NCVS-2 National Crime Victimization Survey 2

OMB No. 1121-0111: Approval Expires 7/31/2006
NOTICE – We are conducting this survey under the authority of Title 13, United States Code, Section 8. Section 9 of this law requires us to keep all information
about you and your household strictly confidential. We may use this information only for statistical purposes. Also, Title 42, Section 3732, United States Code,
authorizes the Bureau of Justice Statistics, Department of Justice, to collect information using this survey. Title 42, Sections 3789g and 3735, United States
Code, also requires us to keep all information about you and your household strictly confidential. According to 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.

NCVS-2

Control number

FORM
(3-22-2005)

U.S. DEPARTMENT OF COMMERCE

PSU

Segment/Suffix

Economics and Statistics Administration

Sample
Serial/
designation/Suffix Suffix

HH No. Spinoff
Indicator

U.S. CENSUS BUREAU
ACTING AS COLLECTING AGENT FOR THE
BUREAU OF JUSTICE STATISTICS

U.S. DEPARTMENT OF JUSTICE

Notes

CRIME INCIDENT REPORT
NATIONAL CRIME VICTIMIZATION SURVEY

1a. LINE NUMBER OF RESPONDENT

601

1b. SCREEN QUESTION NUMBER

602

1c. INCIDENT NUMBER

603

CHECK
ITEM A

2.

3.

4.

If known, mark without asking. If not sure, ASK –
Altogether, how many times did this type of
incident happen during the last 6 months?

CHECK
ITEM C

CHECK
ITEM D

Yes (more than 6 months) – SKIP to 3
No (6 months or less) – Ask 2

605

1
2

While living at this address
Before moving to this address

606

Month

Year

607

____________ Number of incidents

How many incidents?
(Refer to 4.)

608

1
2

1–5 incidents (not a "series") – SKIP to 6
6 or more incidents – Fill Check Item C

Are these incidents similar to each other
in detail, or are they for different types of
crimes? (If not sure, ASK.)

609

1
2

Similar – Fill Check Item D
Different (not a "series") – SKIP to 6

Can you (respondent) recall enough
details of each incident to distinguish
them from each other? (If not sure, ASK.)

610

1
2

Yes (not a "series") – SKIP to 6
No (is a "series") – Reduce entry in
screen question if necessary – Read 5

5.

The following questions refer only to the most
recent incident. (ASK item 6.)

6.

About what time did (this/the most recent)
incident happen?

During day
612

1
2
3
4

After 6 a.m. – 12 noon
After 12 noon – 3 p.m.
After 3 p.m. – 6 p.m.
Don’t know what time of day
At night

5
6
7
8

After 6 p.m. – 9 p.m.
After 9 p.m. – 12 midnight
After 12 midnight – 6 a.m.
Don’t know what time of night
OR

9

Don’t know whether day or night

USCENSUSBUREAU

NCVS-2, Page 1 Black ink

2

Incident number (ex., 01)

Has the respondent lived at this
address for more than 6 months?
(If not sure, refer to 33a on the
NCVS-1 or ASK.)

(You said that during the last 6 months –
(Refer to appropriate screen question for
description of crime.)) In what month did
(this/the first) incident happen? (Show
calendar if necessary. Encourage respondent to
give exact month.)

CHECK
ITEM B

Line number (ex., 01)

Screen question number (ex., 39)

You said that during the last 6 months –
(Refer to appropriate screen question for
description of crime.) Did (this/the first)
incident happen while you were living here
or before you moved to this address?

N
C
V
S

NCVS-2, Page 1, 10% Pantone 185 Red

I
N
C
I
D
E
N
T
R
E
P
O
R
T

7.

In what city, town, or village did
this incident occur?

613

1
2
3
4

Outside U.S. – SKIP to 10
Not inside a city/town/village – Ask 8a
SAME city/town/village as present residence – SKIP to 9
DIFFERENT city/town/village from
⎫
present residence – Specify
⎬Ask 8a

5

Don’t know – Ask 8a

⎭

8a. In what county and state did it
614

occur?

County ________________ State __________

8b. Is this the same county and state
as your present residence?

9.

Did this incident occur on an
American Indian Reservation or
on American Indian Lands?

10.

Where did this incident happen?
Mark (X) only one box.

615

1
2

Yes
No

633

1
2

Yes
No

616

1

2

3
4

IN RESPONDENT’S HOME OR LODGING
In own dwelling, own attached garage, or
enclosed porch (Include illegal entry or attempted
illegal entry of same)
In detached building on own property, such as
detached garage, storage shed, etc. (Include illegal
entry or attempted illegal entry of same)
In vacation home/second home (Include illegal
entry or attempted illegal entry of same)
In hotel or motel room respondent was staying
in (Include illegal entry or attempted illegal entry
of same)
NEAR OWN HOME

5
6
7

Own yard, sidewalk, driveway, carport, unenclosed
porch (does not include apartment yards)
Apartment hall, storage area, laundry room (does
not include apartment parking lot/garage)
On street immediately adjacent to own home

⎫
⎬
⎭

Ask
11

⎫
⎬SKIP
to 18
⎭

AT, IN, OR NEAR A FRIEND’S/RELATIVE’S/
NEIGHBOR’S HOME
8
9
10
11

At or in home or other building on their property
Yard, sidewalk, driveway, carport (does not
include apartment yards)
Apartment hall, storage area, laundry room (does
not include apartment parking lot/garage)
On street immediately adjacent to their home

⎫SKIP
⎬to 18
⎭

COMMERCIAL PLACES
12
24
25
26
14
27

Inside restaurant, bar, nightclub
Inside bank
Inside gas station
Inside other commercial building, such as a store
Inside office
Inside factory or warehouse
PARKING LOTS/GARAGES

15
16
17

Commercial parking lot/garage
Noncommercial parking lot/garage
Apartment/townhouse parking lot/garage

⎫
⎬
⎭

SKIP
to 17 c

⎫ SKIP
⎬ to 17 c
⎭

SCHOOL
18
19

Inside school building
On school property (school parking area,
play area, school bus, etc.)

SKIP to 17a
SKIP to 17c

OPEN AREAS, ON STREET OR PUBLIC
TRANSPORTATION
20
21
22

In apartment yard, park, field, playground (other
than school)
On the street (other than immediately adjacent to
own/friend’s/relative’s/neighbor’s home)
On public transportation or in station (bus, train,
plane, airport, depot, etc.)
OTHER

23

Other – Specify

⎫ SKIP
⎬ to 17 c
⎭
FORM NCVS-2 (3-22-2005)

Page 2

NCVS-2, Page 2 Black ink

⎫
⎬SKIP
to 18
⎭

NCVS-2, Page 2, 10% Pantone 185 Red

11.

Did the offender live (here/there) or
have a right to be (here/there), for
instance, as a guest or a repairperson?

617

1
2
3

Yes – SKIP to 19
⎫
No
⎬ Ask 12
Don’t know ⎭

12.

Did the offender actually get INSIDE
your (house/apartment /room/garage/
shed/ enclosed porch)?

618

1
2
3

Yes – SKIP to 14
⎫
No
⎬ Ask 13
Don’t know ⎭

13.

Did the offender TRY to get in your
(house/apartment/room/garage/shed/
porch)?

619

1
2
3

Yes – Ask 14
No – SKIP to 19
Don’t know – Ask 14

14.

Was there any evidence, such as a
broken lock or broken window, that
the offender(s) (got in by force/TRIED
to get in by force)?

620

1
2

Yes – Ask 15
No – SKIP to 16

15.

What was the evidence? Anything
else?
Mark (X) all that apply.

625

1

Window

*

2
3
4

Damage to window (include frame, glass
broken/removed/cracked)
Screen damaged/removed
Lock on window damaged/tampered with
in some way
Other – Specify
Door

5

626

6
7

*

8

Damage to door (include frame, glass
panes or door removed)
Screen damaged/removed
Lock or door handle damaged/tampered
with in some way
Other – Specify
Other

16.

How did the offender (get in/TRY to
get in)?
Mark (X) only one box.

627

9

Other than window or door – Specify

1

8
9

Let in
Offender pushed his/her way in after door
opened
Through OPEN DOOR or other opening
Through UNLOCKED door or window
Through LOCKED door or window – Had
key
Through LOCKED door or window – Picked
lock, used credit card, etc., other than key
Through LOCKED door or window – Don’t
know how
Don’t know
Other – Specify

2
3
4
5
6
7

17a. Was it your school?

