Download:
pdf |
pdfNCVS CS – Field Test
Table of Contents
Appendix A – Incident Level and Person Level Survey Questionnaires
Appendix B – Estimates Generated from Field Test Instrument
Appendix C – CS Field Test Timeline
Appendix D – CS Survey Supplement Materials
-
Wave 1 letter
Postcard reminder
Automated telephone reminder script
Wave 2 letter
Wave 3 letter
OMB No xxx‐xxxx
Expires xx/xx/xxxx
Crime Survey
Title 42, Section 3732, United States Code, authorizes the Bureau of Justice Statistics, Department of Justice, to collect information using this survey and
requires us to keep all information about you and your household strictly confidential. Under the Paperwork Reduction Act of 1995, no persons are required to
respond to a collection of information unless such collection displays a valid OMB number. The valid OMB control number for this information collection is xxxxxxxx. Comments regarding any other aspect of this data collection may be sent to, to the Bureau of Justice Statistics Director at Bureau of Justice
Statistics, 810 Seventh Street, NW Washington, DC 20531 or by calling survey support staff toll-free 1-xxx-xxx-xxxx.
Start Here
Please use a black or blue pen to complete this
form.
5. In the last 3 years, do you believe your
community has:
Become safer
Stayed the same
Become less safe
Mark to indicate your answer. If you want
to change your answer, darken the box and
mark the correct answer.
1. On the whole, how much of the time is the
community where you live safe?
Don’t know
Always safe
Mostly safe
Sometimes safe
Rarely safe
Never safe
6. Overall, how much of the time is the place
where you work safe?
Always safe
Mostly safe
Sometimes safe
Rarely safe
Never safe
2. Is there any place within a mile of your home
where you would be afraid to walk alone at
night?
Does not apply; do not work
Yes
No
7. While living at this address, have you ever
contacted the local police department for
assistance?
3. How often does fear of crime prevent you from
doing things you would like to do?
Yes
No GO TO 9
Very often
Somewhat often
Rarely
Never
8. If so, how satisfied were you with the police
response?
Very satisfied
Mostly satisfied
Somewhat satisfied
Not at all satisfied
4. When you leave your home, how often do you
think about it being broken into or vandalized
while you're away?
Very often
Somewhat often
Rarely
Never
9. How would you rate the job the local police
department is doing in your community?
Excellent
Good
Fair
Poor
Don’t know
1
Your Household
A. Do you own or rent the place where you're
living?
Own
Rent
Other, describe below
B. How long have you lived at this address?
1 year or less
Less than 5 years, more than 1 year
5 years or more
C. Including yourself, how many people age 18 and
older live in this household? Be sure to include
yourself, all family members, roommates, and
boarders.
number of people age 18 and older
D. How many children ages 0‐ 17 live in this
household? Please include small children and
infants.
number of children ages 0‐17
Continue answering about the adults in this
household on the next page.
2
(YOU) Adult 1
Starting with you complete each column for each
These questions ask about the second adult living
person age 18 or older living in this household.
You will be Adult 1.
Adult 2
in this household. This will be Adult 2.
The information you provide will help you with
some later questions.
1. What is Adult 2’s first name? For later questions
this is Adult number 2.
FIRST NAME
2. What is Adult 2’s age?
3. Is Adult 2 male or female?
1. What is your first name? For later questions this is
Adult number 1.
FIRST NAME
2. What is your age?
3. Are you male or female?
Male
Female
Male
Female
4. Is Adult 2 of Hispanic or Latino origin?
4. Are you of Hispanic or Latino origin?
Yes, Hispanic or Latino
No, not Hispanic or Latino
Yes, Hispanic or Latino
No, not Hispanic or Latino
5. What is your race?
5. What is Adult 2’s race?
Please mark all that apply.
Please mark all that apply.
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
6. What is Adult 2’s highest grade, or level of school
completed?
6. What is your highest grade, or level of school
completed?
Less than High School
High School diploma or GED
Some College or Technical School
Bachelor’s degree
Master’s degree or higher
Less than High School
High School diploma or GED
Some College or Technical School
Bachelor’s degree
Master’s degree or higher
If there are more adults living in this household,
If there are more adults living in this household,
continue answering on the next page for the
third adult. If there are no other adults, continue
with Section A on page 5.
continue answering the next column for the
second adult. If you are the only adult, continue
with Section A on page 5.
3
Adult 3
Adult 4
These questions ask about the third adult living in
These questions ask about the fourth adult living
this household. This will be Adult 3.
1. What is Adult 3’s first name? For later questions
this is Adult number 3.
FIRST NAME
2. What is Adult 3’s age?
3. Is Adult 3 male or female?
in this household. This will be Adult 4.
1. What is Adult 4’s first name? For later questions
this is Adult number 4.
FIRST NAME
2. What is Adult 4’s age?
3. Is Adult 4 male or female?
Male
Female
Male
Female
4. Is Adult 3 of Hispanic or Latino origin?
4. Is Adult 4 of Hispanic or Latino origin?
Yes, Hispanic or Latino
No, not Hispanic or Latino
Yes, Hispanic or Latino
No, not Hispanic or Latino
5. What is Adult 3’s race?
5. What is Adult 4’s race?
Please mark all that apply.
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Please mark all that apply.
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
6. What is Adult 3’s highest grade, or level of school
completed?
6. What is Adult 4’s highest grade, or level of school
completed?
Less than High School
High School diploma or GED
Some College or Technical School
Bachelor’s degree
Master’s degree or higher
Less than High School
High School diploma or GED
Some College or Technical School
Bachelor’s degree
Master’s degree or higher
If there are more adults living in this household,
Continue with Section A on the next page.
continue answering the next column for the
fourth adult. If there are no other adults,
continue with Section A on the next page.
4
Section A: Violent Crimes
A 'violent crime' is when another person who is
physically present with you does something
unlawful to you or another household member.
‐‐ Violent crimes may have happened at home,
on the street, at work or school, or anywhere
else.
‐‐Include crimes where the offender was someone
you know, a stranger, or even a family
member.
1. In the past 12 months, were you or anyone else
you listed attacked, mugged, or threatened with
violence?
Yes
No
2. In the past 12 months, did anyone ATTEMPT to
attack you or anyone else you listed?
Yes
No
3. In the past 12 months, did anyone force you or
anyone else you listed to have sex with them, or
to engage in unwanted sex‐related activity?
Yes
No
4. In the past 12 months, did anyone ATTEMPT to
force you or anyone else you listed to have sex
with them, or to engage in unwanted sex‐
related activity?
Yes
No
If you marked 'YES' for any question above
(1, 2, 3, or 4), continue with question 5 on the
next page. Otherwise skip to Section B on
page 9.
5
Violent Crimes:
Most Recent Incident
You reported that you or someone else you listed
experienced a violent crime in the past 12 months.
Please start with the most recent incident.
If there were none, please go to Section B on page 11.
8. Where did it happen?
In the victim’s home or yard
In the victim’s neighborhood, but not their
home or yard
Somewhere else in this city
Outside of this city
5. In what month and year did the most recent
violent crime happen?
9. Was the victim confronted by the offender
during this incident?
By confronted, we mean that the offender
approached the victim, or had some contact with
the victim.
If you are unsure, make your best guess –
including the month the incident occurred.
month
year
Yes
No
6. Who did this happen to? Write in the adult
number of the person(s) this happened to from
question C on page 2. Then write in that
person’s first name.
10. How well did the victim know the offender?
If there was more than one victim or offender,
answer for the offender the victim knew the best.
Later questions will refer to this person or these
persons as the "victim."
Adult #
Refer to Adults listed
on pages 3 and 4.
Well known
A casual acquaintance GO TO 12
By sight only GO TO 12
Victim did not know the offender(s)GO TO 12
First Name
11. How did the victim know that offender?
Spouse at time of incident
Ex‐spouse at time of incident
Parent or step parent
Own child or step‐child
Brother or sister
Boyfriend or girlfriend
Friend
Some other relationship
7. What happened?
Provide as many details as you can recall, such
as: where it happened, who was attacked, what
injuries occurred, and what (if anything) was
stolen.
12. Did the offender have a weapon such as a gun
or a knife, or something to use as a weapon?
Yes
No
Don’t know
13. Did the offender attack the victim?
Yes GO TO 16 on the next page
No
6
14. Did the offender ATTEMPT to attack the victim?
22. Did anyone report this crime to the police?
Yes GO TO 16
No
Yes
No GO TO 25
15. Did the offender threaten the victim with harm
in any way?
23. Did the police come once the incident was
reported to them?
Yes
No
Yes
No GO TO 25
16. Did the victim experience any type of
unwanted sexual contact such as forced or
coerced sexual intercourse, or any other sexual
assault, including any attempted sexual
contact by force?
