Information Collection

National Suicide Prevention Lifeline Imminent Risk Form

IC 199784 under ICR 201804-0930-001 · OMB 0930-0333.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Imminent Risk Form National Suicide Prevention Lifeline Imminent Risk Form	Form and Instruction
Imminent Risk Form Imminent Risk Form 0930-0333_Attach1_ImminentRiskFormRev_FINAL.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	Imminent Risk Form	Imminent Risk Form	0930-0333_Attach1_ImminentRiskFormRev_FINAL.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 116

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	220	-44	264
Annual IC Time Burden (Hours)	57	-8	65
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.