The National Intimate Partner and Sexual Violence Survey (NISVS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2014 National Intimate Partner and Sexual Violence Survey	Form and Instruction	New	Available
2014 National Intimate Partner and Sexual Violence Screen	Form and Instruction	New	Available
National Intimate Partner and Sexual Violence Survey - Screener	Form	Removed	Available
National Intimate Partner and Sexual Violence Survey	Form	Removed	Available
Timeline NISVS.docx	Supplementary Document	Uploaded 2015-02-06	Available
AttaF_SecAgree_0822.docx	Supplementary Document	Uploaded 2014-10-20	Available
AttD_IRB_0822.pdf	Supplementary Document	Uploaded 2014-10-20	Available
AttaC_OutConslt_0822.pdf	Supplementary Document	Uploaded 2014-10-16	Available
Att B_60dy_FRN_0822.pdf	Supplementary Document	Uploaded 2014-10-16	Available
AttA_AuthLeg_0822.docx	Supplementary Document	Uploaded 2014-10-16	Available
SSB_0822_06FEB2015.docx	Supporting Statement B	Uploaded 2015-02-06	Available
SSA_0822_06FEB2015.doc	Supporting Statement A	Uploaded 2015-02-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213548	2014 National Intimate Partner and Sexual Violence Survey	Form and Instruction	New
213547	2014 National Intimate Partner and Sexual Violence Screen	Form and Instruction	New
189767	National Intimate Partner and Sexual Violence Survey - Screener	Form	Removed
189766	National Intimate Partner and Sexual Violence Survey	Form	Removed

ICR Details

OMB Control No: 0920-0822	ICR Reference No: 201410-0920-019
Status: Historical Active	Previous ICR Reference No: 201305-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 19428
Title: The National Intimate Partner and Sexual Violence Survey (NISVS)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/18/2015
	Date Received in OIRA: 11/10/2014
Terms of Clearance: Approval is provided for the calendar year 2015 data collection, contingent on OMB’s understanding that CDC will: a) convene a panel of experts in survey methods to obtain advice regarding how to address design concerns raised by the National Research Council; b) continue to collaborate with the Bureau of Justice Statistics; c) submit a full revision request for the 2016 data collection to reflect anticipated changes to the questionnaire to reduce burden and increase utility, and d) submit a full revision in 2017 that begins to phase in changes recommended by panel of experts. The steps leading up to the goal of fielding a new design by 2019 are described in the supplemental document entitled “Timeline.” The 2016 ICR revision should include a summary of the issues raised and the options recommended for consideration by the expert panel.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	36 Months From Approved	06/30/2014
Responses	97,500	0	54,096
Time Burden (Hours)	9,458	0	6,078
Cost Burden (Dollars)	0	0	0

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Abstract: The National Intimate Partner and Sexual Violence Survey is an ongoing, nationally representative survey to assess experiences of intimate partner violence, sexual violence and stalking among adults in the US. It measures lifetime victimization for these types of violence as well as in the previous 12 months.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 21931	04/18/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 62627	10/20/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
2014 National Intimate Partner and Sexual Violence Survey	None, None	2014 National Intimate Partner and Sexual Violence Screen/Survey-Spanish ,   2014 National Intimate Partner and Sexual Violence Screen/Survey-English
National Intimate Partner and Sexual Violence Survey - Screener	none, none	NISVS ,   NISVS - Spanish version
National Intimate Partner and Sexual Violence Survey	none, none	NISVS ,   NISVS - Spanish version ,   NISVS ,   NISVS - Spanish version
2014 National Intimate Partner and Sexual Violence Screen	None, None	2014 National Intimate Partner and Sexual Violence Screen/Survey-English ,   2014 National Intimate Partner and Sexual Violence Screen/Survey-Spanish

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	97,500	54,096	0	43,404	0	0
Annual Time Burden (Hours)	9,458	6,078	0	3,380	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Change in this request is due to full implementation of the previous pilot-tested information collection instrument.

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Annual Cost to Federal Government: $2,585,332

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/10/2014

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