Project Evaluators - State/Tribal

Cross-Site Evaluation of the Garrett Lee Smith Memorial Suicide Prevention and Early Intervention Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:

Documents and Forms

Document Name Document Type
Form H1. EIRF Analysis Project Evaluators - State/Tribal Form and Instruction
H1. EIRF Analysis H1. EIRF Analysis Form (EIRF) H1. EIRF Analysis Form (EIRF).docx Form and Instruction
Project Evaluator--StateTribal & Campus Other Documents.pdf Project Evaluator--StateTribal & Campus Other Documents IC Document

Information Collection (IC) Details

IC Title:	Project Evaluators - State/Tribal	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	H1. EIRF Analysis Form (EIRF)	H1. EIRF Analysis Form (EIRF)	H1. EIRF Analysis Form (EIRF).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 243	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	873	-2,199	3,072
Annual IC Time Burden (Hours)	1,603	1,139	464
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Project Evaluator--StateTribal & Campus Other Documents	Project Evaluator--StateTribal & Campus Other Documents.pdf	08/17/2013

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