Information Collection

National Intimate Partner and Sexual Violence Survey

IC 189766 under ICR 201305-0920-005 · OMB 0920-0822.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0822 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
National Intimate Partner and Sexual Violence Survey	Form
NISVS Attachment G- 2013 NISVS Survey_OMB - 2-27-2013.doc	Form
NISVS - Spanish version Attachment K - NISVS Questionnaire - Spanish Version.docx	Form

IC Title:

National Intimate Partner and Sexual Violence Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	NISVS	Attachment G- 2013 NISVS Survey_OMB - 2-27-2013.doc		Yes	Yes	Fillable Fileable
Form	none	NISVS - Spanish version	Attachment K - NISVS Questionnaire - Spanish Version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,200

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	Previously Approved
Annual Number of Responses for this IC	9,200	-5,800	15,000
Annual IC Time Burden (Hours)	3,833	-2,417	6,250
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.