24. What did the police do while they were there?
Mark all that apply.
Took a report
Searched/looked around
Took evidence (e.g. fingerprints)
Questioned witnesses or suspects
Promised to investigate
Arrested someone
Something else
Yes
No GO TO 20
17. Was the victim forced or coerced to have
sexual intercourse?
Yes GO TO 20
No
I don’t know what the police did
18. Was there an attempt to force or coerce sexual
intercourse from the victim?
25. Was anything stolen or taken during this
incident?
Yes GO TO 20
No
Yes
No GO TO 27
19. Was the victim sexually assaulted in some
other way?
26. What was stolen or taken?
Mark all that apply.
Yes
No
Something the victim had in their possession
or on their person (e.g. purse, wallet, or cell
phone)
Something someone else had in their
possession or on their person (e.g. their purse,
wallet, or cell phone)
A motor vehicle that the victim was in or near
Something else
20. Did the victim suffer any injuries as a result of
this incident?
Yes
No GO TO 22 in the next column
21. Did the victim stay overnight in a hospital as a
result of these injuries?
27. Other than this incident, did another violent
crime happen to you or someone else you
listed in the past 12 months?
Yes
No
Yes Continue with the next most recent
violent crime
No GO TO Section B, page 11
7
Violent Crimes:
Next Most Recent Incident
These questions are about the next most recent violent
crime that happened to you or someone else you listed
in the past 12 months.
If there were no other violent crimes, please go to
Section B on page 11.
31. Where did it happen?
In the victim’s home or yard
In the victim’s neighborhood, but not their
home or yard
Somewhere else in this city
Outside of this city
28. In what month and year did the next most
recent violent crime happen?
32. Was the victim confronted by the offender
during this incident?
By confronted, we mean that the offender
approached the victim, or had some contact with
the victim.
If you are unsure, make your best guess –
including the month the incident occurred.
month
year
Yes
No
29. Who did this happen to? Write in the adult
number of the person(s) this happened to from
question C on page 2. Then write in that
person’s first name.
33. How well did the victim know the offender?
If there was more than one victim or offender,
answer for the offender the victim knew the best.
Later questions will refer to this person or these
persons as the "victim."
Adult #
First Name
Refer to Adults listed
on pages 3 and 4.
Well known
A casual acquaintance GO TO 35
By sight only GO TO 35
Victim did not know the offender(s)GO TO 35
34. How did the victim know that offender?
Spouse at time of incident
Ex‐spouse at time of incident
Parent or step parent
Own child or step‐child
Brother or sister
Boyfriend or girlfriend
Friend
Some other relationship
30. What happened?
Provide as many details as you can recall, such
as: where it happened, who was attacked, what
injuries occurred, and what (if anything) was
stolen.
35. Did the offender have a weapon such as a gun
or a knife, or something to use as a weapon?
Yes
No
Don’t know
36. Did the offender attack the victim?
Yes GO TO 39 on the next page
No
8
37. Did the offender ATTEMPT to attack the victim?
45. Did anyone report this crime to the police?
Yes GO TO 39
No
Yes
No GO TO 48
38. Did the offender threaten the victim with harm
in any way?
46. Did the police come once the incident was
reported to them?
Yes
No
Yes
No GO TO 48
39. Did the victim experience any type of
unwanted sexual contact such as forced or
coerced sexual intercourse, or any other sexual
assault, including any attempted sexual
contact by force?
47. What did the police do while they were there?
Mark all that apply.
Took a report
Searched/looked around
Took evidence (e.g. fingerprints)
Questioned witnesses or suspects
Promised to investigate
Arrested someone
Something else
Yes
No GO TO 43
40. Was the victim forced or coerced to have
sexual intercourse?
Yes GO TO 43
No
I don’t know what the police did
41. Was there an attempt to force or coerce sexual
intercourse from the victim?
48. Was anything stolen or taken during this
incident?
Yes GO TO 43
No
Yes
No GO TO 50
42. Was the victim sexually assaulted in some
other way?
49. What was stolen or taken?
Mark all that apply.
Yes
No
Something the victim had in their possession
or on their person (e.g. purse, wallet, or cell
phone)
Something someone else had in their
possession or on their person (e.g. their purse,
wallet, or cell phone)
A motor vehicle that the victim was in or near
Something else
43. Did the victim suffer any injuries as a result of
this incident?
Yes
No GO TO 45 in the next column
44. Did the victim stay overnight in a hospital as a
result of these injuries?
50. Other than this incident, did another violent
crime happen to you or someone else you
listed in the past 12 months?
Yes
No
Yes Continue with the next most recent
violent crime
No GO TO Section B, page 11
9
51. Other than the incidents that you have already
reported, in what month and year did the third
most recent violent crime happen?
56. Other than the incidents that you have already
reported, in what month and year did the
fourth most recent violent crime happen?
If you are unsure, make your best guess –
including the month the incident occurred.
month
year
month
year
57. Who did this happen to? Write in the adult
number of the person(s) this happened to from
question D on page 2. Then write in that
person’s first name.
Adult #
First Name
Refer to Adults listed
on pages 3 and 4.
52. Who did this happen to? Write in the adult
number of the person(s) this happened to from
question C on page 2. Then write in that
person’s first name.
Adult #
First Name
Refer to Adults listed
on pages 3 and 4.
If you are unsure, make your best guess –
including the month the incident occurred.
Violent Crimes:
Fourth Most Recent Incident
Violent Crimes:
Third Most Recent Incident
53. What happened?
Provide as many details as you can recall, such
as: where it happened, who was attacked, what
injuries occurred, and what (if anything) was
stolen.
58. What happened?
Provide as many details as you can recall, such
as: where it happened, who was attacked, what
injuries occurred, and what (if anything) was
stolen.
54. Did anyone report this crime to the police?
59. Did anyone report this crime to the police?
Yes
No
Yes
No
55. Other than this incident, did another violent
crime happen to you or someone else you
listed in the past 12 months?
60. Other than this incident, did another violent
crime happen to you or someone else you
listed in the past 12 months?
Yes Continue with the next most recent
violent crime in the next column
No GO TO Section B on the next page
Yes
No GO TO Section B on the next page
61. You’ve already described four violent crimes.
Other than those incidents, how many more
violent crimes happened to you or someone else
you listed in the past 12 months?
10
additional violent crime incidents
Section B:
Theft and Break‐ins
This section will ask about times in the past 12 months
where someone may have stolen something, tried to
steal something, or broken into this home.
Do not include any incidents you reported in the
previous section as a violent crime.
65. In the past 12 months, was anything stolen
from this house or apartment, from the yard,
or from any other building that is part of your
home, like a garage or shed?
62. In the past 12 months, did you or others in this
household have anything stolen?
Yes
No
‐‐ It could have been something you wear or
carry, like a wallet or purse, watch, or jewelry.
‐‐ It could have been electronic equipment, like a
phone, tablet, or MP3 player.
66. In the past 12 months, so far as you know, did
anyone ATTEMPT to steal something that
belonged to you or others in this household?
Yes
No
Yes
No
67. In the past 12 months, did anyone break into
this home, or attempt to break in, whether or
not anything was stolen?
63. In the past 12 months, was a car or other
motor vehicle stolen or used without
permission?
Yes
No
Yes
No
68. In the past 12 months, did your or others in
this household have anything stolen while at
work, or while away from your home?
64. In the past 12 months, was anything stolen from
a car?
‐‐ Think only of things that belong to you or
others in this household.
‐‐ It could have been hubcaps or other parts, a
radio or stereo, gasoline, personal items, or
anything else.
Yes
No
If you marked 'YES' for any of these questions
(62 through 68), continue with the next page.
Otherwise skip to Section C on page 14.
Yes
No
11
Theft and Break‐ins:
Most Recent Incident
These next questions are about a theft or break‐in that
happened to you or others in this household in the past
12 months. If there was more than one, please start with
the most recent.
If there were no thefts or break‐ins, please go to
Section C on page 14.
73. Did the offender ATTEMPT to get inside the
home, structure, or building?
Yes
No GO TO 75
74. Was there any evidence, such as a broken lock
or broken window, that the offender(s) got in by
force or tried to get in by force?
69. In what month and year did the most recent
incident happen?
Yes
No
‐‐ If you are unsure, make your best guess –
including the month the incident occurred.
75. Was something stolen or taken without
permission that belonged to you or others in this
household?
month
year
Yes GO TO 77
No
70. What happened?
76. Did the offender ATTEMPT to take something
that belonged to you or others in this
household?
Provide as many details as you can recall, such
as: where it happened, and what was stolen.
Yes
No
77. Was a car or other motor vehicle stolen during
this incident?
