Information Collection

National Suicide Prevention Lifeline Imminent Risk Form

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Suicide Prevention Lifeline Imminent Risk Form	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	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 %

	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

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.