OMB No. 1121-0111: Approval Expires 7/31/2009 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 number. N C Control number NCVS-2 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 FORM Sample designation/Suffix Serial/ Suffix Spinoff Indicator Segment/Suffix HH No. PSU IImplementation Date: (07-01-2008) V Notes CRIME INCIDENT REPORT S NATIONAL CRIME VICTIMIZATION SURVEY LINE NUMBER OF RESPONDENT 1a. 601 Line number (ex., 01) 2 1b. SCREEN QUESTION NUMBER 602 Screen question number (ex., 39) 1c. INCIDENT NUMBER 603 Incident number (ex., 01) 2a. Has the respondent lived at this address for more than 6 months? (If not sure, refer to 33a on the NCVS-1 or ASK.) I CHECK Yes (more than 6 months) - SKIP to 3 No (6 months or less) - ASK 2 ITEM A N C I 2b. INCIDENTADDRESS While living at this address Before moving to this address D 1 605 You said that during the last 6 months - (description of the crime reported in the screen question.) Did (this/the first) incident happen while you were living here or before you moved to this address? 2 E N T 3. INCIDENTDATE R 606 E In what month did (this/the first) incident happen? Encourage respondent to give exact month. Month Year P O R 4. INCIDENTNUMBEROFTIMES ____________ Number of incidents 607 T If unsure, ask - Altogether, how many times did this type of incident happen during the last 6 months? 1-5 incidents (not a "series") - SKIP to 6 6 or more incidents - ASK 5b How many incidents? (Refer to 4.) 5a. CHECK 608 1 ITEM B 2 5b. Similar - ASK 5c Different (not a "series") - SKIP to 6 INCIDENTSSIMILAR CHECK 609 1 ITEM C 2 If unsure, ask: Are these incidents similar to each other in detail or are they for different types of crimes? 5c. Yes (not a "series") 1 610 CHECK RECALLDETAILS ITEM D No (is a "series") 2 If unsure, ask: Can you recall enough details of each incident to distinguish them from each other? 6. INCIDENTTIME During day 612 After 6 a.m. - 12 noon 1 (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? After 12 noon - 3 p.m. 2 After 3 p.m. - 6 p.m. 3 4 Don't know what time of day At night After 6 p.m. - 9 p.m. 5 6 After 9 p.m. - 12 midnight 7 After 12 midnight - 6 a.m. 8 Don't know what time of night OR 9 Don't know whether day or night USCENSUSBUREAU 7a. INCIDENTPLACE 613 Outside U.S. - SKIP to 10a Not inside a city/town/village - ASK 8a SAME city/town/village as present residence - SKIP to 9 1 2 In what city, town, or village did this incident occur? 3 DIFFERENT city/town/village from present residence 4 ASK 7b 5 Don't know - ASK 8a 7b. INCIDENTPLACESPEC Specify Please specify the city, town, or village, in which the incident occurred. 8a. INCIDENTSTATE 614 State ________________ In what state did it occur? 8b. INCIDENTCOUNTY County ________________ In what county did it occur? Yes 8c. COUNTYSTATE 615 1 2 No Ask or verify: Is this the same county and state as your present residence? 9. INCIDENTAIR Yes 1 633 2 No Did this incident occur on an American Indian Reservation or on American Indian Lands? 10a. LOCATION_GENERAL In your home or lodging? - SKIP to 10b 1 Near your home? - SKIP to 10c 2 Did this incident happen ... Read each category until respondent says "yes", then enter appropriate precode. At, in or near a friend's/relative's/neighbor's home? - SKIP to 10d 3 At a commercial place? - SKIP to 10e 4 In a parking lot or garage? - SKIP to 10f 5 At school? - SKIP to 10g 6 In open areas, on the street, or on public transportation? - SKIP to - 10h 7 Some where else? - SKIP to 10i 8 Notes Page 2 10b. LOCATION_IN_HOME In own dwelling, own attached garage, or enclosed porch (Include illegal entry or attempted illegal entry of same) 616 1 Ask if necessary: Where in your home or lodging did this incident happen? In detached building on own property, such as detached garage, storage shed, etc. (Include illegal entry of same) 2 SKIP to 11 In vacation home/second home (Include illegal entry or attempted illegal entry of same) 3 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) 10c. LOCATION_NEAR_HOME 5 Ask if necessary: Where near your home or lodging did this incident happen? SKIP to 18 Apartment hall, storage area, laundry room (does not include apartment parking lot/garage) 6 On street immediately adjacent to own home or lodging 7 At or in home or other building on their property 10d. LOCATION_OTHER_HOME 8 9 Yard, sidewalk, driveway, carport (does not include apartment yards) Ask if necessary: Where at, in, or near a friend's/relative's/ neighbor's home did this incident happen? 10 SKIP to 18 Apartment hall, storage area, laundry room (does not include apartment parking lot/garage) 1 On street immediately adjacent to their home Inside restaurant, bar, nightclub 10e. LOCATION_COMMERCE 12 Inside bank 24 Ask if necessary: At what type of a commercial place did this incident happen? Inside gas station 25 SKIP to 17c Inside other commercial building, such as a store 26 Inside office 14 Inside factory or warehouse 27 10f. LOCATION_PARKING Commercial parking lot/garage 15 Noncommercial parking lot/garage SKIP to 17c 16 Ask if necessary: In what type of a parking lot or garage did this incident happen? Apartment/townhouse parking lot/ garage 17 10g. LOCATION_SCHOOL Inside school building SKIP to 17a 18 On school property (school parking area, play area, school bus, etc.) 19 SKIP to 17c Ask if necessary: Where at school did this incident happen? 10h. LOCATION_OPEN_AREA In apartment yard, park, field, playground (other than school) 20 Ask if necessary: Where in an open area, on the street, or on public transportation did this incident happen? On the street (other than immediately adjacent to own/friend's/relative's/ neighbor's home) 21 SKIP to 18 On public transportation or in station (bus, train, plane, airport, depot, etc.) 22 10i. LOCATION_SPEC Other - Specify 23 SKIP to 17c Please specify the other location where this incident occurred. Page 3 11. OFFENDERLIVE 617 Yes - SKIP to 19 1 No 2 Did the offender live (here/there) or have a right to be (here/there), for instance, as a guest or a repairperson? ASK 12 3 Don't know 12. OFFENDERINSIDE 618 Yes - SKIP to 14 1 No 2 Did the offender actually get INSIDE your (house/apartment/room/garage/ shed/ enclosed porch)? ASK 13 Don't know 3 13. OFFENDERTRY Yes - ASK 14 619 1 No - SKIP to 19 2 Did the offender TRY to get in your (house/ apartment/room/garage/shed/porch)? 