Yes GO TO 79
No
78. Did anyone ATTEMPT to steal a car or other
motor vehicle?
Yes
No
79. What was the total value of the property that
was taken?
71. Where did it happen?
$
In this home or yard
In this neighborhood
Somewhere else in this city
Outside of this city
.00
80. Did you or anyone else report this incident to
the police?
Yes
No
If the incident occurred in this home continue
with question 72, otherwise go to question 75
in the next column.
81. Did another theft or break‐in happen to you or
others in this household in the past 12 months?
72. Did the offender actually get inside the home,
structure, or building?
Yes GO TO 74 in the next column
No
12
Yes GO TO 82 on the next page
No GO TO Section C on page 14
These are about the next most recent theft or break‐in in
the past 12 months.
If there were no thefts or break‐ins, please go to
Section C on page 14.
86. Did the offender ATTEMPT to get inside the
home, structure, or building?
82. In what month and year did the next most
recent incident happen?
87. Was there any evidence, such as a broken lock
or broken window, that the offender(s) got in by
force or tried to get in by force?
‐‐ If you are unsure, make your best guess –
including the month the incident occurred.
88. Was something stolen or taken without
permission that belonged to you or others in this
household?
month
year
83. What happened?
89. Did the offender ATTEMPT to take something
that belonged to you or others in this
household?
90. Was a car or other motor vehicle stolen during
this incident?
91. Did anyone ATTEMPT to steal a car or other
motor vehicle?
Yes
No
84. Where did it happen?
92. What was the total value of the property that
was taken?
In this home or yard
In this neighborhood
Somewhere else in this city
Outside of this city
$ .00
93. Did you or anyone else report this incident to
the police?
If the incident occurred in this home continue
with question 85, otherwise go to question 88 in
the next column.
Yes
No
85. Did the offender actually get inside the home,
structure, or building?
Yes GO TO 92
No
Yes
No
Yes GO TO 90
No
Provide as many details as you can recall, such
as: where it happened, and what was stolen.
Yes
No
Yes
No GO TO 88
94. Did another theft or break‐in happen to you or
others in this household in the past 12 months?
Yes GO TO 87 in the next column
No
13
Yes GO TO 95 on the next page
No GO TO Section C on page 14
These questions are about the third most recent theft or
break‐in in the past 12 months.
If there were no thefts or break‐ins, please go to
Section C on page 14.
99. Did the offender ATTEMPT to get inside the
home, structure, or building?
95. In what month and year did the third most
recent incident happen?
100. Was there any evidence, such as a broken lock
or broken window, that the offender(s) got in by
force or tried to get in by force?
If you are unsure, make your best guess –
including the month the incident occurred.
month
101. Was something stolen or taken without
permission that belonged to you or others in this
household?
year
96. What happened?
Provide as many details as you can recall, such
as: where it happened, and what was stolen.
102. Did the offender ATTEMPT to take something
that belonged to you or others in this
household?
103. Was a car or other motor vehicle stolen during
this incident?
Yes GO TO 105
No
104. Did anyone ATTEMPT to steal a car or other
motor vehicle?
97. Where did it happen?
Yes
No
Yes GO TO 103
No
Yes
No
Yes
No GO TO 101
Yes
No
In this home or yard
In this neighborhood
Somewhere else in this city
Outside of this city
105. What was the total value of the property that
was taken?
$ .00
106. Did you or anyone else report this incident to
the police?
If the incident occurred in this home continue
with question 98, otherwise go to question 101
in the next column.
98. Did the offender actually get inside the home,
structure, or building?
Yes
No
107. Did another theft or break‐in happen to you or
others in this household in the past 12 months?
Yes GO TO 100 in the next column
No
14
Yes GO TO 108 on the next page
No GO TO Section C on page 14
These questions are about the fourth most recent theft
or break‐in in the past 12 months.
If there were no thefts or break‐ins, please go to
Section C on page 14.
113. Was there any evidence, such as a broken lock
or broken window, that the offender(s) got in by
force or tried to get in by force?
108. In what month and year did the fourth most
recent incident happen?
114. Was something stolen or taken without
permission that belonged to you or others in this
household?
‐‐ If you are unsure, make your best guess –
including the month the incident occurred.
115. Did the offender ATTEMPT to take something
that belonged to you or others in this
household?
year
109. What happened?
Provide as many details as you can recall, such
as: where it happened, and what was stolen.
116. Was a car or other motor vehicle stolen during
this incident?
117. Did anyone ATTEMPT to steal a car or other
motor vehicle?
Yes
No
118. What was the total value of the property that
was taken?
110. Where did it happen?
In this home or yard
In this neighborhood
Somewhere else in this city
Outside of this city
$ .00
119. Did you or anyone else report this incident to
the police?
If the incident occurred in this home continue
with question 111, otherwise go to question
114 in the next column.
Yes
No
120. Did another theft or break‐in happen to you or
others in this household in the past 12 months?
111. Did the offender actually get inside the home,
structure, or building?
Yes GO TO 113 in the next column
No
Yes GO TO 121
No GO TO Section C on the next page
121. You’ve already described four thefts or break‐
ins. Other than those incidents, how many more
thefts or break‐ins happened to you or others in
this household in the past 12 months?
112. Did the offender ATTEMPT to get inside the
home, structure, or building?
Yes GO TO 118
No
Yes
No
Yes GO TO 116
No
month
Yes
No
Yes
No GO TO 114
15
additional thefts or break‐ins
These last few questions will ask you about other kinds
of crimes that you or someone else you listed may have
experienced, such as, identify theft or vandalism.
Do not include any incidents you may have reported in
the previous sections.
127. How many times in the last 12 months has this
happened?
122. In the last 12 months has this home or the
property of anyone in this household been
vandalized?
128. In the last 12 months have you or anyone you
listed discovered or been told that someone
used or attempted to use their personal
information to obtain new credit cards or loans,
or for other fraudulent purposes?
Yes
No GO TO 124
129. How many times in the last 12 months has this
happened?
123. How many times in the last 12 months has this
happened?
number of vandalism incidents
130. Which category best fits the approximate total
income of all persons in your household over the
past 12 months?
Yes
No GO TO 126
125. How many times in the last 12 months has this
happened?
‐‐ Count multiple uses of the same card number
before discovery as one time.
number of times
126. In the last 12 months have you or anyone you
listed discovered or been told that someone
used or attempted to use other accounts
without permission?
‐‐ Include accounts such as cell phones, bank
accounts, debit cards, or check cards.
‐‐ Include money from jobs or other earnings,
pensions, interest, rent, Social Security
payments, and so on.
number of times
‐‐ Count multiple times before discovery as one
time.
124. In the last 12 months have you or anyone you
listed discovered or been told that someone used
or attempted to use any existing credit cards?
Yes
No GO TO 130
number of times
‐‐ Think about any vandalism done to your home,
or to any motor vehicles owned by members of
this household in the last 12 months.
‐‐ Count multiple uses of an account before
discovery as one time.
$0 to $10,000
$10,001 to $20,000
$20,001 to $30,000
$30,001 to $40,000
$40,001 to $50,000
$50,001 to $60,000
$60,001 to $75,000
$75,001 to $100,000
$100,001 to $150,000
$150,001 or more
Thank you for completing this survey. Please return
it in the postage‐paid envelope provided.
Yes
No GO TO 128 in the next column
16
THIS PAGE INTENTIONALLY LEFT BLANK.
17
OMB No xxx‐xxxx Expires xx/xx/xxxx
Crime Survey
A Survey Sponsored by The
Bureau of Justice Statistics
Title 42, Section 3732, United States Code, authorizes the Bureau of Justice Statistics, Department of Justice, to collect
information using this survey and requires us to keep all information about you and your household strictly confidential.
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such
collection displays a valid OMB number. The valid OMB control number for this information collection is xxxx-xxxx.
Comments regarding any other aspect of this data collection may be sent to, to the Bureau of Justice Statistics Director at
Bureau of Justice Statistics, 810 Seventh Street, NW Washington, DC 20531 or by calling survey support staff toll-free 1xxx-xxx-xxxx.
Start Here
Please use a black or blue pen to complete this
5.
form.
Become safer
Stayed the same
Become less safe
Don’t know
Mark to indicate your answer. If you want
1.
to change your answer, darken the box and
mark the correct answer.
On the whole, how much of the time is the
community where you live safe?
6.
Always safe
Mostly safe
Sometimes safe
Rarely safe
Never safe
Is there any place within a mile of your home
where you would be afraid to walk alone at
night?
7.
Yes
No
3.
While living at this address, have you ever
contacted the local police department for
assistance?
Yes GO TO 8
No GO TO 9
How often does fear of crime prevent you from
doing things you would like to do?
