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Federal forms, ICRs, and supporting documents

Information Collection Request

Test of State Surveys on Intimate Partner Violence (IPV) and Sexual Violence

ICR 200302-0920-004 · OMB 0920-0586 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
7048 Test of State Surveys on Intimate Partner Violence (IPV) and Sexual Violence Migrated
ICR Details
0920-0586 200302-0920-004
Historical Active
HHS/CDC
Test of State Surveys on Intimate Partner Violence (IPV) and Sexual Violence
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 04/21/2003
Retrieve Notice of Action (NOA) 02/25/2003
Approved for one year as a pilot. CDC shall provide OMB with the final report and summary of findings prior to releasing the pilot results.
  Inventory as of this Action Requested Previously Approved
04/30/2004 04/30/2004
2,800 0 0
2,800 0 0
0 0 0
The goal of this pilot study is to test two modules on intimate partner violence and sexual violence for possible inclusion as modules in the Behavioral Risk Factor Surveillance System surveys. The pilot will be conducted in Delaware, Idaho, Michigan, New Jersey, New Mexico and South Carolina. The overall benefit of this initiative is to increase knowledge regarding the magnitude and scope of intimate partner violence against women and men in the United States. The modules developed for this project will assist state and Federal policymakers in collecting reliable, timely data on intimate....
None
None
No
1
IC Title Form No. Form Name
Test of State Surveys on Intimate Partner Violence (IPV) and Sexual Violence
  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 2,800 0 0 2,800 0 0
Annual Time Burden (Hours) 2,800 0 0 2,800 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.
02/25/2003