Form #1 Permission to Obtain Police Report from Police Agency

55 East Monroe Street
Chicago, IL 60603

Procedure for obtaining police reports for
Survey of Crime Victimization Cognitive interviews
Method:
NORC will obtain written permission from the individual for each police report in order to obtain a copy
from the police department. (See Form #1). This will be done after the interview and payment process has
been completed.
Handling and Storage of Police Reports:
A trained NORC project staff member, based in Chicago, will work with the independent police department
to determine the correct procedure to obtain the report. Once the report is obtained by NORC staff, it will
be secured in an envelope and brought immediately back to NORC’s office where is will be secured in a
locked filing cabinet. Within two business days, NORC will convert the hardcopy form into an electronic
format and destroy the hardcopy. All electronic files will be stored on NORC’s secure servers. At the
completion of the study, all electronic forms will be permanently deleted.

Our mission is to conduct high quality social science research in the public interest.

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FORM #1: Permission to Obtain Police Report from Police Agency
Person Contact Information
Name:
Street Address:
City:

State:

Home Phone Number:

(

)

-

Cell Phone Number: (

Zip:
)

-

Incident Information
Date of Incident:

Police Report Number:

Incident
Location:

Name of Responding
Police Agency:

Short Description
of Incident:

NORC requests your permission to obtain a copy of the police report(s) for the incident described above.
Police report(s) will be used only by staff at NORC and the U. S. Bureau of Justice Statistics for the purpose
of making improvements to the National Crime Victimization Survey. The report(s) will be scanned and
stored on NORC’s secure server and the hard copy of the report will be destroyed. The findings from an
examination of the police reports will only be released in summary form that does not identify individuals
who participated in the study.
I, _______________________, grant permission to NORC to contact the police agency named above and
obtain the police report filed regarding the incident above.

Signature of Individual Granting Permission

Date