Information Collection Request

Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP)

ICR 202601-2900-003 · OMB 2900-0904 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 10-317e SSG Fox SPGP - Baseline Mental Health Screening Checklist Form and Instruction New Available
Form 10-317d SSG Fox SPGP - Program Exit Screening Checklist Form Modified Available
Form 10-317c SSG Fox SPGP - Participant Satisfaction Survey Form Modified Available
Form 10-317b SSG Fox SPGP - Intake Form Form and Instruction Modified Available
Form 10-317a SSG Fox SPGP - Eligibility Screening Form Form Modified Available
Form 10-316f SSG Fox SPGP - Quarterly Grantee Financial Report Form and Instruction Removed Available
Form 10-316e SSG Fox SPGP - Annual Grantee Financial Report Form and Instruction Modified Available
Form 10-316d SSG Fox SPGP - Corrective Action Plan (CAP) Form and Instruction Modified Available
Form 10-316c SSG Fox SPGP - Program & Budget Change Request Form Modified Available
Form 10-316b SSG Fox SPGP - Mid-year Grantee Performance Report Form Modified Available
Form 10-316a SSG Fox SPGP - Annual Grantee Performance Report Form Removed Available
Form 10-315b SSG Fox SPGP - Renewal Application Form and Instruction Modified Available
Form 10-315a SSG Fox SPGP - Application Form and Instruction Modified Available
30-Day FRN_2900-0904_SSG Fox Suicide Prev Grant Prog (SPGP)_pub 05132026.pdf Supplementary Document Uploaded 2026-05-13 Available
60-Day FRN_2900-0904_SSG Fox Suicide Prev Grant Prog (SPGP)_pub 02202026.pdf Supplementary Document Uploaded 2026-03-02 Available
SSA_2900-0904_SSG Fox Suicide Prevention Grant Prog (SPGP)_updated May 2026.docx Supporting Statement A Uploaded 2026-05-13 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
280148 SSG Fox SPGP - Baseline Mental Health Screening Checklist Form and Instruction NewSSG Fox SPGP - Baseline Mental Health Screening Checklist
253146 SSG Fox SPGP - Program Exit Screening Checklist Form ModifiedSSG Fox SPGP - Program Exit Screening Checklist
253145 SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS) Other-Screening Tool Removed
253144 SSG Fox SPGP - Participant Satisfaction Survey Form ModifiedSSG Fox SPGP - Participant Satisfaction Survey
253143 SSG Fox SPGP - Intake Form Form and Instruction ModifiedSSG Fox SPGP - Intake Form
253142 SSG Fox SPGP - Eligibility Screening Form ModifiedSSG Fox SPGP - Eligibility Screening Form
253141 SSG Fox SPGP - Other Grantee Financial Report Form and Instruction RemovedSSG Fox SPGP - Quarterly Grantee Financial Report
253140 SSG Fox SPGP - Annual Grantee Financial Report Form and Instruction ModifiedSSG Fox SPGP - Annual Grantee Financial Report
253139 SSG Fox SPGP - Corrective Action Plan (CAP) Form and Instruction ModifiedSSG Fox SPGP - Corrective Action Plan (CAP)
253138 SSG Fox SPGP - Program & Budget Change Request Form ModifiedSSG Fox SPGP - Program & Budget Change Request
253136 SSG Fox SPGP - Grantee Performance Report Form ModifiedSSG Fox SPGP - Mid-year Grantee Performance Report
253133 SSG Fox SPGP - Annual Grantee Performance Report Form RemovedSSG Fox SPGP - Annual Grantee Performance Report
253131 SSG Fox SPGP - Renewal Application Form and Instruction ModifiedSSG Fox SPGP - Renewal Application
253128 SSG Fox SPGP - Application Form and Instruction ModifiedSSG Fox SPGP - Application

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
54,525 0
31,166 0
0 0





Reginfo record details
11
table that charts list of burden
IC Title Form No. Form Name
SSG Fox SPGP - Annual Grantee Financial Report 10-316e
SSG Fox SPGP - Annual Grantee Performance Report 10-316a
SSG Fox SPGP - Application 10-315a
SSG Fox SPGP - Baseline Mental Health Screening Checklist 10-317e
SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS)
SSG Fox SPGP - Corrective Action Plan (CAP) 10-316d
SSG Fox SPGP - Eligibility Screening 10-317a
SSG Fox SPGP - Grantee Performance Report 10-316b
SSG Fox SPGP - Intake Form 10-317b
SSG Fox SPGP - Other Grantee Financial Report 10-316f
SSG Fox SPGP - Participant Satisfaction Survey 10-317c
SSG Fox SPGP - Program & Budget Change Request 10-316c
SSG Fox SPGP - Program Exit Screening Checklist 10-317d
SSG Fox SPGP - Renewal Application 10-315b

table that charts list of burden
  Total Request 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 54,525 0 0 48,225 0 6,300
Annual Time Burden (Hours) 31,166 0 0 29,500 0 1,666
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No