628

1
2

Yes
No – SKIP to 17c

17b. In what part of the school building did

629

1
2
3
4

Classroom
Hallway/Stairwell
Bathroom/Locker room
Other (library, gym, auditorium, cafeteria)

630

1
2
3
4

Open to the public
Restricted to certain people (or nobody
had a right to be there)
Don’t know
Other – Specify

it happen?

17c. ASK OR VERIFY –
Did the incident happen in an area
restricted to certain people or was it
open to the public at the time?

18.

ASK OR VERIFY –
Did it happen outdoors, indoors, or
both?

631

1
2
3

Indoors (inside a building or enclosed space)
Outdoors
Both

19.

ASK OR VERIFY –
How far away from home did this
happen?

632

1

At, in, or near the building containing
the respondent’s home/next door
A mile or less
Five miles or less
Fifty miles or less
More than 50 miles
Don’t know how far

PROBE –
Was it within a mile, 5 miles, 50 miles
or more?
Mark (X) first box that respondent is sure of.

2
3
4
5
6

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 3 Black ink

⎫
⎬
⎭
⎫
⎬
⎭

SKIP
to 19

SKIP
to 19

Page 3

NCVS-2, Page 3, 10% Pantone 185 Red

20a. ASK OR VERIFY –
Were you or any other member of this
household present when this incident
occurred?

634

1
2

Yes – Ask 20b
No – SKIP to 56, page 8

635

1
2
3

Respondent only
Respondent and other household member(s)
Only other household member(s), not
respondent – SKIP to 59, page 8

636

1
2

Yes
No

637

1
2
3

Yes – Ask 23
⎫
No
⎬ SKIP to 24
Don’t know ⎭

638

1
2
3
4
5
6

Hand gun (pistol, revolver, etc.)
Other gun (rifle, shotgun, etc.)
Knife
Other sharp object (scissors, ice pick, axe, etc.)
Blunt object (rock, club, blackjack, etc.)
Other – Specify

639

1
2

Yes – SKIP to 29, page 5
No – Ask 25

640

1

Yes – SKIP to 28a
No – Ask 26

20b. ASK OR VERIFY –
Which household members were
present?
FIELD REPRESENTATIVE – If proxy interview,
"Respondent" refers to the person for whom
the proxy interview is taken, not the proxy
respondent.

21.

ASK OR VERIFY –
Did you personally see an offender?
FIELD REPRESENTATIVE – If proxy
interview, replace "you" with the name of
person for whom the proxy interview is
being taken in 21–115.

22.

23.

Did the offender have a weapon such
as a gun or knife, or something to use
as a weapon, such as a bottle or
wrench?
What was the weapon? Anything else?
Mark (X) all that apply.

24.

25.

*

Did the offender hit you, knock you
down or actually attack you in any
way?
Did the offender TRY to attack you?

2

26.
27.

Did the offender THREATEN you with
harm in any way?

641

What actually happened? Anything
else?
Mark (X) all that apply.

642

1
2

*

FIELD REPRESENTATIVE – If box 4, ASK –
Do you mean forced or coerced sexual
intercourse including attempts?
If "Yes," change entry in Item 24 to "Yes."
Delete entries in 25–27.

1
2
3
4
5
6
7
8
9
10

Yes – SKIP to 28b
No – Ask 27
Something taken without permission
Attempted or threatened to take something
Harassed, argument, abusive language
Unwanted sexual contact with force
(grabbing, fondling, etc.)
Unwanted sexual contact without force
(grabbing, fondling, etc.)
Forcible entry or attempted forcible entry of
house/apartment
Forcible entry or attempted forcible entry of
car
Damaged or destroyed property
Attempted or threatened to damage or
destroy property
Other – Specify

⎫
⎬
⎭

Verbal threat of rape
Verbal threat to kill
Verbal threat of attack other than to kill or rape
Verbal threat of sexual assault other than rape
Unwanted sexual contact with force
(grabbing, fondling, etc.)
Unwanted sexual contact without force
(grabbing, fondling, etc.)
Weapon present or threatened with weapon
Shot at (but missed)
Attempted attack with knife/sharp weapon
Attempted attack with weapon other than
gun/knife/sharp weapon
Object thrown at person
Followed or surrounded
Tried to hit, slap, knock down, grab, hold,
trip, jump, push, etc.
Other – Specify

⎫
⎬
⎭

SKIP
to
Check
Item E2,
page 6

28a. How did the offender TRY to attack
643

you? Any other way?

*
28b. How were you threatened? Any
other way?
Mark (X) all that apply.

1
2
3
4
5
6

FIELD REPRESENTATIVE – If box 5, ASK –
Do you mean forced or coerced sexual
intercourse including attempts?

*

7
8
9
10

645

11

*

12
13

644

If "Yes," change entry in Item 24 to "Yes."
Delete entries in 25–28.

14

Page 4

NCVS-2, Page 4 Black ink

} Ask 21

SKIP
to
Check
Item E2,
page 6

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 4, 10% Pantone 185 Red

29.

How were you attacked? Any other way?
Mark (X) all that apply.

646

*
FIELD REPRESENTATIVE – If raped, ASK –
Do you mean forced or coerced sexual
intercourse?
If No, ASK – What do you mean?

647

*
If tried to rape, ASK –
Do you mean attempted forced or
coerced sexual intercourse?
If No, ASK – What do you mean?

30.

31.

648

*

649

1
2
3

What were the injuries you suffered, if
any? Anything else?

655

1
2
3
4
5
6
7
8
9
10

*

FIELD REPRESENTATIVE – If raped and box 1
in item 29 is NOT marked, ASK –
Do you mean forced or coerced sexual
intercourse?
If No, ASK – What do you mean?

656

*

If attempted rape and box 2 in item 29 is NOT
marked, ASK –
Do you mean attempted forced or
coerced sexual intercourse?
If No, ASK – What do you mean?

33.

34.

35.

12
13
14

Did the offender THREATEN to hurt you
before you were actually attacked?

Mark (X) all that apply.

32.

1
2
3
4
5
6
7
8
9
10
11

11

None – SKIP to Check Item E2, page 6
Raped
Attempted rape
Sexual assault other than rape or attempted rape
Knife or stab wounds
Gun shot, bullet wounds
Broken bones or teeth knocked out
Internal injuries
Knocked unconscious
Bruises, black eye, cuts, scratches,
swelling, chipped teeth
Other – Specify

657

Which injuries were caused by a weapon
OTHER than a gun or knife?
Enter code(s) from 31.

658

Were you injured to the extent that you
received any medical care, including
self treatment?

659

1
2

Yes – Ask 35
No – SKIP to Check Item E2, page 6

Where did you receive this care?
Anywhere else?
Mark (X) all that apply.

660

1
2
3

At the scene
At home/neighbor’s/friend’s
Health unit at work/school, first aid station
at a stadium/park, etc.
Doctor’s office/health clinic
Emergency room at hospital/emergency clinic
Hospital (other than emergency room)
Other – Specify

CHECK
ITEM E1

*

*

1
2

Yes – Ask 33
No – SKIP to 34

Code

Is (box 6) "Hospital" marked in 35?

Code

Code

Yes – Ask 36
No – SKIP to 38

Did you stay overnight in the hospital?
662

37.

Yes
No
Other – Specify

ASK OR VERIFY –
Were any of the injuries caused by a
weapon other than a gun or knife?

4
5
6
7

36.

Raped
Tried to rape
Sexual assault other than rape or attempted rape
Shot
Shot at (but missed)
Hit with gun held in hand
Stabbed/cut with knife/sharp weapon
Attempted attack with knife/sharp weapon
Hit by object (other than gun) held in hand
Hit by thrown object
Attempted attack with weapon other than
gun/knife/sharp weapon
Hit, slapped, knocked down
Grabbed, held, tripped, jumped, pushed, etc.
Other – Specify

How many days did you stay (in the
hospital)?

1
2

Yes – Ask 37
No – SKIP to 38

663

____________ Number of days
Page 5

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 5 Black ink

NCVS-2, Page 5, 10% Pantone 185 Red

38.

39.

