NCVS-7 National Crime Victimization Survey 7

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

NCVS-7

FORM
(10-14-2004)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

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

U.S. DEPARTMENT OF JUSTICE

NONINTERVIEW RECORD

Control number
PSU

Segment/Suffix

Sample
designation/Suffix

Serial/
Suffix

FIELD REPRESENTATIVE
Type A – Fill Control number and items 1 –11
Type B – Fill Control number and items 1 – 6, and 11
Type C – Fill Control number and items 1, 5, and 6

6.
216

NOTE: Do not use this form for Type Z noninterviews

1.

Return date

Name

218

201

207

3.
208

4.

219

1

Urban

2

Rural

216

FARM SALES (Type A or B only) (cc item 10)

226
227
225

X

Item blank

1

$1,000
or more

2

Less than
$1,000

228
229

TYPE OF LIVING QUARTERS (Type A or B only)
(cc items 11c and 11d)

1
2
3
4
5
6
7

230
231
232

House, apartment, flat
HU in nontransient hotel, motel, etc.
HU permanent in transient hotel, motel, etc.
HU in rooming house
Mobile home or trailer with no permanent room added
Mobile home or trailer with one or more permanent
rooms added
HU not specified above – Describe

233

216

247
240
241
242
243
244
245

OTHER unit
8
9
10
11
12

246

Quarters not HU in rooming or boarding house
Unit not permanent in transient hotel, motel, etc.
Unoccupied site for mobile home, trailer, or tent
Student quarters in college dormitory
OTHER unit not specified above – Describe

256
257
248

7.
217

5.

Refused – Fill 7
Other occupied – Specify

Then fill 7

LAND USE (Type A or B only) (cc item 9)

Housing unit
209

REASON FOR NONINTERVIEW (cc item 30f)
TYPE A
211
Duplicate (2000 sample design only) – Fill 7
213
Language problems – Fill 7
216
No one home – Fill 7
217
Temporarily absent Then fill 7

FIELD REPRESENTATIVE IDENTIFICATION
Code

2.

NATIONAL CRIME
VICTIMIZATION SURVEY

HH No. Spinoff
Indicator

*
8.

DATE COMPLETED

219

215
Month

Day

Year

Notes

9.
220

10.
221

11.
222

223

USCENSUSBUREAU

N
C
V
S

TYPE B
Vacant – regular
Vacant – storage of HH furniture
Temporarily occupied by persons with usual residence
elsewhere (URE)
Unfit or to be demolished
Under construction, not ready
Converted to temporary business or storage
Unoccupied site for mobile home, trailer, or tent
Permit granted, construction not started
Other – Specify

TYPE C
Unused line of listing sheet
Demolished
House or trailer moved
Outside segment
Converted to permanent business or storage
Merged
Condemned
Built after April 1, 1990/2000
Removed during subsampling (2000 sample design only)
Unit already had a chance of selection (2000 sample design only)
Permit abandoned or other – Specify

RACE (Type A only) Mark (X) all that apply. (cc item 24)
White
1
2
Black
3
Other
PUBLIC HOUSING (Type A only) (cc item 8c)
Item blank
X
Yes (public housing)
1
No (not public housing)
2
MANAGER VERIFICATION OF PUBLIC HOUSING
(Type A only) (cc item 8d)
X
Item blank
Unable to verify
Able to verify
1
3
CATI/telephone
Public housing
2
Not public housing
Other – Specify
4

AMERICAN INDIAN RESERVATION OR AMERICAN
INDIAN LANDS (Type A only) (cc item 8e)
X

Item blank

1

Yes

2

No

RESTRICTED ACCESS (Type A or B only) (cc item 27c)
Gated or walled community
X
1
Yes
2
No
Item blank
Building with restricted access
X
Item blank
1
Yes
2
No

7