Privacy Impact Assessment

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Privacy Impact Assessment Form
v 1.47.2
Status Draft

Form Number

F-85416

Form Date

Question

Answer

1

OPDIV:

CDC

2

PIA Unique Identifier:

P-8832430-809984

2a Name:

2/16/2016 1:17:58 PM

National Intimate Partner and Sexual Violence Survey 3.0
(NISVS 3.0)
General Support System (GSS)
Major Application

3

Minor Application (stand-alone)

The subject of this PIA is which of the following?

Minor Application (child)
Electronic Information Collection
Unknown

3a

Identify the Enterprise Performance Lifecycle Phase
of the system.

Implementation
Yes

3b Is this a FISMA-Reportable system?

4

Does the system include a Website or online
application available to and for the use of the general
public?

5

Identify the operator.

6

Point of Contact (POC):

7

Is this a new or existing system?

8

Does the system have Security Authorization (SA)?

8b Planned Date of Security Authorization

No
Yes
No
Agency
Contractor
POC Title

Business Steward

POC Name

Marci-Jo Kresnow-Sedacca

POC Organization NCIPC
POC Email

[email protected]

POC Phone

404.488.4753
New
Existing
Yes
No
March 31, 2016
Not Applicable

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11 Describe the purpose of the system.

The National Intimate Partner and Sexual Violence Survey
(NISVS 3.0) is a surveillance system that annually collects
lifetime and 12-month victimization of intimate partner
violence, sexual violence and stalking of men and women in
the U.S. over the age of 18. The survey also collects data on age
at first time victimization, demographic characteristics of
respondents, demographic characteristics of perpetrators,
information about the patterns and impact of the violence
experienced and specific health related issues.

Describe the type of information the system will
The system will collect names, contact information,
collect, maintain (store), or share. (Subsequent
12
questions will identify if this information is PII and ask interviewee’s responses, and results of survey and other
evaluations via telephone interviews.
about the specific data elements.)

Provide an overview of the system and describe the
13 information it will collect, maintain (store), or share,
either permanently or temporarily.

14 Does the system collect, maintain, use or share PII?

The National Intimate Partner and Sexual Violence Survey
(NISVS 3.0) is a surveillance system that annually collects
lifetime and 12-month victimization of intimate partner
violence, sexual violence and stalking of men and women in
the U.S. over the age of 18. The survey also collects data on age
at first time victimization, demographic characteristics of
respondents, demographic characteristics of perpetrators,
information about the patterns and impact of the violence
experienced and specific health related issues.
The data collected by NISVS 3.0 is used to inform policies and
programs that are aimed at preventing sexual violence,
stalking and intimate partner violence. This data will eventually
be used to examine national trends in sexual violence, stalking
and intimate partner violence and to evaluate and track the
effectiveness of prevention programs aimed at these types of
violence. NISVS is developed by Centers for Disease Control
and Prevention. RTI is the contractor, they conducts the
interviews, houses the data, and post the data quarterly to
CDC.
Yes
No

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15

Indicate the type of PII that the system will collect or
maintain.

Social Security Number

Date of Birth

Name

Photographic Identifiers

Driver's License Number

Biometric Identifiers

Mother's Maiden Name

Vehicle Identifiers

E-Mail Address

Mailing Address

Phone Numbers

Medical Records Number

Medical Notes

Financial Account Info

Certificates

Legal Documents

Education Records

Device Identifiers

Military Status

Employment Status

Foreign Activities

Passport Number

Taxpayer ID

Employees
Public Citizens
16

Business Partners/Contacts (Federal, state, local agencies)

Indicate the categories of individuals about whom PII
is collected, maintained or shared.

Vendors/Suppliers/Contractors
Patients
Other

17 How many individuals' PII is in the system?
18 For what primary purpose is the PII used?
19

Describe the secondary uses for which the PII will be
used (e.g. testing, training or research)

500-4,999
Contact and follow-up
None

20 Describe the function of the SSN.

N/A

20a Cite the legal authority to use the SSN.

N/A

Public Health Service Act, Section 301, "Research and
Identify legal authorities governing information use Investigation," (42 U.S.C. 241); and Sections 304, 306 and 308(d)
21
which discuss authority to maintain data and provide
and disclosure specific to the system and program.
assurances of confidentiality for health research and related
activities (42 U.S.C. 242 b, k, and m(d)).
22

Are records on the system retrieved by one or more
PII data elements?

Yes
No

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Published:
Identify the number and title of the Privacy Act
System of Records Notice (SORN) that is being used
22a
to cover the system or identify if a SORN is being
developed.

