Information Collection

Unmoderated Cognitive Testing for the 2023 Survey of Sexual Victimization Incident Forms

IC 260058 under ICR 202409-1121-002 · OMB 1121-0339.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0339 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment A. Unmoderated Cognitive Testing Instrument.docx	Other-Survey
Memo_OMB Generic Clearance_SSV_Unmoderated Cognitive Testing_5.4.2023.docx Memo to OMB for Unmoderated Cognitive Test of SSV instrument	IC Document
Attachment B. Consent Form.docx Consent Form	IC Document
Attachment C. Participant recruitment email.docx Recruitment email	IC Document
1121-0339 Gen IC Template.docx 1121-0339 Gen IC	IC Document

IC Title:

Unmoderated Cognitive Testing for the 2023 Survey of Sexual Victimization Incident Forms

Agency IC Tracking Number:

BJS

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			Attachment A. Unmoderated Cognitive Testing Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Correctional Activities

Subfunction: Criminal Incarceration

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo to OMB for Unmoderated Cognitive Test of SSV instrument	Memo_OMB Generic Clearance_SSV_Unmoderated Cognitive Testing_5.4.2023.docx	05/04/2023
Consent Form	Attachment B. Consent Form.docx	05/04/2023
Recruitment email	Attachment C. Participant recruitment email.docx	05/04/2023
1121-0339 Gen IC	1121-0339 Gen IC Template.docx	05/09/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.