Information Collection

An Outcome Evaluation of the SOS Signs of Suicide Prevention Program

IC 191740 under ICR 201001-0720-002 · OMB 0720-0047.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
SOS Evaluation PI R. Aseltine Survey Versions 3C.pdf	Other-Survey
SOS English Consent 3a 2008-2009.doc English Consent Form	IC Document
SOS Spanish Consent 3a 2008-2009.doc Spanish Consent Form	IC Document
SOS Polish Consent 3a 2008-2009.doc Polish Consent Form	IC Document
Privacy Act Statement SOS Evaluation PI R Aseltine-FINAL.doc PAS	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			SOS Evaluation PI R. Aseltine Survey Versions 3C.pdf		No		Paper Only

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 840

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,680	1,680
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
English Consent Form	SOS English Consent 3a 2008-2009.doc	01/11/2010
Spanish Consent Form	SOS Spanish Consent 3a 2008-2009.doc	01/11/2010
Polish Consent Form	SOS Polish Consent 3a 2008-2009.doc	01/11/2010
PAS	Privacy Act Statement SOS Evaluation PI R Aseltine-FINAL.doc	01/11/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.