Information Collection

Healthcare Organization Staff

IC 272541 under ICR 202411-0930-003 · OMB 0930-0401.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0401 can be found here:

2025-09-30 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Training Utilizati Healthcare Organization Staff	Form and Instruction
Form Training Utilizati Training Utilization and Preservation 6/12 month Healthcare Organization Staff	Form and Instruction
Form Training Utilizati Training Utilization and Preservation Baseline Healthcare Organization Staff	Form and Instruction
Form Key Informant Inte Key Informant Interview Case Study Healthcare Organization Staff	Form and Instruction
Form Workforce Survey Workforce Survey Healthcare Organization Staff	Form and Instruction
Training Utilizati Training Utilization and Preservation 6/12 month Att I. Training Utilization and Preservation 6_12_OMB_clean.docx	Form and Instruction
Training Utilizati Training Utilization and Preservation 6/12 month Att I. Training Utilization and Preservation 6_12_OMB_clean.docx	Form and Instruction
Training Utilizati Training Utilization and Preservation Baseline Att H. Training Utilization and Preservation Baseline_OMB_Fig1Update_clean.docx	Form and Instruction
Training Utilizati Training Utilization and Preservation Baseline Att H. Training Utilization and Preservation Baseline_OMB_Fig1Update_clean.docx	Form and Instruction
Key Informant Inte Key Informant Interview Case Study Att D. Key Informant Interview Guide_OMB_clean.docx	Form and Instruction
Key Informant Inte Key Informant Interview Case Study Att D. Key Informant Interview Guide_OMB_clean.docx	Form and Instruction
Workforce Survey Workforce Survey Att F. Workforce Survey_OMB_clean.docx	Form and Instruction
Workforce Survey Workforce Survey Att F. Workforce Survey_OMB_clean.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Healthcare Organization Staff

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Training Utilization and Preservation 6/12 month	Yes	Yes	Fillable Fileable
Form and Instruction	Training Utilization and Preservation Baseline	Yes	Yes	Fillable Fileable
Form and Instruction	Key Informant Interview Case Study	Yes	Yes	Fillable Fileable
Form and Instruction	Workforce Survey	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: GLS National Outcomes Evaluation Suicide Prevention Data Center

FR Citation: 75 FR 28264

Number of Respondents: 13,202

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	66,010	66,010
Annual IC Time Burden (Hours)	17,163	17,163
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.

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