Information Collection

Public Safety Officer Suicide Reporting Module

IC 251027 under ICR 202506-0920-011 · OMB 0920-0607.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Public Safety Officer Suicide Reporting Module	Form and Instruction
Public Safety Officer Suicide Module Public Safety Officer Suicide Reporting Module	Form and Instruction
Public Safety Officer Suicide Module Att 5_NVDRS Web-Based Data Entry Screenshots_06.16.2025.pdf	Form and Instruction
Public Safety Officer Suicide Module Att 5_NVDRS Web-Based Data Entry Screenshots_06.16.2025.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

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
Form and Instruction	n/a				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

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	Previously Approved
Annual Number of Responses for this IC	24,024	24,024
Annual IC Time Burden (Hours)	4,004	4,004
Annual IC Cost Burden (Dollars)	82,883	82,883

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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