Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
SSG Fox SPGP - Annual Grantee Financial Report Modified 90 68 0 Form and Instruction 10-316e SSG Fox SPGP - Annual Grantee Financial Report
SSG Fox SPGP - Annual Grantee Performance Report Modified 90 68 0 Form 10-316a SSG Fox SPGP - Annual Grantee Performance Report
SSG Fox SPGP - Application Modified 250 8750 0 Form and Instruction 10-315a SSG Fox SPGP - Application
SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS) Modified 6030 1508 0 Other-Screening Tool
SSG Fox SPGP - Corrective Action Plan (CAP) Modified 25 13 0 Form and Instruction 10-316d SSG Fox SPGP - Corrective Action Plan (CAP)
SSG Fox SPGP - Eligibility Screening Modified 6030 3015 0 Form 10-317a SSG Fox SPGP - Eligibility Screening Form
SSG Fox SPGP - Intake Form & Assessments Modified 6030 3015 0 Form and Instruction 10-317b SSG Fox SPGP - Intake Form & Assessments
SSG Fox SPGP - Other Grantee Financial Report Modified 180 90 0 Form and Instruction 10-316f SSG Fox SPGP - Quarterly Grantee Financial Report
SSG Fox SPGP - Other Grantee Performance Report Modified 180 90 0 Form 10-316b SSG Fox SPGP - Other Grantee Performance Report
SSG Fox SPGP - Participant Satisfaction Survey Modified 5000 1250 0 Form 10-317c SSG Fox SPGP - Participant Satisfaction Survey
SSG Fox SPGP - Program Change Request Modified 180 45 0 Form 10-316c SSG Fox SPGP - Program Change Request
SSG Fox SPGP - Program Exit Checklist Modified 6030 3015 0 Form 10-317d SSG Fox SPGP - Program Exit Checklist & Assessments
SSG Fox SPGP - Renewal Application Modified 90 900 0 Form and Instruction 10-315b SSG Fox SPGP - Renewal Application
Total burden requested under this ICR: 30205 21827 0  
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