The National Intimate Partner and Sexual Violence Survey (NISVS)

Forms and Documents

Document Name	Status
National Intimate Partner and Sexual Violence Survey - Screener Form	Modified
National Intimate Partner and Sexual Violence Survey Form	Modified
Supporting Statement B - 2-27-2013.docx Supporting Statement B	2013-05-01
Attachment J - NISVS Questionnaire Changes.docx Supplementary Document	2013-05-01
Attachment I - Advance Letter of Introduction_v3.doc Supplementary Document	2013-05-01
Attachment H - RTI Confidentiality Agreement.doc Supplementary Document	2013-05-01
Attachment E - Interagency Agreement.pdf Supplementary Document	2013-05-01
Attachment D - Outside Consultation.pdf Supplementary Document	2013-05-01
Attachment C - Public Comment.docx Supplementary Document	2013-05-01
Attachment B - Published 60-Day Notice.pdf Supplementary Document	2013-05-01
Attachment F - Local IRB Approval.pdf Supplementary Document	2013-05-01
Attachment A - Authorizing Legislation.docx Supplementary Document	2013-05-01
Attachment I - Advance Letter of Introduction_v3.doc Supplementary Document	2013-05-01
Supporting Statement A - 5-1-2013.doc Supporting Statement A	2013-05-01

IC Document Collections

IC ID	Document Title	Status
189767	National Intimate Partner and Sexual Violence Survey - Screener Form	Modified
189766	National Intimate Partner and Sexual Violence Survey Form	Modified

ICR Details

OMB Control No: 0920-0822	ICR Reference No: 201305-0920-005
Status: Historical Active	Previous ICR Reference No: 201209-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 19428
Title: The National Intimate Partner and Sexual Violence Survey (NISVS)
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: 06/10/2013
	Date Received in OIRA: 05/10/2013
Terms of Clearance: Approved for one year for the pilot test of the revised intstruments. Any changes made as a result of the pilot phase will be described in a revision request to continue the collection beyond the pilot phase. Also, previous terms of clearance 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.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	36 Months From Approved	11/30/2013
Responses	54,096	0	88,318
Time Burden (Hours)	6,078	0	9,916
Cost Burden (Dollars)	0	0	0

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Abstract: The National Intimate Partner and Sexual Violence Survey is an ongoing, nationally representative survey to assess experiences of intimate partner violence, sexual violence and stalking among adults in the US. It measures lifetime victimization for these types of violence as well as in the previous 12 months.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

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 75165	12/19/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 26032	05/03/2013
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
National Intimate Partner and Sexual Violence Survey	none, none	NISVS ,   NISVS - Spanish version
National Intimate Partner and Sexual Violence Survey - Screener	none, none	NISVS ,   NISVS - Spanish version

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ICR Summary 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	54,096	88,318	0	-34,222	0	0
Annual Time Burden (Hours)	6,078	9,916	0	-3,838	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: There is a decrease in burden due to the decrease in the number of respondents for the year of pilot testing. The changes to the instrument are twofold: first, the current NISVS survey instrument has been shortened in efforts to reduce the burden on respondents and to develop a core instrument that will be administered on an annual basis. Second, topic specific modules contain questions to produce data that are needed on a regular basis but are not needed annually.

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Annual Cost to Federal Government: $2,552,004

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? No

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: 05/10/2013

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