Information Collection

Defense Sexual Assault Incident Restricted Reporting

IC 234080 under ICR 202412-0704-006 · OMB 0704-0482.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DD Form 2965 Defense Sexual Assault Incident Restricted Reporting	Form
DD Form 2965 Defense Sexual Assault Incident Database (DSAID) Data Fo dd2965.PDF	Form
DD Form 2965 Defense Sexual Assault Incident Database (DSAID) Data Fo DD2965.pdf	Form
DD Form 2910 Victim Reporting Preference Statement dd2910 DRAFT - for OMB review 20240722.PDF	Form
DD Form 2910 Victim Reporting Preference Statement dd2910 DRAFT - for OMB review 20240722.PDF	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	DD Form 2965	Defense Sexual Assault Incident Database (DSAID) Data Form	DD2965.pdf		Yes	Yes	Fillable Fileable
Form	DD Form 2910	Victim Reporting Preference Statement	dd2910 DRAFT - for OMB review 20240722.PDF		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,176

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 25 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,176	2,176
Annual IC Time Burden (Hours)	2,176	2,176
Annual IC Cost Burden (Dollars)	57,251	57,251

Documents for IC

table that charts IC Documents
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.