DoDSER Suicide Event Report

DoDSER Phone Script for Collecting Information from the Public, e.g., Family Members.

Hello, my name is ___________ and I'm calling on behalf of the Department of Defense about your [ENTER RELATIONSHIP: son, daughter, etc]. [If suicide]I am very sorry for your loss. We would like to learn from this so I would like to ask you some questions about him/her and his/her suicide. It is voluntary and should take no more than 10 minutes of your time. Are you willing to hear more about the questions I have?

If “Yes”:

I am about to request information on suicides [or instances of self-harm behavior (including suicide attempts and suicidal ideations)] that may have occurred among active military personnel, reserve military personnel, or members of the National Guard. This information may be collected into the Department of Defense Suicide Event Report (DoDSER). You are not required to provide any information, but any information you provide may assist DoD in promoting the health of the Armed Forces.

The authorities permitting this collection include 10 U.S.C. 136 and 10 U.S.C. Chapter 55. The information you provide may be disclosed for reasons compatible with why it was collected and when permitted by the HIPAA Privacy Rule and other applicable privacy laws. The OMB Control Number for this collection of information is 0720.XXXX and the expiration date is Xx/XX/20XX. Would you like to know more about the authorities, purposes, routine uses, or disclosures, or receive a paper copy of the full Privacy Act Statement?

[If the individual (the interviewee) requests additional information about the authorities, purposes, routine uses, or disclosures, that section of the Privacy Act Statement is read. If the individual requests a paper copy of the PAS, the individual may choose whether to withhold any responses until a paper copy of the above PAS has been provided.]