Attachment 4b CATI CAPI incident report

OMB No.
FORM

SCV-2

: Approval Expires MM/DD/YEAR

RTI-INTERNATIONAL

ACTING AS COLLECTING AGENT FOR THE
BUREAU OF JUSTICE STATISTICS

IImplementation Date: (dd-mm-yyyy)

U.S. DEPARTMENT OF JUSTICE

CRIME INCIDENT REPORT
SURVEY OF CRIME VICTIMIZATION
2. INCIDENT ADDRESS
[FOR CIR2+, FILL: Next,] You reported that in the past 6
months, that is since FILL DATE, you experienced the
following: FILL INCIDENT (1,2,3..) DESCRIPTION CREATED
BY INTERVIEWER. Did this incident happen while you
were living here or before you moved to this
address?
3a. INCIDENTDATE
In what month and year did this incident
happen?
Encourage respondent to give exact month.

3b. We are only asking about crimes that
happened in the past 6 months. We will not
collect information on this incident. Did you have
anything else like this happen between [FILL
REFERENCE PERIOD]?
4. INCIDENTNUMBEROFTIMES

1
2

605

While living at this address
Before moving to this address

2
606

Month

Year

IF DATE IS OUTSIDE OF REFERENCE PERIOD, ASK 3b.
ELSE, CONTINUE TO 4.
1

Yes - START NEW CIR TO GET DATE OF THIS INCIDENT;
THEN PROCEED WITH REMAINING CIR QUESTIONS.

2

No - START CIR FOR NEXT TYPE OF CRIME REPORTED IN
SCREENER, OR GO TO END.

____________ Number of incidents

607

If unsure, ask -

Altogether, how many times did this type of
incident happen during the last 6 months?
5a.

CHECK

How many incidents?
(Refer to 4.)

608

ITEM A

1
2

1-5 incidents (not a "series") - SKIP to 6
6 or more incidents - ASK 5b

5b.

CHECK

INCIDENTSSIMILAR

609

1
2

Similar - ASK 5c
Different (not a "series") - SKIP to 6

610

1
2

Yes (not a "series")
No (is a "series")

ITEM B

If unsure, ask:

Are these incidents similar to each other in
detail or are they for different types of crimes?
5c.

CHECK

ITEM C

RECALLDETAILS

If unsure, ask:

Can you recall enough details of each incident to
distinguish them from each other?
6. INCIDENTTIME
(If box 2 is marked in 5c, read: The following questions

refer only to the most recent incident.)
About what time did (this/the most recent)
incident happen?

612
1
2
3
4
5
6
7
8
9

RTI INTERNATIONAL

S
C
V

During day
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
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
Don't know whether day or night

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

7a. INCIDENTPLACE

613

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

Outside U.S.
Not inside a city/town/village
SAME city/town/village as present residence
DIFFERENT city/town/village from
present residence

1
2
3
4

8a. LOCATION_GENERAL

5

Don't know

1

In your home or lodging? - ASK 8b
Near your home? - SKIP to 8c
At, in or near a friend's/relative's/neighbor's
home?

2

Did this incident happen ...

3

Read each category until respondent says "yes", then
enter appropriate precode.

4

At a commercial place?
In a parking lot or garage?
At school?
In open areas, on the street, or
on public transportation?
Some where else?

5
6
7
8

8b. LOCATION_IN_HOME

616

1

In own dwelling, own attached garage,
or enclosed porch (Include illegal entry
or attempted illegal entry of same)

2

In detached building on own property,
such as detached garage, storage shed,
etc. (Include illegal entry of same)

Ask if necessary:
Where in your home or lodging did this
incident happen?

3

In vacation home/second home
(Include illegal entry or attempted
illegal entry of same)

4

In hotel or motel room respondent was
staying in (Include illegal entry or
attempted illegal entry of same)

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 or lodging

5

8c. LOCATION_NEAR_HOME
Ask if necessary:

6

Where near your home or lodging did this
incident happen?

