Information Collection

Survey on Sexual Violence

IC 12623 under ICR 200712-1121-002 · OMB 1121-0292.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0292 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSV-1 Survey on Sexual Violence	Form
SSV-1 Survey on Sexual Violence - Federal Bureau of Prisons ssv1.pdf	Form
SSV-2 Survey on Sexual Violence - State Prison Systems ssv2.pdf	Form
SSV-3 Survey on Sexual Violence - Local Jail Jurisdictions ssv3.pdf	Form
SSV-4 Survey on Sexual Violence - Other Correctiona Facilities ssv4.pdf	Form
SSV-5 Survey on Sexual Violence ssv5.pdf	Form
SSV-6 Survey on Sexual Violence - Locally or Privately-Operate ssv6.pdf	Form
SSV-IA Survey on Sexual Violence - Incident Form (Adults) SSVIA.pdf	Form
SSV-IJ Survey on Sexual Violence - Incident Form (Juvenile) SSVIJ.pdf	Form

IC Title:

Survey on Sexual Violence

Agency IC Tracking Number:

BJS

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSV-1	Survey on Sexual Violence - Federal Bureau of Prisons	ssv1.pdf	No	Paper Only
Form	SSV-2	Survey on Sexual Violence - State Prison Systems	ssv2.pdf	No	Paper Only
Form	SSV-3	Survey on Sexual Violence - Local Jail Jurisdictions	ssv3.pdf	No	Paper Only
Form	SSV-4	Survey on Sexual Violence - Other Correctiona Facilities	ssv4.pdf	No	Paper Only
Form	SSV-5	Survey on Sexual Violence	ssv5.pdf	No	Paper Only
Form	SSV-6	Survey on Sexual Violence - Locally or Privately-Operated Juvenile Facilities	ssv6.pdf	No	Paper Only
Form	SSV-IA	Survey on Sexual Violence - Incident Form (Adults)	SSVIA.pdf	No	Paper Only
Form	SSV-IJ	Survey on Sexual Violence - Incident Form (Juvenile)	SSVIJ.pdf	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 761

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	761	0	761
Annual IC Time Burden (Hours)	1,150	-372	1,522
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.