Department of Defense Suicide Event Report (DoDSer)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
DoDSER 2016 proposed changes.DOCX	Supplementary Document	Uploaded 2016-05-16	Available
Supporting Statement Part A _DoDSER_FINAL_21Dec2015.DOCX	Supporting Statement A	Uploaded 2016-05-16	Available
6490 14 6182013.pdf	Supplementary Document	Uploaded 2014-09-09	Available
SSN_Justification_Memo.pdf	Supplementary Document	Uploaded 2014-09-09	Available
PIA.pdf	Supplementary Document	Uploaded 2014-09-09	Available
DoDSER Online SORN 15 NOV 2013.pdf	Supplementary Document	Uploaded 2014-09-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213137	DoDSER Suicide Event Report	Other-Data Fields	Modified

ICR Details

OMB Control No: 0720-0058	ICR Reference No: 201604-0720-002
Status: Historical Active	Previous ICR Reference No: 201409-0720-001
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: Department of Defense Suicide Event Report (DoDSer)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/05/2016
	Date Received in OIRA: 05/17/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	36 Months From Approved	03/31/2018
Responses	1,375	0	1,375
Time Burden (Hours)	229	0	229
Cost Burden (Dollars)	3,266	0	3,266

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Abstract: 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.

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Authorizing Statute(s): None

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:
	80 FR 63203	10/19/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 30266	05/16/2016
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
DoDSER Suicide Event Report

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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	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

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:

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Annual Cost to Federal Government: $866,240

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 05/17/2016

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