Clinicians/Providers

Zero Suicide Evaluation

Documents and Forms

Document Name Document Type
Form Consumer Study Int Clinicians/Providers Form and Instruction
Consumer Study Int Consumer Study Interest Form Att K. Consumer Study Interest Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Clinicians/Providers	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Consumer Study Interest Form	Consumer Study Interest Form	Att K. Consumer Study Interest Form.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: 180	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	1,440	1,440
Annual IC Time Burden (Hours)	360	360
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.