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CONCACAF is the organization that supervises and organizes international soccer (football to non-Americans) competitions in the regions in its name.
CONCACAF is responsible for the region's World Cup and Olympics qualifying (both men's and women's) and youth tournaments (under-20, under-17, etc), as well as club tournaments like the CONCACAF Champions Cup.
Men's World Cup Qualifying
The most important and highest profile function of CONCACAF is qualifying for the men's World Cup. The process is long and complicated, and takes more than 2 years to complete (World Cups take place every 4 years, so qualifying for the next one starts soon after the previous one is completed).
The early phases of qualifying involve home and away knockout pairings and round-robin group play. Every team in the region has a chance, although tiny island nations are usually dispatched in the first round (such as Aruba and the Cayman Islands).
The semifinal round is composed of 12 teams, divided into 3 groups of four teams. The winners of the early phases are in the semifinals, along with the top 4 squads from the previous World Cup's qualifying (United States, Costa Rica, Jamaica and Mexico for 2002 qualifying) who get byes into the semifinals.
In the semifinals, each team plays every other team in their group home and away (so 6 games total, 2 versus each of the other 3 teams). The top 2 teams in each group advance to the finals stage.
In the finals, the 6 teams play each other, home and away (10 games each; 2 against each of the other 5 teams). The top 3 teams qualify for the World Cup.
As of the time of this writeup, CONCACAF qualifying for the 2002 World Cup is in the finals. The 6 teams are: United States, Mexico, Jamaica, Costa Rica, Trinidad and Tobago, and Honduras.
Update Dec. 2001: Mexico, U.S., and Costa Rica qualified for World Cup 2002
(And if you think THAT was confusing, the earlier phases are even more complicated...)
Traditionally, Mexico has been the dominant team in the region. However, in recent years the United States has improved and is on a par with their southern neighbors.