Information Collection

Defense Sexual Assault Incident Database

IC 200363 under ICR 201509-0704-003 · OMB 0704-0482.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0704-0482 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD 2965 Defense Sexual Assault Incident Database	Form and Instruction
DD 2965 Defense Sexual Assault Incident Database (DSAID) Data Fo dd2965_20150824.pdf	Form and Instruction
DD 2910 Victim Reporting Preference Statement dd2910_20151103.pdf	Form

IC Title:

Defense Sexual Assault Incident Database

Agency IC Tracking Number:

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DD 2965	Defense Sexual Assault Incident Database (DSAID) Data Form	dd2965_20150824.pdf		Yes	Yes	Fillable Printable
Form	DD 2910	Victim Reporting Preference Statement	dd2910_20151103.pdf		Yes	Yes	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title: DHRA 06 Defense Sexual Assault Incident Database

FR Citation: 79 FR 38534

Number of Respondents: 1,130

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,130	-2,070	3,200
Annual IC Time Burden (Hours)	1,313	-1,887	3,200
Annual IC Cost Burden (Dollars)	29,640	29,640	0

Documents for IC

table that charts IC Documents
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.