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Student - Campus
Cross-Site Evaluation of the Garrett Lee Smith Memorial Suicide Prevention and Early Intervention Program
OMB: 0930-0286
IC ID: 178435
OMB.report
HHS/SAMHSA
OMB 0930-0286
ICR 201512-0930-006
IC 178435
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0286 can be found here:
2023-11-30 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
Form TUP-S Campus
Student - Campus
Form and Instruction
TUP-S Campus TUP-S Campus
Att F-1. TUP-S Campus Dec2015.doc
Form and Instruction
SMSS Campus SMSS Campus
Att L-1. SMSS Campus Dec2015.docx
Form and Instruction
Att F-2. TUP-S Campus Consent to Contact Form Dec2015.docx
TUP-S Campus Consent to Contact Form
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Student - Campus
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
TUP-S Campus
TUP-S Campus
Att F-1. TUP-S Campus Dec2015.doc
Yes
Yes
Fillable Fileable
Form and Instruction
SMSS Campus
SMSS Campus
Att L-1. SMSS Campus Dec2015.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
901
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
901
0
-7,901
0
0
8,802
Annual IC Time Burden (Hours)
89
0
-3,620
0
0
3,709
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
TUP-S Campus Consent to Contact Form
Att F-2. TUP-S Campus Consent to Contact Form Dec2015.docx
12/23/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.