The National Intimate Partner and Sexual Violence Survey (NISVS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
ABS in-bound CATI survey	Form and Instruction	Removed	Available
Phase 3 - ABS inbound CATI	Form and Instruction	Removed	Repair queued
NISVS Survey - phone - Spanish	Form and Instruction	Modified	Available
NISVS survey - phone - English	Form and Instruction	Modified	Available
Phase 3 - ABS phone survey	Form and Instruction	Modified	Repair queued
ABS web Survey - screenshots	Form and Instruction	Removed	Available
ABS web Survey	Form and Instruction	Removed	Available
Phase 3 - ABS web Survey	Form and Instruction	Removed	Repair queued
NISVS Web screener and survey - Spanish	Form and Instruction	Modified	Repair queued
NISVS Web screener and survey - English	Form and Instruction	Modified	Repair queued
Phase 3 - ABS Web Survey	Form and Instruction	Modified	Repair queued
ABS Paper screener using YMOF method	Form and Instruction	Removed	Available
Phase 3 - ABS Paper screener - YMOF method	Form and Instruction	Removed	Repair queued
ABS paper screener	Form	Modified	Repair queued
Phase 3 - ABS, paper screener	Form	Modified	Repair queued
ABS Web screener and survey - Spanish	Form and Instruction	Modified	Available
ABS Web screener and survey - English	Form and Instruction	Modified	Available
Phase 3 - ABS, web screener	Form and Instruction	Modified	Repair queued
RDD (CATI) Screener	Form and Instruction	Removed	Available
Phase 3 - RDD (CATI) screener	Form and Instruction	Removed	Repair queued
Cognitive Testing Protocol	Form and Instruction	Removed	Available
Phase 2 - Cognitive testing	Form and Instruction	Removed	Repair queued
Panel, web Survey screenshots	Form and Instruction	Removed	Available
Panel, web Survey	Form and Instruction	Removed	Available
Phase 2 - Panel, web Survey	Form and Instruction	Removed	Repair queued
ABS, in-bound CATI survey	Form and Instruction	Removed	Available
Phase 2 - ABS, in-bound CATI	Form and Instruction	Removed	Repair queued
ABS Paper Survey	Form and Instruction	Removed	Available
Phase 2 - ABS Paper Survey	Form and Instruction	Removed	Repair queued
Web survey - screenshots	Form and Instruction	Removed	Available
ABS Web Survey	Form and Instruction	Removed	Available
Phase 2 - ABS web Survey	Form and Instruction	Removed	Repair queued
Phase 2 RDD (CATI) Survey	Form and Instruction	Removed	Available
Phase 2 - RDD (CATI) Survey	Form and Instruction	Removed	Repair queued
Paper screener - YMOF method	Form and Instruction	Removed	Available
Phase 2 - ABS screener, paper YMOF method	Form and Instruction	Removed	Repair queued
Paper screener using Roster Method	Form and Instruction	Removed	Available
Phase 2 - ABS, paper screener, Roster method	Form and Instruction	Removed	Repair queued
ABS web screener	Form and Instruction	Removed	Available
Phase 2 - ABS web screener	Form and Instruction	Removed	Repair queued
RDD Screener	Form and Instruction	Removed	Available
Phase 2- RDD (CATI) screener	Form and Instruction	Removed	Repair queued
IRB Approval.pdf	Supplementary Document	Uploaded 2021-05-20	Repair queued
OMB Change Request for NISVS_5.4.21_FINAL (003).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-05-19	Repair queued
Att O_Pilot Sample Design and Data Collection Procedures.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att N_Westat Recommendations for NISVS.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att K_Crosswalk of Survey Revisions.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att J_Screener Thank You Letter_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att I.5_Reminder Postcard_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att I.4_Survey Follow-up Letter_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att I.3_Screener Follow-up Letter_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att I.2_Advance Letter for Survey_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att I.1_Advance Letter for Screener_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