7

9. OFFENDERLIVE
Did the person who committed the crime, that is
the offender, live (here/there or have a right to
be (here/there), for instance, as a guest or a
repair person?
10. OFFENDERINSIDE

617

618

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

619

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

12. FORCEDENTRY
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)?

Page 2

620

2

Yes - SKIP to 15a
No

3

Don't know

1
2

Yes - SKIP to 12
No

3

Don't know

1
2

Yes - ASK 12
No - SKIP to 15a

3

Don't know - ASK 12

1

Yes - ASK 13
No - SKIP to 14

1

2

ASK 10

ASK 11

SKIP
to 15a

SKIP
to 9

SKIP
to 15a

Window

13. EVIDENCE
625

What was the evidence?

1

Damage to window (include frame,
glass broken/removed/cracked)

2

Screen damaged/removed

3

Lock on window damaged/tampered
with in some way

4

Other - Specify_____________________

*

Probe: Anything else?
Enter all that apply.

SKIP
to 15a

Door

626

*

5

Damage to door (include frame, glass
panes or door removed)

6

Screen damaged/removed

7

Lock or door handle damaged/tampered
with in some way

8

Other - Specify _____________________

SKIP
to 15a

Other

Other than window or door - Specify____________

9

14. OFFENDERGETIN

627

How did the offender (get in/TRY to get in)?

1

Let in

2

Offender pushed his/her way in after
door opened

3

Through OPEN DOOR or other opening

4

Through UNLOCKED door or window

5

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

6

7

15a. HHMEMBERPRESENT

8

Don't know

9

Other - Specify _____________________

634

1
2

Yes - ASK 15b
No - SKIP to 34

635

1

Respondent only
Respondent and other household
member(s)
Only other household member(s), not
respondent - SKIP to 34

Ask or verify Were you or any other member of this
household present when this incident
occurred?
You may need to probe to obtain more details to
determine if respondent was present.
15b. WHICHMEMBER
Ask or verify -

2

Which household members were present?

3

16. SEEOFFENDER

636

1
2

Yes
No

637

1
2
3

Yes - ASK 18a
No
Don't know

Ask or verify -

Ask 16

Did you personally see an offender?
17. WEAPONPRESENT
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?
18a. WEAPON
What was the weapon?
Probe: Anything else?
Enter all that apply.

18b. WEAPON_SPEC

638

*

1
2
3
4
5
6

SKIP to 19

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 - ASK 18b

SKIP
to 19

Specify

Please specify the other weapon.
Page 3

19. ATTACK

639

1
2

Yes - SKIP to 24a
No - ASK 20

640

1
2

Yes - SKIP to 23a
No - ASK 21

641

1
2

Yes - SKIP to 23c
No - ASK 22a

642

1
2

Did the offender hit you, knock you down or
actually attack you in any way?
20. TRYATTACK
Did the offender TRY to attack you?
21. THREATEN
Did the offender THREATEN you with harm in
any way?
22a. WHATHAPPEN

*

What actually happened?

3
4

Probe: Anything else?
Enter all that apply.

5
6
7
8
9
10

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 - ASK 22b

SKIP
to 28a

Specify - SKIP to 28a

22b. WHATHAPPEN_SPEC
Please specify what actually happened.
23a. HOWTRYATTACK
How did the offender TRY to attack you?
Probe: Any other way?

643

*

1
2
3
4
5

Enter all that apply.

6
644

*

7
8
9
10

645

*

11
12
13
14

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 - ASK 23b

SKIP
to 28a

Specify - SKIP to 28a

23b. HOWTRYATTACK_SPEC
Please specify how the offender TRIED to attack you.
23c. HOWTHREATEN
How were you threatened?

643

*

Probe: Any other way?

1
2
3
4
5

Enter all that apply.

6
644

*

7
8
9
10

645

*

11
12
13
14

23d. HOWTHREATEN_SPEC
Please specify how you were threatened.
Page 4

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 - ASK 23d

Specify - SKIP to 28a

SKIP
to
28a

24a. HOWATTACK

1
2
3

646

How were you attacked?

*

Probe: Any other way?

