Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Youth Experience R Youth Experience Reflective Journal (YERJ)	Form and Instruction	Modified	Repair queued
Form Youth Outcomes and Youth Outcomes and Resiliency Survey (YORS)	Form and Instruction	Modified	Available
Form Youth Outcomes and Youth	Form and Instruction	Modified	Repair queued
Form TSA-6-12 TSA-6-12	Form and Instruction	Modified	Available
Form TSA-P TSA-P	Form and Instruction	Modified	Available
Form TSA Consent to Con TSA Consent to Contact	Form and Instruction	Modified	Available
Form TSA Consent to Con Providers Trainees	Form and Instruction	Modified	Available
Form Prevention Strateg Prevention Strategies Inventory (PSI)	Form and Instruction	Modified	Repair queued
Form EIRFT-Screening Fo EIRFT-Screening Form	Form and Instruction	Modified	Available
Form EIRFT-Individual F EIRFT-Individual Form	Form and Instruction	Modified	Available
Form Training Activity Training Activity Summary Page (TASP)	Form and Instruction	Modified	Available
Form Prevention Strateg Project Evaluators	Form and Instruction	Modified	Available
0930-0286 No Material or Nonsubstantive Change-GLS Evaluation - OMB.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2026-01-12	Available
0930-0286 No Material or Nonsubstantive Change-GLS Evaluation.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-09-29	Repair queued
0930-0286 No Material or Nonsubstantive Change-GLS Evaluation.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-09-29	Repair queued
Att K. SPDC DUA 7_24_23 final.docx	Supplementary Document	Uploaded 2023-11-30	Available
Att K. SPDC DUA 7_24_23 final.docx	Supplementary Document	Uploaded 2023-11-30	Repair queued
Att A. GLS Memorial Act 7_24_23 final.docx	Supplementary Document	Uploaded 2023-11-29	Available
Att A. GLS Memorial Act 7_24_23 final.docx	Supplementary Document	Uploaded 2023-11-29	Repair queued
GLS Evaluation Part B 7-24_23 final.docx	Supporting Statement B	Uploaded 2023-11-29	Available
GLS Evaluation Part B 7-24_23 final.docx	Supporting Statement B	Uploaded 2023-11-29	Repair queued
GLS Evaluation Part A 7_24_23 final.docx	Supporting Statement A	Uploaded 2023-11-30	Available
GLS Evaluation Part A 7_24_23 final.docx	Supporting Statement A	Uploaded 2023-11-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
178435	Youth	Form and Instruction	Modified	Youth Experience Reflective Journal (YERJ)
178435	Youth	Form and Instruction	Modified	Youth Outcomes and Resiliency Survey (YORS)
178435	Youth	Form and Instruction	Modified
178433	Providers Trainees	Form and Instruction	Modified	TSA-6-12
178433	Providers Trainees	Form and Instruction	Modified	TSA-P
178433	Providers Trainees	Form and Instruction	Modified	TSA Consent to Contact
178433	Providers Trainees	Form and Instruction	Modified
178432	Project Evaluators	Form and Instruction	Modified	Prevention Strategies Inventory (PSI)
178432	Project Evaluators	Form and Instruction	Modified	EIRFT-Screening Form
178432	Project Evaluators	Form and Instruction	Modified	EIRFT-Individual Form
178432	Project Evaluators	Form and Instruction	Modified	Training Activity Summary Page (TASP)
178432	Project Evaluators	Form and Instruction	Modified

ICR Details

OMB Control No: 0930-0286	ICR Reference No: 202509-0930-013
Status: Active	Previous ICR Reference No: 202311-0930-002
Agency/Subagency: HHS/SAMHSA	Agency Tracking No: 20339
Title: Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Evaluation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/15/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2027	01/31/2027	01/31/2027
Responses	22,107	0	22,107
Time Burden (Hours)	5,008	0	5,008
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected through the four stages of the cross-site evaluation of the GLS Suicide Prevention and Early Intervention Programs will describe for State/Tribal grantees (1) the context in which suicide prevention activities are being implemented, (2) the products and services funded through the program, (3) the training experiences of individuals who receive training as part of the suicide prevention programs, (4) the utilization and penetration of the skills, knowledge and techniques learned through suicide prevention training programs, and (5) the referral networks in place to support youth identified at risk for suicide.

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Authorizing Statute(s): US Code: 42 USC 520E-2 Name of Law: Mental and Bhavioral Health Services on Campus
  

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:
	88 FR 63593	09/15/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 82389	11/24/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Project Evaluators	Training Activity Summary Page (TASP), EIRFT-Individual Form, EIRFT-Screening Form, Prevention Strategies Inventory (PSI)	Training Activity Summary Page (TASP) ,   EIRFT-Individual Form ,   EIRFT-Screening Form ,   Prevention Strategies Inventory (PSI)
Providers Trainees	TSA Consent to Contact, TSA-P, TSA-6-12	TSA Consent to Contact ,   TSA-P ,   TSA-6-12
Youth	Youth Outcomes and Resiliency Survey (YORS), Youth Experience Reflective Journal (YERJ)	Youth Outcomes and Resiliency Survey (YORS) ,   Youth Experience Reflective Journal (YERJ)

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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	22,107	22,107	0	0	0	0
Annual Time Burden (Hours)	5,008	5,008	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $2,354,274

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.     No

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.     No

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: 09/30/2025

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