3 Don't know - ASK 14 14. FORCEDENTRY Yes - ASK 15a 620 1 No - SKIP to 16a 2 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)? Window 15a. EVIDENCE 625 Damage to window (include frame, glass broken/removed/cracked) 1 What was the evidence? Probe: Anything else? Enter all that apply. * SKIP to 19 Screen damaged/removed 2 Lock on window damaged/tampered with in some way 3 SKIP to 15b Other - Specify 4 Door Damage to door (include frame, glass panes or door removed) 5 SKIP to 19 Screen damaged/removed 6 Lock or door handle damaged/tampered with in some way 626 7 * Other - Specify 8 SKIP to 15c Other Other than window or door - Specify 9 SKIP to 15d 15b. EVIDENCE_SPEC14 - SKIP to 19 Specify Please specify what was the other evidence related to a window. 15c. EVIDENCE_SPEC18 - SKIP to 19 Specify Please specify what was the other evidence related to a door. 15d. EVIDENCE_SPEC19 - SKIP to 19 Specify Please specify what was the evidence other than to a window or door. Notes Page 4 16a. OFFENDERGETIN 627 Let in 1 Offender pushed his/her way in after door opened 2 How did the offender (get in/TRY to get in)? Through OPEN DOOR or other opening 3 Through UNLOCKED door or window 4 SKIP to 19 Through LOCKED door or window - Had key 5 Through LOCKED door or window - Picked lock, used credit card, etc., other than key 6 Through LOCKED door or window - Don't know how 7 Don't know 8 SKIP to 16b Other - Specify 9 16b. OFFENDERGETIN_SPEC - SKIP to 19 Specify Please specify - how the offender got in/TRIED to get in. 17a. RESPONDENTSSCHOOL 628 Yes 1 No - SKIP to 17c 2 Was it your school? 17b. PARTSCHOOLBLDG Classroom 629 1 Hallway/Stairwell 2 In what part of the school building did it happen? 3 Bathroom/Locker room Other (library, gym, auditorium, cafeteria) 4 17c. RESTRICTEDAREA Open to the public 630 1 SKIP to 18 Restricted to certain people (or nobody had a right to be there) 2 Ask or verify - Did the incident happen in an area restricted to certain people or was it open to the public at the time? Don't know 3 Other - Specify - ASK 17d 4 17d. RESTRICTEDAREA_SPEC Specify Please specify. 18.INSIDEOROUT Indoors (inside a building or enclosed space) 631 1 Ask or verify - Did it happen outdoors, indoors, or both? Outdoors 2 Both 3 19. FARFROMHOME At, in, or near the building containing the respondent's home/next door 632 1 Ask or verify- How far away from home did this happen? PROBE: Was it within a mile, 5 miles, 50 miles or more? Enter the code for the first answer category that the respondent is sure of. A mile or less 2 Five miles or less 3 4 Fifty miles or less More than 50 miles 5 Don't know how far 6 Yes - ASK 20b 20a. HHMEMBERPRESENT 634 1 No - SKIP to 56 2 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. Respondent only 20b. WHICHMEMBER 1 635 Ask 21 Respondent and other household member(s) Ask or verify - Which household members were present? 2 Only other household member(s), not respondent - SKIP to 59a 3 Page 5 21. SEEOFFENDER Yes 636 1 No 2 Ask or verify - Did you personally see an offender? 22. WEAPONPRESENT 637 Yes - ASK 23a 1 No 2 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? SKIP to 24 Don't know 3 23a. WEAPON 638 Hand gun (pistol, revolver, etc.) Other gun (rifle, shotgun, etc.) Knife 1 * 2 What was the weapon? Probe: Anything else? Enter all that apply. SKIP to 24 3 Other sharp object (scissors, ice pick, axe, etc.) Blunt object (rock, club, blackjack, etc.) 4 5 Other - Specify - ASK 23b 6 23b. WEAPON_SPEC Specify Please specify the other weapon. 24. ATTACK 639 Yes - SKIP to 29a No - ASK 25 1 2 Did the offender hit you, knock you down or actually attack you in any way? 25. TRYATTACK 640 Yes - SKIP to 28a 1 No - ASK 26 2 Did the offender TRY to attack you? 26. THREATEN 641 Yes - SKIP to 28c 1 No - ASK 27a 2 Did the offender THREATEN you with harm in any way? 27a. WHATHAPPEN 642 1 Something taken without permission SKIP to 35c 2 Attempted or threatened to take something * What actually happened? Probe: Anything else? Enter all that apply. 3 Harassed, argument, abusive language 4 Unwanted sexual contact with force (grabbing, fondling, etc.) SKIP to 27c 5 Unwanted sexual contact without force (grabbing, fondling, etc.) 6 Forcible entry or attempted forcible entry of house/apartment SKIP to 35c 7 Forcible entry or attempted forcible entry of car 8 Damaged or destroyed property 9 Attempted or threatened to damage or destroy property Other - Specify - ASK 27b 10 27b. WHATHAPPEN_SPEC Specify - SKIP to 35c Please specify what actually happened. 27c. SEXCONFORCEPROBE_1 Yes - SKIP to 29a No - SKIP to 35c 1 2 You mentioned some type of unwanted sexual contact with force. Do you mean forced or coerced sexual intercourse including attempts? Notes Page 6 28a. HOWTRYATTACK 643 Verbal threat of rape 1 SKIP to 35c * Verbal threat to kill 2 How did the offender TRY to attack you? Probe: Any other way? Enter all that apply. Verbal threat of attack other than to kill or rape 3 4 Verbal threat of sexual assault other than rape Unwanted sexual contact with force (grabbing, fondling, etc.) 5 SKIP to 28e Unwanted sexual contact without force (grabbing, fondling, etc.) 6 Weapon present or threatened with weapon 7 644 8 Shot at (but missed) * 9 Attempted attack with knife/sharp weapon SKIP to 35c Attempted attack with weapon other than gun/knife/sharp weapon 10 645 Object thrown at person 11 12 Followed or surrounded * Tried to hit, slap, knock down, grab, hold, trip, jump, push, etc. 13 14 Other - Specify - ASK 28b 28b. HOWTRYATTACK_SPEC Specify - SKIP to 35c Please specify how the offender TRIED to attack you. 28c. HOWTHREATEN 643 Verbal threat of rape 1 SKIP to 35c * Verbal threat to kill 2 How were you threatened? Probe: Any other way? Enter all that apply. Verbal threat of attack other than to kill or rape 3 4 Verbal threat of sexual assault other than rape Unwanted sexual contact with force (grabbing, fondling, etc.) 5 SKIP to 28e Unwanted sexual contact without force (grabbing, fondling, etc.) 6 Weapon present or threatened with weapon 7 644 8 Shot at (but missed) * 9 Attempted attack with knife/sharp weapon SKIP to 35c Attempted attack with weapon other than gun/knife/sharp weapon 10 645 Object thrown at person 11 12 Followed or surrounded * Tried to hit, slap, knock down, grab, hold, trip, jump, push, etc. 13 14 Other - Specify - ASK 28d 28d. HOWTHREATEN_SPEC Specify - SKIP to 35c Please specify how you were threatened. 