OMB control number

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

OMB 2900-0904 · VA.

OMB 2900-0904

On October 17, 2020, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, Public Law (P. L.) 116-171 (the Act), codified as a note to section 1720F of title 38, United States Code (U.S.C.), was enacted in law. Section 201 of the Act mandated VA establish the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP) to reduce Veteran suicide through the provision of community-based grants to certain eligible entities to provide or coordinate the provision of suicide prevention services to eligible individuals and their families. In order to award grants under the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, and assess services and compliance with grants provided, VA will require submission of Applications for grants and Renewals of grants, Eligibility Screening, Suicide Risk Tools, Participant Satisfaction Surveys, Intake Forms, Baseline Mental Health Screening and Program Exit Screening Checklists (which each utilize the same five standardized assessment tools), and Grantee Compliance Reports (performance and financial).

The latest form for Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP) expires 2029-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 10-317e SSG Fox SPGP - Baseline Mental Health Screening Checklist (document unavailable) Form and Instruction
Form 10-317d SSG Fox SPGP - Program Exit Screening Checklist Form
Form 10-317c SSG Fox SPGP - Participant Satisfaction Survey Form
Form 10-317b SSG Fox SPGP - Intake Form Form and Instruction
Form 10-317a SSG Fox SPGP - Eligibility Screening Form Form
Form 10-316f SSG Fox SPGP - Quarterly Grantee Financial Report Form and Instruction
Form 10-316e SSG Fox SPGP - Annual Grantee Financial Report Form and Instruction
Form 10-316d SSG Fox SPGP - Corrective Action Plan (CAP) Form and Instruction
Form 10-316c SSG Fox SPGP - Program & Budget Change Request Form
Form 10-316b SSG Fox SPGP - Mid-year Grantee Performance Report Form
Form 10-316a SSG Fox SPGP - Annual Grantee Performance Report Form
Form 10-315b SSG Fox SPGP - Renewal Application Form and Instruction
Form 10-315a SSG Fox SPGP - Application Form and Instruction
30-Day FRN_2900-0904_SSG Fox Suicide Prev Grant Prog (SPGP)_pub 05132026.pdf Supplementary Document
60-Day FRN_2900-0904_SSG Fox Suicide Prev Grant Prog (SPGP)_pub 02202026.pdf Supplementary Document
SSA_2900-0904_SSG Fox Suicide Prevention Grant Prog (SPGP)_updated May 2026.docx Supporting Statement A
SSG Fox SPGP - Baseline Mental Health Screening Checklist Form and Instruction
SSG Fox SPGP - Program Exit Screening Checklist Form
SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS) Other-Screening Tool
SSG Fox SPGP - Participant Satisfaction Survey Form
SSG Fox SPGP - Intake Form Form and Instruction
SSG Fox SPGP - Eligibility Screening Form
SSG Fox SPGP - Other Grantee Financial Report Form and Instruction
SSG Fox SPGP - Annual Grantee Financial Report Form and Instruction
SSG Fox SPGP - Corrective Action Plan (CAP) Form and Instruction
SSG Fox SPGP - Program & Budget Change Request Form
SSG Fox SPGP - Grantee Performance Report Form
SSG Fox SPGP - Annual Grantee Performance Report Form
SSG Fox SPGP - Renewal Application Form and Instruction
SSG Fox SPGP - Application Form and Instruction

All Historical Document Collections

202601-2900-003	Reinstatement with change of a previously approved collection	2026-05-13
202210-2900-015 Approved with change	Extension without change of a currently approved collection	2023-01-20
202203-2900-009 Approved without change	New collection (Request for a new OMB Control Number)	2022-05-02

OMB Details

SSG Fox SPGP - Application

Federal Enterprise Architecture: Health - Health Care Services

Form 10-315a

SSG Fox SPGP - Application

Fillable Printable

Form and instruction

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