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Federal forms, ICRs, and supporting documents

Information Collection Request

Risk and Protective Factors of Intimate Partner Violence Survey

ICR 199801-0920-001 · OMB 0920-0426 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
6838 Risk and Protective Factors of Intimate Partner Violence Survey Migrated
ICR Details
0920-0426 199801-0920-001
Historical Active
HHS/CDC
Risk and Protective Factors of Intimate Partner Violence Survey
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 03/02/1998
Retrieve Notice of Action (NOA) 01/09/1998
  Inventory as of this Action Requested Previously Approved
01/31/1999 01/31/1999
2,700 0 0
630 0 0
0 0 0
The purpose of the project is to test empirically the findings of a focus group study "Identification of Early Warning Signs and Protective Factors in Intimate Violence Prevention" by conducting an early warning signs and protective factors random digit dial survey. The survey will gather data from approximately 2,700 women using an interview protocol which was developed and pilot tested. Findings of the survey will be used by Federal agencies to support current activities and initiate research to contribute to reducing partner violence.
None
None
No
1
IC Title Form No. Form Name
Risk and Protective Factors of Intimate Partner Violence Survey
  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 2,700 0 0 2,700 0 0
Annual Time Burden (Hours) 630 0 0 630 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/09/1998