28e. SEXCONFORCEPROBE_2 Yes - ASK 29a No - SKIP to 35c 1 2 You mentioned some type of unwanted sexual contact with force. Do you mean forced or coerced sexual intercourse including attempts? - ASK 29c 29a. HOWATTACK Raped 646 1 Tried to rape - ASK 29d 2 How were you attacked? Probe: Any other way? Enter all that apply. * Sexual assault other than rape or attempted rape Shot 3 4 Shot at (but missed) 5 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 6 647 7 8 * SKIP to 30a 9 10 Attempted attack with weapon other than gun/knife/sharp weapon 11 648 * Hit, slapped, knocked down Grabbed, held, tripped, jumped, pushed, etc. Other - Specify - ASK 29b 12 13 14 29b. HOWATTACK_SPEC Specify - SKIP to 30a Please specify how you were attacked. Page 7 29c. RAPE_CK1 Yes - SKIP to 30a No - go back to 29a You mentioned rape. Do you mean forced or coerced sexual intercourse? If "no", then ask: What do you mean? 29d. ATTRAPE_CK1 Yes - SKIP to 30a No - go back to 29a You mentioned attempted rape. Do you mean attempted forced or coerced sexual intercourse? If "no", then ask: What do you mean? Yes 30a. PRETHREATEN 649 1 SKIP to 31a No 2 Did the offender THREATEN to hurt you before you were actually attacked? Other - Specify - ASK 30b 3 30b. PRETHREATEN_SPEC Specify Please specify. SKIP to 35c 31a. INJURY 655 1 None Raped SKIP to 31c 2 * What were the injuries you suffered, if any? Probe: Anything else? Enter all that apply. 3 SKIP to 31d Attempted rape 4 Sexual assault other than rape or attempted rape Knife or stab wounds 5 6 7 SKIP to 32 656 Gun shot, bullet wounds 8 Broken bones or teeth knocked out Internal injuries * 9 10 Knocked unconscious Bruises, black eye, cuts, scratches, swelling, chipped teeth 11 Other - Specify - ASK 31b 31b. INJURY_SPEC Specify - SKIP to 32 Please specify the injuries you suffered. 31c. RAPE_CK2 Yes - SKIP to 32 No - go back to 31a You mentioned rape. Do you mean forced or coerced sexual intercourse? If "no", then ask: What do you mean? 31d. ATTRAPE_CK2 Yes - SKIP to 32a No - go back to 31a You mentioned attempted rape. Do you mean attempted forced or coerced sexual intercourse? If "no", then ask: What do you mean? 32a. INJURYNOTGUN 657 Yes - ASK 32b 1 No - SKIP to 33a 2 Ask or verify- Were any of the injuries caused by a weapon other than a gun or knife? 32b. FIRSTINJURY Raped 2 658 Attempted rape 3 * Which injuries were caused by a weapon OTHER than a gun or knife? Enter all that apply. Sexual assault other than rape or attempted rape 4 Broken bones or teeth knocked out Internal injuries 7 8 9 Knocked unconscious 10 Bruises, black eye, cuts, scratches, swelling, chipped teeth 11 Other - Specify 33a. MEDICALCARE 659 Yes - ASK 33b 1 No - SKIP to 35c 2 Were you injured to the extent that you received any medical care, including self treatment? Page 8 33b. RECEIVECAREWHERE 660 At the scene 1 At home/neighbor's/friend's * 2 Where did you receive this care? Probe: Anywhere else? Enter all that apply. SKIP to 33d Health unit at work/school, first aid station at a stadium/park, etc. 3 Doctor's office/health clinic Emergency room at hospital/emergency clinic Hospital (other than emergency room) 4 5 6 Other - Specify - ASK 33c 7 33c. RECEIVECAREWHERE_SPEC Specify Please specify where you received this care. 33d. Is (box 6) "Hospital" marked in 35a? Yes - ASK 34a CHECK 1 ITEM E1 No - SKIP to 35a 2 34a. CAREOVERNIGHT 662 Yes - ASK 34b 1 No - SKIP to 35a 2 Did you stay overnight in the hospital? 663 34b. CAREDAYHOSPIT ____________ Number of days How many days did you stay in the hospital? 35a. MEDICALINSURANCE 664 1 Yes No 2 At the time of the incident, were you covered by any medical insurance, or were you eligible for benefits from any other type of health benefits program, such as medicaid, Veterans Administration, or Public Welfare? Don't know 3 35b. MEDICALEXPENSES $ ____________ . 00 Total amount 665 What was the total amount of your medical expenses resulting from this incident (INCLUDING anything paid by insurance)? Include hospital and doctor bills, medicine, therapy, braces, and any other injury related expenses. Obtain an estimate, if necessary. No cost 0 35c. Is (box 1) "Yes" marked in 24, 25 or 26 or are (box 4 or 5) "Unwanted sexual contact with or without force" marked in 27? Yes - ASK 36a CHECK 1 ITEM E2 No - SKIP to 39 2 36a. IMPACT_JOB emo_toll_impact_job Being a victim of crime affects people in different ways. Next I would like to ask you some questions about how being a crime victim may have affected you. Did being a victim of this crime lead you to have significant problems with your job or schoolwork, or trouble with your boss, coworkers, or peers? Yes 1 No 2 36b. IMPACT_FAMILY emo_toll_impact_family Did being a victim of this crime lead you to have significant problems with family members or friends, including getting into more arguments or fights than you did before, not feeling you could trust them as much, or not feeling as close to them as you did before? Yes 1 No 2 36c. HOW_DISTRESSING emo_toll_how_distressing How distressing was being a victim of this crime to you? Was it not at all distressing, mildly distressing, moderately distressing, or severely distressing? Not at all distressing 1 Mildly distressing 2 Moderately distressing 3 Severely distressing 4 Page 9 36d. Is (box 1) "Yes" marked in 36a or 36b or are (box 3 or 4) "Moderately or severely distressing" marked in 36c? Yes - ASK 37 CHECK 1 ITEM E3 No - SKIP to 39 2 Still thinking about your distress associated with being a victim of this crime did you feel any of the following ways for A MONTH OR MORE? Did you feel ... 