National Intimate Partner and Sexual Violence SURVEY - General Population

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-0822 National Intimate Partner and Sexual Violence SURVEY - General Population Form and Instruction
0920-0822 National Intimate Partner and Sexual Violence Survey (NI AttE_NISVS_Survey_English_clea.docx Form and Instruction
0920-0822 National Intimate Partner and Sexual Violence Survey (NI AttH_NISVS_Survey_Spanish_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	National Intimate Partner and Sexual Violence SURVEY - General Population	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	0920-0822	National Intimate Partner and Sexual Violence Survey (NISVS) Screen/Survey - Spanish	AttH_NISVS_Survey_Spanish_clean.docx	NA	No		Fillable Fileable
Form and Instruction	0920-0822	National Intimate Partner and Sexual Violence Survey (NISVS) Screen/Survey - English	AttE_NISVS_Survey_English_clea.docx	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 30,000	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	Previously Approved
Annual Number of Responses for this IC	30,000	5,000	25,000
Annual IC Time Burden (Hours)	12,500	2,083	10,417
Annual IC Cost Burden (Dollars)	0	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.