[NCIPC] The National Intimate Partner and Sexual Violence Survey (NISVS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0822 Att L_Web_Phone Screeners and Survey Instrument_Spanish	Form and Instruction	Unchanged	Available
Form 0920-0822 Att K_Web_Phone Screeners and Survey Instrument_English	Form and Instruction	Unchanged	Available
Form 0920-0822 Questionnaire, phone (Att. K-L)	Form and Instruction	Unchanged	Repair queued
Form 0920-0822 Att L_Web_Phone Screeners and Survey Instrument_Spanish	Form and Instruction	Unchanged	Available
Form 0920-0822 Att K_Web_Phone Screeners and Survey Instrument_English_REV1.10.23Clean	Form and Instruction	Unchanged	Available
Form 0920-0822 Questionnaire, web (Att. K-L)	Form and Instruction	Unchanged	Missing upstream
Form 0920-0822 Att N_Paper Screener_Spanish	Form and Instruction	Unchanged	Available
Form 0920-0822 Att K_Web_Phone Screeners and Survey Instrument_English	Form and Instruction	Unchanged	Available
Form 0920-0822 Screener (Att. K-N )	Form and Instruction	Unchanged	Repair queued
Form 0920-0822 Att T_Advance Letters_Spanish	Form and Instruction	Unchanged	Available
Form 0920-0822 Att S_Advance Letters_English	Form and Instruction	Unchanged	Available
Form 0920-0822 Advance Letter (Att. S-T)	Form and Instruction	Unchanged	Repair queued
CHANGE REQUEST 0920-0822_Common Form.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-03	Available
CHANGE REQUEST 0920-0822_Common Form.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-03	Repair queued
SSA_0822_NISVS_10.16.23_CLEAN.docx	Supplementary Document	Uploaded 2023-11-09	Available
SSA_0822_NISVS_10.16.23_CLEAN.docx	Supplementary Document	Uploaded 2023-11-09	Repair queued
NISVS_Non-substantive Change Request_10.19.2023.docx	Supplementary Document	Uploaded 2023-11-09	Available
NISVS_Non-substantive Change Request_10.19.2023.docx	Supplementary Document	Uploaded 2023-11-09	Repair queued
Att I_Overview of NISVS-5 Survey Revisions_REV1.10.23Clean.docx	Supplementary Document	Uploaded 2023-02-16	Available
Att I_Overview of NISVS-5 Survey Revisions_REV1.10.23Clean.docx	Supplementary Document	Uploaded 2023-02-16	Repair queued
Att H_NISVS Cognitive Testing Reports.pdf	Supplementary Document	Uploaded 2023-02-16	Available
Att H_NISVS Cognitive Testing Reports.pdf	Supplementary Document	Uploaded 2023-02-16	Repair queued
Att G_NISVS Redesign_Pilot Test Final Report.docx	Supplementary Document	Uploaded 2023-02-16	Available
Att G_NISVS Redesign_Pilot Test Final Report.docx	Supplementary Document	Uploaded 2023-02-16	Repair queued
Att F_Nonresponse Follow-up Study Report.docx	Supplementary Document	Uploaded 2023-02-16	Available
Att F_Nonresponse Follow-up Study Report.docx	Supplementary Document	Uploaded 2023-02-16	Repair queued
Att E_Feasibility Study Report.docx	Supplementary Document	Uploaded 2023-02-16	Available
Att E_Feasibility Study Report.docx	Supplementary Document	Uploaded 2023-02-16	Repair queued
Att B_Federal register notice.pdf	Supplementary Document	Uploaded 2023-02-16	Available
Att B_Federal register notice.pdf	Supplementary Document	Uploaded 2023-02-16	Available
Att A_AuthLeg_0822.docx	Supplementary Document	Uploaded 2023-02-16	Available
Att A_AuthLeg_0822.docx	Supplementary Document	Uploaded 2023-02-16	Repair queued
Att R_PIA_NISVS.pdf	Supplementary Document	Uploaded 2023-02-16	Available
Att R_PIA_NISVS.pdf	Supplementary Document	Uploaded 2023-02-16	Repair queued
Att U_Research or Non-Research Determination for NISVS.pdf	Supplementary Document	Uploaded 2023-02-16	Available
Att U_Research or Non-Research Determination for NISVS.pdf	Supplementary Document	Uploaded 2023-02-16	Repair queued
NISVS Change Request 04JUN2021.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-08-27	Available
NISVS Change Request 04JUN2021.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-08-27	Repair queued
IRB Approval.pdf	Supplementary Document	Uploaded 2021-05-20	Available
IRB Approval.pdf	Supplementary Document	Uploaded 2021-05-20	Repair queued
OMB Change Request for NISVS_5.4.21_FINAL (003).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-05-19	Available
OMB Change Request for NISVS_5.4.21_FINAL (003).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-05-19	Missing upstream
Att O_Pilot Sample Design and Data Collection Procedures.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att O_Pilot Sample Design and Data Collection Procedures.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att N_Westat Recommendations for NISVS.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att N_Westat Recommendations for NISVS.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att K_Crosswalk of Survey Revisions.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att K_Crosswalk of Survey Revisions.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att J_Screener Thank You Letter_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att J_Screener Thank You Letter_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att I.5_Reminder Postcard_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att I.5_Reminder Postcard_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att I.4_Survey Follow-up Letter_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att I.4_Survey Follow-up Letter_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att I.3_Screener Follow-up Letter_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att I.3_Screener Follow-up Letter_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
Att I.2_Advance Letter for Survey_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att I.2_Advance Letter for Survey_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Missing upstream
Att I.1_Advance Letter for Screener_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Available
Att I.1_Advance Letter for Screener_CLEAN.docx	Supplementary Document	Uploaded 2021-05-19	Repair queued
AttL_Cognitive Testing Protocol.docx	Supplementary Document	Uploaded 2020-01-06	Available
AttL_Cognitive Testing Protocol.docx	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttK.2_NISVS Workgroup Summary.docx	Supplementary Document	Uploaded 2020-01-06	Available
AttK.2_NISVS Workgroup Summary.docx	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttK.1_NISVS Workgroup Participants.docx	Supplementary Document	Uploaded 2020-01-06	Available
AttK.1_NISVS Workgroup Participants.docx	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttG_PIA_NISVS.pdf	Supplementary Document	Uploaded 2020-01-06	Available
AttG_PIA_NISVS.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttF_Security Agreement.pdf	Supplementary Document	Uploaded 2020-01-06	Available
AttF_Security Agreement.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttD_IRB Approval.pdf	Supplementary Document	Uploaded 2020-01-06	Available
AttD_IRB Approval.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttC_Outside Consultation.pdf	Supplementary Document	Uploaded 2020-01-06	Available
AttC_Outside Consultation.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttB1_60Day - FRN-0822.pdf	Supplementary Document	Uploaded 2020-01-06	Available
AttB1_60Day - FRN-0822.pdf	Supplementary Document	Uploaded 2020-01-06	Repair queued
AttA_AuthLeg_0822.docx	Supplementary Document	Uploaded 2020-01-06	Available
AttA_AuthLeg_0822.docx	Supplementary Document	Uploaded 2020-01-06	Repair queued
SSB_NISVS_12.7.22.docx	Supporting Statement B	Uploaded 2023-02-16	Available
SSB_NISVS_12.7.22.docx	Supporting Statement B	Uploaded 2023-02-16	Repair queued
SSA_0822_NISVS_12.7.22_revised 3.28.23_CLEAN.docx	Supporting Statement A	Uploaded 2023-05-03	Available
SSA_0822_NISVS_12.7.22_revised 3.28.23_CLEAN.docx	Supporting Statement A	Uploaded 2023-05-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
239171	Questionnaire, phone (Att. K-L)	Form and Instruction	Unchanged	Att L_Web_Phone Screeners and Survey Instrument_Spanish
239171	Questionnaire, phone (Att. K-L)	Form and Instruction	Unchanged	Att K_Web_Phone Screeners and Survey Instrument_English
239171	Questionnaire, phone (Att. K-L)	Form and Instruction	Unchanged
239169	Questionnaire, web (Att. K-L)	Form and Instruction	Unchanged	Att L_Web_Phone Screeners and Survey Instrument_Spanish
239169	Questionnaire, web (Att. K-L)	Form and Instruction	Unchanged	Att K_Web_Phone Screeners and Survey Instrument_English_REV1.10.23Clean
239169	Questionnaire, web (Att. K-L)	Form and Instruction	Unchanged
239167	Screener (Att. K-N )	Form and Instruction	Unchanged	Att N_Paper Screener_Spanish
239167	Screener (Att. K-N )	Form and Instruction	Unchanged	Att K_Web_Phone Screeners and Survey Instrument_English
239167	Screener (Att. K-N )	Form and Instruction	Unchanged
239165	Advance Letter (Att. S-T)	Form and Instruction	Unchanged	Att T_Advance Letters_Spanish
239165	Advance Letter (Att. S-T)	Form and Instruction	Unchanged	Att S_Advance Letters_English
239165	Advance Letter (Att. S-T)	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-0822	ICR Reference No: 202503-0920-002
Status: Historical Active	Previous ICR Reference No: 202311-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0822
Title: [NCIPC] The National Intimate Partner and Sexual Violence Survey (NISVS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/18/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/28/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	05/31/2026	05/31/2026
Responses	211,067	0	211,067
Time Burden (Hours)	17,949	0	17,949
Cost Burden (Dollars)	0	0	0

