Phase 2 - ABS web screener

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⚠️ Notice: This information collection may be referencing outdated material.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 2 - ABS web screener Form and Instruction
ABS web screener AttE.2A_Web Survey_12.13.19.docx Form and Instruction
ABS web screener AttE.2A_Web Survey_12.13.19.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Phase 2 - ABS web screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 screener	AttE.2A_Web Survey_12.13.19.docx		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: 333	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-333	333
Annual IC Time Burden (Hours)	-17	17
Annual IC Cost Burden (Dollars)	-440	440

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.