OMB control number

Zero Suicide Evaluation

OMB 0930-0401 · HHS/SAMHSA.

OMB 0930-0401

Zero Suicide is a commitment to suicide prevention in health and behavioral health care systems and a framework with a specific set of tools and strategies. It proposes that suicide deaths for individuals under care within health and behavioral health systems are preventable, and that a systematic approach to quality improvement in these settings is both available and necessary to identify suicidal patients and keep them safe. The Zero Suicide Evaluation is designed to assess the implementation and outcomes of SAMHSA’s Zero Suicide Program. Specifically, the Zero Suicide Evaluation will gather information about health system implementation of the Zero Suicide model, including staff training; health care provider training, knowledge, practices, and confidence related to implementing the core elements of the Zero Suicide model; consumer experiences with services provided under the Zero Suicide model; and outcomes related to suicide attempts and deaths.

The latest form for Zero Suicide Evaluation expires 2028-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form Prevention Strateg Prevention Strategies Inventory (document unavailable) Form and Instruction
Form Training Activity Training Activity Summary Page Form and Instruction
Form Prevention Strateg Project Evaluator Form and Instruction
Form Consumer Study Int Consumer Study Interest Form Form and Instruction
Form Workforce Survey Workforce Survey Form and Instruction
Form Key Informant Inte Key Informant Interview Case Study Form and Instruction
Form Training Utilizati Training Utilization and Preservation Baseline Form and Instruction
Form Training Utilizati Training Utilization and Preservation 6/12 month Form and Instruction
Form Key Informant Inte Key Informant Interview Cost Study Form and Instruction
Form Key Informant Inte Key Informant Interview Case Study Form and Instruction
Form Behavioral Health Behavioral Health Provider Survey Form and Instruction
Form Consumer Experienc Consumer Experience Survey Form and Instruction
Form Consumer Key Infor Consumer Key Informant Interview Form and Instruction
Form Consumer Study Int Consumer Study Interest Form Form and Instruction
0930-0401 No Material or Nonsubstantive Change-Zero Suicide.docx Justification for No Material/Nonsubstantive Change
ZS_SSA 11.21.24.docx Supporting Statement A
Att N. Public Law 114-255.pdf Supplementary Document
Att M. 2023-2026 samhsa-strategic-plan.pdf Supplementary Document
Att A. PublicHealthServiceAct_AmendedFebruary2024.pdf Supplementary Document
Project Evaluator Form and Instruction
Project Evaluator Form and Instruction
Project Evaluator Form and Instruction
Clinicians/Providers Form and Instruction
Clinicians/Providers Form and Instruction
Healthcare Organization Staff Form and Instruction
Healthcare Organization Staff Form and Instruction
Healthcare Organization Staff Form and Instruction
Healthcare Organization Staff Form and Instruction
Healthcare Organization Staff Form and Instruction
Grantee/Healthcare Organization Administrator Form and Instruction
Grantee/Healthcare Organization Administrator Form and Instruction
Grantee/Healthcare Organization Administrator Form and Instruction
Grantee/Healthcare Organization Administrator Form and Instruction
Consumer Form and Instruction
Consumer Form and Instruction
Consumer Form and Instruction
Consumer Form and Instruction

All Historical Document Collections

202509-0930-009	No material or nonsubstantive change to a currently approved collection	2025-09-30
202411-0930-003 Approved with change	New collection (Request for a new OMB Control Number)	2024-11-22

OMB Details

Consumer

Federal Enterprise Architecture: Health - Public Health Monitoring

Form Consumer Study Interest Form	Consumer Study Interest Form	Fillable Fileable	Form and instruction
Form Consumer Experience Survey	Consumer Experience Survey	Fillable Fileable	Form and instruction
Form Consumer Key Informant Interview	Consumer Key Informant Interview	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.