4
5
6
7
8
9
10

Enter all that apply.
647

*

11

648

*

12
13
14

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 - ASK 24b

SKIP
to 25a

Specify

24b. HOWATTACK_SPEC
Please specify how you were attacked.
25a. INJURY

655

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

*

1
2
3
4
5

Enter all that apply.
656

6

*

7
8
9
10
11

SKIP to 28a
None
Raped
Attempted rape
Sexual assault other than rape or attempted
rape
Knife or stab wounds
Gun shot, bullet wounds
SKIP
Broken bones or teeth knocked out
to
Internal injuries
26a
Knocked unconscious
Bruises, black eye, cuts, scratches,
swelling, chipped teeth
Other - Specify - ASK 25b

Specify

25b. INJURY_SPEC
Please specify the injuries you suffered.
26a. MEDICALCARE

659

1
2

Were you injured to the extent that you
received any medical care, including self
treatment?
26b. RECEIVECAREWHERE
Where did you receive this care?

4
5
6
7

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____________________

1
2

Yes - ASK 27a
No - SKIP to 28a

662

1
2

Yes - ASK 27b
No - SKIP to 28a

663

____________ Number of days

660

*

Probe: Anywhere else?
Enter all that apply.

26c.

CHECK

ITEM D

1
2
3

Is (box 6) "Hospital" marked in
26b?

27a. CAREOVERNIGHT
Did you stay overnight in the hospital?
27b. CAREDAYHOSPIT

Yes - ASK 26b
No - SKIP to 28a

How many days did you stay in the hospital?
28a. PROTECTSELF

666

28b. DURINGINCIDENT
Was there anything you did or tried to do about the
incident while it was going on?

1
2

Did you do anything with the idea of protecting
YOURSELF or your PROPERTY while the
incident was going on?
667

1
2

Yes - ASK 29
No/took no action/kept still - ASK 28b

Yes - ASK 29
No/took no action/kept still - SKIP to 30

Page 5

29. ACTIONSDURINGINC
What did you do?
Probe: Anything else?

USED PHYSICAL FORCE TOWARD OFFENDER
668

*

Enter all that apply.

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

1
2
3
4
5
6

RESISTED OR CAPTURED OFFENDER
669

*

Defended self or property (struggled,
ducked, blocked blows, held onto property)
Chased, tried to catch or hold offender

7
8

SCARED OR WARNED OFF OFFENDER
Yelled at offender, turned on lights,
threatened to call police, etc.

9

PERSUADED OR APPEASED OFFENDER
10
670

11

*

Cooperated, or pretended to (stalled, did
what they asked)
Argued, reasoned, pleaded, bargained, etc.
ESCAPED OR GOT AWAY

12

Ran or drove away, or tried; hid, locked door
GOT HELP OR GAVE ALARM

671

13
14

*
15

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

30. ANYONEPRESENT

677

Other - Specify __________________________

1

Yes - ASK 31
No
Don't know

2

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

16

3

1

682

2

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 18
years of age.)
32. PERSONSHARMEDNUM

3

Yes - ASK 32
No
Don't know

SKIP to 34

SKIP to 34

683

____________ Number of persons

684

____________ Number of persons

How many? (Do not include yourself, the
offender or children under 18 years of age.)
33a. HHMEMHARMED
How many of these persons are members of
your household now? (Do not include yourself,
the offender or children under 18 years of age.)

0

33b. HHMEMHARMED_NAMES

None - SKIP to 34

Line number(s)

If not sure ask:
Who are these household members? (Do not
include yourself, the offender, or children
under 18 years of age)
Enter the line number(s) of other household members.

