National Crime Victimization Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NCVS-2 Spanish Crime Incident Report - Spanish	Form	Unchanged	Available
Form NCVS-1 Spanish Basic Screen Questionnaire - Spanish	Form	Unchanged	Available
Form NCVS-541 Reinterview Screener	Form	Unchanged	Available
Form NCVS-500 Control Card	Form	Unchanged	Available
Form NCVS-2 Crime Incident Report	Form	Unchanged	Available
Form NCVS -1 Basic Screen Questionnaire	Form	Unchanged	Available
OMB memo to temporarily waive expiration date.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2015-06-12	Repair queued
omb memo- state sample boost_v2.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2013-06-24	Available
OMB memo- state sample boost.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2013-06-18	Available
83c-fill_stateboost.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2013-06-04	Available
Response to OMB regarding passback questions.docx	Supplementary Document	Uploaded 2012-08-21	Available
nsvso12sol.pdf	Supplementary Document	Uploaded 2012-08-21	Available
NCVS_594(L)_thank you (Spanish).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_594(L)_thank you (English).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_573(L)_follow-up (Spanish).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_573(L)_follow-up (English).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_593(L)_thank you_continuing (Spanish).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_593(L)_thank you_continuing (English).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_572(L)_intro letter (Viet).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_572(L)_intro letter (Spanish).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_572(L)_intro letter (Korean).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_572(L)_intro letter (English).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_572(L)_intro letter (Chinese_s).pdf	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_572(L)_intro letter (Chinese).pdf	Supplementary Document	Uploaded 2012-06-25	Available
Screenshot of NCVS Instrument screen containing the OMB number.docx	Supplementary Document	Uploaded 2012-06-25	Available
NCVS_Supporting_Statement_Part_A 8-20-12.doc	Supporting Statement A	Uploaded 2012-08-21	Available
legislation.doc	Supplementary Document	Uploaded 2009-07-08	Available
NCVS_Supporting_Statement_Part_B_revised.docx	Supporting Statement B	Uploaded 2012-08-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
12401	National Crime Victimization Survey	Form	Unchanged	Crime Incident Report - Spanish
12401	National Crime Victimization Survey	Form	Unchanged	Basic Screen Questionnaire - Spanish
12401	National Crime Victimization Survey	Form	Unchanged	Reinterview Screener
12401	National Crime Victimization Survey	Form	Unchanged	Control Card
12401	National Crime Victimization Survey	Form	Unchanged	Crime Incident Report
12401	National Crime Victimization Survey	Form	Unchanged	Basic Screen Questionnaire
12401	National Crime Victimization Survey	Instruction	Unchanged

ICR Details

OMB Control No: 1121-0111	ICR Reference No: 201506-1121-002
Status: Historical Active	Previous ICR Reference No: 201305-1121-002
Agency/Subagency: DOJ/OJP	Agency Tracking No: BJS
Title: National Crime Victimization Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/21/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/16/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	08/31/2015	08/31/2015
Responses	240,200	0	240,200
Time Burden (Hours)	80,450	0	80,450
Cost Burden (Dollars)	0	0	0

---

Abstract: The National Crime Victimization Survey collects analyzes publishes, and disseminates statistics on the amount and type of crime committed against households and indiduals in the U.S. Respondents include persons 12 years or older living in about 51,000 interviewed households in 329 stratification PSUs. This no material change is requested to allow for a three-month waiver of printing the OMB expiration date on the NCVS questionnaire and cover letter to the respondents. The U.S. Census Bureau has to send the first wave of materials for duplication in early July for administering in September, October, and November. The new expiration date will not be known at that time as the package is just now in the final stages of review and will be submitted to OMB in mid/late June. BJS respectfully requests a waiver of the requirement to publish the expiration date of OMB number on the NCVS materials for three months (through November 30, 2015).

---

Authorizing Statute(s): US Code: 42 USC Section 3732 Name of Law: Justice System Improvement
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 17523	03/26/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 32138	05/31/2012
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
National Crime Victimization Survey	NCVS-500, NCVS -1, NCVS-2, NCVS-541, NCVS-1 Spanish, NCVS-2 Spanish	Basic Screen Questionnaire ,   Crime Incident Report ,   Control Card ,   Reinterview Screener ,   Basic Screen Questionnaire - Spanish ,   Crime Incident Report - Spanish

---

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	240,200	240,200	0	0	0	0
Annual Time Burden (Hours)	80,450	80,450	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Changes to the survey instrument adding Race of Offender questions.

---

Annual Cost to Federal Government: $0

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

---

Common Form ICR:  No

---

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: 06/16/2015

---