Very often
Somewhat often
Rarely
Never
8.
If yes, how satisfied were you with the police
response?
Very satisfied
Mostly satisfied
Somewhat satisfied
Not at all satisfied
4.
Overall, how much of the time is the place
where you work safe?
Always safe
Mostly safe
Sometimes safe
Rarely safe
Never safe
Does not apply; do not work
2.
In the last 3 years, do you believe your
community has:
When you leave your home, how often do you
think about it being broken into or vandalized
while you're away?
9.
Very often
Somewhat often
Rarely
Never
How would you rate the job the local police
department is doing in your community?
Excellent
Good
Fair
Poor
Don’t know
1
17. In what month and year did the most recent
break‐in occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Thefts and Break‐ins
10. In the last 12 months, did anyone break into
your home or get in without permission?
Yes GO TO 11
No GO TO 19
11. In the last 12 months, was you home broken
into or entered without permission more than
once?
month
year
18. Please describe the most recent break‐in:
what happened and where it happened.
Yes
No
12. Was someone at home any time in the last 12
months when someone broke in or entered your
home without permission?
Yes GO TO 13
No GO TO 14
19. In the last 12 months, did anyone try to break
into your home, but not succeed?
13. When someone was home, did they see the
offender?
Yes
No, no attempted break‐ins
Yes
No
20. In the last 12 months, was a car, truck, or other
motor vehicle belonging to anyone in your
household …
14. Was anything stolen when someone broke in or
entered your home without permission any time
in the last 12 months?
The vehicle was vandalized or broken into
Something was stolen from the vehicle
The vehicle itself was stolen
Yes GO TO 15
No GO TO 16
Yes No
15. What was stolen in the last 12 months?
21. Besides what you told us about earlier, was
anything else stolen from your home, yard or
vehicle in the last 12 months?
Yes GO TO 22
No GO TO 24
22. In what month and year did the most recent
theft occur?
If you are unsure, make your best guess—
including the month the incident occurred.
16. In the past 12 months, was any break‐in or entry
without permission reported to the police?
Yes
No
2
month
year
23. Please describe what was stolen during the most
recent theft.
29. How many children ages 0‐17 live in this
household? Please include small children and
infants.
Number of children ages 0‐17
24. Thinking about everything that may have been
stolen from your hone or from members of your
household in the past 12 months, what yould
you say was the total value of everything that
was taken?
30. Which category best fits the approximate total
income of all persons in your household over the
past 12 months?
Include money from jobs or other earnings,
pensions, interest, rent, Social Security payments,
and so on.
Nothing was taken
Less than $10
$10‐$49
$50‐$249
$250‐$999
$1,000 or more
$0 to $10,000
$10,001 to $20,000
$20,001 to $30,000
$30,001 to $40,000
$40,001 to 50,000
$50,001 to $60,000
$60,001 to $75,000
$75,001 to $100,000
$100,001 to $150,000
$150,000 or more
25. In the past 12 months, were any of these thefts
reported to the police?
Yes
No
Does not apply, nothing stolen
Questions
about You (Adult 1)
Your Household
You are Adult 1. Please answer Questions 31 to 80
for yourself (Adult 1).
26. Do you own or rent the place where you’re
living?
Physical Attacks
Own
Rent
Other, describe below
31. In the last 12 months, has anyone physically
attacked you?
Yes GO TO 32
No GO TO 41
27. How long have you lived at this address?
32. In the last 12 months, were you physically
attacked more than once?
1 year or less
Less than 5 years, more than 1 year
5 years or more
Yes
No
28. Including yourself ‐‐How many people age 18
and older live in this household? Include
yourself, family members, roommates, and
boarders.
33. Did the person(s)who attacked you have a
weapon?
Yes GO TO 34
No GO TO 35
Don’t know GO TO 35
Number of people age 18 and older
3
34. What type of weapon(s) did they have?
Threats
41. In the last 12 months, has anyone threatened
you with physical violence?
Yes GO TO 42
No GO TO 50
35. In the last 12 months, were you injured during
an attack?
Yes
No
42. In the last 12 months, were you threatened on
more than one occassion?
Yes
No
36. In the last 12 months, was anything stolen from
you during an attack?
Yes
No
43. Did the person(s) who threatened you have a
weapon?
Yes GO TO 44
No GO TO 45
Don’t know GO TO 45
37. At the time, what was your relationship with the
person or persons who attacked you?
Please mark all that apply.
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
44. What type of weapon(s) did they have?
45. In the last 12 months, was anything stolen when
you were threatened?
38. In the past 12 months, were any of these attacks
reported to the police?
Yes
No
Yes
No
46. At the time, what was your relationship with the
person or persons who threatened you with
physical violence?
Please mark all that apply.
39. In what month and year did the most recent
attack occur?
If you are unsure, make your best guess—
including the month the incident occurred.
month
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
year
40. Please describe the most recent attack: what
happened and where it happened.
47. In the past 12 months, were any of these threats
reported to the police?
Yes
No
4
48. In what month and year did the most recent
threat occur?
If you are unsure, make your best guess—
including the month the incident occurred.
month
55. At the time, what was your relationship with the
person or persons who forced you to have
unwanted sexual activity?
Please mark all that apply.
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
year
49. Please describe the most recent threat:
what happened and where it happened
56. In the past 12 months, was any of the forced
unwanted sexual activity reported to the police?
Yes
No
57. In what month and year did the most recent
forced unwanted sexual activity occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Unwanted Sexual Activity
50. In the last 12 months, did anyone force you to
have any type of unwanted sexual activity?
Yes GO TO 51
No GO TO 59
month
year
58. Please describe the most recent forced
unwanted sexual activity: what happened and
where it happened
51. Were you forced to have unwanted sexual
activity more than once?
Yes
No
52. Did the person(s) who forced you to have
unwanted sexual activity have a weapon?
Yes GO TO 53
No GO TO 54
Don’t know GO TO 54
Threats of Unwanted Sexual Activity
53. What type of weapon(s) did they have?
59. In the last 12 months, did anyone threaten you
with any type of forced unwanted sexual
activity? Include times when someone
threatened or tried to force you but did not
succeed.
54. In the last 12 months, were you injured during
forced unwanted sexual activity?
Yes GO TO 60
No GO TO 68
Yes
No
5
67. Please describe the most recent threat of
unwanted sexual activity: what happened and
where it happened
60. In the last 12 months, were you threatened with
unwanted sexual activity more than once?
Yes
No
61. Did the person(s) who threatened you with
forced unwanted sexual activity have a weapon?
Yes GO TO 62
No GO TO 63
Don’t know GO TO 63
62. What type of weapon(s) did they have?
Other Thefts Not Described Earlier
68. Besides what you may have told us about
earlier, did you have anything else stolen in the
last 12 months? (For example: cash, a wallet,
purse, watch, jewelry, cell phone, tablet, or
anything else that might have been stolen.)
63. Were you injured during the threat of forced
unwanted sexual activity?
Yes
No
Yes GO TO 69
No GO TO 71
64. At the time, what was your relationship with the
person or persons who threatened you with
forced unwanted sexual activity?
Please mark all that apply.
69. In what month and year did your most recent
theft occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
month
year
70. Please describe what was stolen in the most
recent theft:
65. In the past 12 months, were any of the threats
of forced unwanted sexual activity reported to
the police?
Yes
No
71. In the past 12 months, were any of the other
things stolen reported to the police?
66. In what month and year did the most recent
threat of forced unwanted sexual activity occur?
If you are unsure, make your best guess—
including the month the incident occurred.
month
Yes
No
72. In the last 12 months, did you have a credit or
debit card stolen or used without your
permission?
year
Yes
No
6
Adult 2
Please answer Questions 81 to 130 about Adult 2.
If you are the only adult in the household, please
mail the completed survey back in the postage‐paid
envelope.
73. In the last 12 months, did you have a bank
account used without your permission?
Yes
No
Physical Attacks
74. In the last 12 months, did anyone steal your
private information or use it to get a credit card
or a loan?
81. In the last 12 months, has anyone physically
attacked Adult 2?
Yes
No
Yes GO TO 82
No GO TO 91
75. In the past 12 months, did you or anyone else
tell the police about any unauthorized use of
your financial accounts or personal information?
82. In the last 12 months, was Adult 2 physically
attacked more than once?
Yes
No
Yes
No
About You – Adult 1
83. Did the person(s) who attacked Adult 2 have a
weapon?
76. What is your gender?
Male
Female
77. What is your age?
Yes GO TO 84
No GO TO 85
Don’t know GO TO 85
84. What type of weapon(s) did they have?
78. Are you of Hispanic or Latino origin?
Yes, Hispanic or Latino
No, not Hispanic or Latino
85. In the last 12 months, was Adult 2 injured during
an attack?