AttL_Cognitive Testing Protocol.docx	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttK.2_NISVS Workgroup Summary.docx	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttK.1_NISVS Workgroup Participants.docx	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttG_PIA_NISVS.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttF_Security Agreement.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttD_IRB Approval.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttC_Outside Consultation.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttB1_60Day - FRN-0822.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttA_AuthLeg_0822.docx	Supplementary Document	Uploaded 2020-01-06	Repair queued
SSB _ 0822 NISVS _3.18.20.docx	Supporting Statement B	Uploaded 2020-03-19	Repair queued
SSA _ 0822 NISVS _3.17.20.docx	Supporting Statement A	Uploaded 2020-03-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
239172	Phase 3 - ABS inbound CATI	Form and Instruction	Removed	ABS in-bound CATI survey
239172	Phase 3 - ABS inbound CATI	Form and Instruction	Removed
239171	Phase 3 - ABS phone survey	Form and Instruction	Modified	NISVS Survey - phone - Spanish
239171	Phase 3 - ABS phone survey	Form and Instruction	Modified	NISVS survey - phone - English
239171	Phase 3 - ABS phone survey	Form and Instruction	Modified
239170	Phase 3 - ABS web Survey	Form and Instruction	Removed	ABS web Survey - screenshots
239170	Phase 3 - ABS web Survey	Form and Instruction	Removed	ABS web Survey
239170	Phase 3 - ABS web Survey	Form and Instruction	Removed
239169	Phase 3 - ABS Web Survey	Form and Instruction	Modified	NISVS Web screener and survey - Spanish
239169	Phase 3 - ABS Web Survey	Form and Instruction	Modified	NISVS Web screener and survey - English
239169	Phase 3 - ABS Web Survey	Form and Instruction	Modified
239168	Phase 3 - ABS Paper screener - YMOF method	Form and Instruction	Removed	ABS Paper screener using YMOF method
239168	Phase 3 - ABS Paper screener - YMOF method	Form and Instruction	Removed
239167	Phase 3 - ABS, paper screener	Form	Modified	ABS paper screener
239167	Phase 3 - ABS, paper screener	Form	Modified
239165	Phase 3 - ABS, web screener	Form and Instruction	Modified	ABS Web screener and survey - Spanish
239165	Phase 3 - ABS, web screener	Form and Instruction	Modified	ABS Web screener and survey - English
239165	Phase 3 - ABS, web screener	Form and Instruction	Modified
239163	Phase 3 - RDD (CATI) screener	Form and Instruction	Removed	RDD (CATI) Screener
239163	Phase 3 - RDD (CATI) screener	Form and Instruction	Removed
239162	Phase 2 - Cognitive testing	Form and Instruction	Removed	Cognitive Testing Protocol
239162	Phase 2 - Cognitive testing	Form and Instruction	Removed
239161	Phase 2 - Panel, web Survey	Form and Instruction	Removed	Panel, web Survey screenshots
239161	Phase 2 - Panel, web Survey	Form and Instruction	Removed	Panel, web Survey
239161	Phase 2 - Panel, web Survey	Form and Instruction	Removed
239159	Phase 2 - ABS, in-bound CATI	Form and Instruction	Removed	ABS, in-bound CATI survey
239159	Phase 2 - ABS, in-bound CATI	Form and Instruction	Removed
239157	Phase 2 - ABS Paper Survey	Form and Instruction	Removed	ABS Paper Survey
239157	Phase 2 - ABS Paper Survey	Form and Instruction	Removed
239156	Phase 2 - ABS web Survey	Form and Instruction	Removed	Web survey - screenshots
239156	Phase 2 - ABS web Survey	Form and Instruction	Removed	ABS Web Survey
239156	Phase 2 - ABS web Survey	Form and Instruction	Removed
239155	Phase 2 - RDD (CATI) Survey	Form and Instruction	Removed	Phase 2 RDD (CATI) Survey
239155	Phase 2 - RDD (CATI) Survey	Form and Instruction	Removed
239154	Phase 2 - ABS screener, paper YMOF method	Form and Instruction	Removed	Paper screener - YMOF method
239154	Phase 2 - ABS screener, paper YMOF method	Form and Instruction	Removed
230016	Phase 2 - ABS, paper screener, Roster method	Form and Instruction	Removed	Paper screener using Roster Method
230016	Phase 2 - ABS, paper screener, Roster method	Form and Instruction	Removed
213548	Phase 2 - ABS web screener	Form and Instruction	Removed	ABS web screener
213548	Phase 2 - ABS web screener	Form and Instruction	Removed
213547	Phase 2- RDD (CATI) screener	Form and Instruction	Removed	RDD Screener
213547	Phase 2- RDD (CATI) screener	Form and Instruction	Removed

