Service Level Measurement—PREVENTS Survey

Forms and Documents

Document Name	Status
Form 2020-2900-0876-P2 Service-Level Measurement- PREVENTS Survey Form and Instruction	New
Supporting Statement-A PREVVENTS 0625 (002).docx Supporting Statement A	2020-06-25
PREVENTS Survey v4_6-25-20.pdf Supplementary Document	2020-06-25
Supporting Statement B- PREVENTS (001).docx Supporting Statement B	2020-06-24

IC Document Collections

IC ID	Document Title	Status
242424	Service-Level Measurement- PREVENTS Survey Form and Instruction	New

ICR Details

OMB Control No: 2900-0880	ICR Reference No: 202006-2900-008
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: 2020-2900-0876-P
Title: Service Level Measurement—PREVENTS Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 06/30/2020
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 07/02/2020
	Date Received in OIRA: 06/26/2020
Terms of Clearance: Please resubmit for normal clearance

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		6 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This survey provides customer experience insights related to the experience of Veterans in accessing services and resources made possible via Executive Order 13861, known as the President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS). Feedback on this survey from Veterans Service Organizations, Veterans, and community organizations will help ensure that the PREVENTS Office has the information it needs to implement the Roadmap and communicate its efforts to empower Veterans and prevent suicide. Survey respondents will include Veterans Service Organization Members, Veterans, and individuals affiliated with nonprofit and community organizations. This survey is a non-probability-based survey and is not intended to make inferences about any overall population. This survey will be administered to Veterans who are affiliated with Veteran Service Organizations, individuals affiliated with Veteran-focused community-based or nonprofit organizations, or individuals who are affiliated with Veteran Service Organizations (VSOs). The survey will be publicized via an article that contains a survey link in a Blog in the Vet Resources Newsletter produced by the Department of Veterans Affairs, email communications with Veterans Service Organizations, and e-mail, in-person, and video-message communications to community-based organizations and strategic partners. Collected data are uploaded to the VSignals survey analysis tool and raw data are made present for analysis. Survey questions focus on current and potential mental health resources, communication channels, and outreach strategies that are currently being provided, or could be provided, to Veterans to ensure their safety and security.

Emergency Justfication: The survey in question is directly associated with Executive Order 13861- Executive Order on a National Roadmap to Empower Veterans and End Suicide- signed March 5, 2019. As part of that Executive Order, the President's PREVENTS task force has immediate upcoming deadlines to report Veteran sentiment and insights to the White House as per guidelines and timelines established by the Administration and Congress as part of the Roadmap report that the Task Force is creating. The President's Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS) will focus on a holistic public health approach to suicide prevention. PREVENTS seeks to change the culture surrounding mental health and suicide prevention through enhanced community integration, prioritized research activities, and implementation strategies that emphasize improved overall health and well-bein

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Authorizing Statute(s): EO: EO 13861 Name/Subject of EO: Executive Order on a National Roadmap to Empower Veterans and End Suicide
  

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:
	85 FR 1472	03/13/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 31614	05/26/2020
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Service-Level Measurement- PREVENTS Survey	2020-2900-0876-P2	Service-Level Measurement- PREVENTS Survey

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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: Survey was shortened in order to limit the burden to respondents.

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Annual Cost to Federal Government: $7,650

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? No

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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: 06/26/2020

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