Information Collection

DoDSER Suicide Event Report

IC 213137 under ICR 201604-0720-002 · OMB 0720-0058.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0720-0058 can be found here:

Documents and Forms

Document Name Document Type
dodser2014_itembank_FINAL.docx Other-Data Fields
DoDSER PAS Disclosure.docx Other-Privacy Act Statement
DoDSER Data Collection Phone Script.docx Other-Phone Script
DoDSER Initial Log On and Intro Screen Shots.pdf Other-Log on and Introductory Screen

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DoDSER Suicide Event Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Fields	dodser2014_itembank_FINAL.docx	Yes	Yes	Fillable Fileable
Other-Privacy Act Statement	DoDSER PAS Disclosure.docx	Yes	Yes	Fillable Fileable
Other-Phone Script	DoDSER Data Collection Phone Script.docx	Yes	Yes	Fillable Fileable
Other-Log on and Introductory Screen Shots	DoDSER Initial Log On and Intro Screen Shots.pdf	Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title: Department of Defense Suicide Event Report (DoDSER) System	FR Citation: 75 FR 24928

Number of Respondents: 1,375	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,375	1,375
Annual IC Time Burden (Hours)	229	229
Annual IC Cost Burden (Dollars)	3,266	3,266

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.