34. ONEORMOREOFFENDERS
Ask or verify Was the crime committed by only one or by
more than one offender?

Page 6

692

1
2
3

Only one - SKIP to 36
More than one - SKIP to 45
Don't know - ASK 35

35. KNOWOFFENDERS

693

1
2

Yes - ASK 36
No - SKIP to 57

698

1
2
3

Male
Female
Don't know

1
2
3

Do you know anything about one of the
offenders?
36. SINGOFFENDERGENDER
Was the offender male or female?
37. SINGOFFENDERAGE

700

1
2
3

Under 12
12-17
18-29
30 or older
Don't know
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 39
No (not drinking/not on drugs)
Don't know (if drinking or on drugs)

699

How old would you say the offender was?
38a. SINGOFFENDERGANG

4
5

Was the offender a member of a street gang, or
don't you know?
38b. SINGOFFENDERDRINKDRUG
Was the offender drinking or on drugs, or don't
you know?
39. SINGOFFENDERDRINKORDRUG

40. SINGOFFENDERKNEW

1
2
3
4

703

1
2
3

Knew or had seen before - SKIP to 42
Stranger
Don't know

704

1
2
3

Yes
Not sure (possibly or probably)
No

705

1
2

Sight only - SKIP to 44
Casual acquaintance
Well known

Was the offender someone you knew or a
stranger you had never seen before?
41. SINGOFFENDERRECOG
Would you be able to recognize the offender if
you saw him/her?
42. SINGOFFENDERHOWWELL
How well did you know the offender - by sight
only, casual acquaintance, or well known?
43. SINGOFFENDERRELATION

3
707
1
2
3
4

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

5
6
7
8
9
10
11
12
14
15
16
17
18
13

44a. Were any of the offenders Hispanic or
Latino?

1
2
3

44b. SINGOFFENDERRACE

708

What race or races was the offender?
Please select one or more.
Was the offender...

1
2
3
4
5
6

45. HOWMANYOFFENDERS

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

702

Which was it? (Drinking or on drugs?)

710

SKIP to 40

SKIP to 44a

ASK 43

RELATIVE
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)
Teacher/school staff
Other nonrelative - Specify___________
Yes
No
Don't know

White?
Black or African American?
American Indian or Alaska Native?
Asian?

SKIP to 57

Native Hawaiian or other Pacific
Islander?
Don't know
Number of offenders

How many offenders?
Page 7

46. MULTOFFENDERGENDER

711

1
2
3
4

All male
All female
SKIP to 48
Don't know sex of any offenders
Both male and female
If only two offenders, SKIP
to 72; otherwise ASK 47

712

1
2
3
4

Mostly male
Mostly female
Evenly divided
Don't know

1
2
3

Under 12
12-17
18-29
30 or older
Don't know

Were they male or female?

47. MULTOFFENDERMOSTGENDER
Were they mostly male or mostly female?

48. MULTOFFENDERYOUNG

713

How old would you say the youngest was?

4
5

49. MULTOFFENDEROLD

4
5

Under 12
12-17
18-29
30 or older
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 51
No (not drinking/not on drugs)
Don't know (if 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

718

1
2
3
4

All known
Some known
All strangers
Don't know

719

1
2
3

Yes
Not sure (possibly or probably)
No

720

1
2
3

Sight only
Casual acquaintance
Well known

1
2
3

714

How old would you say the oldest was?

50a. MULTOFFENDERGANG
Were any of the offenders a member of a street
gang, or don't you know?
50b. MULTOFFENDERDRINKDRUG
Were any of the offenders drinking or on
drugs, or don't you know?
51. MULTOFFENDERDRINKORDRUG
Which was it? (Drinking or on drugs?)
52. MULTOFFENDERKNEW
Were any of the offenders known to you, or
were they strangers you had never seen
before?
53. MULTOFFENDERRECOG
Would you be able to recognize any of them if
you saw them?
54. MULTOFFENDERHOWWELL

*

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

SKIP to 52

SKIP
to 54
ASK 53

SKIP to 56a

Probe: Anything else?
Enter all that apply.
55. MULTOFFENDERRELATION
How did you know them? For example, were
they friends, cousins, etc.?

723

*

Probe: Anything else?

1
2
3
4
5
6

Enter all that apply.
724

*

725

*

7
8
9
10
11
12
14
15
16
17
18
13

Page 8

RELATIVE
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)
Teacher/school staff
Other nonrelative - Specify __________

56a. Were any of the offenders Hispanic or
Latino?

1

Yes - AKS 56b

2

No
Don't know

3

56b. What ethnicity were most of the offenders?

