Information Collection

Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test

IC 209193 under ICR 201408-1121-004 · OMB 1121-0343.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test	Form
W2 ACASI Tutorial.docx	Instruction
W1 Event History Calendar.docx	Instruction
Demographics W3 Demographics.docx	Form
ACASI Questionnaire W ACASI questionnaire.docx	Form and Instruction
V CATI Questionnaire V CATI questionnaire.docx	Form and Instruction
National Study on Health and Safety C Field_Mail_Household_Roster_Survey.pdf	Form
ACASI Household Screener E Field ACASI Household Roster.doc	Form
CATI Landline Screener G CATI Landline Screener.docx	Form
CATI Cell Phone Screener H CATI Cell Phone Screening.docx	Form
Recruitment Screener M High Risk Recruit Script.docx	Form and Instruction
Cell Phone Screener T-1 Modified Phone Questionnaire_for cell only feasibility 2 test.docx	Form and Instruction
All Attachments A-Z with TOC.pdf Attachments A-Z with Table of Contents	IC Document
OMB memo.docx Submission of burden changes to the Rape and Sexual Assault Pilot Study	IC Document

IC Title:

Agency IC Tracking Number:

BJS

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Demographics	W3 Demographics.docx	Yes	Yes	Fillable Fileable
Instruction			W2 ACASI Tutorial.docx	Yes	Yes	Fillable Fileable
Instruction			W1 Event History Calendar.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	ACASI Questionnaire	W ACASI questionnaire.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	V CATI Questionnaire	V CATI questionnaire.docx	Yes	Yes	Fillable Fileable
Form	N/A	National Study on Health and Safety	C Field_Mail_Household_Roster_Survey.pdf	Yes	Yes	Fillable Fileable
Form	N/A	ACASI Household Screener	E Field ACASI Household Roster.doc	Yes	Yes	Fillable Fileable
Form	N/A	CATI Landline Screener	G CATI Landline Screener.docx	Yes	Yes	Fillable Fileable
Form	N/A	CATI Cell Phone Screener	H CATI Cell Phone Screening.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Recruitment Screener	M High Risk Recruit Script.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Cell Phone Screener	T-1 Modified Phone Questionnaire_for cell only feasibility 2 test.docx	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55,060

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	55,060	2,000	53,060
Annual IC Time Burden (Hours)	11,894	29	11,865
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachments A-Z with Table of Contents	All Attachments A-Z with TOC.pdf	11/05/2013
Submission of burden changes to the Rape and Sexual Assault Pilot Study	OMB memo.docx	08/06/2014

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