Upstream risk factors for behavioral health and suicide in military personnel: An examination of social determinants of health

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SDOH Informed Consent Updated 06NOV24.pdf	Supplementary Document	Uploaded 2025-01-10	Available
SDOH Informed Consent Updated 06NOV24.pdf	Supplementary Document	Uploaded 2025-01-10	Repair queued
Eligibility_Screener.pdf	Supplementary Document	Uploaded 2025-01-10	Repair queued
Eligibility_Screener.pdf	Supplementary Document	Uploaded 2025-01-10	Repair queued
SDOH Study Invitation and Reminder Emails.docx	Supplementary Document	Uploaded 2025-01-10	Repair queued
SDOH Study Invitation and Reminder Emails.docx	Supplementary Document	Uploaded 2025-01-10	Repair queued
0703-SDOH_SSB_12.19.2024.docx	Supporting Statement B	Uploaded 2025-01-10	Available
0703-SDOH_SSB_12.19.2024.docx	Supporting Statement B	Uploaded 2025-01-10	Repair queued
0703-SDOH_SSA_7.21.2025.docx	Supporting Statement A	Uploaded 2025-07-21	Repair queued
0703-SDOH_SSA_1.10.2025.docx	Supporting Statement A	Uploaded 2025-01-10	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
273473	Follow-up Survey	Other-Survey	New
273472	Baseline Survey	Other-Survey	New

ICR Details

OMB Control No: 0703-0102	ICR Reference No: 202501-0703-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: DOW/NAVY	Agency Tracking No: 0703-SDOH
Title: Upstream risk factors for behavioral health and suicide in military personnel: An examination of social determinants of health
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/08/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/13/2025
Terms of Clearance: Data assets resulting from this collection must be cataloged in the agency comprehensive data inventory, consistent with the Open Government Data Act of 2018 and conforming with OMB's implementation guidance in M-25-05, and other related policies and guidance.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2028	36 Months From Approved
Responses	1,687	0	0
Time Burden (Hours)	422	0	0
Cost Burden (Dollars)	6,407	0	0

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Abstract: Many service members face adverse social determinants of health (SDOH), such as financial, housing, and food insecurity, isolation or distance from others, and social stressors such as racism and discrimination. Exposure to adverse SDOH may place service members at higher risk for behavioral health symptoms and/or suicidality. This study will develop and administer a cross-cutting, comprehensive assessment of upstream risk factors (i.e., SDOH) for behavioral health issues and suicide among Sailors and Marines to determine the relationship between social risk factors and future behavioral health issues in this population. We will also develop procedures for linking Sailors and Marines to appropriate services and programs based on their reported social and behavioral health needs.

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Authorizing Statute(s): None

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:
	89 FR 53595	06/27/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 1990	01/10/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Baseline Survey
Follow-up Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	1,687	0	0	1,687	0	0
Annual Time Burden (Hours)	422	0	0	422	0	0
Annual Cost Burden (Dollars)	6,407	0	0	6,407	0	0

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: This is a new collection with a new associated burden.

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Annual Cost to Federal Government: $744,000

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.     Yes

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.     Yes

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: 01/13/2025

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