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Survey on Sexual Violence
Survey on Sexual Violence
OMB: 1121-0292
IC ID: 12623
OMB.report
DOJ/OJP
OMB 1121-0292
ICR 201103-1121-001
IC 12623
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1121-0292 can be found here:
2024-05-06 - Revision of a currently approved collection
2021-06-29 - Revision of a currently approved collection
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
URL
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
Federal Enterprise Architecture Business Reference Module
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,481
0
1,481
0
0
0
Annual IC Time Burden (Hours)
992
0
992
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.