Information Collection

Survey on Sexual Violence

IC 12623 under ICR 201103-1121-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 SSV Federal Bureau of Prisons Summary Form ssv1_final.pdf Form
SSV-2 SSV State Prison Systems Summary Form ssv2_final.pdf Form
SSV-3 SSV Local Jail Jurisdictions Summary Form ssv3_final.pdf Form
SSV-4 SSV Other Correctional Facilities Summary Form ssv4_final.pdf Form
SSV-5 SSV State Juvenile Systems Summary Form ssv5_final.pdf Form
SSV-6 SSV Locally or Privately-Operated Juvenile Facilities Su ssv6_final.pdf Form
SSV IA SSV Incident Form Adult ssvia_fillable.pdf Form
SSV IJ SSV Incident Form Juveniles ssvij_fillable.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?	Can Be Submitted Electronically?	Electronic Capability
Form	SSV-1	SSV Federal Bureau of Prisons Summary Form	ssv1_final.pdf	Yes	Yes	Fillable Fileable
Form	SSV-2	SSV State Prison Systems Summary Form	ssv2_final.pdf	Yes	Yes	Fillable Fileable
Form	SSV-3	SSV Local Jail Jurisdictions Summary Form	ssv3_final.pdf	Yes	Yes	Fillable Fileable
Form	SSV-4	SSV Other Correctional Facilities Summary Form	ssv4_final.pdf	Yes	Yes	Fillable Fileable
Form	SSV-5	SSV State Juvenile Systems Summary Form	ssv5_final.pdf	Yes	Yes	Fillable Fileable
Form	SSV-6	SSV Locally or Privately-Operated Juvenile Facilities Summary Form	ssv6_final.pdf	Yes	Yes	Fillable Fileable
Form	SSV IA	SSV Incident Form Adult	ssvia_fillable.pdf	Yes	Yes	Fillable Fileable
Form	SSV IJ	SSV Incident Form Juveniles	ssvij_fillable.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,481	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
Annual Number of Responses for this IC	1,481	1,481
Annual IC Time Burden (Hours)	992	992
Annual IC Cost Burden (Dollars)	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.