1

Mostly Hispanic or Latino

2

Mostly non-Hispanic or Latino
Equal number of each ethnicity
Don't know

3
4

56c. What race or races were the offenders?
Please select one or more.
Were they...

726

*

White?
Black or African American?
American Indian/Alaska Native?
Asian?

1
2
3
4

Probe: Anything else?

SKIP to 56c

Native Hawaiian or other Pacific Islander?
Don't know

5
6

IF MORE THEN ONE ANSWER OPTION IS
CHOSEN, GO TO 56d. ELSE, SKIP TO 57.

726

56 d. What race were most of the offenders?

*

1
2
3
4
5
6
7

731

57. THEFT
Ask or verify:

Mostly White
Mostly Black or African American
Mostly American Indian or Alaska Native
Mostly Asian
Mostly Native Hawaiian or otherPacific Islander
Equal number of each race
Don't know

1

Yes - SKIP to 65a

2

No
Don't know

3

Was something stolen or taken without
permission that belonged to you or others in
the household? (Include anything stolen from
the business operated from the respondent's
home.)
58. ATTEMPTTHEFT

732

Ask or verify:
Did the offender(s) ATTEMPT to take something
that belonged to you or others in the household?
(Include anything stolen from the operated from
the respondent's home.)
59. ATTEMPTTHEFTWHAT
What did the offender try to take?
Probe: Anything else?
Enter all that apply.

Yes - ASK 59
No
Don't know

1
2
3

733

*

734

1
2
3
4
5
6
7

*

735

*

736

8
9
10
11
12
13

*

737

*
60. ATTEMPTTHEFTOWNER
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?
61.

CHECK

ITEM E

Did the offender try to take cash, a
purse, or a wallet?
(Is box 1, 2, or 3 marked in 59?)

738

14
15
16
17
1
2
3
4
5

SKIP to 74

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 ____________________
Don't know
Respondent only
Respondent and other household
member(s)
Other household member(s) only
Nonhousehold member(s) only
Other - Specify___________________
Yes - ASK 62
No - SKIP to 63
Page 9

62. ATTEMPTTHEFTONPERSON

742

1
2

Yes
No

745

1
2

Yes - ASK 64
No - SKIP to 74

Ask or verify:
Was the (cash/purse/wallet) on your person,
for instance, in a pocket or being held?
63. ATTEMPTTHEFTITEMONPERSON
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
64. ATTEMPTTHEFTITEMS
Which items did the offender(s) try to take
directly from you?

746

*

4
5
6
7

Exclude property not belonging to respondent or
other household member.

8
9
10
11
12
13
14
15
16
40

65a. WHATWASTAKEN
What was taken that belonged to you or
others in the household?

748

*

Probe: Anything else?
Enter all that apply.
749

*

1
2
3
4

5
6
7
8
9
10

750

11

*
12
13

*

Part of motor vehicle (tire, hubcap, attached car
stereo or satellite radio, attached CB radio, etc.)
Unattached
Other motormotor
vehiclevehicle accessories or equipment
(unattached CD player or satellite radio, etc.)
Gasoline or oil
Bicycle or parts
HOUSEHOLD FURNISHINGS
TV, DVD player, VCR, stereo, other household
appliances
Silver, china, art objects
Other household furnishings (furniture, rugs, etc.)

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

17
18

753

VEHICLE OR PARTS
Car

20
21

752

*

CASH/PURSE/WALLET/CREDIT CARDS
Cash
Purse
Wallet
Credit cards, check, bank cards

19

14
15
16

MISCELLANEOUS
754

*
755

22
23
24
25
26
27

Page 10

SKIP
to 74

Tried to take everything marked in 63
directly from respondent

PERSONAL EFFECTS
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

*
*

751

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

Tools, machines, office equipment
Farm or garden produce, plants, fruit, logs
Animals -pet or livestock
Food or liquor
Other - Specify _______________
Don't know

65b.

CHECK

ITEM F

Follow the skip pattern for the first
category met, based on the entries in
65a.