At the time of the incident, were you
covered by any medical insurance, or
were you eligible for benefits from any
other type of health benefits program,
such as medicaid, Veterans
Administration, or Public Welfare?
What was the total amount of your
medical expenses resulting from this
incident (INCLUDING anything paid by
insurance)? Include hospital and doctor
bills, medicine, therapy, braces, and any
other injury related expenses.

664

1
2
3

665

$ ____________ .
0
X

Yes
No
Don’t know

00

Total amount

No cost
Don’t know

FIELD REPRESENTATIVE – Obtain an estimate,
if necessary.
CHECK
ITEM E2

40.

Is the respondent female and between
the ages of 18–49?

Research shows that pregnant women
may be at a higher risk of being the
victim of a violent crime.
Were you pregnant at the time of this
incident?

Yes – Ask 40
No – SKIP to 41a
960

1
2

Yes
No

666

1
2

Yes – SKIP to 42
No/took no action/kept still – Ask 41b

about the incident while it was going on?

667

1
2

Yes – Ask 42
No/took no action/kept still – SKIP to 47

What did you do? Anything else?
Mark (X) all that apply. Then fill Check Item F.

668

41a. Did you do anything with the idea of
protecting YOURSELF or your PROPERTY
while the incident was going on?

41b. Was there anything you did or tried to do

42.

USED PHYSICAL FORCE TOWARD OFFENDER

*

669

*

1
2
3
4
5
6

Attacked offender with gun; fired gun
Attacked with other weapon
Attacked without weapon (hit, kicked, etc.)
Threatened offender with gun
Threatened offender with other weapon
Threatened to injure, no weapon
RESISTED OR CAPTURED OFFENDER

7

Defended self or property (struggled, ducked,
blocked blows, held onto property)
Chased, tried to catch or hold offender
SCARED OR WARNED OFF OFFENDER
Yelled at offender, turned on lights,
threatened to call police, etc.
PERSUADED OR APPEASED OFFENDER
Cooperated, or pretended to (stalled, did
what they asked)
Argued, reasoned, pleaded, bargained, etc.

8
9

10
670

11

*
12

671

13
14

*
15

16

CHECK
ITEM F

Was the respondent injured in this
incident? (Is box 2–11 marked in
31 on page 5?)

ESCAPED OR GOT AWAY
Ran or drove away, or tried; hid, locked door
GOT HELP OR GAVE ALARM
Called police or guard
Tried to attract attention or help, warn others
(cried out for help, called children inside)
REACTED TO PAIN OR EMOTION
Screamed from pain or fear
OTHER
Other – Specify

Yes – Ask 43a
No – SKIP to 43b

43a. Did you take these actions before, after,
or at the same time that you were
injured?
Mark (X) all that apply.

43b. Did (any of) your action(s) help the
situation in any way?
Probe – Did your actions help you avoid
injury, protect your property, escape
from the offender – or were they helpful
in some other way?

672

*
673

1
2
3

Actions taken before injury
Actions taken after injury
Actions taken at same time as injury

1
2
3

Yes – Ask 44
⎫
No
⎬ SKIP to 45
Don’t know ⎭

FORM NCVS-2 (3-22-2005)

Page 6

NCVS-2, Page 6 Black ink

NCVS-2, Page 6, 100% Pantone 185 Red

44.

How were they helpful? Any other way?
Mark (X) all that apply.

674

1
2
3
4
5
6

Helped avoid injury or greater injury to respondent
Scared or chased offender off
Helped respondent get away from offender
Protected property
Protected other people
Other – Specify

675

1
2
3

Yes – Ask 46
⎫
No
⎬ SKIP to 47
Don’t know ⎭

How did they make the situation worse?
Any other way?
Mark (X) all that apply.

676

1
2
3
4
5
6

Led to injury or greater injury to respondent
Caused greater loss of property or damage to property
Other people got hurt (worse)
Offender got away
Made offender angrier, more aggressive, etc.
Other – Specify

47.

Was anyone present during the
incident besides you and the offender?
(Other than children under age 12.)

677

1
2
3

Yes – Ask 48
⎫
No
⎬ SKIP to Check Item G
Don’t know ⎭

48.

Did the actions of (this person/any of
these people) help the situation in any
way?

678

1
2
3

Yes – Ask 49
⎫
No
⎬ SKIP to 50
Don’t know ⎭

49.

How did they help the situation? Any
other way?
Mark (X) all that apply.

679

1
2
3
4
5
6

Helped avoid injury or greater injury to respondent
Scared or chased offender off
Helped respondent get away from offender
Protected property
Protected other people
Other – Specify

680

1
2
3

Yes – Ask 51
⎫
No
⎬ SKIP to 52
Don’t know ⎭

681

1
2
3
4
5
6

Led to injury or greater injury to respondent
Caused greater loss of property or damage to property
Other people got hurt (worse)
Offender got away
Made offender angrier, more aggressive, etc.
Other – Specify

682

1
2
3

Yes – Ask 53
⎫
No
⎬ SKIP to Check Item G
Don’t know ⎭

683

____________ Number of persons

684

0

45.

Did (any of) your action(s) make the
situation worse in any way?

*

PROBE – Did your actions lead to injury,
greater injury, loss of property, make the
offender angrier, or make the situation
worse in some other way?

46.

50.

51.

52.

53.

54.

Did the actions of (this person/any of
these people) make the situation worse
in any way?

How did they make the situation worse?
Any other way?
Mark (X) all that apply.

Not counting yourself, were any of the
persons present during the incident harmed
(Pause), threatened with harm (Pause), or
robbed by force or threat of harm? (Do not
include yourself, the offender, or children
under 12 years of age.)
How many? (Do not include yourself,
the offender or children under 12 years
of age.)
How many of these persons are
members of your household now? (Do
not include yourself, the offender or
children under 12 years of age.)

*

*

*

None

____________ Number of persons
Name(s)
OR

Line number(s)

FIELD REPRESENTATIVE – Enter name(s) or
line number(s) of other household member(s).
If not sure, ask.

Page 7

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 7 Black ink

NCVS-2, Page 7, 10% Pantone 185 Red

CHECK
ITEM G

55.

Did respondent use or threaten to use
physical force against the offender?
(Is box 1–6 marked in 42 on page 6?)

Who was the first to use or threaten to
use physical force – you, the offender,
or someone else?

685

1
2

Yes – Ask 55
No – SKIP to 60

686

1
2
3
4

Respondent
Offender(s)
Someone else
Don’t know

687

1
2

Yes – Ask 57
No – SKIP to 88, page 11

Mark (X) only one box.

56.

If household member was present, SKIP to 59.
Do you know or have you learned
anything about the offender(s) – for
instance, whether there was one or
more than one offender involved,
whether it was someone young or old,
or male or female?

⎫
⎬ SKIP to 60
⎭

57.

How sure are you of this information?
Do you have a suspicion, are you fairly
sure or are you certain?

688

1
2
3

Suspicion
Fairly sure
Certain

58.

How did you learn about the offender(s)?
Any other way?

689

1
2

Respondent saw or heard offender
From other member of household
who was eyewitness
From eyewitness(es) other than
household member(s)
From police
Other person (not eyewitness)
Offender(s) admitted it
Offender(s) had threatened to do it
Stolen property found on offender’s
property or in offender’s possession
Figured it out by who had motive,
opportunity, or had done it before
Other – Specify

*

Mark (X) all that apply.

3

690

*

4
5
6
7
8
9
10

59.

What actually happened? Anything else?
Mark (X) all that apply.

691

*

⎫
⎬
⎭

SKIP
to 88,
page 11

8

Something taken without permission
Attempted or threatened to take something
Harassed, argument, abusive language
Forcible entry or attempted forcible entry
of house/apartment
Forcible entry or attempted forcible entry of car
Damaged or destroyed property
Attempted or threatened to damage or
destroy property
Other – Specify

1
2
3
4
5
6
7

60.

ASK OR VERIFY –
Was the crime committed by only one or
by more than one offender?

692

1
2
3

Only one – SKIP to 62
More than one – SKIP to 73
Don’t know – Ask 61

61.

Do you know anything about one of the
offenders?

693

1
2

Yes – Ask 62
No – SKIP to 88, page 11

Notes

Page 8

NCVS-2, Page 8 Black ink

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 8, 10% Pantone 185 Red

62.

Was the offender male or female?

698

1
2
3

Male
Female
Don’t know

63.

How old would you say the offender
was?

