The National Intimate Partner and Sexual Violence Survey (NISVS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
National Intimate Partner and Sexual Violence Survey - Military	Form and Instruction	New	Available
National Intimate Partner and Sexual Violence Screen - Military	Form and Instruction	New	Available
National Intimate Partner and Sexual Violence Survey - General Population	Form and Instruction	Modified	Available
National Intimate Partner and Sexual Violence Screen - General Population	Form and Instruction	Modified	Available
NISVS Work Group Timeline 070816 - Final OMB comments CDC 071916 clean OMB.docx	Supplementary Document	Uploaded 2016-07-19	Available
Att. J. Program Changes_NISVS FINAL 12MAY2016.docx	Supplementary Document	Uploaded 2016-05-12	Available
SSA_0822_NISVS_050516 v2 OMB comments 07 15_2016 revisions clean OMB.docx	Supporting Statement A	Uploaded 2016-07-19	Available
SSB_0822_0822_NISVS 042016KA OMB comments 07 15_2016 revisions clean OMB.docx	Supporting Statement B	Uploaded 2016-07-19	Available
AttI_ Lead Letters_2016_03_31.docx	Supplementary Document	Uploaded 2016-05-12	Available
Timeline NISVS.docx	Supplementary Document	Uploaded 2015-02-06	Repair queued
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

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
221495	National Intimate Partner and Sexual Violence Survey - Military	Form and Instruction	New
221494	National Intimate Partner and Sexual Violence Screen - Military	Form and Instruction	New
219906	App G_Cognitive Laboratory Survey		Removed
219905	App D_Recruitment Phone Screener	Other-WORD	Removed
219904	App C_Recruitment Web Screener	Other-Screenshots	Removed
213548	National Intimate Partner and Sexual Violence Survey - General Population	Form and Instruction	Modified
213547	National Intimate Partner and Sexual Violence Screen - General Population	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0822	ICR Reference No: 201604-0920-012
Status: Historical Active	Previous ICR Reference No: 201601-0920-018
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0822
Title: The National Intimate Partner and Sexual Violence Survey (NISVS)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/25/2016
	Date Received in OIRA: 05/13/2016
Terms of Clearance: Approval is provided for data collection for 2016 - 2018, contingent on OMB’s understanding that CDC is committed to: a) obtaining advice from a panel of experts in survey methods regarding how to address design concerns raised by the National Research Council; b) continuing to collaborate with the Bureau of Justice Statistics; c) continuing to incorporate changes to the questionnaire to reduce burden and increase utility (including adopting best practices for sexual orientation and gender identity questions), and d) keeping OMB informed of the recommendations of the survey design experts and how CDC intends to address their recommendations. A timeline for addressing these terms of clearance is uploaded as a supplemental document.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2018	36 Months From Approved	07/31/2016
Responses	279,600	0	97,590
Time Burden (Hours)	27,107	0	9,525
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. The Revision requests a continuation of data collection among non-institutionalized adult men and women aged 18 years or older in the United States assessing lifetime experiences of intimate partner violence (IPV), sexual violence (SV) and stalking with a new and improved data collection tool aimed at reducing the time and complexity of the instrument, thus reducing the burden on the respondent. In addition, in collaboration with the Department of Defense (DoD), NISVS (using the same newly revised survey described above)will collect information regarding the experiences of IPV, SV and stalking among active duty women and men in the military and wives of active duty men.

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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:
	80 FR 28618	05/19/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 29266	05/11/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
App C_Recruitment Web Screener
App D_Recruitment Phone Screener
App G_Cognitive Laboratory Survey
National Intimate Partner and Sexual Violence Survey - General Population	NA, NA	National Intimate Partner and Sexual Violence Screen/Survey (NISVS) 3.0 - General Population and Military - FINAL English ,   National Intimate Partner and Sexual Violence Screen/Survey (NISVS) 3.0 General Population and Military - FINAL Spanish
National Intimate Partner and Sexual Violence Screen - General Population	NA, NA	National Intimate Partner and Sexual Violence Screen/Survey (NISVS) 3.0 General Population and Military - FINAL English ,   National Intimate Partner and Sexual Violence Screen/Survey (NISVS) 3.0 General Population and Military - FINAL Spanish
National Intimate Partner and Sexual Violence Screen - Military	NA	National Intimate Partner and Sexual Violence Screen/Survey (NISVS) 3.0 General Population and Military - FINAL English
National Intimate Partner and Sexual Violence Survey - Military	NA	National Intimate Partner and Sexual Violence Screen/Survey (NISVS) 3.0 General Population and Military - FINAL English

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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	279,600	97,590	0	182,010	0	0
Annual Time Burden (Hours)	27,107	9,525	0	17,582	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: Revision of NISVS results in removal of a number of information collections and an overall increase in Burden Hours due to a change in the periodicity of the survey and addition of DoD/Military participants..

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Annual Cost to Federal Government: $4,895,472

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: 05/13/2016

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