Information Collection

National Center for Victims of Crime: Service Referral Questionnaire

IC 11662 under ICR 200703-1103-001 · OMB 1103-0066.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1103-0066 National Center for Victims of Crime: Service Referral Questionnaire	Form and Instruction
1103-0066 National Center for Victims of Crime: Service Referral Q NCVCQuestionnaireFORMFinal.doc www.ncvc.org	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1103-0066	National Center for Victims of Crime: Service Referral Questionnaire	NCVCQuestionnaireFORMFinal.doc	www.ncvc.org	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	12,000	2,000	10,000
Annual IC Time Burden (Hours)	3,000	500	2,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.