Healthcare Organization Staff

Zero Suicide Evaluation

Documents and Forms

Document Name Document Type
Form Training Utilizati Healthcare Organization Staff Form and Instruction
Training Utilizati Training Utilization and Preservation 6/12 month Att I. Training Utilization and Preservation 6_12_OMB_clean.docx Form and Instruction
Training Utilizati Training Utilization and Preservation Baseline Att H. Training Utilization and Preservation Baseline_OMB_Fig1Update_clean.docx Form and Instruction
Key Informant Inte Key Informant Interview Case Study Att D. Key Informant Interview Guide_OMB_clean.docx Form and Instruction
Workforce Survey Workforce Survey Att F. Workforce Survey_OMB_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Healthcare Organization Staff	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Training Utilization and Preservation 6/12 month	Training Utilization and Preservation 6/12 month	Att I. Training Utilization and Preservation 6_12_OMB_clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Training Utilization and Preservation Baseline	Training Utilization and Preservation Baseline	Att H. Training Utilization and Preservation Baseline_OMB_Fig1Update_clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Key Informant Interview Case Study	Key Informant Interview Case Study	Att D. Key Informant Interview Guide_OMB_clean.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Workforce Survey	Workforce Survey	Att F. Workforce Survey_OMB_clean.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: GLS National Outcomes Evaluation Suicide Prevention Data Center	FR Citation: 75 FR 28264

Number of Respondents: 13,202	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	66,010	66,010
Annual IC Time Burden (Hours)	17,163	17,163
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.