OMB
.report
Search
SSG Fox SPGP - Eligibility Screening
Staff Sergeant Parker Gordon Fox - Suicide Prevention Grant Program (SSG Fox SPGP)
OMB: 2900-0904
IC ID: 253142
OMB.report
VA
OMB 2900-0904
ICR 202210-2900-015
IC 253142
( )
Documents and Forms
Document Name
Document Type
Form 10-317a
SSG Fox SPGP - Eligibility Screening
Form
10-317a SSG Fox SPGP - Eligibility Screening Form
VA Form 10-317a_Eligibility Screening Form_SPGP.docx
Form
10-317a SSG Fox SPGP - Eligibility Screening Form
VA Form 10-317a_Eligibility Screening Form_SPGP.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
SSG Fox SPGP - Eligibility Screening
Agency IC Tracking Number:
2900-0904
Is this a Common Form?
No
IC Status:
Modified
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
Form
10-317a
SSG Fox SPGP - Eligibility Screening Form
VA Form 10-317a_Eligibility Screening Form_SPGP.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
6,030
0
0
0
0
6,030
Annual IC Time Burden (Hours)
3,015
0
0
0
0
3,015
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