699

1
2
3
4

Under 12
12–14
15–17
18–20

700

1
2
3

Yes (a member of a street gang)
No (not a member of a street gang)
Don’t know (if a member of a street gang)

701

1
2
3

Yes (drinking or on drugs) – Ask 65
No (not drinking/not on drugs)
Don’t know (if drinking or on drugs)

64a. Was the offender a member of a street
gang, or don’t you know?

64b. Was the offender drinking or on drugs,
or don’t you know?

5
6
7

21–29
30+
Don’t know

⎫
⎬
⎭

65.

Which was it? (Drinking or on drugs?)

702

1
2
3
4

Drinking
On drugs
Both (drinking and on drugs)
Drinking or on drugs – could not tell which

66.

Was the offender someone you knew
or a stranger you had never seen
before?

703

1
2
3

Knew or had seen before – SKIP to 68
Stranger
Don’t know

67.

Would you be able to recognize the
offender if you saw him/her?

704

1
2
3

Yes
Not sure (possibly or probably)
No – SKIP to 71

How well did you know the offender –
by sight only, casual acquaintance, or
well known?

705

1
2
3

Sight only – Ask 69
Casual acquaintance
Well known

69.

Would you have been able to tell the
police how they might find the
offender, for instance, where he/she
lived, worked, went to school, or spent
time?

706

1
2
3

Yes
No
Other – Specify

70.

How well did you know the offender?
For example, was the offender a
friend, cousin, etc.?

68.

707

1
2
3
4
5
6

7
8
9
10
11
12
14
15
16
17
13

Was the offender White, Black, or
some other race?

72.

Was this the only time this offender
committed a crime against you or your
household or made threats against
you or your household?

73.

How many offenders?

to 69

SKIP to 70

⎫
⎬ SKIP to 71
⎭

RELATIVE

Mark (X) first box that applies.

71.

⎫
⎬
⎭

⎫
⎬ SKIP
⎭

SKIP to 66

Spouse at time of incident
Ex-spouse at time of incident
Parent or step-parent
Own child or step-child
Brother/sister
Other relative – Specify
NONRELATIVE
Boyfriend or girlfriend, ex-boyfriend or ex-girlfriend
Friend or ex-friend
Roommate, boarder
Schoolmate
Neighbor
Customer/client
Patient
Supervisor (current or former)
Employee (current or former)
Co-worker (current or former)
Other nonrelative – Specify

708

1
2
3
4

White
Black
Other – Specify
Don’t know

709

1
2
3

Yes (only time)
No (there were other times)
Don’t know

x

Number of offenders
Don’t know (number of offenders)

710

⎫
⎬ SKIP to 88, page 11
⎭

Notes

Page 9

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 9 Black ink

NCVS-2, Page 9, 10% Pantone 185 Red

74.

Were they male or female?

711

1
2
3
4

All male
All female
Don’t know sex of any offenders
Both male and female – Ask 75

75.

If there were only 2 offenders (item 73),
SKIP to 76.

712

1
2
3
4

Mostly male
Mostly female
Evenly divided
Don’t know

Were they mostly male or mostly female?

⎫
⎬ SKIP to 76
⎭

76.

How old would you say the youngest
was?

713

1
2
3

Under 12
12–14
15–17

4
5
6

18–20
21–29
30+

7

Don’t know

77.

How old would you say the oldest was?

714

1
2
3

Under 12
12–14
15–17

4
5
6

18–20
21–29
30+

7

Don’t know

715

1
2
3

Yes (a member of a street gang)
No (not a member of a street gang)
Don’t know (if a member of a street gang)

716

1
2
3

Yes (drinking or on drugs) – Ask 79
No (not drinking/not on drugs)
Don’t know (if drinking or on drugs)

78a. Were any of the offenders a member of a
street gang, or don’t you know?

78b. Were any of the offenders drinking or on
drugs, or don’t you know?

⎫
⎬
⎭

SKIP to 80

79.

Which was it? (Drinking or on drugs?)

717

1
2
3
4

Drinking
On drugs
Both (drinking and on drugs)
Drinking or on drugs – could not tell which

80.

Were any of the offenders known to you,
or were they strangers you had never
seen before?

718

1
2

All known
Some known

81.

Would you be able to recognize any of
them if you saw them?

719

1
2
3

Yes
Not sure (possibly or probably)
No – SKIP to 85

82.

How well did you know the offender(s) – by
sight only, casual acquaintance, or well
known?

720

1
2
3

Sight only
Casual acquaintance
Well known

*

⎫ SKIP
⎬
⎭ to 82

3
4

All strangers
Don’t know
⎫
⎬
⎭

⎫
⎬
⎭

Ask 81

SKIP to 83

Mark (X) all that apply.
CHECK
ITEM H

Is "casual acquaintance" or "well
known" marked in 82?

83.

Would you have been able to tell the
police how they might find any of them,
for instance, where they lived, worked,
went to school, or spent time?
Mark (X) only one box.

84.

How did you know them? For example,
were they friends, cousins, etc.?

Yes – SKIP to 84
No – Ask 83
722

Yes
No
Other – Specify

⎫
⎬ SKIP to 85
⎭

RELATIVE
723

Mark (X) all that apply.

1
2
3

*

1
2
3
4
5
6

Spouse at time of incident
Ex-spouse at time of incident
Parent or step-parent
Own child or step-child
Brother/sister
Other relative – Specify
NONRELATIVE

724

*
725

*

85.

Were the offenders White, Black, or
some other race?
Mark (X) all that apply.

86.

If only one box marked in 85, SKIP to 87.
What race were most of the offenders?

726

*

727

7
8
9
10
11
12
14
15
16
17
13

Boyfriend or girlfriend, ex-boyfriend or ex-girlfriend
Friend or ex-friend
Roommate, boarder
Schoolmate
Neighbor
Customer/client
Patient
Supervisor (current or former)
Employee (current or former)
Co-worker (current or former)
Other nonrelative – Specify

1
2
3
4

White
Black
Other – Specify
Don’t know race of any/some

1
2
3
4
5

Mostly White
Mostly Black
Mostly some other race
Equal number of each race
Don’t know

Page 10

NCVS-2, Page 10 Black ink

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 10, 10% Pantone 185 Red

87.

88.

Was this the only time any of these
offenders committed a crime against
you or your household or made threats
against you or your household?
ASK OR VERIFY –
Was something stolen or taken without
permission that belonged to you or
others in the household?

730

1
2
3

Yes (only time)
No (there were other times)
Don’t know

731

1
2
3

Yes – SKIP to 96
No
Don’t know

732

1
2
3

Yes – Ask 90
⎫
No
⎬ SKIP to 110, page 14
Don’t know ⎭

733

1
2
3
4
5
6
7

Cash
Purse
Wallet
Credit cards, checks, bank cards
Car
Other motor vehicle
Part of motor vehicle (tire, hubcap, attached car
stereo or satellite radio, attached CB radio, etc.)
Gasoline or oil
Bicycle or parts
TV, DVD player, VCR, stereo, other household appliances
Silver, china, art objects
Other household furnishings (furniture, rugs, etc.)
Personal effects (clothing, jewelry, toys, etc.)
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)
Other – Specify

FIELD REPRESENTATIVE – Include anything
stolen from an unrecognizable business.
Do not include any items stolen from a
recognizable business operated in the
respondent’s home or in a commercial
establishment.

89.

ASK OR VERIFY –
Did the offender(s) ATTEMPT to take
something that belonged to you or
others in the household?

90.

What did the offender try to take?
Anything else?

*

Mark (X) all that apply?

734

*

8
9
735 10
11
*
12
736 13
* 14
15
737 16

*
17

91.

Did the (property/money) the offender
tried to take belong to you personally,
to someone else in the household, or to
both you and other household
members?

738

1
2
3

Mark (X) only one box.

4
5

Don’t know

Respondent only – SKIP to 92
Respondent and other household member(s) –
Fill Check Item J
Other household member(s) only
– Fill Check Item J
Nonhousehold member(s) only
⎫
Other – Specify
⎬ SKIP to 92

⎭

CHECK
ITEM J

Besides the respondent, which
household member(s) owned the
(property/money) the offender tried to
take?

739

Line number

*

Line number

If not sure, ask. Do not enter the
respondent’s line number.

Line number
OR
40

92.

ASK OR VERIFY –
Was/Were the article(s) IN or
ATTACHED to a motor vehicle when the
attempt was made to take (it/them)?

