The Center for Substance Abuse Prevention (CSAP) assists states in complying with the Synar Amendment’s goals by issuing programmatic requirements and guidance. CSAP is charged with overseeing the states’ implementation of the Synar requirements and provides technical assistance on the requirements and youth tobacco access issues in general. CSAP also provides guidance to states regarding the conduct of random, unannounced inspections. Specifically, in conducting their annual Synar surveys, states must: Develop a sampling frame that includes both over-the-counter and vending machine locations accessible to youth Ensure that the sampling frame includes, at a minimum, 80% of the tobacco outlets in the state (CSAP requires states that use a list frame to conduct and report the results of a coverage study designed to assess the completeness of the sampling frame.) Design a sampling methodology and implementation plan that are based on sound survey sampling methodology Sample a large enough number of outlets to meet SAMHSA’s precision requirement (one-sided 95% confidence interval) Obtain a completion rate of 90% or better Record the actual steps of the survey process in the field and keep records of all sources of sample attrition in the field Weight the results of the Synar survey to account for unequal probabilities of selection, differences in percentages of eligible outlets between strata or clusters, and other deviations from the intended design Penalties for Noncompliance In addition to setting targets for the states, the Synar Amendment established penalties for noncompliance. The penalty for a state is loss of up to 40% of its Substance Abuse Prevention and Treatment Block Grant (SABG) funds. Since these funds account for a large percentage of all state expenditures for substance abuse prevention and treatment, imposition of this penalty could present a severe problem to a state. For example, from FY 1997 to FY 2014, there were 19 instances involving 15 states in which that penalty could have been imposed. In lieu of this penalty, in every year since 2000, Congress has provided an alternative penalty mechanism by which a state can avoid the 40% reduction in its SABG funds if the state stipulates that it will spend its own funds to improve compliance with the law. Specifically, under the alternative penalty, a state that fails to meet Synar requirements can take the following steps to avoid being penalized: Committing additional state funds to ensure compliance with youth tobacco access laws in an amount equal to one percent of its current fiscal year’s block grant for each percentage point by which the state failed to meet the retailer violation target rate for the previous fiscal year Certifying that these additional state funds will be used to supplement and not supplant funds used for tobacco prevention programs and compliance activities in the fiscal year preceding the fiscal year to which the section applies Providing reports to the secretary of the Department of Health and Human Services on all state resources spent in the previous fiscal year and obligated in the current fiscal year for tobacco prevention and compliance activities by program activity The alternative penalty also stipulates that SABG funds cannot be withheld from a U.S. territory that receives less than $1 million in SABG funds for failing to meet the Synar requirements. Congress has provided the alternative penalty option as part of the Consolidated Appropriations Act each year since 2000. Section 212 of the Consolidated Appropriations Act of 2010 H.R. 3288 (P.L. 1-117) made the alternative penalty provision permanent. States took the opportunity afforded by these additional expenditures to strengthen and improve their Synar programs. The alternative penalty approach seems to be more effective in creating systems that reduce youth access to tobacco than a more strictly punitive reduction in funds. These types of federal-state partnerships have proven effective in achieving the intended goals of the Synar program. Funding for Implementation Although there is no dedicated federal source of funding for states to use in implementing the Synar requirements, states may expend funds from the primary prevention setaside of their SABG for carrying out the administrative aspects of the requirements, such as developing the sample design and conducting inspections. SABG funds may not be used to fund enforcement of youth tobacco access laws.