If Box 2 and/or 3 is marked in 65a - SKIP to 65c
If Box 1 is marked in 65a - SKIP to 65d
If none of the conditions above are met - SKIP to 66

65c. PRSWLT_CONTAINMONEY

1
2

Did the stolen (purse/wallet) contain any
money?
65d. AMOUNTCASHTAKEN

747

Yes - ASK 65d
No

$ ____________ .

If Box 1 is marked in 65a ASK 65d
otherwise SKIP to 66

00

Amount of cash taken

If not sure, ask:
How much cash was taken?
66.

CHECK

ITEM G1

Yes - ASK 67
No - SKIP to 69

Was a car or other motor vehicle
stolen?
(Is box 5 or 6 marked in 69a?)

67. PERMISSIONGIVEN

763

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

764

Did the offender return the (car/motor vehicle)
this time?
69.

CHECK

ITEM G2

1
2
3

Yes - ASK 68
No
Don't know

1
2

Yes
No

Yes - ASK 70a
No - SKIP to 70b

Did the offender(s) take a
handgun?
(Is box 20 marked in 69a?)

70a. NUMBERHANDGUNS

SKIP to 69

923

Number of handguns

How many handguns were taken?
70b.

CHECK

ITEM G3

Yes - ASK 70c
No - SKIP to 70d

Did the offender(s) take some other
type of firearm?
(Is box 21 marked in 65a?)

70c. NUMBERFIREARMS

924

Number of firearms

How many other types of firearms were taken?
70d.

CHECK

ITEM H1

Yes - ASK 71a
No - SKIP to 71b

Was cash, a purse, or a wallet
taken? (Is box 1, 2, or 3 marked in
65a?)

71a. CASHONPERSON

767

1
2

Yes
No

768

1
2

Yes - ASK 72
No - SKIP to 73a

Ask or verify:
Was the (cash/purse/wallet) on your person,
for instance, in a pocket or being held?
71b. OTHERONPERSON
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?
Exclude property not belonging to respondent
or other household member

Page 11

72. ITEMSTAKEN
Which items did the offender(s) take directly
from you?

769

4

*

5
6
7

Exclude property not belonging to respondent or
other household member.

8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
40

73a.

CHECK

ITEM H2

Were only cash, a purse, or a wallet
taken? (Are boxes 1, 2, or 3 the
only boxes marked in 65a?)

73b. PROPERTYVALUE
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 the share owned by household
members.)

Credit cards, check, bank cards
Car
Part of motor vehicle (tire, hubcap, attached car
stereo or satellite radio, attached CB radio, etc.)
Unattached
Other motormotor
vehiclevehicle accessories or equipment
(unattached CD player or satellite 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.)
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
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)
Tools, machines, office equipment
Farm or garden produce, plants, fruit, logs
Animals -pet or livestock
Food or liquor
Other
Everything marked in 96a was taken
directly from respondent
Yes - SKIP to 74
No - ASK 73b

770

$ ____________ .

00

Value of property taken

Enter total dollar value for all items taken.
74. POLICEINFORMED

800

Were the police informed or did they find out
about this incident in any way?
75a. POLICEFINDOUT
How did the police find out about it?
Enter first precode that applies.
If proxy interview, we want the proxy respondent to
answer questions 75a - 79 for herself/himself, not for the
person for whom the proxy interview is being taken.

75b. POLICEFINDOUT_SPEC
Please specify how the police found out about it.

Page 12

801

1
2
3

1
2
3
4
5
6
7

Yes - ASK 75a
No - SKIP to 76
Don't know - SKIP to 78
Respondent
Other household member
Someone official called police (guard, apt.
manager, school official, etc.)
Someone else
Police were at scene
Offender was a police officer
Some other way - Specify - ASK 75b

Specify - SKIP to 77

SKIP
to 77

76. NOTREPORTEDPOLICE
What was the reason it was not reported to the
police?

802

*

1
2

Probe: Can you tell me a little more? Any other
reason?

DEALT WITH ANOTHER WAY
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

6

NOT IMPORTANT ENOUGH TO RESPONDENT
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
No insurance, loss less than deductible, etc.

803

7

POLICE COULDN'T DO ANYTHING
Didn't find out until too late

*

8

3

Enter all that apply.
4
5

STRUCTURED PROBE 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?

