Information Collection

Implementation of the Violaence Against Women Reathorization Act 2013

IC 224769 under ICR 202211-2577-002 · OMB 2577-0286.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2577-0286 can be found here:

2025-05-20 - No material or nonsubstantive change to a currently approved collection
2025-01-10 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Form Form 5380 Implementation of the Violaence Against Women Reathorization Act 2013 Form
Form Form 5380 Implementation of the Violaence Against Women Reathorization Act 2013 Form
Form 5380 Notice of Occupancy Rights Under the VAWA VAWA Form 5380 Notice of Occupancy Rights Under the VAWA 10-20-22.docx Form
Form 5380 Notice of Occupancy Rights Under the VAWA VAWA Form 5380 Notice of Occupancy Rights Under the VAWA 10-20-22.docx Form
Form 5381 Model Emergency Transfer Plan for Victims of Domestic Vi VAWA Form 5381 Model Emergency Transfer Plan for Victims of Domestic Violence Dating Violence Sexual Assault or Stalking 10-20-2 Form
Form 5381 Model Emergency Transfer Plan for Victims of Domestic Vi VAWA Form 5381 Model Emergency Transfer Plan for Victims of Domestic Violence Dating Violence Sexual Assault or Stalking 10-20-2 Form
Form 5382 Certification of Domestic Violence Dating Violence Sexua VAWA Form 5382 Certification of Domestic Violence Dating Violence Sexual Assault or Stalking and Alternative Documentation 10-20 Form
Form 5382 Certification of Domestic Violence Dating Violence Sexua VAWA Form 5382 Certification of Domestic Violence Dating Violence Sexual Assault or Stalking and Alternative Documentation 10-20 Form
Form 5383 Emergency Transfer Request for Certain Victims of Sexual VAWA Form 5383 Emergency Transfer Request for Certain Victims of Sexual Assault or Stalking 10-20-22.docx Form
Form 5383 Emergency Transfer Request for Certain Victims of Sexual VAWA Form 5383 Emergency Transfer Request for Certain Victims of Sexual Assault or Stalking 10-20-22.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Implementation of the Violaence Against Women Reathorization Act 2013	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Form 5380	Notice of Occupancy Rights Under the VAWA	VAWA Form 5380 Notice of Occupancy Rights Under the VAWA 10-20-22.docx	Yes	Yes	Fillable Printable
Form	Form 5381	Model Emergency Transfer Plan for Victims of Domestic Violence Dating Violence Sexual Assault or Stalking	VAWA Form 5381 Model Emergency Transfer Plan for Victims of Domestic Violence Dating Violence Sexual Assault or Stalking 10-20-22.docx	Yes	Yes	Fillable Printable
Form	Form 5382	Certification of Domestic Violence Dating Violence Sexual Assault or Stalking and Alternative Documentation	VAWA Form 5382 Certification of Domestic Violence Dating Violence Sexual Assault or Stalking and Alternative Documentation 10-20-22.docx	Yes	Yes	Fillable Printable
Form	Form 5383	Emergency Transfer Request for Certain Victims of Sexual Assault or Stalking	VAWA Form 5383 Emergency Transfer Request for Certain Victims of Sexual Assault or Stalking 10-20-22.docx	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 293,176	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 3 %

	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	5,044,764	-14,732,526	19,777,290
Annual IC Time Burden (Hours)	223,048,055	219,425,685	3,622,370
Annual IC Cost Burden (Dollars)	0	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.