MI/SP Counselor Consent

Monitoring of National Suicide Prevention Lifeline Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0274 can be found here:

Documents and Forms

Document Name Document Type
Form Counselor Consent MI/SP Counselor Consent Form and Instruction
Counselor Consent Counselor Consent Attachment D_Counselor Consent.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	MI/SP Counselor Consent	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
Form and Instruction	Counselor Consent	Counselor Consent	Attachment D_Counselor Consent.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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