An Outcome Evaluation of the SOS Signs of Suicide Prevention Program

Forms and Documents

Document Name	Status
bmc pub health_final.pdf Supplementary Document	2011-03-11
AJPH SOS 2004.pdf Supplementary Document	2011-03-11
sos report_aseltine_sept 2002 report 4 (2).doc Supplementary Document	2011-03-11
sos report_aseltine_sept2002 eval tables.doc Supplementary Document	2011-03-11
Addendum to OMB Supporting Statement. Feb 2011.docx Supporting Statement B	2011-03-11
OMB_Supporting_StatementFinal[1].Feb 2011.docx Supporting Statement A	2011-03-11

IC Document Collections

IC ID	Document Title	Status
191740	An Outcome Evaluation of the SOS Signs of Suicide Prevention Program Other-Survey	New

ICR Details

OMB Control No: 0720-0047	ICR Reference No: 201001-0720-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: An Outcome Evaluation of the SOS Signs of Suicide Prevention Program
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: 04/28/2011
	Date Received in OIRA: 01/11/2010
Terms of Clearance: Approved consistent with revisions submitted by DoD.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	36 Months From Approved
Responses	1,680	0	0
Time Burden (Hours)	840	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The SOS Program is a video-based educational program used by middle and high schools throughout the country in order to educate students about the signs and symptoms of depression and suicidality. This study will assess the effectiveness of the program though surveys administered at two points in time. Results will enable schools to make evidence based decisions on suicide and depression programming for their students.

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Authorizing Statute(s): PL: Pub.L. 109 - 163 721 Name of Law: null
  

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:
	74 FR 48231	09/22/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 48231	09/22/2009
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
An Outcome Evaluation of the SOS Signs of Suicide Prevention Program

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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	1,680	0	0	1,680	0	0
Annual Time Burden (Hours)	840	0	0	840	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: New Collection

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Annual Cost to Federal Government: $492,944

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: 01/11/2010

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