Suicide _VA

Emergency Epidemic Investigation Data Collections - Expedited Reviews

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1011 can be found here:

Documents and Forms

Document Name Document Type
Suicide _VA Form
Interview Guide Appendix 1. Administrator and Counselor Interview Guide.doc Form
Focus Group Guide Appendix 2. Parent Focus Group Guide.doc Form
Letter of Invitation - Fairfax County.pdf Letter of Inviatation IC Document
2015002-XXX Suicide_VA v2.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Suicide _VA	Agency IC Tracking Number:	15DS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 301 [241]

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Interview Guide	Appendix 1. Administrator and Counselor Interview Guide.doc		No		Paper Only
Form	none	Focus Group Guide	Appendix 2. Parent Focus Group Guide.doc		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0113 Epidemic Investigation Case Records	FR Citation: 51 FR 42466

Number of Respondents: 105	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	105	105
Annual IC Time Burden (Hours)	98	98
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Inviatation	Letter of Invitation - Fairfax County.pdf	11/04/2014
Request for Approval	2015002-XXX Suicide_VA v2.docx	11/05/2014

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