79. What is your race?
Please mark all that apply.
Yes
No
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
86. In the last 12 months, was anything stolen from
Adult 2 during an attack?
Yes
No
80. What is the highest grade of school completed,
or the highest degree you have received?
Less than High School
High School diploma or GED
Some College or Technical School
Bachelor’s degree
Master’s degree or higher
7
93. Did the person(s) who threatened Adult 2 have a
weapon?
87. At the time, what was Adult 2’s relationship
with the person or persons who attacked
him/her?
Please mark all that apply.
Yes GO TO 94
No GO TO 95
Don’t know GO TO 95
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
94. What type of weapon(s) did they have?
95. In the last 12 months, was anything stolen when
Adult 2 was threatened?
88. In the past 12 months, were any of these attacks
on Adult 2 reported to the police?
Yes
No
Yes
No
96. At the time, what was Adult 2’s relationship
with the person or persons who threatened
Adult 2 with physical violence?
Please mark all that apply.
89. In what month and year did the most recent
attack on Adult 2 occur?
If you are unsure, make your best guess—
including the month the incident occurred.
month
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
year
90. Please describe the most recent attack on Adult 2:
what happened and where it happened.
97. In the past 12 months, were any of these threats
on Adult 2 reported to the police?
Yes
No
98. In what month and year did the most recent
threat on Adult 2 occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Threats
91. In the last 12 months, has anyone threatened
Adult 2 with physical violence?
Yes GO TO 92
No GO TO 100
92. In the last 12 months, was Adult 2 threatened
on more than one occassion?
Yes
No
8
month
year
105. At the time, what was Adult 2’s relationship
with the person or persons who forced Adult 2
to have unwanted sexual activity?
Please mark all that apply.
99. Please describe the most recent threat on Adult 2:
what happened and where it happened
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
106. In the past 12 months, was any of the forced
unwanted sexual activity on Adult 2 reported to
the police?
Unwanted Sexual Activity
100. In the last 12 months, did anyone force Adult 2
to have any type of unwanted sexual activity?
Yes
No
Yes GO TO 101
No GO TO 109
107. In what month and year did the most recent
forced unwanted sexual activity on Adult 2
occur?
If you are unsure, make your best guess—
including the month the incident occurred.
101. Was Adult 2 forced to have unwanted sexual
activity more than once?
Yes
No
102. Did the person(s) who forced Adult 2 to have
unwanted sexual activity have a weapon?
month
year
108. Please describe the most recent forced
unwanted sexual activity on Adult 2: what
happened and where it happened
Yes GO TO 103
No GO TO 104
Don’t know GO TO 104
103. What type of weapon(s) did they have?
104. In the last 12 months, was Adult 2 injured during
forced unwanted sexual activity?
Yes
No
Threats of Unwanted Sexual Activity
109. In the last 12 months, did anyone threaten Adult 2
with any type of forced unwanted sexual activity?
Include times when someone threatened or tried
to force Adult 2 but did not succeed.
Yes GO TO 110
No GO TO 118
9
117. Please describe the most recent threat of
unwanted sexual activity on Adult 2: what
happened and where it happened
110. In the last 12 months, was Adult 2 threatened
with unwanted sexual activity more than once?
Yes
No
111. Did the person(s) who threatened Adult 2 with
forced unwanted sexual activity have a weapon?
Yes GO TO 112
No GO TO 113
Don’t know GO TO 113
112. What type of weapon(s) did they have?
Other Thefts Not Described Above
118. Besides what you may have told us about
earlier, did Adult 2 have anything else stolen in
the last 12 months? (For example: cash, a wallet,
purse, watch, jewelry, cell phone, tablet, or
anything else that might have been stolen.)
113. Was Adult 2 injured during the threat of forced
unwanted sexual activity?
Yes
No
Yes GO TO 119
No GO TO 121
114. At the time, what was Adult 2’s relationship
with the person or persons who threatened
Adult 2 with forced unwanted sexual activity?
Please mark all that apply.
119. In what month and year did Adult 2’s most
recent theft occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
month
year
120. Please describe what was stolen from Adult 2 in
the most recent theft:
115. In the past 12 months, were any of the threats
of forced unwanted sexual activity on Adult 2
reported to the police?
Yes
No
121. In the past 12 months, were any of the other
things stolen from Adult 2 reported to the
police?
116. In what month and year did the most recent
threat of forced unwanted sexual activity on
Adult 2 occur?
If you are unsure, make your best guess—
including the month the incident occurred.
month
Yes
No
year
10
130. What is the highest grade of school completed,
or the highest degree Adult 2 has received?
122. In the last 12 months, did Adult 2 have a credit
or debit card stolen or used without his/her
permission?
Less than High School
High School diploma or GED
Some College or Technical School
Bachelor’s degree
Master’s degree or higher
Yes
No
123. In the last 12 months, did Adult 2 have a bank
account used without his/her permission?
Yes
No
124. In the last 12 months, did anyone steal Adult 2’s
private information or use it to get a credit card
or a loan?
Please answer Questions 131 to 180 about Adult 3.
If there are only 2 adults in the household, please
mail the completed survey back in the postage‐paid
envelope.
Adult 3
Yes
No
125. In the past 12 months, did Adult 2 or anyone
else tell the police about any unauthorized use
of Adult 2’s financial accounts or personal
information?
Physical Attacks
Yes
No
131. In the last 12 months, has anyone physically
attacked Adult 3?
About Adult 2
Yes GO TO 132
No GO TO 141
126. What gender is Adult 2?
Male
Female
132. In the last 12 months, was Adult 3 physically
attacked more than once?
127. How old is Adult 2?
Yes
No
133. Did the person(s) who attacked Adult 3 have a
weapon?
128. Is Adult 2 of Hispanic or Latino origin?
Yes, Hispanic or Latino
No, not Hispanic or Latino
Yes GO TO 134
No GO TO 135
Don’t know GO TO 135
129. What race is Adult 2 ?
Please mark all that apply.
134. What type of weapon(s) did they have?
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
135. In the last 12 months, was Adult 3 injured during
an attack?
Yes
No
11
142. In the last 12 months, was Adult 3 threatened
on more than one occassion?
136. In the last 12 months, was anything stolen from
Adult 3 during an attack?
Yes
No
Yes
No
137. At the time, what was Adult 3’s relationship
with the person or persons who attacked
him/her?
Please mark all that apply.
143. Did the person(s) who threatened Adult 3 have a
weapon?
Yes GO TO 144
No GO TO 145
Don’t know GO TO 145
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
144. What type of weapon(s) did they have?
145. In the last 12 months, was anything stolen when
Adult 3 was threatened?
138. In the past 12 months, were any of these attacks
on Adult 3 reported to the police?
Yes
No
Yes
No
146. At the time, what was Adult 3’s relationship
with the person or persons who threatened
Adult 3 with physical violence?
Please mark all that apply.
139. In what month and year did the most recent
attack on Adult 3 occur?
If you are unsure, make your best guess—
including the month the incident occurred.
month
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
year
140. Please describe the most recent attack on Adult 3:
what happened and where it happened.
147. In the past 12 months, were any of these threats
on Adult 3 reported to the police?
Yes
No
148. In what month and year did the most recent
threat on Adult 3 occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Threats
141. In the last 12 months, has anyone threatened
Adult 3 with physical violence?
Yes GO TO 142
No GO TO 150
12
month
year
155. At the time, what was Adult 3’s relationship
with the person or persons who forced Adult 3
to have unwanted sexual activity?
Please mark all that apply.
149. Please describe the most recent threat on Adult 3:
what happened and where it happened
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
Unwanted Sexual Activity
156. In the past 12 months, was any of the forced
unwanted sexual activity on Adult 3 reported to
the police?
150. In the last 12 months, did anyone force Adult 3
to have any type of unwanted sexual activity?
Yes
No
Yes GO TO 151
No GO TO 159
151. Was Adult 3 forced to have unwanted sexual
activity more than once?
157. In what month and year did the most recent
forced unwanted sexual activity on Adult 3
occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Yes
No
152. Did the person(s) who forced Adult 3 to have
unwanted sexual activity have a weapon?
Yes GO TO 150
No GO TO 151
Don’t know GO TO 151
month
year
158. Please describe the most recent forced
unwanted sexual activity on Adult 3: what
happened and where it happened
153. What type of weapon(s) did they have?
154. In the last 12 months, was Adult 3 injured during
forced unwanted sexual activity?
Yes
No
Threats of Unwanted Sexual Activity
159. In the last 12 months, did anyone threaten Adult
3 with any type of forced unwanted sexual
activity? Include times when someone
threatened or tried to force Adult 3 but did not
succeed.
