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⚠️ Notice: This information collection may be referencing outdated material.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: Removed

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 %

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