Information Collection

SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS)

IC 253145 under ICR 202210-2900-015 · OMB 2900-0904.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0904 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Columbia Suicide Severity Rating Scale_CSSRS_SSG Fox SPGP.pdf	Other-Screening Tool
Columbia Suicide Severity Rating Scale_CSSRS_SSG Fox SPGP.pdf	Other-Screening Tool

IC Title:

SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS)

Agency IC Tracking Number:

2900-0904

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screening Tool			Columbia Suicide Severity Rating Scale_CSSRS_SSG Fox SPGP.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,030	6,030
Annual IC Time Burden (Hours)	1,508	1,508
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.