Information Collection

DoDSER Suicide Event Report

IC 213137 under ICR 201409-0720-001 · OMB 0720-0058.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0058 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
dodser2014_itembank_FINAL.docx	Other-Data Fields
DoDSER PAS Disclosure.docx	Other-Privacy Act Statement
DoDSER Data Collection Phone Script.docx	Other-Phone Script
DoDSER Initial Log On and Intro Screen Shots.pdf	Other-Log on and Introductory Screen

IC Title:

DoDSER Suicide Event Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Fields	dodser2014_itembank_FINAL.docx	Yes	Yes	Fillable Fileable
Other-Privacy Act Statement	DoDSER PAS Disclosure.docx	Yes	Yes	Fillable Fileable
Other-Phone Script	DoDSER Data Collection Phone Script.docx	Yes	Yes	Fillable Fileable
Other-Log on and Introductory Screen Shots	DoDSER Initial Log On and Intro Screen Shots.pdf	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,375

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,375	1,375
Annual IC Time Burden (Hours)	229	229
Annual IC Cost Burden (Dollars)	3,266	3,266

Documents for IC

table that charts IC Documents
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.