Information Collection

Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test

IC 209193 under ICR 201311-1121-001 · OMB 1121-0343.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0343 can be found here:

Documents and Forms

Document Name Document Type
Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test Form
W2 ACASI Tutorial.docx Instruction
W1 Event History Calendar.docx Instruction
Demographics W3 Demographics.docx Form
ACASI Questionnaire W ACASI questionnaire.docx Form and Instruction
V CATI Questionnaire V CATI questionnaire.docx Form and Instruction
National Study on Health and Safety C Field_Mail_Household_Roster_Survey.pdf Form
ACASI Household Screener E Field ACASI Household Roster.doc Form
CATI Landline Screener G CATI Landline Screener.docx Form
CATI Cell Phone Screener H CATI Cell Phone Screening.docx Form
Recruitment Screener M High Risk Recruit Script.docx Form and Instruction
All Attachments A-Z with TOC.pdf Attachments A-Z with Table of Contents IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Methodological Research to Support the NCVS: Self-Report Data on Rape and Sexual Assault: Pilot Test	Agency IC Tracking Number:	BJS

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Demographics	W3 Demographics.docx	Yes	Yes	Fillable Fileable
Instruction			W2 ACASI Tutorial.docx	Yes	Yes	Fillable Fileable
Instruction			W1 Event History Calendar.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	ACASI Questionnaire	W ACASI questionnaire.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	V CATI Questionnaire	V CATI questionnaire.docx	Yes	Yes	Fillable Fileable
Form	N/A	National Study on Health and Safety	C Field_Mail_Household_Roster_Survey.pdf	Yes	Yes	Fillable Fileable
Form	N/A	ACASI Household Screener	E Field ACASI Household Roster.doc	Yes	Yes	Fillable Fileable
Form	N/A	CATI Landline Screener	G CATI Landline Screener.docx	Yes	Yes	Fillable Fileable
Form	N/A	CATI Cell Phone Screener	H CATI Cell Phone Screening.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Recruitment Screener	M High Risk Recruit Script.docx	Yes	Yes	Fillable Fileable

Line of Business: Law Enforcement

Subfunction: Crime Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53,060	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	53,060	53,060
Annual IC Time Burden (Hours)	11,865	11,865
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachments A-Z with Table of Contents	All Attachments A-Z with TOC.pdf	11/05/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.