Attachment C

Attachment C

Substance Abuse/Mental Health Single State Agency (SSA) Coordination Form

Attachment C

Form Approved

OMB No.0990-0317

Drug Abuse/Mental Health Single State Agency (SSA) Coordination

Coordination with the SSA helps ensure communication, reduce duplication, and facilitate continuity. Therefore, applicants who are not the SSA, must include in an appendix to the application entitled letter to SSA, with a copy of a letter sent to the SSA that (1) transmits a copy of the face page of the application (Standard Form 424) and a copy of the project abstract, and (2) notifies the State that, if it wishes to comment on the proposal, its comments should be sent not later than 60 days after the deadline date for the receipt of applications to:

Director of Grant Review, Office of Program Services

Substance Abuse and Mental Health Services Administration

Room 3-1044, 1 Choke Cherry Road,

Rockville, MD 20857

ATTN: SSA-Funding Announcement No. ___

Note: Applicants should fill in the pertinent RFA number.

Applicants may request that the SSA send them a copy of any State comments.

A listing of SSAs can be found in the grant application kit. If the proposed project falls within the jurisdiction of more than one State, all representative SSAs should be involved.

Public reporting burden for the SSA Notification is estimated to average 10 minutes per response, including the time for copying the face page of the SF 424 and the abstract and preparing the letter for mailing. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to SAMHSA, Reports Clearance Officer, 1 Choke Cherry Road , Rockville, MD 20857. (OMB No. 0990-0317) Do not send the completed form to this address.