37. (a) FEEL_WORRIED Yes No emo_toll_feel_worried 1 2 Worried or anxious? (b) FEEL_ANGRY Yes No 1 emo_toll_feel_angry 2 Angry? (c) FEEL_SAD Yes No 1 emo_toll_feel_sad 2 Sad or depressed? (d) FEEL_VULNERABLE Yes No 1 emo_toll_feel_vulnerable 2 Vulernable? (e) FEEL_VIOLATED Yes No 1 emo_toll_feel_violated 2 Violated? (f) FEEL_MISTRUST Yes No 1 emo_toll_feel_mistrust 2 Like you couldn't trust people? (g) FEEL_UNSAFE Yes No 1 emo_toll_feel_unsafe 2 Unsafe? (h) FEEL_OTHER_WAY Yes No 1 emo_toll_feel_other_way 2 Some other way? 37i. FEEL_OTH_WAY_SP Specify What other way did being a victim of this crime make you feel? 37j. Is (box 1) "Yes" marked in any of 37a through 37h? Yes - ASK 37k CHECK 1 ITEM E4 No - SKIP to 38 2 37k. SEEK_PRO_HELP emo_toll_seek_pro_help Did you seek any kind of professional help for the feelings you experienced as a result of being a victim of this crime? Yes - ASK 37l 1 No - SKIP to 38 2 emo_toll_pro_help_sought 37l. PRO_HELP_SOUGHT Did you seek any kind of professional help for the feelings you experienced as a result of being a victim of this crime? Enter all that apply. Counseling/therapy 1 SKIP to 38 Medication 2 Visited a doctor or nurse 3 Visted ER/hospital/clinic 4 Other - Specify - ASK 37m 5 37m. HELP_SOUGHT_SP Specify What other kind of professional help did you seek? Notes Page 10 Did you experience any of the following physical problems associated with being a victim of this crime for A MONTH OR MORE? Did you experience ... 38. (a) HAVE_HEADACHES Yes No emo_toll_have_headaches 1 2 Headaches? (b) TRBL_SLEEPING Yes No emo_toll_trbl_sleeping 1 2 Trouble sleeping? (c) EATING_PROBS Yes No emo_toll_eating_probs 1 2 Changes in your eating or drinking habits? (d) UPSET_STOMACH Yes No emo_toll_upset_stomach 1 2 Upset stomach? (e) FATIGUE Yes No emo_toll_fatigue 1 2 Fatigue? (f) HIGH_BLOOD_PRESS Yes No emo_toll_high_blood_press 1 2 High blood pressure? (g) MUSCLE_TENSION Yes No emo_toll_muscle_tension 1 2 Muscle tension or back pain? (h) OTHER_PHYSICAL Yes No emo_toll_other_physcial 1 2 Some other physical problem? 38i. OTH_PHY_SP Specify What other physical problem did you experience for A MONTH OR MORE? 38j. Is (box 1) "Yes" marked in any of 38a through 38h? Yes - ASK 38k CHECK 1 ITEM E5 No - SKIP to 39 2 38k. SEEK_HELP_PHYPROBS emo_toll_seek_help_phyprobs Other than any medical care you received for the injury(ies) you suffered) did you seek any professional or medical help for the physical problems you experienced as a result of being a victim of this crime? Yes - ASK 38l 1 No - SKIP to 39 2 38l. KIND_HELP_PHYPROBS emo_toll_kind_help_phyprobs What type of professional or medical help did you seek? Enter all that apply. Counseling/therapy 1 SKIP to 39 Medication 2 Visited a doctor or nurse 3 Visted ER/hospital/clinic 4 Other - Specify - ASK 38m 5 38m. KIND_HELP_PHYOTH_SP Specify What other kind of professional help did you seek? 39. Is respondent female and between the ages of 18-49? Yes - ASK 40 CHECK 1 ITEM F1 No - SKIP to 41a 2 40. PREGATTIMEOFINC Yes 1 960 No Research shows that pregnant women may be at a higher risk of being the victim of a violent crime. Were you pregnant at the time of this incident? 2 Notes Page 11 41a. PROTECTSELF 666 Yes - SKIP to 42a 1 No/took no action/kept still - ASK 41b 2 Did you do anything with the idea of protecting YOURSELF or your PROPERTY while the incident was going on? 41b. DURINGINCIDENT Yes - SKIP to 42a 1 667 No/took no action/kept still - ASK 47 2 Was there anything you did or tried to do about the incident while it was going on? 42a. ACTIONSDURINGINC USED PHYSICAL FORCE TOWARD OFFENDER Attacked offender with gun; fired gun Attacked with other weapon 1 668 What did you do? Probe: Anything else? Enter all that apply. 2 * Attacked without weapon (hit, kicked, etc.) Threatened offender with gun 3 4 Threatened offender with other weapon Threatened to injure, no weapon 5 SKIP to 42c 6 RESISTED OR CAPTURED OFFENDER Defended self or property (struggled, ducked, blocked blows, held onto property) 669 7 * 8 Chased, tried to catch or hold offender SCARED OR WARNED OFF OFFENDER Yelled at offender, turned on lights, threatened to call police, etc. 9 PERSUADED OR APPEASED OFFENDER Cooperated, or pretended to (stalled, did what they asked) 10 Argued, reasoned, pleaded, bargained, etc. 11 670 * ESCAPED OR GOT AWAY SKIP to 42c Ran or drove away, or tried; hid, locked door 12 GOT HELP OR GAVE ALARM Called police or guard 13 Tried to attract attention or help, warn others (cried out for help, called children inside) 14 671 * REACTED TO PAIN OR EMOTION Screamed from pain or fear 15 OTHER Other - Specify - ASK 42b 16 42b. ACTIONSDURINGINC_SPEC Specify Please specify what you did. 42c. Was the respondent injured in this incident? (Are any of the boxes 2-11 marked in 31a?) Yes - ASK 43a CHECK 1 ITEM F2 No - SKIP to 43b 2 43a. INJACTION 672 1 Actions taken before injury Actions taken after injury 2 Did you take these actions before, after, or at the same time that you were injured? Enter all that apply. * Actions taken at same time as injury 3 43b. INJACTIONHELP 1 Yes - ASK 44a 673 No 2 Did (any of) your action(s) help the situation in any way? Probe: Did your action(s) help you avoid injury, protect your property, escape from the offender - or were they helpful in some other way? SKIP to 45 Don't know 3 Notes Page 12 Helped avoid injury or greater injury to respondent Scared or chased offender off 44a. HELP 674 1 SKIP to 45 * How were they helpful? Probe: Any other way? Enter all that apply. 2 Helped respondent get away from offender Protected property 3 4 Protected other people 5 Other - Specify - ASK 44b 6 44b. HELP_SPEC Specify Please specify how were they helpful. 45. ACTIONWORSE 1 Yes - ASK 46a 675 No 2 Did (any of) your action(s) make the situation worse in any way? Probe: Did your action(s) lead to injury, greater injury, loss of property, make the offender angrier, or make the situation worse in some other way? SKIP to 47 Don't know 3 46a. WORSE Led to injury or greater injury to respondent Caused greater loss of property or damage to property Other people got hurt (worse) 676 1 * How did they make the situation worse? Probe: Any other way? Enter all that apply. SKIP to 47 2 3 Offender got away 4 Made offender angrier, more aggressive, etc. Other - Specify - ASK 46b 5 6 46b. WORSE_SPEC Specify Please specify how the respondent's actions made the situation worse. 