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Cross-Site Evaluation of the Garrett Lee Smith Memorial Suicide Prevention and Early Intervention Program
OMB: 0930-0286
IC ID: 178434
OMB.report
HHS/SAMHSA
OMB 0930-0286
ICR 200701-0930-005
IC 178434
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:
2023-11-30 - Reinstatement with change of a previously approved collection
2015-12-28 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form Surveys
GLS
Form and Instruction
Surveys Surveys
OMB Attachments 12.06.07.zip
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
GLS
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
Surveys
Surveys
OMB Attachments 12.06.07.zip
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
36
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
72
6,370
-6,298
0
0
0
Annual IC Time Burden (Hours)
54
0
54
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.