ICR Details

OMB Control No: 0920-0822	ICR Reference No: 202105-0920-008
Status: Historical Active	Previous ICR Reference No: 202001-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0822-21FG
Title: The National Intimate Partner and Sexual Violence Survey (NISVS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/02/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/26/2021
Terms of Clearance: Previous terms continue. CDC will brief OIRA desk officers in advance of upcoming changes. Discussion stemming from this study will also include a discussion of how the Covid-19 response environment may have influenced the generalizability of these findings.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2023	03/31/2023	03/31/2023
Responses	534	0	4,258
Time Burden (Hours)	101	0	1,189
Cost Burden (Dollars)	2,676	0	31,405

---

Abstract: The National Intimate Partner and Sexual Violence Survey is an ongoing, nationally representative survey of non-institutionalized adult men and women aged 18 years or older in the United States assessing lifetime experiences to assess experiences of intimate partner violence, sexual violence and stalking among adults in the US. It measures lifetime victimization for these types of violence as well as in the previous 12 months. This change request is for the pilot testing phase of the NISVS Redesign Study.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 2019	10/09/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 4987	01/28/2020
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Phase 2 - ABS Paper Survey	none	ABS Paper Survey
Phase 2 - ABS screener, paper YMOF method	none	Paper screener - YMOF method
Phase 2 - ABS web Survey	none, none	ABS Web Survey ,   Web survey - screenshots
Phase 2 - ABS web screener	none	ABS web screener
Phase 2 - ABS, in-bound CATI	none	ABS, in-bound CATI survey
Phase 2 - ABS, paper screener, Roster method	none	Paper screener using Roster Method
Phase 2 - Cognitive testing	none	Cognitive Testing Protocol
Phase 2 - Panel, web Survey	none, none	Panel, web Survey ,   Panel, web Survey screenshots
Phase 2 - RDD (CATI) Survey	none	Phase 2 RDD (CATI) Survey
Phase 2- RDD (CATI) screener	none	RDD Screener
Phase 3 - ABS Paper screener - YMOF method	none	ABS Paper screener using YMOF method
Phase 3 - ABS Web Survey	none, none	NISVS Web screener and survey - English ,   NISVS Web screener and survey - Spanish
Phase 3 - ABS inbound CATI	none	ABS in-bound CATI survey
Phase 3 - ABS phone survey	none, none	NISVS survey - phone - English ,   NISVS Survey - phone - Spanish
Phase 3 - ABS web Survey	none, none	ABS web Survey ,   ABS web Survey - screenshots
Phase 3 - ABS, paper screener	none	ABS paper screener
Phase 3 - ABS, web screener	none, none	ABS Web screener and survey - English ,   ABS Web screener and survey - Spanish
Phase 3 - RDD (CATI) screener	none	RDD (CATI) Screener

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	534	4,258	0	-3,724	0	0
Annual Time Burden (Hours)	101	1,189	0	-1,088	0	0
Annual Cost Burden (Dollars)	2,676	31,405	0	-28,729	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This change request is for pilot testing as discussed in the previously approved ICR. Updated documents were not included in the previous submission making this request seem somewhat incongruous with requested changes.

---

Annual Cost to Federal Government: $3,725,698

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/26/2021

---