Information Collection

NCVS Companion Survey (CS)

IC 201740 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⚠️ Notice: This information collection may be referencing outdated material.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
NCVS Companion Survey (CS)	Form
NCVS-554_capi_info_booklet.pdf	Instruction
Approach 2b screener Attachment E - Approach 2B Mail Screener - revised1.pdf	Form
Survey of Neighborhoods Attachment F2 - Approach 2C Mail Screener (generic version) - revised1.pdf	Form
Survey of Chicagoland Neighborhoods Attachment F1 - Approach 2C Mail Screener (local version) - revised1.pdf	Form
Appendix Bundle.docx Appendix Bundle with Table of Contents	IC Document
Attachment G - NCVS1 Core - Basic Screen Questionnaire.pdf Attachment G - Basic Screen Questionnaire	IC Document
Attachment H - NCVS2 Core - Crime Incident Report.pdf Attachment H - NCVS2 Core - Crime Incident Report	IC Document
BJS NCVS-CS test Q and A document.doc Passback Q and A	IC Document
NCVS CS OMB Pilot Package_final2_21_rev1.docx Pilot Study Memorandum updated	IC Document
Appendix Bundle - with Westat edits_rev1.docx Supplementary materials	IC Document

IC Title:

NCVS Companion Survey (CS)

Agency IC Tracking Number:

BJS

IC Status: New

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	None	Approach 2b screener	Attachment E - Approach 2B Mail Screener - revised1.pdf	No		Paper Only
Form	None	Survey of Neighborhoods	Attachment F2 - Approach 2C Mail Screener (generic version) - revised1.pdf	No		Paper Only
Form	None	Survey of Chicagoland Neighborhoods	Attachment F1 - Approach 2C Mail Screener (local version) - revised1.pdf	No		Paper Only
Instruction			NCVS-554_capi_info_booklet.pdf	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,549

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	14,549	14,549
Annual IC Time Burden (Hours)	4,228	4,228
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix Bundle with Table of Contents	Appendix Bundle.docx	03/29/2012
Attachment G - Basic Screen Questionnaire	Attachment G - NCVS1 Core - Basic Screen Questionnaire.pdf	03/29/2012
Attachment H - NCVS2 Core - Crime Incident Report	Attachment H - NCVS2 Core - Crime Incident Report.pdf	03/29/2012
Passback Q and A	BJS NCVS-CS test Q and A document.doc	04/24/2012
Pilot Study Memorandum updated	NCVS CS OMB Pilot Package_final2_21_rev1.docx	04/24/2012
Supplementary materials	Appendix Bundle - with Westat edits_rev1.docx	04/24/2012

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