Project Evaluators - State/Tribal

Cross-Site Evaluation of the Garrett Lee Smith Memorial Suicide Prevention and Early Intervention Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:

Documents and Forms

Document Name Document Type
Form PSI StateTribal Project Evaluators - State/Tribal Form and Instruction
PSI StateTribal PSI StateTribal Att C.1 PSI StateTribal Dec2015.docx Form and Instruction
TASP StateTribal TASP StateTribal Att D.1 TASP StateTribal Dec2015.docx Form and Instruction
EIRF-Individual Fo EIRF-Individual Form StateTribal Att G. EIRF-Individual Form (StateTribal) Dec2015.docx Form and Instruction
EIRF-Screening For EIRF-Screening Form StateTribal Att H. EIRF-Screening Form (StateTribal) Dec2015.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Project Evaluators - State/Tribal	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	PSI StateTribal	PSI StateTribal	Att C.1 PSI StateTribal Dec2015.docx	Yes	Yes	Fillable Fileable
Form and Instruction	TASP StateTribal	TASP StateTribal	Att D.1 TASP StateTribal Dec2015.docx	Yes	Yes	Fillable Fileable
Form and Instruction	EIRF-Individual Form StateTribal	EIRF-Individual Form StateTribal	Att G. EIRF-Individual Form (StateTribal) Dec2015.docx	Yes	Yes	Fillable Fileable
Form and Instruction	EIRF-Screening Form StateTribal	EIRF-Screening Form StateTribal	Att H. EIRF-Screening Form (StateTribal) Dec2015.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 43	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	688	-185	873
Annual IC Time Burden (Hours)	430	-1,173	1,603
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.