Information Collection

Survey on Sexual Violence

IC 12623 under ICR 200712-1121-002 · OMB 1121-0292.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0292 can be found here:

Documents and Forms

Document Name Document Type
Form SSV-1 Survey on Sexual Violence Form
SSV-1 Survey on Sexual Violence - Federal Bureau of Prisons ssv1.pdf Form
SSV-2 Survey on Sexual Violence - State Prison Systems ssv2.pdf Form
SSV-3 Survey on Sexual Violence - Local Jail Jurisdictions ssv3.pdf Form
SSV-4 Survey on Sexual Violence - Other Correctiona Facilities ssv4.pdf Form
SSV-5 Survey on Sexual Violence ssv5.pdf Form
SSV-6 Survey on Sexual Violence - Locally or Privately-Operate ssv6.pdf Form
SSV-IA Survey on Sexual Violence - Incident Form (Adults) SSVIA.pdf Form
SSV-IJ Survey on Sexual Violence - Incident Form (Juvenile) SSVIJ.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey on Sexual Violence	Agency IC Tracking Number:	BJS

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	SSV-1	Survey on Sexual Violence - Federal Bureau of Prisons	ssv1.pdf	No	Paper Only
Form	SSV-2	Survey on Sexual Violence - State Prison Systems	ssv2.pdf	No	Paper Only
Form	SSV-3	Survey on Sexual Violence - Local Jail Jurisdictions	ssv3.pdf	No	Paper Only
Form	SSV-4	Survey on Sexual Violence - Other Correctiona Facilities	ssv4.pdf	No	Paper Only
Form	SSV-5	Survey on Sexual Violence	ssv5.pdf	No	Paper Only
Form	SSV-6	Survey on Sexual Violence - Locally or Privately-Operated Juvenile Facilities	ssv6.pdf	No	Paper Only
Form	SSV-IA	Survey on Sexual Violence - Incident Form (Adults)	SSVIA.pdf	No	Paper Only
Form	SSV-IJ	Survey on Sexual Violence - Incident Form (Juvenile)	SSVIJ.pdf	No	Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 761	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	761	0	761
Annual IC Time Burden (Hours)	1,150	-372	1,522
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.