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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	An Outcome Evaluation of the SOS Signs of Suicide Prevention Program	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
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 %

	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

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.