The National Intimate Partner and Sexual Violence Surveillance System (NISVSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
National Intimate Partner and Sexual Violence Surveillance System - Survey	Form	Modified	Available
Supporting Statement B.docx	Supporting Statement B	Uploaded 2012-08-30	Available
Attachment E - Interagency Agreement.pdf	Supplementary Document	Uploaded 2012-08-30	Available
Attachment D - Outside Consultation.pdf	Supplementary Document	Uploaded 2012-08-30	Available
Attachment C_Public Comment from 60 day notice.docx	Supplementary Document	Uploaded 2012-08-30	Available
Attachment A - Authorizing Legislation.docx	Supplementary Document	Uploaded 2012-08-30	Available
Attachment H - RTI Confidentiality Agreement.doc	Supplementary Document	Uploaded 2012-08-30	Available
Supporting Statement A.doc	Supporting Statement A	Uploaded 2012-08-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
189767	National Intimate Partner and Sexual Violence Surveillance System (NISVSS) - Screen	Other-Letter of Introduction	Modified
189766	National Intimate Partner and Sexual Violence Surveillance System - Survey	Form	Modified

ICR Details

OMB Control No: 0920-0822	ICR Reference No: 201209-0920-002
Status: Historical Active	Previous ICR Reference No: 201011-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: The National Intimate Partner and Sexual Violence Surveillance System (NISVSS)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/05/2012
	Date Received in OIRA: 09/04/2012
Terms of Clearance: Previous terms continue: The agency acknowledges that the estimates derived from this study are likely to be, in some measure, an under estimate of the true prevalence and should be interpreted as such.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2013	6 Months From Approved	11/30/2012
Responses	88,318	0	108,318
Time Burden (Hours)	9,916	0	18,249
Cost Burden (Dollars)	0	0	0

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Abstract: CDC proposes to continue this national surveillance system for six months and will provide more detailed and timely information on intimate partner violence, sexual violence and stalking victimization in the U.S. based on data collected in 2010, 2011, and 2012. The proposed change to the National Intimate Partner and Sexual Violence Survey is CDC includes no longer collecting data on special sub-populations (i.e. military, elderly, AIAN) and thus, focuses the scope of data collection on the general population.

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Authorizing Statute(s): US Code: 5 USC 9 Name of Law: Federal Advisory Committee Act
   US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 109 - 162 904 Name of Law: Violence Against Women and Department of Justice Reauthorization Act of 2005
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 33465	06/06/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 51809	08/27/2012
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
National Intimate Partner and Sexual Violence Surveillance System - Survey	None	The National Intimate Partner and Sexual Violence Survey
National Intimate Partner and Sexual Violence Surveillance System (NISVSS) - Screen

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	88,318	108,318	0	-20,000	0	0
Annual Time Burden (Hours)	9,916	18,249	0	-8,333	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This proposal seeks to increase the sample size by focusing on the general population and not the special sub-populations listed above. The proposed number of response screened is 73,318 annually while the proposed number of respondent surveyed is 15,000 annually. The average burden per screened respondent remains at 3 minutes (total burden in hours equals 3,666) while the average burden per surveyed respondent is 25 minutes (total burden in hours equals 6,250). The number of individuals screened and individuals surveyed equals a total burden of 9,916 hours. This proposed change reduces the total burden by approximately 54%.

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Annual Cost to Federal Government: $2,709,255

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/04/2012

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