NCVS-1A National Crime Victimization Survey 1A

OMB No. 1121-0111: Approval Expires 07/31/2006

NCVS-1A

BEFORE INTERVIEW – TRANSCRIBE FROM CONTROL CARD

FORM
(9-16-2004)

Control number
PSU

U.S. DEPARTMENT OF COMMERCE

Segment/Suffix

Sample
designation/
Suffix

Serial/
Suffix

Economics and Statistics Administration

HH No. Spinoff
Indicator

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

PERSONAL CHARACTERISTICS
NATIONAL CRIME VICTIMIZATION SURVEY

17.

18.

NAME
Last

19.

Type of interview

Line No.
401

Per. – Self-respondent
Tel. – Self-respondent
Per. – Proxy
Fill 13 on NCVS-1 cover page
Tel. – Proxy
Noninterview (Type Z) – Fill 19–28 on this page.
Also fill 14 and adjust item 15c on cover page of
corresponding NCVS-1

1
2
3

First

402

4
5

________
Line No.

AFTER INTERVIEW – TRANSCRIBE FROM CONTROL CARD

20.

21.

(cc 13b)
Relationship to
reference
person

(cc 17)
(cc 18)
Age last Marital status
birthday THIS survey
period

403

22a.

404

22b.

23.

24.

(From previous (cc 19)
Sex
enumeration)
Marital
status LAST
survey period

405

406

25.

26.

(cc 20)
(cc 21)
(cc 22)
Armed Educational Attending
Forces attainment school
member

407

408

409

27.

28.

(cc 23)
Hispanic
origin

(cc 24)
Race

413

412

411

Mark (X) all that
apply.

*
Husband
Wife
________
Son
Age
Daughter
Father
Mother
Brother
Sister
Other relative
Nonrelative
Ref. person

01
02
03
04
05
06
07
08
09
10
11

29.

1
2
3
4
5

Married
Widowed
Divorced
Separated
Never
married

Married
Widowed
Divorced
Separated
Never
married
Not interviewed
last
survey
period

1
2
3
4
5
6

1
2

M
F

1
2

Yes
No

0

____________
Highest level
completed

1

2
3

4

Regular
school
College/
University
Trade
school
Vocational
school
None of
the
above
schools

Yes
No

1
2

1
2
3

4
5

6

White
Black/African
American
American
Indian/Alaska
Native
Asian
Native
Hawaiian/Other
Pacific Islander
Other – Specify

501

Date of interview

Month

Day

Year

MOBILITY QUESTIONS
Before we get to the crime questions, I have one or two
questions that are helpful in studying where and why
crimes occur.

33a.

If unsure, ASK OR VERIFY –
How long have you lived at this address?
(Enter number of months OR years.)

505

OR
506

CHECK
ITEM A

33b.

____________ Years (Round to nearest whole year) –
Fill Check Item A

5 years or more – SKIP to 36a
Less than 5 years – Ask 33b

How many years are entered in 33a?

Altogether, how many times have you moved in the last
5 years, that is, since _________________, 20 ___?

____________ Months (1-11) – SKIP to 33b

508

____________ Number of times

USCENSUSBUREAU

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INDIVIDUAL’S SCREEN QUESTIONS

36a.

I’m going to read some examples that will give you
an idea of the kinds of crimes this study covers.

Briefly describe incident(s)

As I go through them, tell me if any of these
happened to you in the last 6 months, that is
since ________________, 20 ____.
Was something belonging to YOU stolen, such as –
(a) Things that you carry, like luggage, a wallet,
purse, briefcase, book –
(b) Clothing, jewelry, or cellphone –
(c) Bicycle or sports equipment –
(d) Things in your home – like a TV, stereo, or tools –
(e) Things from a vehicle, such as a package,
groceries, camera, or CDs –
OR
(f) Did anyone ATTEMPT to steal anything
belonging to you?

36b.

MARK OR ASK –
Did any incidents of this type happen to you?

532

1

36c.

▲

2

Yes – What happened?
Describe above
No – SKIP to 40a

How many times?
533

Number of times (36c)

40a.

