Information Collection

Survey on Sexual Victimization

IC 12623 under ICR 201403-1121-002 · OMB 1121-0292.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0292 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SSV-1 Survey on Sexual Victimization	Form and Instruction
SSV-1 SSV Federal Bureau of Prisons Summary Form SSV-1.pdf	Form and Instruction
SSV-2 SSV State Prison Systems Summary Form SSV-2.pdf	Form and Instruction
SSV-3 SSV Local Jail Jurisdictions Summary Form SSV-3.pdf	Form and Instruction
SSV-4 SSV Other Correctional Facilities Summary Form SSV-4.pdf	Form and Instruction
SSV-5 SSV State Juvenile Systems Summary Form SSV-5.pdf	Form and Instruction
SSV-6 SSV Locally or Privately-Operated Juvenile Facilities Su SSV-6.pdf	Form and Instruction
SSV IA SSV Incident Form Adult SSV-IA.pdf	Form and Instruction
SSV IJ SSV Incident Form Juveniles SSV-IJ.pdf	Form and Instruction
Attachments.pdf SSV Attachments with Table of Contents	IC Document

IC Title:

Survey on Sexual Victimization

Agency IC Tracking Number:

BJS

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	SSV-1	SSV Federal Bureau of Prisons Summary Form	SSV-1.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SSV-2	SSV State Prison Systems Summary Form	SSV-2.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SSV-3	SSV Local Jail Jurisdictions Summary Form	SSV-3.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SSV-4	SSV Other Correctional Facilities Summary Form	SSV-4.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SSV-5	SSV State Juvenile Systems Summary Form	SSV-5.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SSV-6	SSV Locally or Privately-Operated Juvenile Facilities Summary Form	SSV-6.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SSV IA	SSV Incident Form Adult	SSV-IA.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	SSV IJ	SSV Incident Form Juveniles	SSV-IJ.pdf	Yes	Yes	Fillable Fileable

Line of Business: Correctional Activities

Subfunction: Criminal Incarceration

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,538

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 45 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,538	57	1,481
Annual IC Time Burden (Hours)	1,353	361	992
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SSV Attachments with Table of Contents	Attachments.pdf	03/14/2014

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