Information Collection

National Intimate Partner and Sexual Violence SCREEN - General Population

IC 213547 under ICR 201903-0920-007 · OMB 0920-0822.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0822 can be found here:

2025-03-28 - No material or nonsubstantive change to a currently approved collection
2023-11-09 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0822 National Intimate Partner and Sexual Violence Survey (NISVS) Screen/Survey - English National Intimate Partner and Sexual Violence SCREEN - General Population	Form and Instruction
Form 0920-0822 National Intimate Partner and Sexual Violence Survey (NISVS) Screen/Survey - Spanish National Intimate Partner and Sexual Violence SCREEN - General Population	Form and Instruction
Form 0920-0822 CATI Cognitive Testing Instrument, Round 1 National Intimate Partner and Sexual Violence SCREEN - General Population	Form and Instruction
Form 0920-0822 NISVS Redesign Paper Instrument National Intimate Partner and Sexual Violence SCREEN - General Population	Form and Instruction
Form 0920-0822 Web Instrument for Cognitive Testing, Round 1 National Intimate Partner and Sexual Violence SCREEN - General Population	Form and Instruction
Form 0920-0822 Web-Based Recruitment Screener National Intimate Partner and Sexual Violence SCREEN - General Population	Form and Instruction
Form 0920-0822 NISVS Redesign CATI Cognitive Protocol -- Round 1 National Intimate Partner and Sexual Violence SCREEN - General Population	Form and Instruction
Form 0920-0822 NISVS Redesign Paper Protocol -- Round 1 National Intimate Partner and Sexual Violence SCREEN - 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
0920-0822 CATI Cognitive Testing Instrument, Round 1 Att C. NISVS CATI Cognitive Testing Instrument.docx	Form and Instruction
0920-0822 NISVS Redesign Paper Instrument Att D. NISVS Paper Cognitive Testing Instrument.docx	Form and Instruction
0920-0822 Web Instrument for Cognitive Testing, Round 1 Att E. NISVS Web-Based Cognitive Testing Instrument.docx	Form and Instruction
0920-0822 Web-Based Recruitment Screener Att H. Recruiting Screener.docx	Form and Instruction
0920-0822 NISVS Redesign CATI Cognitive Protocol -- Round 1 Att J. CATI Instrument Cog Testing Protocol.docx	Form and Instruction
0920-0822 NISVS Redesign Paper Protocol -- Round 1 Att K. Paper Instrument Cog Testing Protocol.docx	Form and Instruction
Att A. Description of Program Changes and Adjustments.docx Att A_ Program Changes and Adjustments	IC Document
Att B. Crosswalk of NISVS Instrument Revisions for OMB.docx Att B_Crosswalk of NISVS Instrument Revisions	IC Document
Att F. Cognitive Testing Plan.docx Att F_NISVS Redesign Cognitive Testing Plan	IC Document
Att F. Cognitive Testing Plan.docx Att G_Recruitment Ad	IC Document
Att I. Cog Testing Informed Consent.docx Att I_Consent Form	IC Document
NISVS Non-substantial change request 3.18.19.docx Change Request Justification and Overview	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

National Intimate Partner and Sexual Violence SCREEN - General Population

Agency IC Tracking Number:

0920-0822-19AHR

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.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0822	NA	No		Fillable Fileable
Form and Instruction	0920-0822	NA	No		Fillable Fileable
Form and Instruction	0920-0822		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0822		No		Paper Only
Form and Instruction	0920-0822		Yes	Yes	Fillable Fileable
Form and Instruction	0920-0822		No		Paper Only
Form and Instruction	0920-0822		No		Fillable Fileable
Form and Instruction	0920-0822		No		Paper Only

Federal Enterprise Architecture Business Reference Module

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: 204,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	204,000	204,000
Annual IC Time Burden (Hours)	10,200	10,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att A_ Program Changes and Adjustments		04/04/2019
Att B_Crosswalk of NISVS Instrument Revisions		04/04/2019
Att F_NISVS Redesign Cognitive Testing Plan		04/04/2019
Att G_Recruitment Ad		04/04/2019
Att I_Consent Form		04/04/2019
Change Request Justification and Overview		04/04/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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