OMB.report

Federal forms, ICRs, and supporting documents

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 NameDocument Type
Demographics Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form
ACASI Questionnaire Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form and Instruction
V CATI Questionnaire Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form and Instruction
National Study on Health and Safety Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form
ACASI Household Screener Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form
CATI Landline Screener Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form
CATI Cell Phone Screener Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form
Recruitment Screener Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form and Instruction
Cell Phone Screener Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form and Instruction
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

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 N/A Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Form and Instruction N/A Yes Yes Fillable Fileable
Form and Instruction N/A Yes Yes Fillable Fileable
Form N/A Yes Yes Fillable Fileable
Form N/A Yes Yes Fillable Fileable
Form N/A Yes Yes Fillable Fileable
Form N/A Yes Yes Fillable Fileable
Form and Instruction N/A Yes Yes Fillable Fileable
Form and Instruction N/A Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


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

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Attachments A-Z with Table of Contents 11/05/2013
Submission of burden changes to the Rape and Sexual Assault Pilot Study 08/06/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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