Veteran Suicide Prevention Online Quantitative Surveys

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 10-0513 Veterans' Suicide Prevention Online Quantitative Surveys	Form	New	Repair queued
Justification B Suicide Prevention 03 15 11.doc	Supporting Statement B	Uploaded 2011-05-26	Repair queued
Justification_A_Veteran_Suicide_Prevention_Online_Quantitative_Surveys[1].docx	Supporting Statement A	Uploaded 2011-05-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
195895	Veterans' Suicide Prevention Online Quantitative Surveys	Form	New

ICR Details

OMB Control No:	ICR Reference No: 201101-2900-007
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: Veteran Suicide Prevention Online Quantitative Surveys
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 01/26/2012
	Date Received in OIRA: 06/03/2011
Terms of Clearance: The agency withdraws this request to do some additional work regarding data needs for this program.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In order to prevent suicide by veterans, the Department is attempting to reach out through focus groups with them and their families. The Veterans Health Administration (VHA)will use the information attained through these surveys to support outreach efforts in reaching this critical audience and the people who they trust.

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Authorizing Statute(s): None

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:
	76 FR 34	02/18/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 91	05/11/2011
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Veterans' Suicide Prevention Online Quantitative Surveys	VA Form 10-0513, VA Form 10-0513A, VA Form 10-0513B	Veterans' Online Survey ,   Veterans' Family Members Online Survey ,   Health Care Providers Online Survey

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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. All hours are considered a burden increase.

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Annual Cost to Federal Government: $85,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 06/03/2011

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