Networking Suicide Prevention Hotlines - Evaluation of the Lifeline Policies for Helping Callers at Immient Risk

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Imminent Risk Form National Suicide Prevention Lifeline Imminent Risk Form	Form and Instruction	Modified	Available
0930-0333 Iminent Risk SS-B_5.31.18.doc	Supporting Statement B	Uploaded 2018-06-19	Available
0930-0333 Iminent Risk SS-A_5.31.18.doc	Supporting Statement A	Uploaded 2018-06-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199784	National Suicide Prevention Lifeline Imminent Risk Form	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0333	ICR Reference No: 201804-0930-001
Status: Active	Previous ICR Reference No: 201501-0930-001
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Networking Suicide Prevention Hotlines - Evaluation of the Lifeline Policies for Helping Callers at Immient Risk
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/21/2018
	Date Received in OIRA: 04/06/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2021	36 Months From Approved	06/30/2018
Responses	220	0	264
Time Burden (Hours)	57	0	65
Cost Burden (Dollars)	0	0	0

---

Abstract: The Evaluation of the Lifeline Policies for Helping Callers at Imminent Risk will collect data, using an imminent risk form, to inform the network's knowledge of the extent to which counselors are aware of and being guided by the Lifeline's imminent risk guidelines; counselors' definitions of imminent risk; the rates of active rescue of imminent risk callers; types of rescue; barriers to intervention; and the circumstances in which active rescue is initiated, including the caller's agreement to receive the intervention.

---

Authorizing Statute(s): US Code: 42 USC 290bb-32 Name of Law: Priority of MH Needs of Regional National Significance
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 4918	02/02/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 14871	04/06/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
National Suicide Prevention Lifeline Imminent Risk Form	Imminent Risk Form	Imminent Risk Form

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	220	264	0	-44	0	0
Annual Time Burden (Hours)	57	65	0	-8	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Currently there are 65 annual burden hours in the OMB inventory. CMHS is requesting 57 annual hours for this submission. The decrease adjustment of 8 hours is due to a reduced number of participating centers and therefore, a reduced number of respondents.

---

Annual Cost to Federal Government: $235,407

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/06/2018

---