CHECK
ITEM K

93.

740

1
2

Yes
No

Yes – Ask 93
No – SKIP to 94

Did the offender try to take cash, a
purse, or a wallet? (Is box 1, 2, or 3
marked in 90?)

ASK OR VERIFY –
Was the (cash/purse/wallet) on your
person, for instance, in a pocket or
being held?

Household property

742

1
2

Yes
No
Page 11

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 11 Black ink

NCVS-2, Page 11, 10% Pantone 185 Red

94.

ASK OR VERIFY –
Was there anything (else) the offender(s)
tried to take directly from you, for
instance, from your pocket or hands, or
something that you were wearing?
Exclude property not belonging to
respondent or other household member.

95.

Which items did the offender(s) try to
take directly from you?
Enter code(s) from 90.
Do not include cash/purse/wallet. Exclude
property not belonging to respondent or
other household member.

96.

What was taken that belonged to you or
others in the household? Anything else?

745

1
2

Yes – Ask 95
No – SKIP to 110, page 14

746

– SKIP to 110, page 14

*
Code
OR
40

Code

Code

Tried to take everything marked in 90 directly from
respondent – SKIP to 110, page 14
Cash

747

$ ____________ . 00

Mark (X) all that apply.
FIELD REPRESENTATIVE – If purse or wallet
stolen, ASK –

748

1

*

Amount of cash taken

Only cash taken – Enter amount above
Property
PURSE/WALLET/CREDIT CARDS

Did it contain any money?
2
3

Enter amount of stolen cash where indicated.
Mark the appropriate box(es) for stolen
property or the box for only cash taken.

4

Purse ⎫
⎬ Ask: Did it contain money?
Wallet ⎭
Credit cards, check, bank cards
VEHICLE OR PARTS

749

5
6
7

*

8
9
10

Car
Other motor vehicle
Part of motor vehicle (tire, hubcap, attached car
stereo or satellite radio, attached CB radio, etc.)
Unattached motor vehicle accessories or equipment
(unattached CD player or satellite radio, etc.)
Gasoline or oil
Bicycle or parts
HOUSEHOLD FURNISHINGS

750 11

*
12
13

TV, DVD player, VCR, stereo, other household
appliances
Silver, china, art objects
Other household furnishings (furniture, rugs, etc.)
PERSONAL EFFECTS

751 14

*

15
16
752 17
18

*

19

Portable electronic and photographic gear
(Personal stereo, TV, cellphone, camera, etc.)
Clothing, furs, luggage, briefcase
Jewelry, watch, keys
Collection of stamps, coins, etc.
Toys, sports and recreation equipment
(not listed above)
Other personal and portable objects
FIREARMS

753 20
21

*

Handgun (pistol, revolver)
Other firearm (rifle, shotgun)
MISCELLANEOUS

22
754 23
* 24
25
755 26

Tools, machines, office equipment
Farm or garden produce, plants, fruit, logs
Animals –pet or livestock
Food or liquor
Other – Specify

*
27

97.

Did the stolen (property/money) belong
to you personally, to someone else in
the household, or to both you and other
household members?
Mark (X) only one box.

760

1
2
3
4
5

Don’t know
Respondent only – SKIP to Check Item M1
Respondent and other household
member(s) – Fill Check Item L
Other household member(s) only – Fill Check Item L
Nonhousehold member(s) only
⎫ SKIP to
Other – Specify
⎬ Check Item
⎭ M1

Page 12

NCVS-2, Page 12 Black ink

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 12, 10% Pantone 185 Red

CHECK
ITEM L

Besides the respondent, which
household member(s) owned the
stolen (property/money)?
If not sure, ask. Do not enter the
respondent’s line number.

761

Line number

*

Line number
Line number
40

CHECK
ITEM M1

OR
Household property
Yes – Ask 98
No – SKIP to 100

Was a car or other motor vehicle taken?
(Is box 5 or 6 marked in 96?)

98.

Had permission to use the (car/motor
vehicle) ever been given to the
offender(s)?

763

1
2
3

Yes – Ask 99
⎫
No
⎬ SKIP to Check Item M2
Don’t know ⎭

99.

Did the offender return the (car/motor
vehicle) this time?

764

1
2

Yes ⎫⎬
SKIP to Check Item M2
No ⎭

ASK OR VERIFY –
Was/Were the article(s) IN or
ATTACHED to a motor vehicle when
(they were/it was) taken?

765

1
2

Yes
No

100.

CHECK
ITEM M2

Yes – Ask 101a
No – SKIP to Check Item M3

Did the offender(s) take a handgun?
(Is box 20 marked in 96?)

101a. How many handguns were taken?

_____ Number of handguns

923
X

CHECK
ITEM M3

Yes – Ask 101b
No – SKIP to Check Item N

Did the offender(s) take some other
type of firearm?
(Is box 21 marked in 96?)

101b. How many other types of firearms
were taken?

_____ Number of firearms

924
X

CHECK
ITEM N

Was the (cash/purse/wallet) on your
person, for instance, in a pocket or
being held?

102.

ASK OR VERIFY –
Was there anything (else) the
offender(s) took directly from you, for
instance, from your pocket or hands, or
something that you were wearing?

Don’t know (Number of firearms taken)
Yes – Ask 101c
No – SKIP to 102

Was cash, purse, or a wallet taken?
(Is a cash amount entered or box 1, 2,
or 3 marked in 96?)

101c. ASK OR VERIFY –

Don’t know (Number of handguns taken)

767

1
2

Yes
No

768

1
2

Yes – Ask 103
No – SKIP to 104

Exclude property not belonging to
respondent or other household member.

103.

Which items did the offender(s) take
directly from you?
Enter code(s) from 96.
Do not include cash/purse/wallet. Exclude
property not belonging to respondent or other
household member.

104.

*
Code
OR
40

Code

Code

Everything marked in 96 was taken
directly from respondent

If only cash/checks/credit cards is marked in
item 96, SKIP to 106.
What was the value of the PROPERTY
that was taken? Include recovered
property. (Exclude any stolen cash/
checks/credit cards. If jointly owned with
a nonhousehold member(s), include only
share owned by household members.)

105.

769

How did you decide the value of the
property that was taken? Any other
way?
Mark (X) all that apply.

770

771

*

$ ____________ .
1
2
3
4
5
6
7

Value of property taken

Original cost
Replacement cost
Personal estimate of current value
Insurance report estimate
Police estimate
Don’t know
Other – Specify
Page 13

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 13 Black ink

00

NCVS-2, Page 13, 10% Pantone 185 Red

106. Was all or part of the stolen (money/
property) recovered, not counting
anything received from insurance?

772

1
2
3

107. What was recovered? Anything else?
FIELD REPRESENTATIVE – If purse or wallet
recovered, ASK –
Did it contain any money?
Enter amount of recovered cash where
indicated. Mark the appropriate box(es) for
recovered property or the box for only cash
recovered.

CHECK
ITEM O

Cash

775

Mark (X) all that apply.

Was PROPERTY other than cash,
checks, or credit cards recovered? (If
not sure, ask.)

All – SKIP to Check Item O
Part – Ask 107
None – SKIP to 109

$ ____________ .
776

1

*

777

00

Amount of cash recovered

Only cash recovered
Property

2
3
4
5
6

Purse ⎫
⎬ Ask: Did it contain any money?
Wallet ⎭
Credit cards, checks, bank cards
Car or other motor vehicle
Property other than the above

1
2

Yes – Ask 108
No – SKIP to 109

108. Considering any damage, what was
the value of the property after it was
recovered? (Do not include recovered
cash, checks, or credit cards.)

778

$ ____________ .

109. Was the theft reported to an insurance
company?

779

1
2
3
4

Yes
No
Don’t have insurance
Don’t know

780

1
2

Yes – Ask 111
No – SKIP to 115

781

1
2
3

Yes, all ⎫
Yes, part ⎬⎭ SKIP to 113
No, none – Ask 112

110. (Other than any stolen property) was
anything that belonged to you or other
members of the household damaged in
this incident?

00

Value of property recovered

PROBE – For example, was (a lock or
window broken/clothing damaged/
damage done to a car), or something
else?

111. Was/Were the damaged item(s) repaired
or replaced?

112. How much would it cost to repair or
782

replace the damaged item(s)?

