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Innovation • Partnership • Safer Neighborhoods
U.S. Department of Justice Survey of Neighborhood Crime & Safety
Cover Page Graphics TBD
If you have any questions or concerns about this survey mailing, please call the Survey of Neighborhood Safety
Helpline at 1-xxx-xxx-xxxx or send an email to [email protected]
Formatting Under Development
NOTICE – 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. The valid OMB
control number for this information collection is xxxx-xxxx. The time required to complete this
information collection is estimated to average 6 minutes per response, including the time to review
instructions, search existing data resources, to gather the data needed, and to complete and review
the information collection. Send comments regarding this burden estimate or any other aspect of
this data collection, including suggestions for reducing burden, to DOJ Clearance Officer (xxxx)
ADDRESS, Washington DC ZIP.
U.S. Department of Justice Survey
of Neighborhood Crime & Safety
INSTRUCTIONS
â Please use a black or blue pen to complete this form.
â Mark
to indicate your answer.
â If you want to change your answer, darken the box
and mark the correct answer.
START HERE
Your Neighborhood
The following questions ask about your neighborhood.
By neighborhood, we mean the general area around
your house or the building you live in, where you might
do things such as shopping, going to the park, or
visiting with neighbors.
1. O
n the whole, is this neighborhood a good place
to live?
Yes
No
2. H
ow much of a problem is litter, broken glass or
trash on the sidewalks and streets?
Never a problem
Almost never a problem
Sometimes a problem
Almost always a problem
Always a problem
3. H
ow much of a problem is crime in your
neighborhood?
Never a problem
Almost never a problem
Sometimes a problem
Almost always a problem
Always a problem
For each of the following statements, please indicate
whether you strongly agree, agree, disagree, or
strongly disagree.
4. People around here are willing to help their
neighbors.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
5. This is a close-knit neighborhood.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
6. People in this neighborhood can be trusted.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
57483
7. People in this neighborhood generally get
along with each other.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
8. People in this neighborhood share the same
values.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
Experiences of People in Your Household
The following questions ask about experiences with
victimization you and anyone in your household
have had over the last 12 months. Please include all
experiences, even if they were not reported to the
police.
9. In the last 12 months, has something belonging
to anyone in this household been stolen, such
as a TV, sports equipment, tools, lawn furniture,
bicycle, wallet, purse, jewelry, or cell phone?
Yes
No
10. In the last 12 months, did anyone break into
or attempt to break into your residence, or a
garage, shed, or storage room that you own
or rent?
Yes
No
11. In the last 12 months, were any cars, vans,
trucks or other motor vehicles owned by
anyone in this household stolen or used
without permission?
Yes
No
12. In the last 12 months, did anyone steal or
attempt to steal any parts from a vehicle owned
by anyone in this household, like a tire, car
stereo, hubcap or battery, or anything that was
left in a vehicle?
Yes
No
The following questions ask about incidents in which
someone in your household has been confronted,
attacked, or threatened. Such incidents might be
between people that don’t know each other, but often
involve people who do know each other. Please include
all incidents, whether or not the people involved knew
each other.
13. In the last 12 months, did anyone take or try to
take something by force or threat of force from
anyone in the household?
Yes
No
14. In the last 12 months, has anyone in this
household been attacked with some type of
weapon, such as a gun, knife, baseball bat, or
rock?
Yes
No
15. In the last 12 months, has anyone in this
household been attacked in another way, such
as someone grabbing, forcing unwanted sexual
activity, punching, or choking?
Yes
No
57483
16. In the last 12 months, has anyone in this
household been threatened with any kind of
attack?
Yes
No
Your Household
20. Please think about everyone who currently lives
in your household. In the table below, please
indicate how many females and how many
males are in each age range provided.
Police and 911 Services
Age
Range
Please indicate whether you strongly agree, agree,
neither agree nor disagree, disagree, or strongly
disagree with each of the following statements.
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
18. The police do a good job in responding to
people in the neighborhood after they have
been victims of crime.
Strongly Agree
Agree
Neither Agree nor Disagree
Disagree
Strongly Disagree
19. When people in your neighborhood call 911,
does help arrive quickly?
Yes
No
Don’t Know
Number
of Males
Under 18
years old
18 through
24 years old
17. The police are doing a good job in dealing with
problems that really concern people in this
neighborhood.
Strongly Agree
Number
of Females
25 through
34 years old
35 through
54 years old
55 years old
and older
21. In your household, is any adult not working
who would like to find a job? (Do not include
students or retired persons.)
Yes
No
22. Does anyone in your household work in the
following fields?
Medical or Health Field?
Yes
No
Mental Health Services Field?
Yes
No
Law Enforcement or Security
Field?
Yes
No
Retail Sales?
Yes
No
Transportation Field?
Yes
No
57483
23. Do you own or rent the place where you’re
living?
Own
25. How many times have you moved in the past 5
years?
0 times
Rent
1 times
Other
2 times
3 or more times
24. How long have you lived at this address?
1 year or less
1 to 5 years
5 or more years (skip to 26)
26. What is the best phone number to use to
contact you? (This phone number will only be
used for the purpose of this research study.)
-
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Thank you for completing this survey. Please return your form in the postage paid
envelope provided or mail to:
Mail
to:
Name
Address
City, State Zip
57483
| File Type | application/pdf |
| File Modified | 2011-07-21 |
| File Created | 2011-07-21 |