9

Could not recover or identify property Could not
find or identify offender, lack of proof
POLICE WOULDN'T HELP

10

11

804

*
12
13

805

*
806

14
15
16
17

*

18
19

77.

CHECK

ITEM I

Were the police informed? (Is
"Yes" marked in 74?

78. CONTACTAUTHORITIES

829

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

830

*

Probe: Any others?

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
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

1
2

Yes - ASK 78
No - SKIP to 80

1
2
3

Yes - ASK 79
No
Don't know

1
2
3
4
5

Prosecutor, district attorney
Magistrate
Court
Juvenile, probation, or parole officer
Other - Specify__________________

1
2
3
4
5
6
7
8
9
10
11

Working or on duty - SKIP to 82
On the way to or from work - SKIP to 82
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__________________
Don't know - ASK 81

1
2

Yes
No

SKIP to 80

Enter all that apply.
80. DOINGATINCIDENTTIME

832

Ask or verify:
What were you doing when this incident
(happened/started)?

81. JOBDURINGINCIDENT
Ask or verify:

840

ASK
81

Did you have a job at the time of the incident?

Page 13

82

CHECK

ITEM J

Is this incident part of a series of
crimes? (Is box 2 (is a "series")
marked in 5c?)

83a. SERIESNUMTIMES

Yes - ASK 83a
No - SKIP to 89

1
2

____________ Number of incidents - SKIP to 84a

883

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?
83b. SERIESDK

Don't know - ASK 83b

January _________________
February _________________
March ___________________
April _____________________
May _____________________
June _____________________
July ______________________
August ___________________
September ________________
October __________________
November _________________
December ________________

84. SERIESWHICHMONTHQ1
PROGRAMMER: DISPLAY THE SIX MONTHS IN THE
REFERENCE PERIOD.

885

How many times did this happen in:

85. SERIESLOCATION

1
2
3

889

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

1
2

893

Did the same thing happen each time?

All in the same place
Some in the same place
None in the same place
All by same person
Some by same person
None by same person
Don't know

1
2
3
4

890

Were all, some, or none of these incidents
done by the same person(s)?
87a. SAMETHINGEACHTIME

No way of knowing
Happened too many times
Some other reason - Specify___________

1
2
3

884

Is that because there is no way of knowing, or
because it happened too many times, or is
there some other reason?

Yes - SKIP to 88
No - ASK 87b

Specify

87b. HOWINCIDENTSDIFFER
How did the incidents differ?
88.

CHECK

ITEM K

SERIESCONTACTORNOT

CONTACT CRIMES

895
1

Do not read to respondent.
Enter precode that best describes this series of crimes.
If more than one category describes this series, enter
the appropriate precode with the lowest number.
Please choose only one code.

2

3
4

5
6

7

8
9

10

11

12

Page 14

Completed or threatened violence in the course of the
victim's job (police officer, security guard, psychiatric
social worker, etc.)
Completed or threatened violence between spouses,
other relatives, friends, neighbors, etc.
Completed or threatened violence at school or on
school property
Other contact crimes (other violence,
pocket picking, purse snatching, etc.) Specify ____________________________
Theft or attempted theft of motor vehicles
NONCONTACT CRIMES
Theft or attempted theft of motor vehicle parts (tire,
hubcap, battery, attached car stereo, etc.)
Theft or attempted theft of contents of motor vehicle,
including unattached parts
Theft or attempted theft at school or on school property
Illegal entry of, or attempt to enter, victim's home, other
building on property, second home, hotel, motel
Theft or attempted theft from victim's
home or vicinity by person(s) KNOWN to
victim (roommate, babysitter, etc.)
Theft or attempted theft from victim's home or vicinity
by person(s) UNKNOWN to victim
Other theft or attempted theft (at work, while
shopping, etc.) - Specify ____ __________________

SUMMARY
ITEM L
Summarize this incident. Also include any details
about the incident that were not asked about in the
incident report that might help clarify the incident.

89a.

CHECK

89b.

