Providers - State/Tribal - Trainees

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⚠️ Notice: This information collection may be referencing outdated material.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 D3 TUP-S Verbal Co Providers - State/Tribal - Trainees Form and Instruction
D3 TUP-S Verbal Co D3 TUP-S Verbal Consent Script D9. TUP-S-6 Month Instrument and Verbal Consent.docx Form and Instruction
D2. Training Utili D2. Training Utilization and Preservation Survey D2. Training Utilization and Preservation Survey_Consent to Contact Form_Formatted.docx Form and Instruction
D9. TUP-S-6 Month D9. TUP-S-6 Month Instrument and Verbal Consent D9. TUP-S-6 Month Instrument and Verbal Consent.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Providers - State/Tribal - Trainees	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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	D3 TUP-S Verbal Consent Script	D3 TUP-S Verbal Consent Script	D9. TUP-S-6 Month Instrument and Verbal Consent.docx	Yes	Yes	Fillable Fileable
Form and Instruction	D2. Training Utilization and Preservation Survey	D2. Training Utilization and Preservation Survey	D2. Training Utilization and Preservation Survey_Consent to Contact Form_Formatted.docx	Yes	Yes	Fillable Fileable
Form and Instruction	D9. TUP-S-6 Month Instrument and Verbal Consent	D9. TUP-S-6 Month Instrument and Verbal Consent	D9. TUP-S-6 Month Instrument and Verbal Consent.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,467	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,467	-388,421	391,888
Annual IC Time Burden (Hours)	395	-16,984	17,379
Annual IC Cost Burden (Dollars)	0	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.