Behavioral Health Providers/Stakeholders - 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⚠️ Notice: This information collection may be referencing outdated material.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 BHPS StateTribal Behavioral Health Providers/Stakeholders - State/Tribal Form and Instruction
BHPS StateTribal BHPS StateTribal Att J. BHPS StateTribal Dec2015.docx Form and Instruction
RNS StateTribal RNS StateTribal Att K. RNS (StateTribal) Dec2015.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Behavioral Health Providers/Stakeholders - 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BHPS StateTribal	BHPS StateTribal	Att J. BHPS StateTribal Dec2015.docx		Yes	Yes	Fillable Fileable
Form and Instruction	RNS StateTribal	RNS StateTribal	Att K. RNS (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: 433	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	433	-1,419	1,852
Annual IC Time Burden (Hours)	322	-920	1,242
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.