47. ANYONEPRESENT 1 Yes - ASK 48 677 No 2 Was anyone present during the incident besides you and the offender? (Other than children under age 12.) SKIP to 54c Don't know 3 48. OTHERSACTIONS 1 Yes - ASK 49a 678 No 2 Did the actions of (this person/any of these people) help the situation in any way? SKIP to 50 Don't know 3 49a. HOWOTHERSHELP Helped avoid injury or greater injury to respondent Scared or chased offender off 679 1 SKIP to 50 * How did they help the situation? Probe: Any other way? Enter all that apply. 2 Helped respondent get away from offender Protected property 3 4 Protected other people 5 Other - Specify - ASK 49b 6 Specify 49b. HOWOTHERSHELP_SPEC Please specify how they helped the situation. 50. OTHERSACTIONSWORSE 1 Yes - ASK 51a 680 Did the actions of (this person/any of these people) make the situation worse in any way? No 2 SKIP to 52 Don't know 3 Notes Page 13 Led to injury or greater injury to respondent Caused greater loss of property or damage to property Other people got hurt (worse) 51a. OTHWORSE 1 681 * How did they make the situation worse? Probe: Any other way? Enter all that apply. SKIP to 52 2 3 Offender got away 4 Made offender angrier, more aggressive, etc. Other - Specify - ASK 51b 5 6 51b. OTHWORSE_SPEC Specify Please specify how they made the situation worse. 52. PERSONSHARMED 1 Yes - ASK 53 682 No 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 12 years of age.) SKIP to 54c Don't know 3 53. PERSONSHARMEDNUM ____________ Number of persons 683 How many? (Do not include yourself, the offender or children under 12 years of age.) ____________ Number of persons 54a. HHMEMHARMED 684 How many of these persons are members of your household now? (Do not include yourself, the offender or children under 12 years of age.) 0 None - SKIP to 54c 54b. HHMEMHARMED_NAMES Line number(s) If not sure ask: Who are these household members? (Do not include yourself, the offender, or children under 12 years of age) Enter the line number(s) of other household members. 54c. Did the respondent use or threaten to use physical force against the offender? (Are any of the boxes 1-6 marked in 42a?) Yes - ASK 55 CHECK 685 1 ITEM G No - SKIP to 60 2 55. FIRSTTOUSEFORCE 686 Respondent 1 SKIP to 60 Offender(s) 2 Who was the first to use or threaten to use physical force - you, the offender, or someone else? Someone else 3 56. KNOWLEARNOFFENDERS Yes - ASK 57 687 1 No - SKIP to 88 2 Do you know or have you learned anything about the offender(s) - for instance, whether there was one or more than one offender involved, whether it was someone young or old, or male or female? Suspicion 57. SUREOFINFO 688 1 Fairly sure 2 How sure are you of this information? Do you have a suspicion, are you fairly sure or are you certain? Certain 3 Notes Page 14 58a. LEARNOFFENDERS Respondent saw or heard offender 689 1 From other member of household who was eyewitness 2 * How did you learn about the offender(s)? Probe: Any other way? Enter all that apply. From eyewitness(es) other than household member(s) 3 From police 4 SKIP to 88 Other person (not eyewitness) 5 Offender(s) admitted it 6 Offender(s) had threatened to do it 7 690 Stolen property found on offender's property or in offender's possession 8 * Figured it out by who had motive, opportunity, or had done it before 9 Other - Specify - ASK 58b 10 58b. LEARNOFFENDERS_SPEC Specify - SKIP to 88 Please specify how you learned about the offender(s). 59a. HAPPEN 691 Something taken without permission Attempted or threatened to take something Harassed, argument, abusive language 1 2 * What actually happened? Probe: Anything else? Enter all that apply. 3 Forcible entry or attempted forcible entry of house/apartment 4 SKIP to 60 Forcible entry or attempted forcible entry of car Damaged or destroyed property 5 6 Attempted or threatened to damage or destroy property 7 Other - Specify - ASK 59b 8 59b. HAPPEN_SPEC Specify Please specify what actually happened. 60. ONEORMOREOFFENDERS Only one - SKIP to 62 692 1 More than one - SKIP to 73 Don't know - ASK 61 2 Ask or verify - Was the crime committed by only one or by more than one offender? 3 61. KNOWOFFENDERS Yes - ASK 62 693 1 No - SKIP to 88 2 Do you know anything about one of the offenders? 62. SINGOFFENDERGENDER Male 698 1 Female 2 Was the offender male or female? Don't know 3 63. SINGOFFENDERAGE Under 12 21-29 1 5 699 12-14 30 or older 2 6 How old would you say the offender was? Don't know 15-17 3 7 4 18-20 64a. SINGOFFENDERGANG 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) 1 700 2 Was the offender a member of a street gang, or don't you know? 3 64b. SINGOFFENDERDRINKDRUG Yes (drinking or on drugs) - ASK 65 No (not drinking/not on drugs) 1 701 2 Was the offender drinking or on drugs, or don't you know? SKIP to 66 Don't know (if drinking or on drugs) 3 65. SINGOFFENDERDRINKORDRUG Drinking 1 702 On drugs 2 Which was it? (Drinking or on drugs?) Both (drinking and on drugs) Drinking or on drugs - could not tell which 3 4 66. SINGOFFENDERKNEW Knew or had seen before - SKIP to 68 Stranger 703 1 2 Was the offender someone you knew or a stranger you had never seen before? Don't know 3 Page 15 67. SINGOFFENDERRECOG Yes 704 1 SKIP to 69a Not sure (possibly or probably) No - SKIP to 71a 2 Would you be able to recognize the offender if you saw him/her? 3 68. SINGOFFENDERHOWWELL Sight only - ASK 69a 705 1 Casual acquaintance 2 SKIP to 70a How well did you know the offender - by sight only, casual acquaintance, or well known? Well known 3 69a. SINGOFFENDERSIGHT Yes 1 706 SKIP to 71a No 2 Would you have been able to tell the police how they might find the offender, for instance, where he/she lived, worked, went to school, or spent time? Other - Specify - ASK 69b 3 69b. SINGOFFENDERSIGHT_SPEC Specify - SKIP to 71a Please specify. 70a. SINGOFFENDERRELATION RELATIVE 707 Spouse at time of incident Ex-spouse at time of incident Parent or step-parent 1 How well did you know the offender? For example, was the offender a friend, cousin, etc.? 2 SKIP to 71a 3 Own child or step-child 4 Brother/sister 5 Other relative - Specify - ASK 70b 6 NONRELATIVE Boyfriend or girlfriend, ex-boyfriend or ex-girlfriend Friend or ex-friend 7 8 Roommate, boarder 9 Schoolmate 10 Neighbor 11 SKIP to 71a Customer/client 12 Patient 14 15 Supervisor (current or former) Employee (current or former) Co-worker (current or former) 16 17 18 Teacher/school staff Other nonrelative - Specify - ASK 70c 13 70b. SINGOFFENDERRELATION_SPEC_16 Specify - SKIP to 71a Please specify the other relative. 