$ ____________ .
0
x

00

Cost to repair/replace – SKIP
to 114

No cost – SKIP to 115
Don’t know – SKIP to 114

113. How much was the repair or
783

replacement cost?

$ ____________ .

114. Who (paid/will pay) for the repairs or
replacement? Anyone else?
Mark (X) all that apply.

784

*

00

Cost to repair/replace – Ask 114

0
x

No cost – SKIP to 115
Don’t know – Ask 114

1
2
3
4
5
6

Items will not be repaired or replaced
Household member
Landlord or landlord’s insurance
Victim’s (or household’s) insurance
Offender
Other – Specify

Notes

Page 14

NCVS-2, Page 14 Black ink

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 14, 10% Pantone 185 Red

115. Were the police informed or did they
find out about this incident in any way?

800

1
2
3

Yes – Ask 116
No – SKIP to 117
Don’t know – SKIP to 130, page 17

801

1
2
3

Respondent – SKIP to 119
Other household member
⎫
Someone official called police (guard, apt.
⎬ SKIP
manager, school official, etc.)
Someone else
⎭ to 121
Police were at scene – SKIP to 123
Offender was a police officer
⎫
Some other way – Specify
⎬ SKIP to 124

116. How did the police find out about it?
Mark (X) first box that applies.
FIELD REPRESENTATIVE – If proxy interview,
we want the proxy respondent to answer
questions 116–134 for herself/himself, not for
the person for whom the proxy interview is
being taken.

4
5
6
7

⎭

117. What was the reason it was not
reported to the police? (Can you tell me
a little more?) Any other reason?
Mark (X) all that apply.
STRUCTURED PROBE –

DEALT WITH ANOTHER WAY

802

*

1
2

Was the reason because you dealt with
it another way, it wasn’t important
enough to you, insurance wouldn’t
cover it, police couldn’t do anything,
police wouldn’t help, or was there some
other reason?

Reported to another official (guard, apt. manager,
school official, etc.)
Private or personal matter or took care of it myself or
informally; told offender’s parent
NOT IMPORTANT ENOUGH TO RESPONDENT

3
4
5

Minor or unsuccessful crime, small or no loss,
recovered property
Child offender(s), "kid stuff"
Not clear it was a crime or that harm was intended
INSURANCE WOULDN’T COVER

6

No insurance, loss less than deductible, etc.
POLICE COULDN’T DO ANYTHING

803

7

*

8
9

Didn’t find out until too late
Could not recover or identify property
Could not find or identify offender, lack of proof
POLICE WOULDN’T HELP

10
804

*

11
12
13

Police wouldn’t think it was important enough,
wouldn’t want to be bothered or get involved
Police would be inefficient, ineffective (they’d arrive
late or not at all, wouldn’t do a good job, etc.)
Police would be biased, would harass/insult
respondent, cause respondent trouble, etc.)
Offender was police officer
OTHER REASON

805

*
806

*

14
15
16
17
18

19

CHECK
ITEM P

1
2

Is more than one reason marked in 117?

Did not want to get offender in trouble with the law
Was advised not to report to police
Afraid of reprisal by offender or others
Did not want to or could not take time – too
inconvenient
Other – Specify

Respondent not present or doesn’t know why it
wasn’t reported
Yes – Ask 118
No – SKIP to 130, page 17

118. Which of these would you say was the
most important reason why the incident
was not reported to the police?
Enter code from 117.

808
30

Code – SKIP to 130, page 17
No one reason more important – SKIP to 130, page 17

Notes

Page 15

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 15 Black ink

NCVS-2, Page 15, 10% Pantone 185 Red

119. Besides the fact that it was a crime, did
YOU have any other reason for
reporting this incident to the police?

809

*

Any other reason?
Mark (X) all that apply.
STRUCTURED PROBE –
Did you report it to get help with this
incident, to recover your loss, to stop or
punish the offender, to let police know
about it, or was there some other
reason?

1
2

TO GET HELP WITH THIS INCIDENT
Stop or prevent THIS incident from happening
Needed help after incident due to injury, etc.

3
4

TO RECOVER LOSS
To recover property
To collect insurance

5
6
810

*

7
8

10

TO LET POLICE KNOW
To improve police surveillance of respondent’s home,
area, etc.
Duty to let police know about crime

11
12

OTHER
Other reason – Specify
No other reason – SKIP to 121

9

811

*
CHECK
ITEM Q

Yes – Ask 120
No – SKIP to 121

Is more than one reason marked in 119?

120. Which of these would you say was the
most important reason why the incident
was reported to the police?
Enter code from 119.

121. Did the police come when they found
out about the incident?

122. How soon after the police found out did
they respond? Was it within 5 minutes,
within 10 minutes, an hour, a day, or
longer?
Mark (X) first category respondent is sure of.

123. What did they do while they were
(there/here)? Anything else?
Mark (X) all that apply.

813
21
22
1
2
3
4

Yes – Ask 122
⎫
No
Don’t know ⎬⎭ SKIP to 124
Respondent went to police – SKIP to 123

815

1
2
3
4
5
6

Within 5 minutes
Within 10 minutes
Within an hour
Within a day
Longer than a day
Don’t know how soon

816

1
2
3
4
5
6
7
8
9

Took report
Searched/looked around
Took evidence (fingerprints, inventory, etc.)
Questioned witnesses or suspects
Promised surveillance
Promised to investigate
Made arrest
Other – Specify
Don’t know

818

1
2
3

Yes – Ask 125
⎫
No
Don’t know ⎬⎭ SKIP to 128

819

1
2
3
4
5

Police contacted respondent or other HHLD member
Respondent (or other HHLD member) contacted police
Both
Don’t know
Other – Specify

820

1
2
3
4

In person
Not in person (by phone, mail, etc.)
Both in person and not in person
Don’t know

821

1
2
3
4
5
6
7

Took report
Questioned witnesses or suspects
Did or promised surveillance/investigation
Recovered property
Made arrest
Stayed in touch with respondent/household
Other – Specify

8
9

Nothing (to respondent’s knowledge)
Don’t know

817

*

have any later contact with the police
about the incident?

125. Did the police get in touch with you or
did you get in touch with them?

126. Was that in person, by phone, or some
other way?

127. What did the police do in following up
this incident? Anything else?
Mark (X) all that apply.

Code
No one reason more important
Because it was a crime was most important

814

*

124. Did you (or anyone in your household)

TO GET OFFENDER
To prevent further crimes against respondent/
respondent’s household by this offender
To stop this offender from committing other
crimes against anyone
To punish offender
Catch or find offender – other reason or no
reason given

*

822

*

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128. Did you (or someone in your household)
sign a complaint against the offender(s) to
the police department or the authorities?

825

1
2

Yes
No

826

1
2
3

Yes
No
Don’t know

827

1
2
3

Yes – Ask 131
⎫
No
⎬ SKIP to Check Item R
Don’t know ⎭

828

1
2
3

Government
Private
Don’t know

129. ASK OR VERIFY –
As far as you know, was anyone arrested
or were charges brought against anyone in
connection with this incident?

130. Did you (or someone in your household)
receive any help or advice from any office
or agency —other than the police — that
deals with victims of crime?

131. Was that a government or private
agency?

CHECK
ITEM R

Yes – Ask 132
No – SKIP to 135

Were the police informed? (Is "Yes"
marked in 115 on page 15?)

132. Have you (or someone in your
household) had contact with any other
authorities about this incident (such as
a prosecutor, court, or juvenile officer)?

829

1
2
3

Yes – Ask 133
⎫
No
⎬ SKIP to 134
Don’t know ⎭

830

1
2
3
4
5

Prosecutor, district attorney
Magistrate
Court
Juvenile, probation or parole officer
Other – Specify

1

Yes – Specify

2
3

No
Don’t know

1
2
3
4
5
6
7
8
9
10

Working or on duty – SKIP to 138a
On the way to or from work – SKIP to Check Item S
On the way to or from school
On the way to or from other place
Shopping, errands
Attending school
Leisure activity away from home
Sleeping
Other activities at home
Other – Specify

11

Don’t know

133. Which authorities? Any others?
Mark (X) all that apply.

*

134. Do you expect the police, courts, or
other authorities will be doing anything
further in connection with this incident?

