National Suicide Prevention Lifeline Imminent Risk Form

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

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

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.