Garrett Lee Smith Campus Case Studies

Forms and Documents

Document Name	Status
Form Instruments GLS Campus Case Studies Form and Instruction	New
OMB response2 10 9 09.docx Supplementary Document	2009-10-15
CCS OMB Response110 05 09.doc Supplementary Document	2009-10-15
CCS Supporting Statement 4_29_09.doc Supporting Statement B	2009-06-12
Other Documents.zip Supplementary Document	2009-06-12
CCS Supporting Statement 10_6_09 VB2.doc Supporting Statement A	2009-10-15

IC Document Collections

IC ID	Document Title	Status
189722	GLS Campus Case Studies Form and Instruction	New

ICR Details

OMB Control No: 0930-0305	ICR Reference No: 200906-0930-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Garrett Lee Smith Campus Case Studies
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/09/2009
	Date Received in OIRA: 06/25/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved
Responses	1,770	0	0
Time Burden (Hours)	1,017	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The GLS Campus Case Studies (CCS) have been planned to provide additional context and information about successful suicide prevention activities on a select group of campuses. The case studies will use a three-stage model to describe and evaluate the public health approaches to suicide prevention used on up to six GLS-funded campuses. The CCS includes three data collection stages to: (1) identify campus infrastructures to support help-seeking behaviors, coping strategies, and protective factors; (2) identify facilitators/barriers to help-seeking behaviors, coping strategies and risk and protective factors; and (3) follow-up to identify campus infrastructure and discuss evaluation findings. There are 10 data collection instruments within the three evaluation stages for which clearance is being requested.

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Authorizing Statute(s): US Code: 5 USC 520 Name of Law: CMHS
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 48225	08/18/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 28705	06/17/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
GLS Campus Case Studies	Instruments	Instruments

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,770	0	0	1,770	0	0
Annual Time Burden (Hours)	1,017	0	0	1,017	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection.

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Annual Cost to Federal Government: $83,072

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/25/2009

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