70c. SINGOFFENDERRELATION_SPEC_28 Specify Please specify the other nonrelative. 71a. SINGOFFENDERRACE White 1 708 SKIP to 72 Black 2 Was the offender White, Black, or some other race? Other - Specify - ASK 71b 3 Don't know - SKIP to 72 4 71b. SINGOFFENDERRACE_SPEC Specify Please specify some other race. 72. SINGOFFENDERONLYTIME Yes (only time) 709 1 No (there were other times) SKIP to 88 2 Was this the only time this offender committed a crime against you or your household or made threats against you or your household? Don't know 3 73. HOWMANYOFFENDERS 710 Number of offenders How many offenders? Notes Page 16 74. MULTOFFENDERGENDER All male 711 1 All female SKIP to 76 2 Were they male or female? Don't know sex of any offenders Both male and female 3 If only two offenders, SKIP to 76 otherwise ASK 75 4 Mostly male 75. MULTOFFENDERMOSTGENDER 1 712 Mostly female 2 Were they mostly male or mostly female? Evenly divided 3 Don't know 4 Under 12 21-29 76. MULTOFFENDERYOUNG 1 5 713 12-14 30 or older 2 6 How old would you say the youngest was? Don't know 15-17 3 7 4 18-20 77. MULTOFFENDEROLD Under 12 21-29 1 5 714 12-14 30 or older 2 6 Don't know How old would you say the oldest was? 15-17 3 7 4 18-20 78a. MULTOFFENDERGANG 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) 1 715 2 Were any of the offenders a member of a street gang, or don't you know? 3 78b. MULTOFFENDERDRINKDRUG Yes (drinking or on drugs) - ASK 79 No (not drinking/not on drugs) 1 716 2 Were any of the offenders drinking or on drugs, or don't you know? SKIP to 80 Don't know (if drinking or on drugs) 3 79. MULTOFFENDERDRINKORDRUG Drinking 1 717 On drugs 2 Which was it? (Drinking or on drugs?) Both (drinking and on drugs) Drinking or on drugs - could not tell which 3 4 80. MULTOFFENDERKNEW All known SKIP to 82a 1 718 Some known 2 Were any of the offenders known to you, or were they strangers you had never seen before? All strangers 3 ASK 81 Don't know 4 81. MULTOFFENDERRECOG Yes 1 719 SKIP to 83a Not sure (possibly or probably) No - SKIP to 85a 2 Would you be able to recognize any of them if you saw them? 3 Sight only 82a. MULTOFFENDERHOWWELL 1 720 Casual acquaintance 2 * How well did you know the offender(s) - by sight only, casual acquaintance, or well known? Probe: Anything else? Enter all that apply. Well known 3 82b. Is "casual acquaintance" or "well known" marked in 82a? Yes - SKIP to 84a CHECK ITEM H No - ASK 83a Yes 83a. MULTOFFENDERSIGHT 1 722 SKIP to 85a No 2 Would you have been able to tell the police how they might find any of them, for instance, where they lived, worked, went to school, or spent time? Other - Specify - ASK 83b 3 83b. MULTOFFENDERSIGHT_SPEC Specify - SKIP to 85a Please specify. Notes Page 17 84a. MULTOFFENDERRELATION RELATIVE Spouse at time of incident Ex-spouse at time of incident Parent or step-parent 1 723 How did you know them? For example, were they friends, cousins, etc.? Probe: Anything else? Enter all that apply. 2 SKIP to 85a * 3 Own child or step-child 4 Brother/sister 5 Other relative - Specify - ASK 84b 6 NONRELATIVE Boyfriend or girlfriend, ex-boyfriend or ex-girlfriend Friend or ex-friend 7 724 * 8 Roommate, boarder 9 Schoolmate 10 Neighbor 725 11 SKIP to 85a Customer/client 12 * Patient 14 15 Supervisor (current or former) Employee (current or former) Co-worker (current or former) 16 17 18 Teacher/school staff Other nonrelative - Specify - ASK 84c 13 84b. MULTOFFENDERRELATION_SPEC_16 Specify - SKIP to 85a Please specify the other relative. 84c. MULTOFFENDERRELATION_SPEC_28 Specify Please specify the other nonrelative. 85a. MULTOFFENDERRACE White 726 1 SKIP to 85c Black 2 * Were the offenders White, Black, or some other race? Probe: Anything else? Enter all that apply. Other - Specify - ASK 85b 3 Don't know race of any/some - SKIP to 85c 4 85b. MULTOFFENDERRACE_SPEC Specify Please specify some other race. 85c. Is more than one box marked in 85a? Yes - ASK 86 CHECK ITEM I No - SKIP to 87 86. MULTOFFENDERRACEMOST Mostly White 1 727 Mostly Black 2 Mostly some other race What race were most of the offenders? 3 Equal number of each race Don't know 4 5 87. MULTOFFENDERONLYTIME Yes (only time) 730 1 No (there were other times) 2 Was this the only time any of these offenders committed a crime against you or your household or made threats against you or your household? Don't know 3 88. THEFT Yes - SKIP to 96a 731 1 No 2 Ask or verify: 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.) Include anything stolen from an unrecognizable business. Do not include anything stolen from a recognizable business in respondent's home or another business, such as merchandise or cash from a register. Don't know 3 Page 18 Yes - ASK 90a 89. ATTEMPTTHEFT 1 732 No 2 SKIP to 110 Don't know 3 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.) Do not include anything the offender tried to steal from a recognizable business in respondent's home or another business, such as merchandise or cash from a register. 90a. ATTEMPTTHEFTWHAT Cash 1 733 Purse 2 * Wallet What did the offender try to take? Probe: Anything else? Enter all that apply. 3 Credit cards, checks, bank cards Car 4 5 Other motor vehicle 6 Part of motor vehicle (tire, hubcap, attached car stereo or satellite radio, attached CB radio, etc.) Gasoline or oil 734 7 * SKIP to 91a 8 Bicycle or parts 9 TV, DVD player, VCR, stereo, other household appliances Silver, china, art objects 10 735 * 11 Other household furnishings (furniture, rugs, etc.) Personal effects (clothing, jewelry, toys, etc.) 12 13 736 * 14 Handgun (pistol, revolver) Other firearm (rifle, shotgun) Other - Specify - ASK 90b 15 16 737 Don't know - SKIP to 91a 17 * 90b. ATTEMPTTHEFTWHAT_SPEC Specify Please specify what the offender(s) tried to take. 91a. ATTEMPTTHEFTOWNER Respondent only - SKIP to 92a 1 738 Respondent and other household member(s) 2 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? SKIP to 91c 3 Other household member(s) only Nonhousehold member(s) only - SKIP to 92a 4 5 Other - Specify - ASK 91b 91b. ATTEMPTTHEFTOWNER_SPEC Specify - SKIP to 92a Please specify who the (property/money) the offender(s) tried to take belonged to. 91c. ATTEMPTHEFTLNS