CRIME SERIES CHECK

PROGRAMMER: IF 5c=1 OR WAS NOT ASKED, DISPLAY: "PRESS NEXTTO CONTINUE." AND LOOP THOUGH CIRs AS NEEDED BASED ON THE
SCREENER DATA. AFTER LAST CIR, MOVE ON TO EMPLOYMENT QUESTIONS.
IF 5c=2 (INDICATING THAT THIS CIR IS SERIES), THEN DISPLAY:
CRIME SERIES CHECK:
INTERVIEWER: DETERMINE IF THE NEXT CIR IS PART OF A CRIME SERIES THAT HAS BEEN REPORTED PREVIOUSLY BY RESPONDENT.
INCIDENT X (CRIME SERIES): [FILL WITH DESCRIPTION OF CRIME SERIES INCIDENT FROM SCREENER]
NEXT CIR: [FILL WITH DESCRIPTION FROM SCREENER]
INTERVIEWER: YOU HAVE INDICATED THAT INCIDENT X [FILL 1,2, ETC.] IS PART OF A CRIME SERIES. IS THE NEXT CIR PART OF THE SAME
CRIME SERIES?
1
2

89c.

Yes - GO TO CHECK2
No - PRESS NEXT TO CONTINUE WITH NEXT CIR.

CHECK 2

YOU HAVE INDICATED THAT THE NEXT CIR IS PART OF A CRIME SERIES REPORTED BY THE
RESPONDENT. THE NEXT CIR WILL BE SKIPPED. IS THIS CORRECT?
1
2

Yes - SKIP NEXT CIR - PART OF CRIME SERIES ALREADY DISCUSSED
No - ADMINISTER CIR - NOT PART OF CRIME SERIES

90. JOBLASTWEEK
Did you have a job or work at a business last
week? Do not include volunteer work or work
around the house. (If R is a farm or business
operator, incude unpaid work.)
91. JOBDURINGREFPERIOD
Did you have a job or work at a business
during the last 6 months?

1
2

Yes - IF CATI INCENTIVE CASE, SKIP TO 92. ELSE, GO TO 93.
No - ASK 91

1
2

Yes
No

IF CATI INCENTIVE CASE, ASK 92. ELSE, GO TO 93.

CATI INCENTIVE CASES ONLY
92. Those are all the questions I have for you
today. In order to mail your incentive to you
and to make sure our information is correct, so
that we may contact you at Wave 2, I just need
to verify your contact information.
- FILL NAME FROM SCREENER1
- FILL ADDRESS/CITY/STATE/ZIP VERIFIED IN ADDRESS
VERIFICATION
- FILL PHONE NUMBERS PROVIDED IN SCREENER
Is this information correct?
92a. Do you have an e-mail address?

1
2

Yes
No - CORRECT INFORMATION

1
2

Yes
No - SKIP TO 92b

92a_1. What is your current e-mail address?

Page 15

92b.

Your incentive will be mailed to you from RTI.
Pease allow 3-4 weeks for delivery..
GO TO SPAWNING SCREENS.
FOR ALL CAPI CASES AND CATI NON-INCENTIVE CASES

93. To make sure our information is correct, so that
we may contact you at Wave 2, I just need to
verify the contact information you have
provided today.
- FILL NAME FROM SCREENER1
- FILL ADDRESS/CITY/STATE/ZIP VERIFIED IN ADDRESS
VERIFICATION
- FILL PHONE NUMBERS PROVIDED IN SCREENER
Is this information correct?

93a. Do you have an e-mail address?

1
2

Yes
No - CORRECT INFORMATION

1
2

Yes
No - IF CAPI INCENTIVE CASE, SKIP TO 93b. ELSE, GO TO SPAWNING
SCREENS

93a_1. What is your current e-mail address?
IF CAPI INCENTIVE CASE, SKIP TO 93b. ELSE, GO TO SPAWNING
SCREENS.
93b. INTERVIEWER: PLEASE PAY THE RESPONDENT THE CASH INCENTIVE AND COMPLETE THE INCENTIVE RECEIPT FORM.
GO TO SPAWNING SCREENS.

Page 16