Information Collection Request

Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP) - AR16

ICR 202203-2900-009 · OMB 2900-0904 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 10-317d SSG Fox SPGP - Program Exit Checklist & Assessments Form New Repair queued
Form 10-317c SSG Fox SPGP - Participant Satisfaction Survey Form New Repair queued
Form 10-317b SSG Fox SPGP - Intake Form & Assessments Form and Instruction New Repair queued
Form 10-317a SSG Fox SPGP - Eligibility Screening Form New Repair queued
Form 10-316f SSG Fox SPGP - Quarterly Grantee Financial Report Form and Instruction New Repair queued
Form 10-316e SSG Fox SPGP - Annual Grantee Financial Report Form and Instruction New Repair queued
Form 10-316d SSG Fox SPGP - Corrective Action Plan (CAP) Form and Instruction New Repair queued
Form 10-316c SSG Fox SPGP - Program Change Request Form New Repair queued
Form 10-316b SSG Fox SPGP - Other Grantee Performance Report Form New Repair queued
Form 10-316a SSG Fox SPGP - Annual Grantee Performance Report Form New Repair queued
Form 10-315b SSG Fox SPGP - Renewal Application Form and Instruction New Repair queued
Form 10-315a SSG Fox SPGP - Application Form and Instruction New Repair queued
Short Warwick Edinburgh Mental Well Being Scale (SWEMWS).pdf Supplementary Document Uploaded 2022-04-28 Repair queued
Socio Economic Status (SES).pdf Supplementary Document Uploaded 2022-04-28 Repair queued
Patient Health Questionnaire (PHQ9).pdf Supplementary Document Uploaded 2022-04-28 Repair queued
Interpersonal Support Evaluation List (ISEL-12).pdf Supplementary Document Uploaded 2022-04-28 Missing upstream
Generalized Self-Efficacy Scale.pdf Supplementary Document Uploaded 2022-04-28 Repair queued
Supporting Statement A_SSG Fox Suicide Prevention Grant Program (SPGP)_AR16_updated Apr 2022.docx Supporting Statement A Uploaded 2022-04-28 Missing upstream

IC Document Collections

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
6 Months From Approved
30,205 0
21,827 0
0 0





table that charts list of burden
  Total Request 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 30,205 0 0 30,205 0 0
Annual Time Burden (Hours) 21,827 0 0 21,827 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No