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Providers Trainees
Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Evaluation
OMB: 0930-0286
IC ID: 178433
OMB.report
HHS/SAMHSA
OMB 0930-0286
ICR 202311-0930-002
IC 178433
( )
Documents and Forms
Document Name
Document Type
Form TSA Consent to Con
Providers Trainees
Form and Instruction
TSA Consent to Con TSA Consent to Contact
Att F. TSA-Phone for OMB 7_24_23 final.docx
Form and Instruction
TSA Consent to Con TSA Consent to Contact
Att F. TSA-Phone for OMB 7_24_23 final.docx
Form and Instruction
TSA-P TSA-P
Att D. TSA-Post_for OMB 7_24_23 final.docx
Form and Instruction
TSA-P TSA-P
Att D. TSA-Post_for OMB 7_24_23 final.docx
Form and Instruction
TSA-6-12 TSA-6-12
Att E. TSA-6_12_for OMB 7_24_23 final.docx
Form and Instruction
TSA-6-12 TSA-6-12
Att E. TSA-6_12_for OMB 7_24_23 final.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Providers 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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
TSA Consent to Contact
TSA Consent to Contact
Att F. TSA-Phone for OMB 7_24_23 final.docx
Yes
Yes
Fillable Fileable
Form and Instruction
TSA-P
TSA-P
Att D. TSA-Post_for OMB 7_24_23 final.docx
Yes
Yes
Fillable Fileable
Form and Instruction
TSA-6-12
TSA-6-12
Att E. TSA-6_12_for OMB 7_24_23 final.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:
20,428
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
20,428
0
20,428
0
0
0
Annual IC Time Burden (Hours)
3,974
0
3,974
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.