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:
0930-0286
ICR Reference No:
202509-0930-013
Status:
Active
Previous ICR Reference No:
202311-0930-002
Agency/Subagency:
HHS/SAMHSA
Agency Tracking No:
20339
Title:
Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention 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:
01/15/2026
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/30/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2027
01/31/2027
01/31/2027
Responses
22,107
0
22,107
Time Burden (Hours)
5,008
0
5,008
Cost Burden (Dollars)
0
0
0
Abstract:
The information collected through the four stages of the cross-site evaluation of the GLS Suicide Prevention and Early Intervention Programs will describe for State/Tribal grantees (1) the context in which suicide prevention activities are being implemented, (2) the products and services funded through the program, (3) the training experiences of individuals who receive training as part of the suicide prevention programs, (4) the utilization and penetration of the skills, knowledge and techniques learned through suicide prevention training programs, and (5) the referral networks in place to support youth identified at risk for suicide.
Authorizing Statute(s):
US Code:
42 USC 520E-2
Name of Law: Mental and Bhavioral Health Services on Campus
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:
88 FR 63593
09/15/2023
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 82389
11/24/2023
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Project Evaluators
Training Activity Summary Page (TASP), EIRFT-Individual Form, EIRFT-Screening Form, Prevention Strategies Inventory (PSI)
Training Activity Summary Page (TASP)
,
EIRFT-Individual Form
,
EIRFT-Screening Form
,
Prevention Strategies Inventory (PSI)
Providers Trainees
TSA Consent to Contact, TSA-P, TSA-6-12
TSA Consent to Contact
,
TSA-P
,
TSA-6-12
Youth
Youth Outcomes and Resiliency Survey (YORS), Youth Experience Reflective Journal (YERJ)
Youth Outcomes and Resiliency Survey (YORS)
,
Youth Experience Reflective Journal (YERJ)
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
22,107
22,107
0
0
0
0
Annual Time Burden (Hours)
5,008
5,008
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:
$2,354,274
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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:
09/30/2025
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