42 USC § 300x-27
42 USC § 300x-28
42 USC § 300x-29
42 USC § 300x-30
42 USC § 300x-31
42 USC § 300x-32
42 USC § 300x-51
42 USC § 300x-52
42 USC § 300x-53
42 USC § 300x-56
42 USC § 300x-57
42 USC § 300x-63
42 USC § 300x-65
42 USC § 300x-66

I hereby certify that the state or territory will comply with Title XIX, Part B, Subpart II and Subpart III of
the Public Health Service (PHS) Act, as amended, and summarized above, except for those sections in
the PHS Act that do not apply or for which a which a waiver has been granted or may be granted by the
Secretary for the period covered by this agreement.
State: Insert name
Name of Chief Executive Officer (CEO) or Designee: Insert name
Signature of CEO or Designee 1: Inset name
Title:
1

If the agreement is signed by an authorized designee, a copy of the designation must be attached.

I.

State Information

Chief Executive Officer’s Funding Agreements, Assurances Non-Construction Programs and
Certifications (Form 3)
Fiscal Year 2014

Date Signed: mm/dd/yyyy