Department of Defense Suicide Event Report (DoDSer)

ICR 201604-0720-002

OMB: 0720-0058

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2016-05-16
Supporting Statement A
2016-05-16
Supplementary Document
2014-09-09
Supplementary Document
2014-09-09
Supplementary Document
2014-09-09
Supplementary Document
2014-09-09
IC Document Collections
IC ID
Document
Title
Status
213137 Modified
ICR Details
0720-0058 201604-0720-002
Historical Active 201409-0720-001
DOD/DODOASHA
Department of Defense Suicide Event Report (DoDSer)
Revision of a currently approved collection   No
Regular
Approved without change 08/05/2016
Retrieve Notice of Action (NOA) 05/17/2016
  Inventory as of this Action Requested Previously Approved
08/31/2019 36 Months From Approved 03/31/2018
1,375 0 1,375
229 0 229
3,266 0 3,266

The DoD Suicide Event Report (DoDSER) standardizes suicide surveillance efforts across the services (Air Force, Army, Marine Corps, and Navy) to support the DoD's suicide prevention mission. Information collected is intended to inform programs and research designed to prevent suicide and suicide behaviors among military personnel. Respondents may include but are not limited to individuals familiar with event details to include colleagues, supervisors, medical and behavioral health providers, family members, and friends. This revision of the DoDSER form is designed to improve overall data collection quality.

None
None

Not associated with rulemaking

  80 FR 63203 10/19/2015
81 FR 30266 05/16/2016
No

1
IC Title Form No. Form Name
DoDSER Suicide Event Report

  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 1,375 1,375 0 0 0 0
Annual Time Burden (Hours) 229 229 0 0 0 0
Annual Cost Burden (Dollars) 3,266 3,266 0 0 0 0
No
No

$866,240
No
No
No
No
No
Uncollected
Frederick Licari 571 372-0493 [email protected]

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/17/2016


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