Yes GO TO 160
No GO TO 168
13
167. Please describe the most recent threat of
unwanted sexual activity on Adult 3: what
happened and where it happened
160. In the last 12 months, was Adult 3 threatened
with unwanted sexual activity more than once?
Yes
No
161. Did the person(s) who threatened Adult 3 with
forced unwanted sexual activity have a weapon?
Yes GO TO 162
No GO TO 163
Don’t know GO TO 163
162. What type of weapon(s) did they have?
Other Thefts Not Described Above
168. Besides what you may have told us about
earlier, did Adult 3 have anything else stolen in
the last 12 months? (For example: cash, a wallet,
purse, watch, jewelry, cell phone, tablet, or
anything else that might have been stolen.)
163. Was Adult 3 injured during the threat of forced
unwanted sexual activity?
Yes
No
Yes GO TO 169
No GO TO 171
164. At the time, what was Adult 3’s relationship
with the person or persons who threatened
Adult 3 with forced unwanted sexual activity?
Please mark all that apply.
169. In what month and year did Adult 3’s most
recent theft occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
month
year
170. Please describe what was stolen from Adult 3 in
the most recent theft:
165. In the past 12 months, were any of the threats
of forced unwanted sexual activity on Adult 3
reported to the police?
Yes
No
171. In the past 12 months, were any of the other
things stolen from Adult 3 reported to the
police?
166. In what month and year did the most recent
threat of forced unwanted sexual activity on
Adult 3 occur?
If you are unsure, make your best guess—
including the month the incident occurred.
month
Yes
No
172. In the last 12 months, did Adult 3 have a credit
or debit card stolen or used without his/her
permission?
year
Yes
No
14
Adult 4
Please answer Questions 181 to 230 about Adult 4.
If there are only 3 adults in the household, please
mail the completed survey back in the postage‐paid
envelope.
174. In the last 12 months, did anyone steal Adult 3’s
private information or use it to get a credit card
or a loan?
Physical Attacks
173. In the last 12 months, did Adult 3 have a bank
account used without his/her permission?
Yes
No
181. In the last 12 months, has anyone physically
attacked Adult 4?
Yes
No
Yes GO TO 182
No GO TO 191
175. In the past 12 months, did Adult 3 or anyone
else tell the police about any unauthorized use
of Adult 3’s financial accounts or personal
information?
182. In the last 12 months, was Adult 4 physically
attacked more than once?
Yes
No
Yes
No
About Adult 3
183. Did the person(s) who attacked Adult 4 have a
weapon?
176. What gender is Adult 3?
Male
Female
177. How old is Adult 3?
Yes GO TO 184
No GO TO 185
Don’t know GO TO 185
184. What type of weapon(s) did they have?
178. Is Adult 3 of Hispanic or Latino origin?
Yes, Hispanic or Latino
No, not Hispanic or Latino
185. In the last 12 months, was Adult 4 injured during
an attack?
179. What race is Adult 3 ?
Please mark all that apply.
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Yes
No
186. In the last 12 months, was anything stolen from
Adult 4 during an attack?
180. What is the highest grade of school completed,
or the highest degree Adult 3 has received?
Less than High School
High School diploma or GED
Some College or Technical School
Bachelor’s degree
Master’s degree or higher
15
Yes
No
193. Did the person(s) who threatened Adult 4 have a
weapon?
187. At the time, what was Adult 4’s relationship
with the person or persons who attacked
him/her?
Please mark all that apply.
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
194. What type of weapon(s) did they have?
195. In the last 12 months, was anything stolen when
Adult 4 was threatened?
188. In the past 12 months, were any of these attacks
on Adult 4 reported to the police?
Yes
No
196. At the time, what was Adult 4’s relationship
with the person or persons who threatened
Adult 4 with physical violence?
Please mark all that apply.
189. In what month and year did the most recent
attack on Adult 4 occur?
If you are unsure, make your best guess—
including the month the incident occurred.
month
year
190. Please describe the most recent attack on Adult 4:
what happened and where it happened.
197. In the past 12 months, were any of these threats
on Adult 4 reported to the police?
Yes
No
198. In what month and year did the most recent
threat on Adult 4 occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Threats
191. In the last 12 months, has anyone threatened
Adult 4 with physical violence?
Yes GO TO 192
No GO TO 200
192. In the last 12 months, was Adult 4 threatened
on more than one occassion?
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
Yes
No
Yes GO TO 194
No GO TO 195
Don’t know GO TO 195
Yes
No
16
month
year
205. At the time, what was Adult 4’s relationship
with the person or persons who forced Adult 2
to have unwanted sexual activity?
Please mark all that apply.
199. Please describe the most recent threat on Adult 4:
what happened and where it happened
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
Unwanted Sexual Activity
206. In the past 12 months, was any of the forced
unwanted sexual activity on Adult 4 reported to
the police?
200. In the last 12 months, did anyone force Adult 4
to have any type of unwanted sexual activity?
Yes GO TO 201
No GO TO 209
Yes
No
201. Was Adult 4 forced to have unwanted sexual
activity more than once?
207. In what month and year did the most recent
forced unwanted sexual activity on Adult 4
occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Yes
No
202. Did the person(s) who forced Adult 4 to have
unwanted sexual activity have a weapon?
Yes GO TO 203
No GO TO 204
Don’t know GO TO 204
year
208. Please describe the most recent forced
unwanted sexual activity on Adult 4: what
happened and where it happened
203. What type of weapon(s) did they have?
204. In the last 12 months, was Adult 4 injured during
forced unwanted sexual activity?
month
Yes
No
Threats of Unwanted Sexual Activity
209. In the last 12 months, did anyone threaten Adult
4 with any type of forced unwanted sexual
activity? Include times when someone
threatened or tried to force Adult 4 but did not
succeed.
17
Yes GO TO 210
No GO TO 218
217. Please describe the most recent threat of
unwanted sexual activity on Adult 4: what
happened and where it happened
210. In the last 12 months, was Adult 4 threatened
with unwanted sexual activity more than once?
Yes
No
211. Did the person(s) who threatened Adult 4 with
forced unwanted sexual activity have a weapon?
Yes GO TO 212
No GO TO 213
Don’t know GO TO 213
212. What type of weapon(s) did they have?
Other Thefts Not Described Above
218. Besides what you may have told us about
earlier, did Adult 4 have anything else stolen in
the last 12 months? (For example: cash, a wallet,
purse, watch, jewelry, cell phone, tablet, or
anything else that might have been stolen.)
213. Was Adult 4 injured during the threat of forced
unwanted sexual activity?
Yes
No
Yes GO TO 219
No GO TO 222
214. At the time, what was Adult 4’s relationship
with the person or persons who threatened
Adult 4 with forced unwanted sexual activity?
Please mark all that apply.
219. In what month and year did Adult 4’s most
recent theft occur?
If you are unsure, make your best guess—
including the month the incident occurred.
Spouse, partner, boyfriend or girlfriend
Former spouse, partner, boyfriend or
girlfriend
Other family member or relative
Other friend or acquaintance
Did not know the person
month
year
220. Please describe what was stolen from Adult 4 in
the most recent theft:
215. In the past 12 months, were any of the threats
of forced unwanted sexual activity on Adult 4
reported to the police?
Yes
No
221. In the past 12 months, were any of the other
things stolen from Adult 4 reported to the
police?
216. In what month and year did the most recent
threat of forced unwanted sexual activity on
Adult 4 occur?
If you are unsure, make your best guess—
including the month the incident occurred.
month
Yes
No
222. In the last 12 months, did Adult 4 have a credit
or debit card stolen or used without his/her
permission?
year
18
Yes
No
223. In the last 12 months, did Adult 4 have a bank
account used without his/her permission?
231. Are there more than 4 adults living at your
home?
Yes
No
224. In the last 12 months, did anyone steal Adult 4’s
private information or use it to get a credit card
or a loan?
Yes GO TO 232
No Survey is complete
232. Did any of the other adults in this home
experience a crime in the last 12 months?
Yes
No
Yes GO TO 233
No Survey is complete
225. In the past 12 months, did Adult 4 or anyone
else tell the police about any unauthorized use
of Adult 2’s financial accounts or personal
information?
233. Please describe the crime(s):
Yes
No
About Adult 4
226. What gender is Adult 4?
Male
Female
227. How old is Adult 4?
228. Is Adult 4 of Hispanic or Latino origin?
Yes, Hispanic or Latino
No, not Hispanic or Latino
229. What race is Adult 4?
Please mark all that apply.
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Thank you.
Please return survey in the
envelope provided.
230. What is the highest grade of school completed,
or the highest degree Adult 4 has received?
