Information Collection Request

Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP)

ICR 202601-2900-003 · OMB 2900-0904 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 10-317e SSG Fox SPGP - Baseline Mental Health Screening Checklist Form and Instruction New Available
Form 10-317d SSG Fox SPGP - Program Exit Screening Checklist Form Modified Available
Form 10-317c SSG Fox SPGP - Participant Satisfaction Survey Form Modified Available
Form 10-317b SSG Fox SPGP - Intake Form Form and Instruction Modified Available
Form 10-317a SSG Fox SPGP - Eligibility Screening Form Form Modified Available
Form 10-316f SSG Fox SPGP - Quarterly Grantee Financial Report Form and Instruction Removed Available
Form 10-316e SSG Fox SPGP - Annual Grantee Financial Report Form and Instruction Modified Available
Form 10-316d SSG Fox SPGP - Corrective Action Plan (CAP) Form and Instruction Modified Available
Form 10-316c SSG Fox SPGP - Program & Budget Change Request Form Modified Available
Form 10-316b SSG Fox SPGP - Mid-year Grantee Performance Report Form Modified Available
Form 10-316a SSG Fox SPGP - Annual Grantee Performance Report Form Removed Available
Form 10-315b SSG Fox SPGP - Renewal Application Form and Instruction Modified Available
Form 10-315a SSG Fox SPGP - Application Form and Instruction Modified Available
30-Day FRN_2900-0904_SSG Fox Suicide Prev Grant Prog (SPGP)_pub 05132026.pdf Supplementary Document Uploaded 2026-05-13 Available
60-Day FRN_2900-0904_SSG Fox Suicide Prev Grant Prog (SPGP)_pub 02202026.pdf Supplementary Document Uploaded 2026-03-02 Available
SSA_2900-0904_SSG Fox Suicide Prevention Grant Prog (SPGP)_updated May 2026.docx Supporting Statement A Uploaded 2026-05-13 Available
IC Document Collections
IC IDCollectionTypeStatusForm
280148 SSG Fox SPGP - Baseline Mental Health Screening Checklist Form and Instruction NewSSG Fox SPGP - Baseline Mental Health Screening Checklist
253146 SSG Fox SPGP - Program Exit Screening Checklist Form ModifiedSSG Fox SPGP - Program Exit Screening Checklist
253145 SSG Fox SPGP - Columbia Suicide Risk Screening (CSSRS) Other-Screening Tool Removed
253144 SSG Fox SPGP - Participant Satisfaction Survey Form ModifiedSSG Fox SPGP - Participant Satisfaction Survey
253143 SSG Fox SPGP - Intake Form Form and Instruction ModifiedSSG Fox SPGP - Intake Form
253142 SSG Fox SPGP - Eligibility Screening Form ModifiedSSG Fox SPGP - Eligibility Screening Form
253141 SSG Fox SPGP - Other Grantee Financial Report Form and Instruction RemovedSSG Fox SPGP - Quarterly Grantee Financial Report
253140 SSG Fox SPGP - Annual Grantee Financial Report Form and Instruction ModifiedSSG Fox SPGP - Annual Grantee Financial Report
253139 SSG Fox SPGP - Corrective Action Plan (CAP) Form and Instruction ModifiedSSG Fox SPGP - Corrective Action Plan (CAP)
253138 SSG Fox SPGP - Program & Budget Change Request Form ModifiedSSG Fox SPGP - Program & Budget Change Request
253136 SSG Fox SPGP - Grantee Performance Report Form ModifiedSSG Fox SPGP - Mid-year Grantee Performance Report
253133 SSG Fox SPGP - Annual Grantee Performance Report Form RemovedSSG Fox SPGP - Annual Grantee Performance Report
253131 SSG Fox SPGP - Renewal Application Form and Instruction ModifiedSSG Fox SPGP - Renewal Application
253128 SSG Fox SPGP - Application Form and Instruction ModifiedSSG Fox SPGP - Application
ICR Details
2900-0904 202601-2900-003
Received in OIRA 202210-2900-015
VA VHA-2900-0904
Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP)
Reinstatement with change of a previously approved collection   No
Regular 05/13/2026
  Requested Previously Approved
36 Months From Approved
54,525 0
31,166 0
0 0

On October 17, 2020, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, Public Law (P. L.) 116-171 (the Act), codified as a note to section 1720F of title 38, United States Code (U.S.C.), was enacted in law. Section 201 of the Act mandated VA establish the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP) to reduce Veteran suicide through the provision of community-based grants to certain eligible entities to provide or coordinate the provision of suicide prevention services to eligible individuals and their families. 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, Suicide Risk Tools, Participant Satisfaction Surveys, Intake Forms, Baseline Mental Health Screening and Program Exit Screening Checklists (which each utilize the same five standardized assessment tools), and Grantee Compliance Reports (performance and financial).

US Code: 38 USC 1720F Name of Law: Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program
  
US Code: 38 USC 1720F Name of Law: Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019

Not associated with rulemaking

  91 FR 8311 02/20/2026
91 FR 27136 05/13/2026
No

  Total Request 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 54,525 0 0 48,225 0 6,300
Annual Time Burden (Hours) 31,166 0 0 29,500 0 1,666
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
There are overall increases in the anticipated number of responses and burden hours based upon program data since the last PRA clearance, including an increase in applications. The program requires only one version of the performance report form (10-316b) to be submitted twice annually – at mid-year and end-of-year; the 10-316a form is no longer needed and has been removed from the collection. The program requires only one annual grantee financial report; therefore, VA Form 10-316f is no longer needed and has been removed from the collection. VA Form 10-317b has been split into two forms, with a new 10-317e form being added to the collection.

$133,675
No
    Yes
    Yes
No
No
No
No
Frances O'Donnell 703 405-2449 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/13/2026