09-20-0136

Published:

Published:
In Progress
Directly from an individual about whom the
information pertains
In-Person
Hard Copy: Mail/Fax
Email
Online
Other
Government Sources
23

Within the OPDIV
Other HHS OPDIV
State/Local/Tribal
Foreign
Other Federal Entities
Other

Identify the sources of PII in the system.

Non-Government Sources
Members of the Public
Commercial Data Broker
Public Media/Internet
Private Sector
Other
23a

Identify the OMB information collection approval
number and expiration date.

OMB collection approval number is 0920-0822. The expiration
date is: 06/30/2016.
Yes

24 Is the PII shared with other organizations?

No
Within HHS

Identify with whom the PII is shared or disclosed and
24a
for what purpose.

Other Federal
Agency/Agencies
State or Local
Agency/Agencies
Private Sector

Describe any agreements in place that authorizes the
information sharing or disclosure (e.g. Computer
24b Matching Agreement, Memorandum of
Understanding (MOU), or Information Sharing
Agreement (ISA)).

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24c

Describe the procedures for accounting for
disclosures

Describe the process in place to notify individuals
25 that their personal information will be collected. If
no prior notice is given, explain the reason.
26

Respondents are asked for consent to do interview at the time
of screening; this consent process includes being provided
information about what data will be collected and how it will
be used.
Voluntary

Is the submission of PII by individuals voluntary or
mandatory?

Describe the method for individuals to opt-out of the
collection or use of their PII. If there is no option to
27
object to the information collection, provide a
reason.
Describe the process to notify and obtain consent
from the individuals whose PII is in the system when
major changes occur to the system (e.g., disclosure
28 and/or data uses have changed since the notice at
the time of original collection). Alternatively, describe
why they cannot be notified or have their consent
obtained.
Describe the process in place to resolve an
individual's concerns when they believe their PII has
29 been inappropriately obtained, used, or disclosed, or
that the PII is inaccurate. If no process exists, explain
why not.
Describe the process in place for periodic reviews of
PII contained in the system to ensure the data's
30
integrity, availability, accuracy and relevancy. If no
processes are in place, explain why not.

Mandatory
Their participation is voluntary. Given the recruitment criteria
and the need to ensure diversity in the sample, we need
participants’ PII. They will be able to opt out of the study online if they do not wish to provide PII.

RTI Interviewers will contact participants via phone number to
notify and obtain consent.

The participants names are not included in survey data and
telephone numbers are deleted nightly after interview has
been completed.
Participants will be contacted regularly during the course of
the project. This process will ensure the data’s integrity,
availability, and accuracy.
Users
Administrators
Developers

Identify who will have access to the PII in the system
31
and the reason why they require access.
Contractors

OAMAT Management staff assigned to
the project. Staff that manages the
system and process data.
Internal telephone supervisors –
manage cases and determine
interviewees’ eligibility to participate
in the study. Collect name and address
for contact and follow-up.

Others
Describe the procedures in place to determine which
32 system users (administrators, developers,
Access Control Lists will be used to define user role.
contractors, etc.) may access PII.
Describe the methods in place to allow those with
33 access to PII to only access the minimum amount of
information necessary to perform their job.

Least privilege as the determinant. Only users who need to
make phone calls or contact by name will access the PII.

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Identify training and awareness provided to
personnel (system owners, managers, operators,
contractors and/or program managers) using the
34
system to make them aware of their responsibilities
for protecting the information being collected and
maintained.

Training on security and privacy awareness and IRB training.

Describe training system users receive (above and
35 beyond general security and privacy awareness
training).

Project training on system use,
System specific training on system use.

Do contracts include Federal Acquisition Regulation
36 and other appropriate clauses ensuring adherence to
privacy provisions and practices?

Yes
No

Describe the process and guidelines in place with
37 regard to the retention and destruction of PII. Cite
specific records retention schedules.

After transfer of data based on contract requirements, all data
will be deleted. Encrypted backups will expire after one year.

Describe, briefly but with specificity, how the PII will
38 be secured in the system using administrative,
technical, and physical controls.

The database will use Access Control Lists and other
protection, including field level encryption as necessary. The
data will be protected in a secure data center.

General Comments

OPDIV Senior Official
for Privacy Signature

Beverly E.
Walker -S

Digitally signed by Beverly E. Walker -S
DN: c=US, o=U.S. Government,
ou=HHS, ou=CDC, ou=People,
0.9.2342.19200300.100.1.1=100144034
3, cn=Beverly E. Walker -S
Date: 2016.03.25 12:32:32 -04'00'

HHS Senior
Agency Official
for Privacy

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