Information Collection

The State of State Suicide Prevention: An Environmental Scan

IC 231591 under ICR 201711-0920-012 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.