National Intimate Partner and Sexual Violence SCREEN - 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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Unchanged

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 - English	AttE_NISVS_Survey_English_clea.docx	NA	No		Fillable Fileable
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

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 %

	Approved	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

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.