The National Intimate Partner and Sexual Violence Survey (NISVS)

Forms and Documents

Document Name	Status
Phase 3 - ABS inbound CATI Form and Instruction	Removed
Phase 3 - ABS phone survey Form and Instruction	Modified
Phase 3 - ABS web Survey Form and Instruction	Removed
Phase 3 - ABS Web Survey Form and Instruction	Modified
Phase 3 - ABS Paper screener - YMOF method Form and Instruction	Removed
Phase 3 - ABS, paper screener Form	Modified
Phase 3 - ABS, web screener Form and Instruction	Modified
Phase 3 - RDD (CATI) screener Form and Instruction	Removed
Phase 2 - Cognitive testing Form and Instruction	Removed
Phase 2 - Panel, web Survey Form and Instruction	Removed
Phase 2 - ABS, in-bound CATI Form and Instruction	Removed
Phase 2 - ABS Paper Survey Form and Instruction	Removed
Phase 2 - ABS web Survey Form and Instruction	Removed
Phase 2 - RDD (CATI) Survey Form and Instruction	Removed
Phase 2 - ABS screener, paper YMOF method Form and Instruction	Removed
Phase 2 - ABS, paper screener, Roster method Form and Instruction	Removed
Phase 2 - ABS web screener Form and Instruction	Removed
Phase 2- RDD (CATI) screener Form and Instruction	Removed
IRB Approval.pdf Supplementary Document	2021-05-20
OMB Change Request for NISVS_5.4.21_FINAL (003).docx Justification for No Material/Nonsubstantive Change	2021-05-19
Att O_Pilot Sample Design and Data Collection Procedures.docx Supplementary Document	2021-05-19
Att N_Westat Recommendations for NISVS.docx Supplementary Document	2021-05-19
Att K_Crosswalk of Survey Revisions.docx Supplementary Document	2021-05-19
Att J_Screener Thank You Letter_CLEAN.docx Supplementary Document	2021-05-19
Att I.5_Reminder Postcard_CLEAN.docx Supplementary Document	2021-05-19
Att I.4_Survey Follow-up Letter_CLEAN.docx Supplementary Document	2021-05-19
Att I.3_Screener Follow-up Letter_CLEAN.docx Supplementary Document	2021-05-19
Att I.2_Advance Letter for Survey_CLEAN.docx Supplementary Document	2021-05-19
Att I.1_Advance Letter for Screener_CLEAN.docx Supplementary Document	2021-05-19
AttL_Cognitive Testing Protocol.docx Supplementary Document	2020-01-06
AttK.2_NISVS Workgroup Summary.docx Supplementary Document	2020-01-06
AttK.1_NISVS Workgroup Participants.docx Supplementary Document	2020-01-06
AttG_PIA_NISVS.pdf Supplementary Document	2020-01-06
AttF_Security Agreement.pdf Supplementary Document	2020-01-06
AttD_IRB Approval.pdf Supplementary Document	2020-01-06
AttC_Outside Consultation.pdf Supplementary Document	2020-01-06
AttB1_60Day - FRN-0822.pdf Supplementary Document	2020-01-06
AttA_AuthLeg_0822.docx Supplementary Document	2020-01-06
SSB _ 0822 NISVS _3.18.20.docx Supporting Statement B	2020-03-19
SSA _ 0822 NISVS _3.17.20.docx Supporting Statement A	2020-03-19

IC Document Collections

IC ID	Document Title	Status
239172	Phase 3 - ABS inbound CATI Form and Instruction	Removed
239171	Phase 3 - ABS phone survey Form and Instruction	Modified
239170	Phase 3 - ABS web Survey Form and Instruction	Removed
239169	Phase 3 - ABS Web Survey Form and Instruction	Modified
239168	Phase 3 - ABS Paper screener - YMOF method Form and Instruction	Removed
239167	Phase 3 - ABS, paper screener Form	Modified
239165	Phase 3 - ABS, web screener Form and Instruction	Modified
239163	Phase 3 - RDD (CATI) screener Form and Instruction	Removed
239162	Phase 2 - Cognitive testing Form and Instruction	Removed
239161	Phase 2 - Panel, web Survey Form and Instruction	Removed
239159	Phase 2 - ABS, in-bound CATI Form and Instruction	Removed
239157	Phase 2 - ABS Paper Survey Form and Instruction	Removed
239156	Phase 2 - ABS web Survey Form and Instruction	Removed
239155	Phase 2 - RDD (CATI) Survey Form and Instruction	Removed
239154	Phase 2 - ABS screener, paper YMOF method Form and Instruction	Removed
230016	Phase 2 - ABS, paper screener, Roster method Form and Instruction	Removed
213548	Phase 2 - ABS web screener Form and Instruction	Removed
213547	Phase 2- RDD (CATI) screener Form and Instruction	Removed

ICR Details

OMB Control No: 0920-0822	ICR Reference No: 202105-0920-008
Status: Received in OIRA	Previous ICR Reference No: 202001-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0822-21FG
Title: 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	Date Submitted to OIRA: 05/26/2021

	Requested	Previously Approved
Expiration Date	03/31/2023	03/31/2023
Responses	534	4,258
Time Burden (Hours)	101	1,189
Cost Burden (Dollars)	2,676	31,405

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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. This change request is for the pilot testing phase of the NISVS Redesign Study.

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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:
	84 FR 2019	10/09/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 4987	01/28/2020
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Phase 2 - ABS Paper Survey	none	ABS Paper Survey
Phase 2 - ABS screener, paper YMOF method	none	Paper screener - YMOF method
Phase 2 - ABS web Survey	none, none	ABS Web Survey ,   Web survey - screenshots
Phase 2 - ABS web screener	none	ABS web screener
Phase 2 - ABS, in-bound CATI	none	ABS, in-bound CATI survey
Phase 2 - ABS, paper screener, Roster method	none	Paper screener using Roster Method
Phase 2 - Cognitive testing	none	Cognitive Testing Protocol
Phase 2 - Panel, web Survey	none, none	Panel, web Survey ,   Panel, web Survey screenshots
Phase 2 - RDD (CATI) Survey	none	Phase 2 RDD (CATI) Survey
Phase 2- RDD (CATI) screener	none	RDD Screener
Phase 3 - ABS Paper screener - YMOF method	none	ABS Paper screener using YMOF method
Phase 3 - ABS Web Survey	none, none	NISVS Web screener and survey - English ,   NISVS Web screener and survey - Spanish
Phase 3 - ABS inbound CATI	none	ABS in-bound CATI survey
Phase 3 - ABS phone survey	none, none	NISVS survey - phone - English ,   NISVS Survey - phone - Spanish
Phase 3 - ABS web Survey	none, none	ABS web Survey ,   ABS web Survey - screenshots
Phase 3 - ABS, paper screener	none	ABS paper screener
Phase 3 - ABS, web screener	none, none	ABS Web screener and survey - English ,   ABS Web screener and survey - Spanish
Phase 3 - RDD (CATI) screener	none	RDD (CATI) Screener

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ICR Summary of Burden

	Total Request	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	534	4,258	0	-3,724	0	0
Annual Time Burden (Hours)	101	1,189	0	-1,088	0	0
Annual Cost Burden (Dollars)	2,676	31,405	0	-28,729	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This change request is for pilot testing as discussed in the previously approved ICR. Updated documents were not included in the previous submission making this request seem somewhat incongruous with requested changes.

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Annual Cost to Federal Government: $3,725,698

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: 05/26/2021

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