Networking Suicide Prevention Hotlines - Evaluation of the Lifeline Policies for Helping Callers at Immient Risk

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Imminent Risk Form Imminent Risk Form	Form and Instruction	Modified	Available
0930-0333 Iminent Risk SS-B_4_23_15.doc	Supporting Statement B	Uploaded 2015-04-23	Available
0930-0333 Iminent Risk SS-A__4_23_15.doc	Supporting Statement A	Uploaded 2015-04-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199784	National Suicide Prevention Lifeline Imminent Risk Form	Form and Instruction	Modified	Imminent Risk Form

ICR Details

OMB Control No: 0930-0333	ICR Reference No: 201501-0930-001
Status: Historical Active	Previous ICR Reference No: 201110-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Networking Suicide Prevention Hotlines - Evaluation of the Lifeline Policies for Helping Callers at Immient Risk
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/23/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/08/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2015
Responses	264	0	720
Time Burden (Hours)	65	0	180
Cost Burden (Dollars)	0	0	0

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Abstract: The Evaluation of the Lifeline Policies for Helping Callers at Imminent Risk will collect data, using an imminent risk form, to inform the network's knowledge of the extent to which counselors are aware of and being guided by the Lifeline's imminent risk guidelines; counselors' definitions of imminent risk; the rates of active rescue of imminent risk callers; types of rescue; barriers to intervention; and the circumstances in which active rescue is initiated, including the caller's agreement to receive the intervention.

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Authorizing Statute(s): US Code: 42 USC 290bb-32 Name of Law: Priority of MH Needs of Regional National Significance
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 63415	10/23/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 78098	12/29/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
National Suicide Prevention Lifeline Imminent Risk Form	Imminent Risk Form	Imminent Risk Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	264	720	0	0	-456	0
Annual Time Burden (Hours)	65	180	0	0	-115	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Currently there are 180 hours in the OMB inventory. CMHS is requesting 65 hours. The decrease adjustment of 115 hours is due to a reduced number of respondents.

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Annual Cost to Federal Government: $248,244

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/08/2015

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