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:
0930-0401
ICR Reference No:
202411-0930-003
Status:
Active
Previous ICR Reference No:
Agency/Subagency:
HHS/SAMHSA
Agency Tracking No:
Title:
Zero Suicide Evaluation
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
01/17/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/22/2024
Terms of Clearance:
The agency is granted the exemption to use the minimum categories outlined in Figure 3 of the Directive No. 15 in Attachment B of this collection due to additional burden to the agency and public and the additional risk to privacy or confidentiality.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2028
36 Months From Approved
Responses
74,696
0
0
Time Burden (Hours)
20,520
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
Zero Suicide is a commitment to suicide prevention in health and behavioral health care systems and a framework with a specific set of tools and strategies. It proposes that suicide deaths for individuals under care within health and behavioral health systems are preventable, and that a systematic approach to quality improvement in these settings is both available and necessary to identify suicidal patients and keep them safe. The Zero Suicide Evaluation is designed to assess the implementation and outcomes of SAMHSA’s Zero Suicide Program. Specifically, the Zero Suicide Evaluation will gather information about health system implementation of the Zero Suicide model, including staff training; health care provider training, knowledge, practices, and confidence related to implementing the core elements of the Zero Suicide model; consumer experiences with services provided under the Zero Suicide model; and outcomes related to suicide attempts and deaths.
Authorizing Statute(s):
US Code:
42 USC 290bb-43
Name of Law: Public Health Service Act (PHSA)
Citations for New Statutory Requirements:
None
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:
89 FR 73666
09/11/2024
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 91775
11/20/2024
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
5
IC Title
Form No.
Form Name
Clinicians/Providers
Consumer Study Interest Form
Consumer Study Interest Form
Consumer
Consumer Study Interest Form, Consumer Key Informant Interview, Consumer Experience Survey
Consumer Study Interest Form
,
Consumer Key Informant Interview
,
Consumer Experience Survey
Grantee/Healthcare Organization Administrator
Behavioral Health Provider Survey, Key Informant Interview Case Study, Key Informant Interview Cost Study
Behavioral Health Provider Survey
,
Key Informant Interview Case Study
,
Key Informant Interview Cost Study
Healthcare Organization Staff
Training Utilization and Preservation 6/12 month, Training Utilization and Preservation Baseline, Key Informant Interview Case Study, Workforce Survey
Training Utilization and Preservation 6/12 month
,
Training Utilization and Preservation Baseline
,
Key Informant Interview Case Study
,
Workforce Survey
Project Evaluator
Prevention Strategies Inventory, Training Activity Summary Page
Prevention Strategies Inventory
,
Training Activity Summary Page
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
74,696
0
0
74,696
0
0
Annual Time Burden (Hours)
20,520
0
0
20,520
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new collection.
Annual Cost to Federal Government:
$3,023,033
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.
No
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.
No
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:
Alicia Broadus 240 276-0166 alicia.broadus@samhsa.hhs.gov
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:
11/22/2024
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