Information Collection

Cognitive Testing for Campus Climate Victimization Survey

IC 274676 under ICR 202411-1121-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Cognitive Testing for Campus Climate Victimization Survey	Form and Instruction
Student Perspectives and Experiences Survey (SPES) Instr Attachment A_Draft Campus Climate Victimization Survey_3.31.2025.pdf	Form and Instruction
CCVS testing_OMB generic clearance request_03.31.25.docx Memo to OMB on CCVS	IC Document
Generic Clearance IC Template 1121-0339_CCVS.docx GEN IC Template CCVS	IC Document
All CCVS Attachments_05.07.25.pdf CCVS 2025 Attachments	IC Document

IC Title:

Cognitive Testing for Campus Climate Victimization Survey

Agency IC Tracking Number:

IC Status: New

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
Form and Instruction	N/A	Student Perspectives and Experiences Survey (SPES) Instrument Campus Climate Design and Testing Study	Attachment A_Draft Campus Climate Victimization Survey_3.31.2025.pdf		Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 85 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	82	82
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo to OMB on CCVS	CCVS testing_OMB generic clearance request_03.31.25.docx	04/29/2025
GEN IC Template CCVS	Generic Clearance IC Template 1121-0339_CCVS.docx	04/02/2025
CCVS 2025 Attachments	All CCVS Attachments_05.07.25.pdf	05/07/2025

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