Monitoring of National Suicide Prevention Lifeline Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Instruments Monitoring of National Suicide Prevention Lifeline Form	Form and Instruction	Modified	Available
Hotline SS_8.23.12-B.doc	Supporting Statement B	Uploaded 2012-08-24	Available
Signed EE Memo.pdf	Supplementary Document	Uploaded 2012-08-24	Available
Published FRN.pdf	Supplementary Document	Uploaded 2012-08-24	Available
Other Documents.zip	Supplementary Document	Uploaded 2009-04-16	Available
Hotline SS_8.23.12-A.doc	Supporting Statement A	Uploaded 2012-08-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7689	Monitoring of National Suicide Prevention Lifeline Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0274	ICR Reference No: 201208-0930-003
Status: Historical Active	Previous ICR Reference No: 200904-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Monitoring of National Suicide Prevention Lifeline Form
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 08/27/2012
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/31/2012
	Date Received in OIRA: 08/24/2012
Terms of Clearance: SAMHSA shall make necessary procedural changes to avoid emergency requests in the future.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2013	6 Months From Approved
Responses	3,436	0	0
Time Burden (Hours)	1,181	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Suicide Prevention Lifeline--Call Monitoring Form collect information on the caller, the elements of a suicide risk assessment that are completed by the crisis worker, as well as what action plan that is developed with the caller and what referrals are provided to the caller. Additionally, the evaluation includes follow-up data collection utilizing the Crisis Hotline Telephone Follow-up Assessment. The purpose of this assessment is to collect data regarding: (1) suicide risk status at the time of and since the call, (2) depressive symptoms at follow-up, (3) service utilization since the call, (4) barriers to service access, and (5) the caller's perception of the efficacy of the hotline intervention.

Emergency Justfication: SAMHSA has determined that this information must be collected beyond the expiration as established under Part 1320. This information is essential to the mission of SAMHSA so that we may monitor the extent to which crisis hotline networks are preventing suicides and saving lives

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Authorizing Statute(s): US Code: 42 USC 520A Name of Law: Priority Mental Health Needs of Regional and National Significance
  

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:
	77 FR 51037	08/23/2012
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
Monitoring of National Suicide Prevention Lifeline Form	Instruments	Attachments A D E H J K

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,436	0	0	3,436	0	0
Annual Time Burden (Hours)	1,181	0	0	1,181	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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 reinstatement with no burden change.

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Annual Cost to Federal Government: $446,623

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: 08/24/2012

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