Phase 3 - ABS web Survey

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⚠️ Notice: This information collection may be referencing outdated material.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
Phase 3 - ABS web Survey Form and Instruction
ABS web Survey AttE.2A_Web Survey_12.13.19.docx Form and Instruction
ABS web Survey - screenshots AttE.2B_Web Survey Screenshots.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Phase 3 - ABS web Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	none	ABS web Survey	AttE.2A_Web Survey_12.13.19.docx		Yes	Yes	Fillable Fileable
Form and Instruction	none	ABS web Survey - screenshots	AttE.2B_Web Survey Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 29	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	29	29
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	319	319

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.