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Abstract: The National Intimate Partner and Sexual Violence Survey is an ongoing, nationally representative survey of non-institutionalized adult men and women aged 18 years or older in the United States assessing lifetime experiences to assess experiences of intimate partner violence, sexual violence and stalking among adults in the US. . It measures lifetime victimization for these types of violence as well as in the previous 12 months. NISVS has historically been administered through random-digit-dial sampling. From 2018-2021, CDC conducted feasibility testing and pilot testing aimed at developing methods for transitioning NISVS to an address-based sampling design that would reduce reliance on cell and landline phone participation and improve response rates. The modification in this revision request is to do a full-scale implementation of address-based sampling frame with push-to-web data collection and a call-in telephone option, intended to increase the response rate, and reduce respondent burden.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 12705	03/22/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 3989	01/23/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Advance Letter (Att. S-T)	0920-0822, 0920-0822	Att S_Advance Letters_English ,   Att T_Advance Letters_Spanish
Questionnaire, phone (Att. K-L)	0920-0822, 0920-0822	Att K_Web_Phone Screeners and Survey Instrument_English ,   Att L_Web_Phone Screeners and Survey Instrument_Spanish
Questionnaire, web (Att. K-L)	0920-0822, 0920-0822	Att K_Web_Phone Screeners and Survey Instrument_English_REV1.10.23Clean ,   Att L_Web_Phone Screeners and Survey Instrument_Spanish
Screener (Att. K-N )	0920-0822, 0920-0822	Att K_Web_Phone Screeners and Survey Instrument_English ,   Att N_Paper Screener_Spanish

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	211,067	211,067	0	0	0	0
Annual Time Burden (Hours)	17,949	17,949	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $9,092,501

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/28/2025

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