Information Collection

SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS)

IC 253145 under ICR 202601-2900-003 · OMB 2900-0904.

Documents and Forms

Document Name Document Type
Columbia Suicide Severity Rating Scale_CSSRS_SSG Fox SPGP.pdf Other-Screening Tool

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS)	Agency IC Tracking Number:	2900-0904

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screening Tool			Columbia Suicide Severity Rating Scale_CSSRS_SSG Fox SPGP.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	-6,030	6,030
Annual IC Time Burden (Hours)	-1,508	1,508
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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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