Information Collection

National Suicide Prevention Lifeline Imminent Risk Form

IC 199784 under ICR 201110-0930-001 · OMB 0930-0333.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0333 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Imminent Risk Form National Suicide Prevention Lifeline Imminent Risk Form	Form and Instruction
Imminent Risk Form Imminent Risk Form Attachment A. Imminent Risk Form_1.24.12 final.doc	Form and Instruction
Attachment B. Steering Committee Members.doc Steering Committee Members	IC Document

IC Title:

National Suicide Prevention Lifeline Imminent Risk Form

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
Form and Instruction	Imminent Risk Form	Imminent Risk Form	Attachment A. Imminent Risk Form_1.24.12 final.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 360

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 Agency Discretion
Annual Number of Responses for this IC	720	720
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Steering Committee Members	Attachment B. Steering Committee Members.doc	09/29/2011

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