Counselor Follow-up Questionnaire

Monitoring of National Suicide Prevention Lifeline Form

Documents and Forms

Document Name Document Type
Form Counselor Question Counselor Follow-up Questionnaire Form and Instruction
Counselor Question Counselor Questionnaire Attachment D. Counselor Questionnaire 031616.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Counselor Follow-up Questionnaire	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	Counselor Questionnaire	Counselor Questionnaire	Attachment D. Counselor Questionnaire 031616.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 42	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	630	-620	1,250
Annual IC Time Burden (Hours)	107	-106	213
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.