Information Collection

National Intimate Partner and Sexual Violence Survey - Screener

IC 189767 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
National Intimate Partner and Sexual Violence Survey - Screener Form
NISVS Attachment G- 2013 NISVS Survey_OMB - 2-27-2013.doc Form
NISVS - Spanish version Attachment K - NISVS Questionnaire - Spanish Version.docx Form
Attachment I - Advance Letter of Introduction_v3.doc I - Introductory Letter IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	National Intimate Partner and Sexual Violence Survey - Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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: 44,896	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	44,896	-28,422	73,318
Annual IC Time Burden (Hours)	2,245	-1,421	3,666
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
I - Introductory Letter	Attachment I - Advance Letter of Introduction_v3.doc	05/01/2013

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