Client Follow-up Consent Script

Monitoring of National Suicide Prevention Lifeline Form

Documents and Forms

Document Name Document Type
Form Client Follow-up C Client Follow-up Consent Script Form and Instruction
Client Follow-up C Client Follow-up Consent Script Attachment C. Client Follow-up Consent Script 031616.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Client Follow-up Consent Script	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	Client Follow-up Consent Script	Client Follow-up Consent Script	Attachment C. Client Follow-up Consent Script 031616.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 161	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	161	-208	369
Annual IC Time Burden (Hours)	27	-36	63
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.