2014 National Intimate Partner and Sexual Violence Screen

The National Intimate Partner and Sexual Violence Survey (NISVS)

⚠️ Notice: This information collection may be referencing outdated material.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
2014 National Intimate Partner and Sexual Violence Screen Form and Instruction
2014 National Intimate Partner and Sexual Violence Scree Att E_ Instru_NISVS_Survey_0822.docx Form and Instruction
2014 National Intimate Partner and Sexual Violence Scree AttH_Instr_NISVS_Surv_SPANISH_0822.docx Form and Instruction

Information Collection (IC) Details

IC Title:	2014 National Intimate Partner and Sexual Violence Screen	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	None	2014 National Intimate Partner and Sexual Violence Screen/Survey-English	Att E_ Instru_NISVS_Survey_0822.docx	None	No		Fillable Fileable
Form and Instruction	None	2014 National Intimate Partner and Sexual Violence Screen/Survey-Spanish	AttH_Instr_NISVS_Surv_SPANISH_0822.docx	None	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 85,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	85,000	85,000
Annual IC Time Burden (Hours)	4,250	4,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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