Information Collection

KA and Transfer for Youth Violence and Suicide Prevention Disaster Distress Helpline Campaign Focus Groups

IC 203037 under ICR 201008-0930-002 · OMB 0930-0196.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0196 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment B Scree KA and Transfer for Youth Violence and Suicide Prevention Disaster Distress Helpline Campaign Focus Groups	Form and Instruction
Attachment B Scree Attachment B Screeners Attachment B Screeners 6-22-12.docx	Form and Instruction
Attachment C Moder Attachment C Moderator Guides Attachment C Moderator Guides 6-22-12.docx	Form and Instruction
DDH OMB Supporting Statement 6-22-12.docx Supporting Statement	IC Document
Attachment A Focus Group Plan 6-22-12.docx Attachment A Focus Group Plan	IC Document
Attachment D Messages 6-22-12.doc Attachment D Messages	IC Document

IC Title:

KA and Transfer for Youth Violence and Suicide Prevention Disaster Distress Helpline Campaign Focus Groups

Agency IC Tracking Number:

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
Form and Instruction	Attachment B Screeners	Attachment B Screeners	Attachment B Screeners 6-22-12.docx		Yes	Yes	Fillable Printable
Form and Instruction	Attachment C Moderator Guides	Attachment C Moderator Guides	Attachment C Moderator Guides 6-22-12.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	600	0	0	0	0	0
Annual IC Time Burden (Hours)	125	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement	DDH OMB Supporting Statement 6-22-12.docx	06/25/2012
Attachment A Focus Group Plan	Attachment A Focus Group Plan 6-22-12.docx	06/25/2012
Attachment D Messages	Attachment D Messages 6-22-12.doc	06/25/2012

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