Department of Defense Suicide Event Report (DoDSer)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
DoDSER_Privacy_Act_Statement_2019-08-29.pdf	Supplementary Document	Uploaded 2019-08-29	Available
0720-0058_ DoDSER SSN Justification Memo_2.17.2019.pdf	Supplementary Document	Uploaded 2019-08-29	Available
0720-0058_SSA_08.29.19.docx	Supporting Statement A	Uploaded 2019-08-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213137	DoDSER Suicide Event Report	Other-Data Fields	Modified

ICR Details

OMB Control No: 0720-0058	ICR Reference No: 201907-0720-001
Status: Active	Previous ICR Reference No: 201604-0720-002
Agency/Subagency: DOD/DODOASHA	Agency Tracking No:
Title: Department of Defense Suicide Event Report (DoDSer)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/23/2019
	Date Received in OIRA: 08/29/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2022	36 Months From Approved	10/31/2019
Responses	1,563	0	1,375
Time Burden (Hours)	261	0	229
Cost Burden (Dollars)	5,580	0	3,266

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Abstract: The DoD Suicide Event Report (DoDSER) standardizes suicide surveillance efforts across the services (Air Force, Army, Marine Corps, and Navy) to support the DoD's suicide prevention mission. Information collected is intended to inform programs and research designed to prevent suicide and suicide behaviors among military personnel. Respondents may include but are not limited to individuals familiar with event details to include colleagues, supervisors, medical and behavioral health providers, family members, and friends. This revision of the DoDSER form is designed to improve overall data collection quality.

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Authorizing Statute(s): US Code: 10 USC 55 Name of Law: Medical and Dental Care
   US Code: 10 USC 3013 Name of Law: Secretary of the Army
   US Code: 10 USC 136 Name of Law: Under Secretary of Defense for Personnel and Readiness
   US Code: 10 USC 5013 Name of Law: Secretary of the Navy
   US Code: 10 USC 8013 Name of Law: Secretary of the Air Force
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 22832	05/20/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 45481	08/29/2019
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
DoDSER Suicide Event Report

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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	1,563	1,375	0	188	0	0
Annual Time Burden (Hours)	261	229	0	32	0	0
Annual Cost Burden (Dollars)	5,580	3,266	0	2,314	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: There has been a slight increase in burden since the last OMB review in 2016. The estimated number of respondents has increased from 1,375 to 1,563. The approved burden hours estimate (229) and cost burden ($3,266.00) have increased to 260.5 hours and $5,582.51. This change is due to increased use of the DoDSER.

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Annual Cost to Federal Government: $40,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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.     Yes

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.     Yes

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

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Common Form ICR:  No

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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: 08/29/2019

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