Student - Campus Case

Cross-Site Evaluation of the Garrett Lee Smith Memorial Suicide Prevention and Early Intervention Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:

Documents and Forms

Document Name Document Type
Form Student Instrument Student - Campus Case Form and Instruction
Student Instrument Student Instruments A11 CCS - Student Instruments.pdf Form and Instruction
A12 CCS - Student Supporting Documents.pdf Student Supporting Documents IC Document

Information Collection (IC) Details

IC Title:	Student - Campus Case	Agency IC Tracking Number:

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	Student Instruments	Student Instruments	A11 CCS - Student Instruments.pdf		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 288	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	684	593	91
Annual IC Time Burden (Hours)	336	245	91
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Student Supporting Documents	A12 CCS - Student Supporting Documents.pdf	06/03/2010

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.