(Other than any incidents already mentioned,)
since __________ ______, 20 ____, were you
attacked or threatened OR did you have
something stolen from you –

Briefly describe incident(s)

(a) At home including the porch or yard –
(b) At or near a friend’s, relative’s, or
neighbor’s home –
(c) At work or school –
(d) In places such as a storage shed or
laundry room, a shopping mall,
restaurant, bank, or airport –
(e) While riding in any vehicle –
(f) On the street or in a parking lot –
(g) At such places as a party, theater, gym,
picnic area, bowling lanes, or while
fishing or hunting –
OR
(h) Did anyone ATTEMPT to attack or ATTEMPT
to steal anything belonging to you from any
of these places?

40b.

MARK OR ASK –
Did any incidents of this type happen to you?

539

1

40c.

▲

2

Yes – What happened?
Describe above
No – SKIP to 41a

How many times?
540

Number of times (40c)
FORM NCVS-1A (9-16-2004)

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INDIVIDUAL’S SCREEN QUESTIONS

41a.

(Other than any incidents already mentioned,)
has anyone attacked or threatened you in any
of these ways (Exclude telephone threats) –

Briefly describe incident(s)

(a) With any weapon, for instance, a gun or
knife –
(b) With anything like a baseball bat, frying
pan, scissors, or stick –
(c) By something thrown, such as a rock or
bottle –
(d) Include any grabbing, punching, or choking,
(e) Any rape, attempted rape or other type of
sexual attack –
(f) Any face to face threats –
OR
(g) Any attack or threat or use of force by
anyone at all? Please mention it even if you
are not certain it was a crime.

41b.

MARK OR ASK –
Did any incidents of this type happen to you?

541

1

41c.

▲

2

Yes – What happened?
Describe above
No – SKIP to 42a

How many times?
542

Number of times (41c)

42a.

People often don’t think of incidents committed by
someone they know. (Other than any incidents
already mentioned,) did you have something stolen
from you OR were you attacked or threatened by
(Exclude telephone threats) –

Briefly describe incident(s)

(a) Someone at work or school –
(b) A neighbor or friend –
(c) A relative or family member –
(d) Any other person you’ve met or known?

42b.

MARK OR ASK –
Did any incidents of this type happen to you?

543

1

42c.

▲

2

Yes – What happened?
Describe above
No – SKIP to 43a

How many times?
544

Number of times (42c)

43a.

Incidents involving forced or unwanted sexual
acts are often difficult to talk about. (Other
than any incidents already mentioned,) have
you been forced or coerced to engage in
unwanted sexual activity by –

Briefly describe incident(s)

(a) Someone you didn’t know before –
(b) A casual acquaintance –
OR
(c) Someone you know well?

43b.

MARK OR ASK –
Did any incidents of this type happen to you?

545

1

43c.

▲

2

Yes – What happened?
Describe above
No – SKIP to 44a

How many times?
546

Number of times (43c)
FORM NCVS-1A (9-16-2004)

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INDIVIDUAL’S SCREEN QUESTIONS

44a.

During the last 6 months, (other than any
incidents already mentioned) did you call the
police to report something that happened to
YOU which you thought was a crime?

Briefly describe incident(s)

547

1
2

548

CHECK
ITEM B

OFFICE USE ONLY

*
549

1
2

Yes – Ask 44b
No – SKIP to 45a

▼

44b.

Look at 44a. If unsure, ASK, otherwise, mark
without asking. Were you (was the respondent)
attacked or threatened, or was something
stolen or an attempt made to steal
something that belonged to you (the
respondent) or another household member?

Yes – What happened?
Describe above
No – SKIP to 45a

How many times?

550

Number of times (44b)

45a.

During the last 6 months, (other than any
incidents already mentioned) did anything
which you thought was a crime happen to YOU,
but you did NOT report to the police?

Briefly describe incident(s)

551

1
2

552

CHECK
ITEM C

OFFICE USE ONLY

*
553

1
2

Yes – Ask 45b
No – SKIP to Check Item D

▼

45b.

Look at 45a. If unsure, ASK, otherwise, mark
without asking. Were you (was the respondent)
attacked or threatened, or was something
stolen or an attempt made to steal
something that belonged to you (the
respondent) or another household member?

Yes – What happened?
Describe above
No – SKIP to Check Item D

How many times?

554

Number of times (45b)
NOTES

FORM NCVS-1A (9-16-2004)

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INDIVIDUAL’S CHECK ITEMS D, E, AND G
CHECK
ITEM D

Who besides the respondent was present when the
screen questions were asked? (If telephone
interview, mark box 1 only.)

