View Information Collection Request (ICR) Package

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: 202509-0930-009
Status: Active	Previous ICR Reference No: 202411-0930-003
Agency/Subagency: HHS/SAMHSA	Agency Tracking No:
Title: Zero Suicide Evaluation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/21/2026
	Date Received in OIRA: 09/30/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2028	01/31/2028	01/31/2028
Responses	74,696	0	74,696
Time Burden (Hours)	20,520	0	20,520
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Clinicians/Providers	Consumer Study Interest Form
Consumer	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	, ,
Healthcare Organization Staff	Training Utilization and Preservation 6/12 month, Training Utilization and Preservation Baseline, Key Informant Interview Case Study, Workforce Survey	, , ,
Project Evaluator	Training Activity Summary Page, Prevention Strategies Inventory	,

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

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