831

135. ASK OR VERIFY –
What were you doing when this incident
(happened/started)?
Mark (X) only one box.

832

FIELD REPRESENTATIVE – If proxy interview,
replace "you" with the name of the person for
whom the proxy interview is being taken in
135–173.

136. ASK OR VERIFY –
Did you have a job at the time of the
incident?

840

1
2

Yes – SKIP to Check Item S
No

841

1
2
3
4
5
6

Looking for work
Keeping house
Going to school
Unable to work
Retired
Other – Specify

137. What was your major activity the week
of the incident — were you looking for
work, keeping house, going to school, or
doing something else?
Mark (X) only one box.

⎫
⎬
⎭

SKIP to 151, page 19

Notes

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138a. Now I have a few questions about the
job at which you worked during the
time of the incident.

843

1
2
3

Were you employed by (Read answer
categories) –

4

5

138b. Is this business incorporated?

953

138c. What is the name of the (company/

954

A private company, business, or
individual for wages? – Ask 138b
The Federal government? ⎫
A State, county, or local ⎬SKIP to 138c
government?
⎭
Yourself (Self-employed) in your own
business, professional practice, or
farm? – Ask 138b
A private, not-for-profit, tax-exempt, or
charitable organization? – Ask 138b

1
2
3

Yes
No
Don’t know

1
2
3
4

Manufacturing?
Retail trade?
Wholesale trade?
Something else?

844

1
2
3
4

A city?
Suburban area?
Rural area?
Combination of any of these?

845

1
2
3
4

Yes
No
Don’t know
Other – Specify

141b. Did you usually work days or nights?

846

1
2
3

Days
Nights
Both days and nights/rotating shifts

142. Is this your current job?

959

1
2

Yes
No

government agency/business/
non-profit organization) for which you
worked at the time of the incident?

138d. What kind of business or industry is
this?

955

Read if necessary: What do they make or do
where you worked at the time of the
incident?

138e. Is this mainly... (Read answer

956

categories) –
Mark (X) only one box.

138f. What kind of work did you do, that is,
what was your occupation at the time
of the incident?

957

(For example: plumber, typist, farmer)

139. What were your usual activities or
duties at this job?

140. While working at this job, did you work
mostly in (Read answer categories) –

ASK OR VERIFY –

141a. Did this incident happen at your work

958

site?

CHECK
ITEM S

Was the respondent injured in this incident?
(Is box 2–11 marked in 31 on page 5?)

143. Did YOU lose time from work because
of the injuries you suffered in this
incident?

144. How much time did you lose

Yes (injury marked in 31) – Ask 143
No (blank or None marked in 31) – SKIP to 147
870

1
2

Yes – Ask 144
No – SKIP to 147

0
x

Number of days – Ask 145
Less than one day – SKIP to 147
Don’t know – Ask 145

1
2

Yes – Ask 146
No – SKIP to 147

871

because of injuries?

145. During these days, did you lose any
pay that was not covered by
unemployment insurance, sick
leave, or some other source?

146. About how much pay did you lose?

872

873

$ ____________ .
x

Amount of pay lost

Don’t know

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00

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147. Did YOU lose any (other) time from
work because of this incident for such
things as cooperating with a police
investigation, testifying in court, or
repairing or replacing damaged or
stolen property?
Mark (X) all that apply. If no time was lost for
any of these reasons, mark None (box 6).

874

*

⎫
⎬
⎭

1
2
3
4
5

Police related activities
Court related activities
Repairing damaged property
Replacing stolen items
Other – Specify

6

None (did not lose time from work for any of these
reasons) – SKIP to 151

Ask 148

148. How much time did you lose altogether
because of (name all reasons marked in
147)?

875

149. During these days, did you lose any pay
that was not covered by unemployment
insurance, paid leave, or some other
source?

876

0
x

Number of days – Ask 149
Less than one day – SKIP to 151
Don’t know – Ask 149

1
2

Yes – Ask 150
No – SKIP to 151

150. About how much pay did you lose?
877

$ ____________ . 00
151. Were there any (other) household
members 16 years or older who lost time
from work because of this incident?

878

Amount of pay lost

x

Don’t know

1
2

Yes – Ask 152
No – SKIP to Check Item T

152. How much time did they lose
altogether?

879

Number of days
Less than one day
Don’t know

0
x

CHECK
ITEM T

Was the respondent on the way to or from
work, school, or some other place when the
incident (happened/started)? (Is box 2, 3, or
4 marked in 135 on page 17?)

Yes – Ask 153
No – SKIP to Check Item U

153. ASK OR VERIFY –
You told me earlier you were on the way
(to/from) (work/school/some place) when
the incident happened.
What means of transportation were you
using?
Mark (X) only one box.

CHECK
ITEM U

881

1
2
3
4
5
6
7
8
9
10

Is this incident part of a series
of crimes? (Is box 2 (is a "series")
marked in Check Item D on page 1?)

Car, truck or van
Motorcycle
Bicycle
On foot
School bus (private or public)
Bus or trolley
Subway or rapid transit
Train
Taxi
Other – Specify

Yes – Ask 154
No – SKIP to 161, page 21

154. You have told me about the most recent
incident. How many times did this kind
of thing happen to you during the last 6
months?

883

Number of incidents – Ask 155

884

OR
Don’t know – Is that because there is no way of
knowing, or because it happened too
many times, or is there some other
reason?
1
No way of knowing
2
Happened too many times
3
Some other reason – Specify

155. In what month or months did these
incidents take place?
If more than one quarter involved, ASK
How many in (name months)?
FIELD REPRESENTATIVE – Enter number for
each quarter as appropriate.

Number of incidents per quarter
Jan., Feb.,
April, May,
July, Aug.,
Oct., Nov.,
or March
or June
or Sept.
or Dec.
(Qtr. 1)
(Qtr. 2)
(Qtr. 3)
(Qtr. 4)
885

886

FORM NCVS-2 (3-22-2005)

NCVS-2, Page 19 Black ink

887

888

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156. Did all, some, or none of these incidents
occur in the same place?

889

1
2
3

All in the same place
Some in the same place
None in the same place

890

1
2
3
4

All by same person
Some by same person
None by same person
Don’t know – SKIP to 159

891

1
2
3
4

Relative
Spouse at time of incident
Ex-spouse at time of incident
Parent or step-parent
Other relative – Specify

Mark (X) only one box.

157. Were all, some, or none of these
incidents done by the same person(s)?
Mark (X) only one box.

158. What (was/were) the relationship(s) of
the offender(s) to you? For example,
friend, spouse, schoolmate, etc.
Mark (X) all that apply.

*

5
6
7
892
8
*
11
12
13
14
15
9
10

159. Did the same thing happen each time?

160. Is the trouble still going on?

CHECK
ITEM V1

Mark the ONE category that best
describes this series of crimes.
If more than one category describes
this series, mark the box with the
lowest number.

Nonrelative
Friend or ex-friend
Neighbor
Schoolmate
Roommate, boarder
Customer/client
Patient
Supervisor (current or former)
Employee (current or former)
Co-worker (current or former)
Stranger
Other nonrelative – Specify

893

1
2

Yes
No – How did the incidents differ?

894

1
2

Yes
No – What ended it?

895

1

Contact crimes
Completed or threatened violence in the course of
the victim’s job (police officer, security guard,
psychiatric social worker, etc.)

2

Completed or threatened violence between spouses,
other relatives, friends, neighbors, etc.

3

Completed or threatened violence at school or on
school property

4

Other contact crimes (other violence, pocket picking,
purse snatching, etc.) – Specify

5

Noncontact crimes
Theft or attempted theft of motor vehicles

6

Theft or attempted theft of motor vehicle parts (tire,
hubcap, battery, attached car stereo, etc.)

7

Theft or attempted theft of contents of motor
vehicle, including unattached parts

8

Theft or attempted theft at school or on school
property

9

Illegal entry of, or attempt to enter, victim’s home,
other building on property, second home, hotel,
motel

10

Theft or attempted theft from victim’s home or
vicinity by person(s) known to victim (roommate,
babysitter, etc.)

11

Theft or attempted theft from victim’s home or
vicinity by person(s) unknown to victim

12

Other theft or attempted theft (at work, while
shopping, etc.) – Specify

FORM NCVS-2 (3-22-2005)

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161. Hate crimes or crimes of prejudice or bigotry
occur when (an offender/offenders) target(s)
people because of one or more of their
characteristics or religious beliefs.
Do you have any reason to suspect the
incident just discussed was a hate crime or
crime of prejudice or bigotry?

