SSG Fox SPGP - Intake Form & Assessments

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

Documents and Forms

Document Name Document Type
Form 10-317b SSG Fox SPGP - Intake Form & Assessments Form and Instruction
10-317b SSG Fox SPGP - Intake Form & Assessments SSG Fox SPGP_Intake Form_10-317b_Final.docx Form and Instruction
10-317b SSG Fox SPGP - Intake Form & Assessments SSG Fox SPGP_Intake Form_10-317b_Final.docx Form and Instruction

Information Collection (IC) Details

IC Title:	SSG Fox SPGP - Intake Form & Assessments	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 and Instruction	10-317b	SSG Fox SPGP - Intake Form & Assessments	SSG Fox SPGP_Intake Form_10-317b_Final.docx		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 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,030	6,030
Annual IC Time Burden (Hours)	3,015	3,015
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.