CHECK 739 Line number ITEM J * If not sure, ask: Besides the respondent, which household member(s) owned the (property/money) the offender tried to take? Enter appropriate line number(s). Line number Line number OR Household property 40 92a. ATTEMPTTHEFTITEMSINMV Yes 1 740 No 2 Ask or verify: (Was/Were) the article(s) IN or ATTACHED to a motor vehicle when the attempt was made to take (it/them)? Notes Page 19 92b. Did the offender try to take cash, a purse, or a wallet? (Is box 1, 2, or 3 marked in 90a?) Yes - ASK 93 CHECK ITEM K No - SKIP to 94 93. ATTEMPTTHEFTONPERSON Yes 1 742 No 2 Ask or verify: Was the (cash/purse/wallet) on your person, for instance, in a pocket or being held? 94. ATTEMPTTHEFTITEMONPERSON Yes - ASK 95 745 1 No - SKIP to 110 2 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 95. ATTEMPTTHEFTITEMS Credit cards, checks, bank cards Car 746 4 * 5 Which items did the offender(s) try to take directly from you? Exclude property not belonging to respondent or other household member. Other motor vehicle 6 Part of motor vehicle (tire, hubcap, attached car stereo or satellite radio, attached CB radio, etc.) Gasoline or oil 7 8 Bicycle or parts 9 TV, DVD player, VCR, stereo, other household appliances Silver, china, art objects 10 SKIP to 110 11 Other household furnishings (furniture, rugs, etc.) Personal effects (clothing, jewelry, toys, etc.) 12 13 14 Handgun (pistol, revolver) Other firearm (rifle, shotgun) Other 15 16 Tried to take everything marked in 90a directly from respondent 40 Notes Page 20 96a. WHATWASTAKEN CASH/PURSE/WALLET/CREDIT CARDS Cash 1 What was taken that belonged to you or others in the household? Probe: Anything else? Enter all that apply. 748 Purse 2 * Wallet 3 Credit cards, check, bank cards 4 VEHICLE OR PARTS Car 5 Other motor vehicle 6 Part of motor vehicle (tire, hubcap, attached car stereo or satellite radio, attached CB radio, etc.) 7 749 * Unattached motor vehicle accessories or equipment (unattached CD player or satellite radio, etc.) 8 Gasoline or oil 9 Bicycle or parts 10 HOUSEHOLD FURNISHINGS TV, DVD player, VCR, stereo, other household appliances 11 750 * Silver, china, art objects 12 Other household furnishings (furniture, rugs, etc.) 13 PERSONAL EFFECTS Portable electronic and photographic gear (Personal stereo, TV, cellphone, camera, etc.) 14 751 * Clothing, furs, luggage, briefcase Jewelry, watch, keys 15 16 Collection of stamps, coins, etc. 17 752 Toys, sports and recreation equipment (not listed above) 18 * Other personal and portable objects 19 FIREARMS Handgun (pistol, revolver) Other firearm (rifle, shotgun) 20 753 21 * MISCELLANEOUS Tools, machines, office equipment Farm or garden produce, plants, fruit, logs Animals -pet or livestock 22 23 754 24 * Food or liquor 25 Other - Specify 26 755 Don't know 27 * 96b. Follow the skip pattern for the first category met, based on the entries in 96a. If Box 26 is marked in 96a - ASK 96c CHECK ITEM L1 If Box 2 and/or 3 is marked in 96a - SKIP to 96d If Box 1 is marked in 96a - SKIP to 96e If none of the conditions above are met - SKIP to 97a 96c. WHATWASTAKEN_SPEC Specify - If Box 2 and/or 3 is marked in 96a - ASK to 96d If Box 1 is marked in 96a - SKIP to 96e Otherwise SKIP to 97a Please specify what was taken. Yes - ASK 96e 96d. PRSWLT_CONTAINMONEY 1 No 2 If Box 1 is marked in 96a ASK 96e otherwise SKIP to 97a Did the stolen (purse/wallet) contain any money? 96e. AMOUNTCASHTAKEN 747 $ ____________ . 00 Amount of cash taken If not sure, ask: How much cash was taken? 97a. WHOOWNEDSTOLENPROPERTY Respondent only - SKIP to 97d 1 760 Respondent and other household member(s) 2 Did the stolen (property/money) belong to you personally, to someone else in the household, or to both you and other household members? SKIP to 97c 3 Other household member(s) only Nonhousehold member(s) only - SKIP to 97d 4 5 Other - Specify - ASK 97b 97b. ATTEMPTTHEFTOWNER_SPEC Specify - SKIP to 97d Please specify who the stolen (property/money) belonged to. Page 21 97c. OTHERSOWNEDSTOLENPROPERTY CHECK 761 Line number ITEM L2 * If not sure, ask: Besides the respondent, which household member(s) owned the stolen (property/ money)? Enter appropriate line number(s). Line number Line number OR Household property 40 97d. Was a car or other motor vehicle stolen? (Is box 5 or 6 marked in 96a?) Yes - ASK 98 CHECK ITEM M1 No - SKIP to 100a 98. PERMISSIONGIVEN Yes - ASK 99 1 763 No 2 Had permission to use the (car/motor vehicle) ever been given to the offender(s)? SKIP to 100b Don't know 3 99. RETURNCAR Yes 1 764 SKIP to 100b No 2 Did the offender return the (car/motor vehicle) this time? 100a. ARTICLEINCAR Yes 1 765 No 2 Ask or verify: (Was/Were) the article(s) IN or ATTACHED to a motor vehicle when (it was/they were) taken? 100b. Did the offender(s) take a handgun? (Is box 20 marked in 96a?) Yes - ASK 101a CHECK ITEM M2 No - SKIP to 101b 101a. NUMBERHANDGUNS 923 Number of handguns How many handguns were taken? 101b. Did the offender(s) take some other type of firearm? (Is box 21 marked in 96a?) Yes - ASK 101a CHECK ITEM M3 No - SKIP to 101b 101c. NUMBERFIREARMS 924 Number of handguns How many other types of firearms were taken? 101d. Was cash, a purse, or a wallet taken? (Is box 1, 2, or 3 marked in 96a?) Yes - ASK 102a CHECK ITEM N1 No - SKIP to 102b 102a. CASHONPERSON Yes 1 767 No 2 Ask or verify: Was the (cash/purse/wallet) on your person, for instance, in a pocket or being held? 102b. OTHERONPERSON Yes - ASK 103 768 1 No - SKIP to 104a 2 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 Notes Page 22 103. ITEMSTAKEN Credit cards, check, bank cards 769 4 Car 5 * Which items did the offender(s) take directly from you? Exclude property not belonging to respondent or other household member. Other motor vehicle 6 Part of motor vehicle (tire, hubcap, attached car stereo or satellite radio, attached CB radio, etc.) 7 Unattached motor vehicle accessories or equipment (unattached CD player or satellite radio, etc.) 8 Gasoline or oil 9 Bicycle or parts 10 TV, DVD player, VCR, stereo, other household appliances 11 Silver, china, art objects 12 Other household furnishings (furniture, rugs, etc.) 13 Portable electronic and photographic gear (Personal stereo, TV, cellphone, camera, etc.) 14 Clothing, furs, luggage, briefcase Jewelry, watch, keys 15 16 Collection of stamps, coins, etc. 17 Toys, sports and recreation equipment (not listed above) 18 Other personal and portable objects 19 Handgun (pistol, revolver) Other firearm (rifle, shotgun) 20 21 Tools, machines, office equipment Farm or garden produce, plants, fruit, logs Animals -pet or livestock 22 23 24 Food or liquor 25 Other 26 Everything marked in 96a was taken directly from respondent 40 104a. Were only cash, a purse, or a wallet taken? (Are boxes 1, 2, or 3 the only boxes marked in 96a?) Yes - SKIP to 106 CHECK ITEM N2 No - ASK 104b 104b. PROPERTYVALUE 770 $ ____________ . 