Zero Suicide Evaluation

ICR 202509-0930-009

OMB: 0930-0401

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2025-09-23
Supporting Statement A
2024-11-21
Supplementary Document
2024-11-21
Supplementary Document
2024-11-21
Supplementary Document
2024-11-21
ICR Details
0930-0401 202509-0930-009
Received in OIRA 202411-0930-003
HHS/SAMHSA
Zero Suicide Evaluation
No material or nonsubstantive change to a currently approved collection   No
Regular 09/30/2025
  Requested Previously Approved
01/31/2028 01/31/2028
74,696 74,696
20,520 20,520
0 0

Zero Suicide is a commitment to suicide prevention in health and behavioral health care systems and a framework with a specific set of tools and strategies. It proposes that suicide deaths for individuals under care within health and behavioral health systems are preventable, and that a systematic approach to quality improvement in these settings is both available and necessary to identify suicidal patients and keep them safe. The Zero Suicide Evaluation is designed to assess the implementation and outcomes of SAMHSA’s Zero Suicide Program. Specifically, the Zero Suicide Evaluation will gather information about health system implementation of the Zero Suicide model, including staff training; health care provider training, knowledge, practices, and confidence related to implementing the core elements of the Zero Suicide model; consumer experiences with services provided under the Zero Suicide model; and outcomes related to suicide attempts and deaths.

US Code: 42 USC 290bb-43 Name of Law: Public Health Service Act (PHSA)
  
None

Not associated with rulemaking

  89 FR 73666 09/11/2024
89 FR 91775 11/20/2024
No

5
IC Title Form No. Form Name
Clinicians/Providers Consumer Study Interest Form Consumer Study Interest Form
Consumer Consumer Study Interest Form, Consumer Key Informant Interview, Consumer Experience Survey Consumer Study Interest Form ,   Consumer Key Informant Interview ,   Consumer Experience Survey
Grantee/Healthcare Organization Administrator Behavioral Health Provider Survey, Key Informant Interview Case Study, Key Informant Interview Cost Study Behavioral Health Provider Survey ,   Key Informant Interview Case Study ,   Key Informant Interview Cost Study
Healthcare Organization Staff Training Utilization and Preservation Baseline, Key Informant Interview Case Study, Workforce Survey, Training Utilization and Preservation 6/12 month Training Utilization and Preservation 6/12 month ,   Training Utilization and Preservation Baseline ,   Key Informant Interview Case Study ,   Workforce Survey
Project Evaluator Prevention Strategies Inventory, Training Activity Summary Page Prevention Strategies Inventory ,   Training Activity Summary Page

  Total Request 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 74,696 74,696 0 0 0 0
Annual Time Burden (Hours) 20,520 20,520 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$3,023,033
No
    No
    No
No
No
No
No
Alicia Broadus 240 276-0166 alicia.broadus@samhsa.hhs.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/30/2025


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