The National Intimate Partner and Sexual Violence Survey (NISVS)

Forms and Documents

Document	Type	Status	Availability
Form 0920-0822 National Intimate Partner and Sexual Violence Survey (NISVS) - Developmental Testing	Form and Instruction	New	Available
National Intimate Partner and Sexual Violence Survey - Military	Form and Instruction	Removed	Available
National Intimate Partner and Sexual Violence Screen - Military	Form and Instruction	Removed	Available
Form 0920-0822 National Intimate Partner and Sexual Violence SURVEY - General Population	Form and Instruction	Modified	Available
Form 0920-0822 National Intimate Partner and Sexual Violence SCREEN - General Population	Form and Instruction	Modified	Available
AttL_NISVS Workgroup Summary - Final.docx	Supplementary Document	Uploaded 2018-02-13	Available
AttK_Workgroup Participants.docx	Supplementary Document	Uploaded 2017-12-12	Repair queued
AttJ2_Crosswalk of Program Changes and Adjustments.xlsx	Supplementary Document	Uploaded 2017-12-12	Repair queued
AttJ1_Description of Program Changes and Adjustments-Final.docx	Supplementary Document	Uploaded 2018-02-13	Available
AttI_Lead Letters.docx	Supplementary Document	Uploaded 2017-12-12	Repair queued
AttG_PIA_NISVS_0822.pdf	Supplementary Document	Uploaded 2017-12-12	Available
AttF_Security Agreement.doc	Supplementary Document	Uploaded 2017-12-12	Available
AttD_IRBApproval.pdf	Supplementary Document	Uploaded 2017-12-12	Repair queued
AttC_Outside Consultation.pdf	Supplementary Document	Uploaded 2017-12-12	Available
AttB1_60 Day FRN 2017.pdf	Supplementary Document	Uploaded 2017-12-12	Repair queued
SSB_NISVS_Clean_2.5.18.docx	Supporting Statement B	Uploaded 2018-02-08	Available
SSA_0822_NISVS 11.27.17_clean OMB comment_Jan11 - Rev 2.8.18.docx	Supporting Statement A	Uploaded 2018-02-08	Available
NISVS Work Group Timeline 070816 - Final OMB comments CDC 071916 clean OMB.docx	Supplementary Document	Uploaded 2016-07-19	Available
Timeline NISVS.docx	Supplementary Document	Uploaded 2015-02-06	Available
AttA_AuthLeg_0822.docx	Supplementary Document	Uploaded 2014-10-16	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
230016	National Intimate Partner and Sexual Violence Survey (NISVS) - Developmental Testing	Form and Instruction	New
221495	National Intimate Partner and Sexual Violence Survey - Military	Form and Instruction	Removed
221494	National Intimate Partner and Sexual Violence Screen - Military	Form and Instruction	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: 201712-0920-001
Status: Historical Active	Previous ICR Reference No: 201604-0920-012
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: 02/13/2018
	Date Received in OIRA: 12/27/2017
Terms of Clearance: This clearance includes one year of regular data collection (2018-2019 cycle) plus burden hours to support a series of small but in-depth investigations designed to understand potential non-response bias and explore ways to increase the response rate. Prior consultation with CDC’s OMB desk officer will be needed to determine if any given investigative/developmental project is suitable for submission to OMB as a non-substantive change under the PRA. All non-substantive change requests for the above mentioned non-response investigations must include detailed explanation of goals, justification for approach, protocols and instruments (IC). As per prior terms of clearance, OMB strongly encourages continuded collaboration with the Bureau of Justice Statistics

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	36 Months From Approved	07/31/2018
Responses	239,700	0	279,600
Time Burden (Hours)	25,216	0	27,107
Cost Burden (Dollars)	0	0	0

---

Abstract: The National Intimate Partner and Sexual Violence Survey is an ongoing, nationally representative survey of non-institutionalized adult men and women aged 18 years or older in the United States assessing lifetime experiences 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 for the period March 2018 to March 2019. During 2018 collection will not include the DoD-sponsored component that focused on active duty military respondents, thus the sample size is smaller and questions designed specifically for this subpopulation will be dropped. Small revisions have been made to the questionnaire to improve information quality. In addition a series of small changes are proposed for the recruitment protocol in an effort to increase response rates.

---

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

Citations for New Statutory Requirements: None

---

EO 13771 Designation: Deregulatory

---

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:
	82 FR 43988	09/20/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 60998	12/26/2017
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
National Intimate Partner and Sexual Violence Survey (NISVS) - Developmental Testing	0920-0822	Developmental Testing Tool for NISVS
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
National Intimate Partner and Sexual Violence SURVEY - General Population	0920-0822, 0920-0822	National Intimate Partner and Sexual Violence Survey (NISVS) Screen/Survey - Spanish ,   National Intimate Partner and Sexual Violence Survey (NISVS) Screen/Survey - English
National Intimate Partner and Sexual Violence SCREEN - General Population	0920-0822, 0920-0822	National Intimate Partner and Sexual Violence Survey (NISVS) Screen/Survey - English ,   National Intimate Partner and Sexual Violence Survey (NISVS) Screen/Survey - Spanish

---

ICR Summary 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	239,700	279,600	0	-39,900	0	0
Annual Time Burden (Hours)	25,216	27,107	0	-1,891	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: Submission of 0920-0822 - NISVS is a Revision that includes changes to the questionnaire to improve information quality and to the recruitment protocol in an effort to increase response rates. The study no longer includes Active Duty Military Respondents. This results in a decrease in overall burden.

---

Annual Cost to Federal Government: $7,557,338

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 12/27/2017

---