View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
2900-0904
ICR Reference No:
202210-2900-015
Status:
Active
Previous ICR Reference No:
202203-2900-009
Agency/Subagency:
VA
Agency Tracking No:
2900-0904
Title:
Staff Sergeant Parker Gordon Fox - Suicide Prevention Grant Program (SSG Fox SPGP)
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
03/07/2023
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/20/2023
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2026
36 Months From Approved
03/31/2023
Responses
30,205
0
30,205
Time Burden (Hours)
21,827
0
21,827
Cost Burden (Dollars)
0
0
0
Abstract:
In order to award grants under the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, and assess services and compliance with grants provided, VA will require submission of Applications for grants and Renewals of grants, Eligibility Screening Tools, Suicide Risk Screening Tools, Participant Satisfaction Surveys, Intake Form and Program Exit Checklist (which each utilize the same five standardized assessment tools required for baseline mental health screening, as listed below) and Compliance Reports.
Authorizing Statute(s):
US Code:
38 USC 1720F
Name of Law: Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program
Citations for New Statutory Requirements:
US Code: 38 USC 1720F Name of Law: Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
87 FR 67536
11/08/2022
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 3779
01/20/2023
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
13
IC Title
Form No.
Form Name
SSG Fox SPGP - Annual Grantee Financial Report
10-316e
SSG Fox SPGP - Annual Grantee Financial Report
SSG Fox SPGP - Annual Grantee Performance Report
10-316a
SSG Fox SPGP - Annual Grantee Performance Report
SSG Fox SPGP - Application
10-315a
SSG Fox SPGP - Application
SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS)
SSG Fox SPGP - Corrective Action Plan (CAP)
10-316d
SSG Fox SPGP - Corrective Action Plan (CAP)
SSG Fox SPGP - Eligibility Screening
10-317a
SSG Fox SPGP - Eligibility Screening Form
SSG Fox SPGP - Intake Form & Assessments
10-317b
SSG Fox SPGP - Intake Form & Assessments
SSG Fox SPGP - Other Grantee Financial Report
10-316f
SSG Fox SPGP - Quarterly Grantee Financial Report
SSG Fox SPGP - Other Grantee Performance Report
10-316b
SSG Fox SPGP - Other Grantee Performance Report
SSG Fox SPGP - Participant Satisfaction Survey
10-317c
SSG Fox SPGP - Participant Satisfaction Survey
SSG Fox SPGP - Program Change Request
10-316c
SSG Fox SPGP - Program Change Request
SSG Fox SPGP - Program Exit Checklist
10-317d
SSG Fox SPGP - Program Exit Checklist & Assessments
SSG Fox SPGP - Renewal Application
10-315b
SSG Fox SPGP - Renewal Application
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
30,205
30,205
0
0
0
0
Annual Time Burden (Hours)
21,827
21,827
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$144,796
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
No
Agency Contact:
Frances O'Donnell 703 405-2449 fran.odonnell@cathexiscorp.com
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
01/20/2023
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