555

1

*

2
3
4
5
6
7
8

CHECK
ITEM E

If self-response interview, SKIP to Check Item G
Did the person for whom this interview was taken
help the proxy respondent answer any screen
questions?

CHECK
ITEM G

Telephone interview – SKIP to Check Item G
Personal interview – Mark all that apply.
No one besides respondent present
Respondent’s spouse
HHLD member(s) 12+, not spouse
HHLD member(s) under 12
Nonhousehold member(s)
Someone was present – Can’t say who
Don’t know if someone else present

Transcribe "number of times" entry for each of
the following:

556

1
2
3

Yes
No
Person for whom interview taken not present
No entries transcribed below – Go to
Check Item H

(a) Screen Question, Item 36c, page 2

____________ Number of times (36c)

(b) Screen Question, Item 40c, page 2

____________ Number of times (40c)

(c) Screen Question, Item 41c, page 3

____________ Number of times (41c)

(d) Screen Question, Item 42c, page 3

____________ Number of times (42c)

(e) Screen Question, Item 43c, page 3

____________ Number of times (43c)

(f) Screen Question, Item 44b, page 4

____________ Number of times (44b)

(g) Screen Question, Item 45b, page 4

____________ Number of times (45b)

NOTES

FIELD REPRESENTATIVE – After completing Check Item G, fill a separate crime incident report for each screen question that has an entry
of 1 or more. Do this before marking Check Item H.
FORM NCVS-1A (9-16-2004)

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INDIVIDUAL’S EMPLOYMENT QUESTIONS
Be sure to fill any incident reports before marking Check Item H.

CHECK
ITEM H

47a.

1

Is the respondent 16 years or older?

2

Did you have a job or work at a business LAST WEEK?
(Do not include volunteer work or work around the house.)
(If farm or business operator in household, ask about
unpaid work.)

576

1
2

Yes – Ask 47a
No – SKIP to Check Item I

Yes – SKIP to 48a
No – Ask 47b

ASK OR VERIFY –

47b.

Did you have a job or work at a business DURING THE
LAST 6 MONTHS?

47c.

Did that (job/work) last 2 consecutive weeks
or more?

577

1
2

578

1
2

Yes – Ask 47c
No – SKIP to Check Item I
Yes – Ask 48a
No – SKIP to Check Item I

ASK OR VERIFY –

48a.

Which of the following best describes your job?
PERSONAL INTERVIEW (Show flashcard)

579

TELEPHONE INTERVIEW – Were you employed in
the (Read main headings until you get a yes.
Then read answer categories) –

Medical Profession –As a –
1
Physician
Nurse
2
Technician
3
Other – Specify
4
Mental Health Services Field – Are your duties –
5
Professional (Social worker/psychiatrist)
Custodial care
6
Other – Specify
7

Mark (X) only one category.

Teaching Profession – Were you employed in a –
8
Preschool
Elementary
9
10
Junior high or middle school
High school
11
College or university
12
Technical or industrial school
13
Special education facility
14
Other – Specify
15
Law Enforcement or Security Field – Were you
employed as a –
16
Law enforcement officer
Prison or jail guard
17
Security guard
18
Other – Specify
19
Retail Sales – Were you employed as a –
Convenience or liquor store clerk
Gas station attendant
21
Bartender
22
Other – Specify
23
20

Transportation Field – Were you employed as a –
Bus driver
Taxi cab driver
25
Other – Specify
26
24

OR
27

48b.

ASK OR VERIFY –
Is your job with (Read answer categories) –

580

1
2
3
4

48c.
48d.

If box 12 is marked in 48a, mark without asking.
Are you employed by a college or university?

581

1
2

While working at your job, do you work mostly in
(Read answer categories) –

582

1
2
3
4

CHECK
ITEM I

Is this the last household member to be
interviewed?

Something else – Specify
A private company, business, or individual for wages?
The Federal government?
A State, county, or local government?
Yourself (Self-employed) in your own
business, professional practice, or farm?
Yes
No
A city?
Suburban area?
Rural area?
Combination of any of these?
Yes – END interview.
No – See note below before interviewing next
household member.

FIELD REPRESENTATIVE – If the current respondent is a parent or legal guardian and the next household member to be interviewed is
under 18, tell the current respondent that you will be asking the same questions you just asked him/her.
FORM NCVS-1A (9-16-2004)

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