Less than High School
High School diploma or GED
Some College or Technical School
Bachelor’s degree
Master’s degree or higher
19
Appendix B – Estimates Generated from the Field Test Instruments
The TOC coding scheme for the National Crime Victimization Survey (NCVS) is based on a single
incident of crime. The coding scheme uses a crime hierarchy for classification of the incident, with
more severe crimes receiving priority over less severe ones. For example, a rape accompanied by
robbery will be coded as a rape. This hierarchy is appropriate for the NCVS because it collects data
for each incidence of crime that a respondent reports. In the Companion Study (CS) pretest, the
Incident Level Survey (ILS) used a similar approach. If an incident is identified in the ILS, the
respondent is asked a series of follow-up questions in order to arrive at a TOC code for the incident.
As with the NCVS, a hierarchical coding approach was applied to the ILS data in order to classify an
incident as a crime. In the CS pretest, the Person Level Survey (PLS) is unable to follow this
classification strategy. The PLS gathers information about victimization from the person-level and
asks whether an adult experienced a type of crime (or crime “feature”) within the past year. In the
survey, a respondent could be describing multiple incidents for a given person, but, by design, the
structure of the PLS does not allow us to identify discreet incidents. The goal of the PLS is to
measure and describe “people touched by crime” rather than to generate a traditional crime rate, as
done by the NCVS. The PLS will generate estimates of people experiencing various features of
crime. We also plan to generate an approximated TOC, which will combine various crime features
to arrive at a “most serious crime” for each person included in the survey.
Violent Crime
Violent crime categories in the pretest vary for the ILS and the PLS instruments. At this time we are
assuming a crime hierarchy for both the ILS and the PLS, with the hierarchy applied at the incident
level for the ILS and at the person level for the PLS. Based on the pretest instruments we are able to
support the following violent crime categories:
Incident Level instrument
o Completed rape (approximates NCVS TOC 01)
o Sexual assault with injury (approximates NCVS TOCs 03 and 04)
o Attempted sexual assault (approximates NCVS TOC 02)
o Robbery with injury (approximates NCVS TOCs 05 and 06)
o Robbery without injury (approximates NCVS TOC 07)
o Assault with injury (approximates NCVS TOC 11)
o Attempted assault with a weapon (approximates NCVS TOC 12)
o Threatened assault with a weapon (approximates NCVS TOC 13)
o Sexual assault without injury (approximates NCVS TOC 15)
o Assault without injury and without a weapon (approximates NCVS TOC 17)
o Threatened with harm (approximates NCVS TOCs 18 and 20)
Person Level Instrument
o Forced Sexual Assault (approximates NCVS TOCs 01, 03, 04, and 15)
o Robbery with injury (approximates NCVS TOCs 05 and 06)
o Robbery without injury (approximates NCVS TOC 07)
o Attempted or Threatened Sexual Assault (approximates NCVS TOCs 02 and 19)
1
o
o
o
o
Assault with injury (approximates NCVS TOCs 11 and 14)
Threatened/attempted assault with a weapon (approximates NCVS TOCs 12 and 13)
Assault no weapon and no injury (approximates NCVS TOC 17)
Verbal threat of assault no weapon (approximates NCVS TOC 20)
Comparing the ILS and PLS with the NCVS violent crime TOCs
We have developed potential tables for reporting incidents and for comparisons to Base NCVS. The
incident form can provide frequency, or number of incidents, for the two most recent victimizations
(within each type – person and household). Beyond that, victimization could only be provided as
violent or household, unless summaries are reviewed for third and fourth most recent incidents. The
person level form cannot provide incident frequency, but instead can describe people and households
experiencing a victimization type.
Below we provide a proposed table for comparing the ILS and the PLS with the NCVS. To the
extent possible, the categories are the same between the incident and person level forms. Where they
differ, rows can be combined so similar comparisons can be made between the Incident and Person
tables. In the ILS table the unit of comparison will be incidents, while the unit of comparison in the
PLS table will be the number of victims. The tables include the counts available from the CS
pretest.
Incident Level Survey - Personal Crime Classification – Possible Incident Level Form Table Based
on Base NCVS TOC’s
Incident Form – Constructed
Base
NCVS
TOC’s1
Number of
incidents3
All Violent Crimes
Serious Violent
Rape & Sexual Assault
Completed Rape
Attempted Rape
Sexual Attack with injury
Robbery
Robbery with injury
Robbery without injury
Assault with injury
Attempted/ Threatened assault with
weapon
Threatened Aggravated assault
Simple Assault
Sexual Attack without injury
Most
serious
crime for
each Adult 4
1
2, 192
3, 4
2
0
0
2
0
0
5, 6
7
11,14
12
2
4
8
1
2
4
7
1
13
0
0
15
1
1
2
Assault (no weapon/injury)
17
2
2
Threatened Assault
18, 20
2
2
1. TOC’s 8, 9, 10, 16, 18 and 22 are not listed as they cannot be replicated or approximated
in any way.
2. This TOC cannot be replicated in the incident level form – it is listed here for
completeness since the person level form can approximate it.
3. This is based on unedited data, with the exception of question 9 (the question about
confrontation). If we had edited the pretest data based on the open-ended descriptions,
then some of these incidents would be removed. One example of this is an ILS
respondent describing the murder of a neighbor, which the TOC algorithm coded as an
“Assault with injury”. The rationale for not editing the pretest ILS was that we are
unable to do the same for the PLS (since we did not obtain many open-ended responses).
All data will be fully edited in the Field Test for both the ILS and the PLS.
4. This is the most serious crime reported for each Adult.
Person Level Survey - Personal Crime Classification – Possible Person Level Form Table
Based on Base NCVS TOC’s
Person Form – Constructed
Base NCVS
TOC’s1
People
reportin
g crime2
Most
serious
crime for
each Adult3
1, 3, 4, 15
2, 19
1
1
1
1
5, 6
7
11, 14
1
3
3
1
2
3
All Violent Crimes
Serious Violent
Sexual Assault
Forced Sexual Assault
Attempted/ Threatened Sexual
Assault
Robbery
Robbery with injury
Robbery without injury
Assault with injury
Simple Assault
Threatened Assault
12, 13
1
1
Assault (no weapon/injury)
17
2
2
Verbal threat of assault
20
6
3
1. TOC’s 8, 9, 10, 16, 18 and 22 are not listed as they cannot be replicated or approximated
in any way.
2. This is based on unedited data; multiple TOCs are possible for a given adult, but this does
not necessarily reflect multiple incidents.
3. This is based on unedited data, for the most serious crime reported for a given adult.
3
Property Crime
The Incident Level Survey is very similar to the Base NCVS in the questions it asks about
property crime. However, there are substantial differences in what information is collected
between the Base NCVS and the Person Level Survey. For example, the base NCVS and the ILS
collect whether there is any evidence of damage for a break in. The PLS uses the terminology
‘break-ins’ or ‘break into,’ which imply forcible entry, but without indication of whether there
was any evidence. At this time we are proposing the creation of the following TOC codes for the
CS instruments:
Incident Level instrument
o Burglary, Completed with Forcible Entry (related to NCVS TOC 31)
o Burglary, Completed, Unlawful Entry without Force (related to NCVS TOC 32)
o Attempted forcible entry (related to NCVS TOC 33)
o Motor vehicle theft, completed (related to NCVS TOC 40)
o Attempted motor vehicle theft (related to NCVS TOC 41)
o Completed theft (related to NCVS TOCs 34 to 38)
o Attempted theft (related to NCVS TOC 39)
Person Level instrument
o Burglary, Completed (related to NCVS TOCs 31 and 32)
o Attempted (implied) forcible entry (related to NCVS TOC 33)
o Motor vehicle theft, completed (related to NCVS TOC 40)
o Completed theft (related to NCVS TOCs 34 to 38)
Comparing the ILS and PLS with the NCVS property crime TOCs
We have developed potential tables for reporting incidents and for comparisons to the Base NCVS.
The incident form can provide frequency, or number of incidents, for the four most recent incidents.
The person level form cannot provide incident frequency, but instead can describe households
experiencing a victimization type. Below we provide a proposed table for comparing the ILS and the
PLS with the NCVS.
