Phase 3 - ABS, web screener

[NCIPC] 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⚠️ Notice: This information collection may be referencing outdated material.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 screener Form and Instruction
ABS Web screener and survey - English Att F.1_NISVS Web Screener and Survey English_CLEAN.docx Form and Instruction
ABS Web screener and survey - Spanish Att F.1_NISVS Web Screener and Survey Spanish_CLEAN.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Phase 3 - ABS, web screener	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: Modified

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 and survey - English	Att F.1_NISVS Web Screener and Survey English_CLEAN.docx		Yes	Yes	Fillable Fileable
Form and Instruction	none	ABS Web screener and survey - Spanish	Att F.1_NISVS Web Screener and Survey Spanish_CLEAN.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: 278	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	278	0	278
Annual IC Time Burden (Hours)	14	0	14
Annual IC Cost Burden (Dollars)	0	-367	367

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.