National Suicide Prevention Lifeline Imminent Risk Form

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0333 can be found here:

Documents and Forms

Document Name Document Type
Form Imminent Risk Form National Suicide Prevention Lifeline Imminent Risk Form Form and Instruction
Imminent Risk Form Imminent Risk Form 0930-0333_AttachA_ImminentRiskFormRev_040115_notrack.doc Form and Instruction
Attachment B. Steering Committee Members.doc Steering Committee Members IC Document

Information Collection (IC) Details

IC Title:	National Suicide Prevention Lifeline Imminent Risk Form	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	Imminent Risk Form	Imminent Risk Form	0930-0333_AttachA_ImminentRiskFormRev_040115_notrack.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 132	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	264	-456	720
Annual IC Time Burden (Hours)	65	-115	180
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Steering Committee Members	Attachment B. Steering Committee Members.doc	09/29/2011

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