The State of State Suicide Prevention: An Environmental Scan

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0879 The State of State Suicide Prevention: An Environmental Scan Form and Instruction
0920-0879 Suicide Prevention Web-based Survey - STT Suicide Preven Attachment B_Instrument Web Version.pdf Form and Instruction
0920-0879 Suicide Prevention Web-based Survey - STT Suicide Preven Attachment B_Instrument Web Version.pdf Form and Instruction
0920-0879 Suicide Prevention Web-based Survey - Delegates Attachment B_Instrument Web Version.pdf Form and Instruction
0920-0879 Suicide Prevention Telephone-based Survey - STT Suicide Attachment H - Survey by Phone Script.docx Form and Instruction
Attachment C_Pre-Notification Email.docx Pre-Notification Email IC Document
Attachment D_Notification Email.docx Notification Email IC Document
Attachment E_Reminder Email1.docx Reminder Email 1 IC Document
Attachment F_Reminder Email2.docx Reminder Email 2 IC Document
Attachment I_Reminder Email3.docx Reminder Email 3 IC Document
Attachment G_Reminder Call Script.docx Reminder Call Script IC Document
Attachment J_Thank You Email.docx Thank You Email IC Document
SOS-SCAN-SSA.DOCX Supporting Statement A IC Document
SOS-SCAN-SSB.DOCX Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	The State of State Suicide Prevention: An Environmental Scan	Agency IC Tracking Number:	0920-0879-18AIZ

IC Status: New

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	0920-0879	Suicide Prevention Web-based Survey - STT Suicide Prevention Coordinators	Attachment B_Instrument Web Version.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879	Suicide Prevention Web-based Survey - STT Suicide Prevention Grant Project Directors	Attachment B_Instrument Web Version.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879	Suicide Prevention Web-based Survey - Delegates	Attachment B_Instrument Web Version.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879	Suicide Prevention Telephone-based Survey - STT Suicide Prevention Coordinators	Attachment H - Survey by Phone Script.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 213	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 96 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	213	213
Annual IC Time Burden (Hours)	96	96
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Pre-Notification Email	Attachment C_Pre-Notification Email.docx	05/29/2018
Notification Email	Attachment D_Notification Email.docx	05/29/2018
Reminder Email 1	Attachment E_Reminder Email1.docx	05/29/2018
Reminder Email 2	Attachment F_Reminder Email2.docx	05/29/2018
Reminder Email 3	Attachment I_Reminder Email3.docx	05/29/2018
Reminder Call Script	Attachment G_Reminder Call Script.docx	05/29/2018
Thank You Email	Attachment J_Thank You Email.docx	05/29/2018
Supporting Statement A	SOS-SCAN-SSA.DOCX	05/29/2018
Supporting Statement B	SOS-SCAN-SSB.DOCX	05/29/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.