Information Collection

National Intimate Partner and Sexual Violence Survey (NISVS) - Developmental Testing

IC 230016 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0822 Developmental Testing Tool for NISVS National Intimate Partner and Sexual Violence Survey (NISVS) - Developmental Testing	Form and Instruction
0920-0822 Developmental Testing Tool for NISVS Developmental Testing for NISVS - Mock Instrument 08FEB2018.docx	Form and Instruction

IC Title:

National Intimate Partner and Sexual Violence Survey (NISVS) - Developmental Testing

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	0920-0822			NA	Yes	Yes	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: 5,700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	5,700	5,700
Annual IC Time Burden (Hours)	2,516	2,516
Annual IC Cost Burden (Dollars)	0	0

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.

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