Information Collection

Epi-Aid Investigation of an increase in suicide in Ohio, 2022

IC 256406 under ICR 202101-0920-003 · OMB 0920-1243.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1243 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1243 Epi-Aid Investigation of an increase in suicide in Ohio, 2022 Form
0920-1243 Focus Group Guide Questions Attachment 2_OH suicide prevention Focus Group Guide Questions_OMB_final.docx Form
0920-1243 Interview Guide Questions Attachment 3 OH Suicide prevention Interview Guide Questions_OMB_final.docx Form
Letter of Invitation_Ohio_8.13.22.pdf Letter of Invitation IC Document
Attachment 4_Suicide Epi-Aid_PIA.pdf Privacy Impact Assessment IC Document
Attachment 5_Suicide Epi-Aid_ IRB Determination.docx IRB determination IC Document
Protocol Template Generic Suicide OMB_1243- OH_EpiAid - 10.12.22_final.docx GenIC Request Template IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Epi-Aid Investigation of an increase in suicide in Ohio, 2022	Agency IC Tracking Number:	0920-1243-23AF

IC Status: New

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	0920-1243	Focus Group Guide Questions	Attachment 2_OH suicide prevention Focus Group Guide Questions_OMB_final.docx		Yes	No	Fillable Fileable
Form	0920-1243	Interview Guide Questions	Attachment 3 OH Suicide prevention Interview Guide Questions_OMB_final.docx		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter of Invitation	Letter of Invitation_Ohio_8.13.22.pdf	10/13/2022
Privacy Impact Assessment	Attachment 4_Suicide Epi-Aid_PIA.pdf	10/13/2022
IRB determination	Attachment 5_Suicide Epi-Aid_ IRB Determination.docx	10/13/2022
GenIC Request Template	Protocol Template Generic Suicide OMB_1243- OH_EpiAid - 10.12.22_final.docx	10/13/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.