910

1
2
3

Yes – Ask 162
No
Don’t know

} SKIP to Check Item V3

162. An offender/Offenders can target people for
a variety of reasons, but we are only going
to ask you about a few today. Do you
suspect the offender(s) targeted you
because of...
(a) Your race?

896

1

Yes

2

No

3

Don’t know

(b) Your religion?

897

1

Yes

2

No

3

Don’t know

(c) Your ethnic background or national
origin (for example, people of Hispanic
origin)?

898

1

Yes

2

No

3

Don’t know

(d) Any disability (by this I mean physical,
mental, or developmental disabilities)
you may have?

899

1

Yes

2

No

3

Don’t know

(e) Your gender?

900

1

Yes

2

No

3

Don’t know

(f) Your sexual orientation?

901

1

Yes

2

No

3

Don’t know

911

1

Yes –Specify

No

3

Don’t know

1

Yes –Specify

No

3

Don’t know

If "Yes," SAY – (by this we mean
homosexual, bisexual, or heterosexual)

163. Some offenders target people because
they associate with certain people or the
(offender perceives/offenders perceive)
them as having certain characteristics or
religious beliefs.
Do you suspect you were targeted because
of...
(a)Your association with people who
have certain characteristics or
religious beliefs (for example, a
multiracial couple)?

2

912

(b)The offender(s)’s perception of your
characteristics or religious beliefs (for
example, the offender(s) thought you
were Jewish because you went into a
synagogue)?

913

2

914

CHECK
ITEM V2

Are one or more boxes marked "Yes" in
162 OR 163?

Yes – Ask 164
No – SKIP to Check Item V3

164. Do you have any evidence that this
incident was a hate crime or crime of
prejudice or bigotry?
If "No" or "Don’t know," ASK –

915

1
2
3

Yes – Ask 165
No
Don’t know

} SKIP to Check Item V3

Did the offender(s) say something, write
anything, or leave anything behind at the
crime scene that would suggest you were
targeted because of your characteristics or
religious beliefs?

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165. The next questions ask about the evidence
you have that makes you suspect this
incident was a hate crime or a crime of
prejudice or bigotry. As I read the following
questions, please tell me if any of the
following happened:
(a) Did the offender(s) make fun of you,
make negative comments, use slang,
hurtful words, or abusive language?

916

1

Yes

2

No

3

Don’t know

(b) Were any hate symbols present at the
crime scene to indicate the offender(s)
targeted you for a particular reason (for
example, a swastika, graffiti on the
walls of a temple, a burning cross, or
written words)?

917

1

Yes

2

No

3

Don’t know

(c) Did a police investigation confirm the
offender(s) targeted you (for example,
did the offender(s) confess a motive, or
did the police find books, journals, or
pictures that indicated the offender(s)
(was/were) prejudiced against people
with certain characteristics or religious
beliefs)?

918

1

Yes

2

No

3

Don’t know

(d) Do you know if the offender(s) (has/have)
committed similar hate crimes or crimes
of prejudice or bigotry in the past?

919

1

Yes

2

No

3

Don’t know

(e) Did the incident occur on or near a
holiday, event, location, gathering
place, or building commonly associated
with a specific group (for example, at
the Gay Pride March or at a synagogue,
Korean church, or gay bar)?

920

1

Yes

2

No

3

Don’t know

(f) Have other hate crimes or crimes of
prejudice or bigotry happened to you or
in your area/ neighborhood where
people have been targeted?

921

1

Yes

2

No

3

Don’t know

(g) Do your feelings, instincts, or perception
lead you to suspect this incident was a
hate crime or crime of prejudice or
bigotry, but you do not have enough
evidence to know for sure?

922

1

Yes

2

No

3

Don’t know

1

Yes
No

166. At any time, did you tell the police that you
believed the incident was a hate crime or
crime of prejudice or bigotry?

908

2

Notes

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CHECK
ITEM V3
CHECK
ITEM V4

Is this the first incident reported for this
respondent?

925

Yes – SKIP to INTRO
No – Fill Check Item V4

Is Check Item V5 marked "Yes" for ANY
incidents already reported for this respondent?
(That is, has the respondent indicated that
he/she has a health condition or disability?)

926
9

Yes – SKIP to 172
No – SKIP to Check Item W

FIELD REPRESENTATIVE – Read Introduction.
INTRO:

Research has shown that people with disabilities may be more vulnerable to crime
victimization. The next questions ask about any health conditions, impairments, or disabilities
you may have.

167. Does a mental health condition currently

927

1
2
3

Yes
No
Don’t know

Yes
Yes
Yes

keep you from participating fully in work,
school, or other activities?

168. Do you have any of the following: (Read
categories a–c below.)
(a) An intellectual disability such as
mental retardation or Down
Syndrome?
(b) Autism?
(c) Cerebral Palsy?

169. Have you ever suffered a stroke, brain
tumor, or any type of brain injury that
causes you to have difficulty thinking,
concentrating, or making decisions?

928

1

929

1

930

1

931

1
2
3

2
2
2

No
No
No

3
3
3

Don’t know
Don’t know
Don’t know

Yes
No
Don’t know

170. Other than anything you’ve already
mentioned, do you have any SERIOUS
disabling conditions? Anything else?

932

1
2

FIELD REPRESENTATIVE – If "Yes" list up to
3 different conditions reported by the respondent.
Do not repeat conditions.

3

Yes – Specify
No
Don’t know

933

(First Condition)
934

(Second Condition)
935

(Third Condition)

171. I’m going to read you a list of activities. As
I read each activity, please tell me if you
have difficulty or need help none of the
time, some of the time, most of the time, or
all of the time:

Some
of the
time

Most
of the
time

All of
the
time

(a) Taking care of yourself, such as
bathing, dressing, or eating?

936

1

2

3

4

(b) Communicating, such as talking with
or listening to other people?

937

1

2

3

4

(c) Learning any new skills or activities?

938

1

2

3

4

(d) With mobility such as bending,
walking, or climbing stairs?

939

1

2

3

4

(e) Making important decisions for
yourself about your health care,
education, or career?

940

1

2

3

4

(f) Living independently, such as
preparing meals, doing housework, or
shopping for groceries and personal
items?

941

1

2

3

4

942

1

2

3

4

943

Yes – Ask 172
No – SKIP to Check Item W

(g) Managing your finances, such as
keeping track of your money and
paying bills?
CHECK
ITEM V5

172.

None
of the
time

Is box 1 marked in any of 167 through 170?
(That is, has the respondent indicated that
he/she has a health condition or disability?)

During the incident you just told me
about, do you have reason to suspect
you were victimized because of your
health condition(s), impairment(s), or
disability(ies)?

944

1
2
3

Yes – Ask 173
No
SKIP to Check Item W
Don’t know

}

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173. Which of your health conditions,
impairments, or disabilities do you
believe caused you to be targeted for this
incident?

946

(First Condition)
947

(Second Condition)
948

(Third Condition)
CHECK
ITEM W

Summarize this incident or series of
incidents. Include what was taken, how entry
was gained, how victim was
threatened/attacked, what weapons were
present and how they were used, any
injuries, what victim was doing at time of
attack/threat, whether the incident was
reported to the police or whether only
nonhousehold property was stolen.

ALSO INCLUDE DETAILS ABOUT THE
INCIDENT THAT ARE NOT PROVIDED IN
THE ANSWER CATEGORIES AND THAT
WILL HELP CLARIFY THE INCIDENT.
FIELD REPRESENTATIVE –
Check BOUNDING INFORMATION on the
back of the control card.

CHECK BOUNDING INFORMATION
909

CHECK
ITEM X

CHECK
ITEM Y
CHECK
ITEM Z

Is there an entry for "Number of persons"?
(Refer to 54 on page 7.)

Yes – Be sure you fill or have filled an Incident
Report for each interviewed household
member 12 years of age or over who was
harmed, threatened with harm, or had
something taken from him/her by force or
threat in this incident.
No

Is this the last Incident Report to be filled for
this screen question?

Yes – Fill Check Item Z
No – Go to next Crime Incident Report

Is this the last Incident Report to be filled for
this respondent?

Yes – FILL NCVS-1, Check Item H
No – Go to next Crime Incident Report

Page 24

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Notes

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Notes

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