Cross-Site Evaluation of the Garrett Lee Smith Memorial Suicide Prevention and Early Intervention Program

Forms and Documents

Document Name	Status
Form Surveys GLS Form and Instruction	New
Form Surveys GLS Form and Instruction	New
Form Surveys GLS Form and Instruction	New
Form Surveys GLS Form and Instruction	New
Form Surveys GLS Form and Instruction	New
Form Surveys GLS Form and Instruction	New
Form Surveys GLS Form and Instruction	New
List of Revisions to OMB Submittal SAMHSA.doc Supplementary Document	2007-05-29
Suicide Cross-Site-Eval Supporting Statement 7 13 2006 revised 10 26 2006.doc Supporting Statement B	2006-12-28
Suicide Cross-Site-Eval Supporting Statement 7 13 2006 revised 10 26 2006.doc Supporting Statement A	2006-12-28

IC Document Collections

IC ID	Document Title	Status
178438	GLS Form and Instruction	New
178437	GLS Form and Instruction	New
178436	GLS Form and Instruction	New
178435	GLS Form and Instruction	New
178434	GLS Form and Instruction	New
178433	GLS Form and Instruction	New
178432	GLS Form and Instruction	New

ICR Details

OMB Control No: 0930-0286	ICR Reference No: 200701-0930-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Cross-Site Evaluation of the Garrett Lee Smith Memorial Suicide Prevention and Early Intervention Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/30/2007
	Date Received in OIRA: 01/24/2007
Terms of Clearance: Approved consistent with revisions outlined in SAMHSA memo submitted to OMB.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2010	36 Months From Approved
Responses	26,229	0	0
Time Burden (Hours)	6,331	0	0
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): None

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:
	71 FR 34147	06/13/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 77769	12/27/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
GLS	Surveys	Surveys
GLS	Surveys	Surveys
GLS	Surveys	Surveys
GLS	Surveys	Surveys
GLS	Surveys	Surveys
GLS	Surveys	Surveys
GLS	Surveys	Surveys

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ICR Summary 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	26,229	0	44,590	-18,361	0	0
Annual Time Burden (Hours)	6,331	0	0	6,331	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This is a new data collection.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 12/28/2006

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