Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Evaluation

ICR 202509-0930-013

OMB: 0930-0286

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2025-09-29
Supplementary Document
2023-11-30
Supplementary Document
2023-11-29
Supporting Statement B
2023-11-29
Supporting Statement A
2023-11-30
IC Document Collections
IC ID
Document
Title
Status
178435 Modified
178433 Modified
178432 Modified
ICR Details
0930-0286 202509-0930-013
Received in OIRA 202311-0930-002
HHS/SAMHSA 20339
Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Evaluation
No material or nonsubstantive change to a currently approved collection   No
Regular 09/30/2025
  Requested Previously Approved
01/31/2027 01/31/2027
22,107 22,107
5,008 5,008
0 0

The information collected through the four stages of the cross-site evaluation of the GLS Suicide Prevention and Early Intervention Programs will describe for State/Tribal grantees (1) the context in which suicide prevention activities are being implemented, (2) the products and services funded through the program, (3) the training experiences of individuals who receive training as part of the suicide prevention programs, (4) the utilization and penetration of the skills, knowledge and techniques learned through suicide prevention training programs, and (5) the referral networks in place to support youth identified at risk for suicide.

US Code: 42 USC 520E-2 Name of Law: Mental and Bhavioral Health Services on Campus
  
None

Not associated with rulemaking

  88 FR 63593 09/15/2023
88 FR 82389 11/24/2023
No

3
IC Title Form No. Form Name
Project Evaluators Prevention Strategies Inventory (PSI), Training Activity Summary Page (TASP), EIRFT-Individual Form, EIRFT-Screening Form Prevention Strategies Inventory (PSI) ,   Training Activity Summary Page (TASP) ,   EIRFT-Individual Form ,   EIRFT-Screening Form
Providers Trainees TSA Consent to Contact, TSA-P, TSA-6-12 TSA Consent to Contact ,   TSA-P ,   TSA-6-12
Youth Youth Outcomes and Resiliency Survey (YORS), Youth Experience Reflective Journal (YERJ) Youth Outcomes and Resiliency Survey (YORS) ,   Youth Experience Reflective Journal (YERJ)

  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 22,107 22,107 0 0 0 0
Annual Time Burden (Hours) 5,008 5,008 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
SAMHSA is requesting 5,008 annual burden hours for this submission, representing an increase of 879 annual burden hours over the most recent OMB package. This increase results from revisions to this information collection that increase time allotted for grantees to complete instruments.

$2,354,274
Yes Part B of Supporting Statement
    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


© 2025 OMB.report | Privacy Policy