Information Collection

Defense Sexual Assault Incident Restricted Reporting

IC 234080 under ICR 201811-0704-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Form 2965 Defense Sexual Assault Incident Restricted Reporting	Form
DD Form 2965 Defense Sexual Assault Incident Database (DSAID) Data Fo dd2965 Draft 20181119.pdf	Form
DD Form 2910 Victim Reporting Preference Statement dd2910 Draft 20181114.PDF	Form

IC Title:

Defense Sexual Assault Incident Restricted Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	DD Form 2965	Defense Sexual Assault Incident Database (DSAID) Data Form	dd2965 Draft 20181119.pdf		Yes	Yes	Fillable Fileable
Form	DD Form 2910	Victim Reporting Preference Statement	dd2910 Draft 20181114.PDF		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	789	789

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.