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Phase 3 - ABS Web Survey
[NCIPC] The National Intimate Partner and Sexual Violence Survey (NISVS)
OMB: 0920-0822
IC ID: 239169
OMB.report
HHS/CDC
OMB 0920-0822
ICR 202302-0920-017
IC 239169
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0822 can be found here:
2023-11-09 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Phase 3 - ABS Web Survey
Form and Instruction
NISVS Web screener and survey - English
Att F.1_NISVS Web Screener and Survey English_CLEAN.docx
Form and Instruction
NISVS Web screener and survey - Spanish
Att F.1_NISVS Web Screener and Survey Spanish_CLEAN.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Phase 3 - ABS Web Survey
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
NISVS Web screener and survey - English
Att F.1_NISVS Web Screener and Survey English_CLEAN.docx
Yes
Yes
Fillable Fileable
Form and Instruction
none
NISVS Web screener and survey - Spanish
Att F.1_NISVS Web Screener and Survey Spanish_CLEAN.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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:
195
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
195
0
0
0
0
195
Annual IC Time Burden (Hours)
81
0
0
0
0
81
Annual IC Cost Burden (Dollars)
0
0
-2,147
0
0
2,147
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.