Information Collection

Examination of a Twelve-Month Reference Period

IC 193850 under ICR 201203-1121-036 · OMB 1121-0325.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0325 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NCVS 2 Examination of a Twelve-Month Reference Period	Form and Instruction
Step 2_Call In Script_FINAL_082710.pdf	Other-Form and Instruction
Step 3_Screening questions_FINAL_082710.pdf	Other-Form and Instruction
NCVS 2 NCVS 2 Incident Report NCVS2_Modified Incident Report.pdf	Form and Instruction
NCVS 1 Control Screener NCVS-1 Control Screener_FINAL 061610.pdf	Form
No Number Enhanced Contextual Priming Screener Enhanced Contextual Priming Screener_FINAL 061610.pdf	Form and Instruction
Form #1 Permission to Obtain Police Report from Police Agency Procedures for obtaining Police Report_Final_061610 .pdf	Form
No Number Event History Calendar Interactive Screener Event History Calendar Interactive Screener_FINAL 061610.pdf	Form and Instruction
No Number Probes for NCVS EHC Cognitive Interviews Probes_EHC-ECP_061610.pdf	Form and Instruction
No Number Respondent Debriefing Step 6_Respondent Debriefing FINAL_062410.pdf	Form
Step 1_Advertisement 2_Final_062410.pdf Advertisement Flyer 2	IC Document
Step 1_Advertisement_Final_061610.pdf Advertisement Flyer 1	IC Document
Step 4_Consent_062410.pdf Consent	IC Document
Procedures for upset sample members_Support Sources_FINAL 062410.pdf Procedures for Upset Sample Members Support	IC Document
Step 2_Call In Script_FINAL_062410.pdf Survey Call in Script	IC Document
OMB Memo_Phase III_June 29 2010.pdf OMB Memo for Phase III Cognitive Interviews	IC Document
Responses to SCV OMB Passback_082710.doc OMB Qs and BJS As document	IC Document

IC Title:

Examination of a Twelve-Month Reference Period

Agency IC Tracking Number:

BJS

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NCVS 2	NCVS 2 Incident Report	NCVS2_Modified Incident Report.pdf	Yes	Yes	Fillable Fileable
Form	NCVS 1	Control Screener	NCVS-1 Control Screener_FINAL 061610.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	No Number	Enhanced Contextual Priming Screener	Enhanced Contextual Priming Screener_FINAL 061610.pdf	Yes	Yes	Fillable Fileable
Form	Form #1	Permission to Obtain Police Report from Police Agency	Procedures for obtaining Police Report_Final_061610 .pdf	Yes	Yes	Paper Only
Form and Instruction	No Number	Event History Calendar Interactive Screener	Event History Calendar Interactive Screener_FINAL 061610.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	No Number	Probes for NCVS EHC Cognitive Interviews	Probes_EHC-ECP_061610.pdf	Yes	Yes	Fillable Fileable
Form	No Number	Respondent Debriefing	Step 6_Respondent Debriefing FINAL_062410.pdf	Yes	Yes	Fillable Fileable
Other-Form and Instruction			Step 2_Call In Script_FINAL_082710.pdf	Yes	No	Fillable Fileable
Other-Form and Instruction			Step 3_Screening questions_FINAL_082710.pdf	Yes	No	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 450

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	450	450
Annual IC Time Burden (Hours)	450	450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Advertisement Flyer 2	Step 1_Advertisement 2_Final_062410.pdf	07/19/2010
Advertisement Flyer 1	Step 1_Advertisement_Final_061610.pdf	07/19/2010
Consent	Step 4_Consent_062410.pdf	07/19/2010
Procedures for Upset Sample Members Support	Procedures for upset sample members_Support Sources_FINAL 062410.pdf	07/19/2010
Survey Call in Script	Step 2_Call In Script_FINAL_062410.pdf	07/19/2010
OMB Memo for Phase III Cognitive Interviews	OMB Memo_Phase III_June 29 2010.pdf	07/19/2010
OMB Qs and BJS As document	Responses to SCV OMB Passback_082710.doc	09/07/2010

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