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medication-assisted treatment for substance use disorders

Online Form SMA-162 for New Sponsor Certification of an Opioid Treatment Program


Instructions

On the following pages you can fill out and submit to SAMHSA an on-line form SMA-162, and supporting documents, for New Sponsor Certification of an Opioid Treatment Program (OTP).

Note: SMA-162s for new sponsor of an OTP can be submitted at this site only if the OTP does not have a Program Sponsor with a user account.  All OTPs wishing to submit an SMA-162 for new sponsor, or other purposes, must submit via their account on the SAMHSA OTP Extranet Website at http://otp-extranet.samhsa.gov. All OTPs have an account on the site. For help accessing your program's account, contact the SAMHSA OTP Extranet Information Center at otp-extranet@opioid.samhsa.gov, or 866-687-2728 (866-OTP-CSAT).

TThe instructions below will help you prepare a complete SMA-162 submission that can be processed expeditiously by SAMHSA. You may wish to print  these instructions for use as a checklist in obtaining and preparing all required information and supporting documents for your SMA-162 submission. When ready, click 'Continue' at the bottom of the page to begin completing your online SMA-162.


Who May Submit an SMA-162 Form?

An SMA-162 may only be submitted/signed by an OTP Program Sponsor. The Program Sponsor's name and contact information, including telephone number and e-mail address, are required on the form. After submitting an online SMA-162, a confirmation e-mail will be sent to the Sponsor. The Sponsor will need to click a link supplied in that e-mail to electronically sign the SMA-162 and complete the submission process. The submission process will not be complete until the Sponsor clicks the link in that e-mail. SAMHSA will contact the Sponsor after receipt of a completed SMA-162 if additional information is required.

What Additional Documents are Required With an SMA-162 for New Sponsor Certification?

The following supporting documentation is required to be provided with an SMA-162 application for a new sponsor.  To expedite the submission and processing of your request, SAMHSA recommends you obtain all required supporting documents in electronic format (.TXT, .DOC, or .PDF) for attachment to your submission prior to beginning the completion of the online SMA-162.  /p>

Required Supporting Documentation for an SMA-162 Request for a New Sponsor:

  1. A government issued picture ID.

 
Note to users of screen readers and other assistive technologies: Please report problems
to us at otp-extranet@opioid.samhsa.gov.