Incident Level Form
All Property Crimes
Household burglary (Total)
Completed
Forcible entry
Unlawful entry without force
Attempted forcible entry
Motor vehicle theft (Total)
Number of
incidents
From pretest data
64
12
14
2
4
Completed
Attempted
Theft (Total)
Completed
Attempted
Person Level Form
All Property Crimes
Household burglary (Total)
Completed
Attempted forcible entry
(implied)
Motor vehicle theft (Total)
Completed
Theft (Total)
Completed
3
0
29
4
Number of
households from
pretest data
15
9
4
30
5
Appendix C - CS Field Test Timeline
Data collection in Fall 2015 and 2016
60-day Federal Register Notice
Comment Period
Revised plan based on comments
30-day Federal Register Notice
Submission to OMB
OMB Review
Questions from OMB
Estimated OMB Approval
Survey preparation
Year 1 Data Collection – Start
Year 1 Data Collection – Close
Data preparation and weighting
Analysis and reporting
Year 2 Data Collection – Start
Year 2 Data Collection – Close
Data preparation and weighting
Analysis and reporting
Develop final procedures and survey “kit”
Dec. 11, 2014
Dec. 2014 – Jan. 2015
Feb. 2015
Feb. 2015
Feb. 2015
Feb. – Apr. 2015
Apr/May 2015
May/June 2015
June – Aug. 2015
Sept. 8, 2015
Nov. 30, 2015
Dec. 2015 – Jan. 2016
Feb. – Apr. 2016
Sept. 6, 2016
Nov. 28, 2016
Dec. 2016 – Jan. 2017
Feb. – Apr. 2017
May – July 2017
6
Appendix D
CS Survey Supplemental Materials
- Wave 1 letter
- Postcard reminder
- Automated telephone reminder script
- Wave 2 letter
- Wave 3 letter
7
WAVE 1 LETTER
Dear Resident:
Please complete the enclosed survey from the U.S. Department of Justice, Bureau of Justice
Statistics. This survey is about your household’s experiences with crime and neighborhood
safety. Results from this survey will be used to better understand the needs of American
communities.
Your address is part of a random sample of addresses in the United States. This is part of a
scientific study and your answers represent not only you and your household, but also hundreds
of households like yours. For this reason, your voluntary cooperation is very important.
The information you provide will be used for statistical purposes only and may not be disclosed,
or used, in identifiable form for any other purpose as required by law (Title 42, U.S. Code,
Sections 3789g). Your responses will be combined with those of others to produce statistical
summaries about crime and safety.
Answers to the most frequently asked survey questions are included on the back of this letter.
Section 3732 of the Justice Systems Improvement Act of 1979 authorizes the Bureau of Justice
Statistics to conduct this survey. If you would like further information, you can contact our
survey support at 1-xxx-xxx-xxx or you can visit the BJS website at www.bjs.gov/ncvspilot.cfm.
Crime and safety affect all Americans. Thank you for your generous cooperation. The Bureau of
Justice Statistics appreciates your help in this very important survey.
Sincerely,
William J. Sabol
Director
Bureau of Justice Statistics
U.S. Department of Justice
8
Commonly Asked Questions
What is the U.S. Bureau of Justice Statistics Survey of Crime and Safety?
The U.S. Bureau of Justice (BJS) American Crime Survey is a survey of households to obtain
information about communities.
Who is the sponsor of this study?
The survey is sponsored by the Bureau of Justice Statistics (BJS), U.S. Department of Justice
(DOJ). The survey is conducted under the authority of Title 42, United States Code, Section
3732. To learn more about BJS, you can visit them on the web at www.bjs.gov/ncvspilot.cfm.
How long will it take to complete this survey?
Most households will be able to complete the mailed survey in about 10-12 minutes.
Am I required to complete this survey?
Participation is voluntary and there are no penalties for refusing to answer. However, your
household was randomly selected for this scientific sample survey, and you cannot be replaced
with another household. Your cooperation is extremely important to help ensure the
completeness and accuracy of this much-needed information.
Who will use this information?
Results from this survey (and similar surveys conducted by The U.S. Department of Justice) will
be used to better understand crime and safety in U.S. neighborhoods.
Who can I call with questions?
If you would like further information about the survey, you can contact Westat at 1-xxx-xxxxxxx. For questions about your rights and welfare in this study, you may call the Institutional
Review Board at Westat at 888-920-7631.
How was my household chosen for this study?
Households were selected at random from all residential addresses. By selecting households
randomly, we will be able to create scientific estimates about households in your neighborhood.
It’s important to participate, so that we have an accurate picture of all communities.
How do I know you’ll keep my information confidential?
The information you provide will be used for statistical purposes only and may not be disclosed,
or used, in identifiable form for any other purpose as required by law (Title 42, U.S. Code,
Sections 3789g). Your responses will be combined with those of others to produce statistical
summaries about crime and safety. After the study is completed, identifying information - your
address and phone number - are destroyed.
Who can I call to discuss my feelings about being victimized?
National Domestic Violence Hotline - 1-800-799-7233 (1-800-799-SAFE)
National Sexual Assault Hotline - 1-800-656-4673 (1-800-656-HOPE)
National Suicide Prevention Lifeline - 1-800-273-8255
9
POSTCARD REMINDER
About a week ago we mailed the American Crime Survey to your household, sponsored by the
U.S. Department of Justice, Bureau of Justice Statistics. If someone in your household has
already returned the survey, we thank you very much for your help.
If you have not completed and returned your survey, please do so right away. We need to hear
from everyone and your help is very important to us. Your household was randomly selected to
take part in this survey and cannot be replaced.
If you have any questions, feel free to contact our survey research contractor at 1-xxx-xxx-xxxx.
AUTOMATED TELEPHONE REMINDER SCRIPT
Hello. I am calling on behalf of the U.S. Department of Justice, Bureau of Justice Statistics.
About a week ago we sent your household a questionnaire for the The American Crime Survey.
If you have already returned your completed survey, thank you very much. If you haven’t, we
ask that you complete the survey as soon as possible and return it in the postage paid envelope
provided. If you have any questions about the survey, please call our survey research contractor
at 1-xxx-xxx-xxxx. Thank you again for your help. This message will repeat.
[Households identified for bilingual materials will also hear the message in Spanish, but in these the message will not repeat]
10
June xx, 2014
Dear Resident:
WAVE 2 LETTER
A few weeks ago your household was mailed a survey from the U.S. Bureau of Justice Statistics.
Your address is part of a random sample of addresses in the United States. This is a sample
survey and your answers represent not only you and your household, but also hundreds of
households like yours. For this reason, your voluntary cooperation is very important. We are
enclosing another copy of the survey and ask that your household complete it and return it in the
enclosed, prepaid envelope.
Your address is part of a random sample of addresses in the United States. This is part of a
scientific study and your answers represent not only you and your household, but also hundreds
of households like yours. For this reason, your voluntary cooperation is very important. Some
households will be called for a brief follow-up interview later.
The information you provide will be used for statistical purposes only and may not be disclosed,
or used, in identifiable form for any other purpose as required by law (Title 42, U.S. Code,
Sections 3789g). Your responses will be combined with those of others to produce statistical
summaries about crime and safety.
Answers to the most frequently asked survey questions are included on the back of this letter.
Section 3732 of the Justice Systems Improvement Act of 1979 authorizes the Bureau of Justice
Statistics to conduct this survey. If you would like further information, you can contact our
survey support at 1-xxx-xxx-xxxx or you can visit the BJS website at
www.bjs.gov/ncvspilot.cfm.
Crime and safety affect all Americans. Thank you for your generous cooperation. The Bureau of
Justice Statistics appreciates your help in this very important survey.
Sincerely,
William J. Sabol
Director
Bureau of Justice Statistics
U.S. Department of Justice
11
June 7, 2014
WAVE 3 LETTER
Dear Resident:
A few weeks ago your household was mailed a survey from the U.S. Bureau of Justice Statistics.
Your address is part of a random sample of addresses in the United States. This is part of a
scientific study and your answers represent not only you and your household, but also hundreds
of households like yours. For this reason, your voluntary cooperation is very important. Some
households will be called for a brief follow-up interview later. We are enclosing another copy of
the survey and ask that your household complete it and return it in the enclosed, prepaid
envelope.
The information you provide will be used for statistical purposes only and may not be disclosed,
or used, in identifiable form for any other purpose as required by law (Title 42, U.S. Code,
Sections 3789g). Your responses will be combined with those of others to produce statistical
summaries about crime and safety.
Answers to the most frequently asked survey questions are included on the back of this letter.
Section 3732 of the Justice Systems Improvement Act of 1979 authorizes the Bureau of Justice
Statistics to conduct this survey. If you would like further information, you can contact our
survey support at 1-xxx-xxx-xxxx or you can visit the BJS website at
www.bjs.gov/ncvspilot.cfm.
Crime and safety affect all Americans. Thank you for your generous cooperation. The Bureau of
Justice Statistics appreciates your help in this very important survey.
Sincerely,
William J. Sabol
Director
Bureau of Justice Statistics
U.S. Department of Justice
12
| File Type | application/pdf |
| Author | Pamela Giambo |
| File Modified | 2015-02-11 |
| File Created | 2015-02-10 |