00 Value of property taken 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.) Enter total dollar value for all items taken. 105a. DECIDEDVALUE Original cost 771 1 Replacement cost 2 * How did you decide the value of the property that was taken? Probe: Any other way? Enter all that apply. Personal estimate of current value Insurance report estimate 3 SKIP to 106 4 Police estimate 5 Don't know 6 Other - Specify - ASK 105b 7 105b. DECIDEDVALUE_SPEC Specify Please specify how the value of the property (that was taken) was decided. 106. ALLPARTRECOVERED All - SKIP to 107d Part - ASK 107a 772 1 2 Was all or part of the stolen (money/property) recovered, not counting anything received from insurance? None - SKIP to 109 3 107a. WHATRECOVERED Cash recovered 776 1 Purse 2 * What was recovered? Probe: Anything else? Enter all that apply. Wallet 3 Credit cards, checks, bank cards Car or other motor vehicle 4 5 Property other than the above 6 107b. Follow the skip pattern for the first category met, based on the entries in 107a. If Box 2 and/or 3 is marked in 107a - ASK 107c CHECK ITEM N3 If Box 1 is marked in 107a - SKIP to 107d If none of the conditions above are met - SKIP to 107e Page 23 107c. CONTAINMONEY Yes - ASK 107d 1 No 2 If Box 1 is marked in 107a ASK 107d otherwise SKIP to 107e Did the recovered (purse/wallet) contain any money? 107d. CASHRECOVERED 775 $ ____________ . 00 Amount of cash recovered If necessary: How much cash was recovered? 107e. Was PROPERTY other than cash, checks, or credit cards recovered? (Are boxes 2, 3, 5, or 6 marked in 107a?) Yes - ASK 108 CHECK 777 1 ITEM O No - SKIP to 109 2 108. RECOVEREDCASHVALUE 778 $ ____________ . 00 Value of property recovered Considering any damage, what was the value of the property after it was recovered? Do not include recovered (cash/checks/credit cards) If value of recovered property is the same as value of property taken then enter the amount from 104b above. 109. RECOVEREDINSURANCE Yes 1 779 No 2 Was the theft reported to an insurance company? Don't have insurance 3 Don't know 4 110. DAMAGED Yes - ASK 111 1 780 No - SKIP to 115 2 (Other than any stolen property) was anything that belonged to you or other members of the household damaged in this incident? Probe: For example, was (a lock or window broken/clothing damaged/damage done to a car), or something else? 111. DAMAGEDREPAIRED Yes, all 1 781 SKIP to 113 Yes, part 2 (Was/Were) the damaged item(s) repaired or replaced? No, none - ASK 112 3 SKIP to 114a 112. ESTCOSTTOREPAIRREPLACE 782 $ ____________ . 00 Cost to repair/replace - How much would it cost to repair or replace the damaged item(s)? No cost - SKIP to 115 0 113. ACTCOSTREPAIRREPLACE 783 $ ____________ . 00 Cost to repair/replace - ASK 114a How much was the repair or replacement cost? No cost - SKIP to 115 0 114a. PAIDREPAIRS Items will not be repaired or replaced Household member 1 784 2 Who (paid/will pay) for the repairs or replacement? Probe: Anyone else? Enter all that apply. SKIP to 115 * Landlord or landlord's insurance Victim's (or household's) insurance Offender 3 4 5 Other - Specify - ASK 114b 6 114b. PAIDREPAIRS_SPEC Specify Please specify who (paid/will pay) for the repairs or replacement. 115. POLICEINFORMED Yes - ASK 116a 1 800 No - SKIP to 117a 2 Were the police informed or did they find out about this incident in any way? Don't know - SKIP to 130 3 Page 24 116a. POLICEFINDOUT Respondent - SKIP to 119a Other household member 1 801 2 How did the police find out about it? Enter first precode that applies. If proxy interview, we want the proxy respondent to answer questions 116a - 134b for herself/himself, not for the person for whom the proxy interview is being taken. SKIP to 121 Someone official called police (guard, apt. manager, school official, etc.) 3 Someone else 4 Police were at scene - SKIP to 123a 5 Offender was a police officer - SKIP to 124 6 Some other way - Specify - ASK 116b 7 116b. POLICEFINDOUT_SPEC Specify - SKIP to 124 Please specify how the police found out about it. 117a. NOTREPORTEDPOLICE DEALT WITH ANOTHER WAY Reported to another official (guard, apt. manager, school official, etc.) 1 802 What was the reason it was not reported to the police? Probe: Can you tell me a little more? Any other reason? Enter all that apply. 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? * Private or personal matter or took care of it myself or informally; told offender's parent 2 NOT IMPORTANT ENOUGH TO RESPONDENT 3 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 4 5 INSURANCE WOULDN'T COVER No insurance, loss less than deductible, etc. 6 POLICE COULDN'T DO ANYTHING Didn't find out until too late 7 803 Codes 1-17 SKIP to 117c Could not recover or identify property Could not find or identify offender, lack of proof * 8 9 POLICE WOULDN'T HELP Police wouldn't think it was important enough, wouldn't want to be bothered or get involved 10 11 Police would be inefficient, ineffective (they'd arrive late or not at all, wouldn't do a good job, etc.) 804 * 12 Police would be biased, would harass/insult respondent, cause respondent trouble, etc.) Offender was police officer 13 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 14 805 * 15 16 Did not want to or could not take time - too inconvenient 17 806 * Other - Specify - ASK 117b 18 19 Respondent not present or doesn't know why it wasn't reported - SKIP to 117c 117b. NOTREPORTEDPOLICE_SPEC Specify Please specify the reason it was not reported to the police. 117c. Is more than one reason marked in 117a? Yes - ASK 118 CHECK 1 ITEM P No - SKIP to 130 2 Notes Page 25 118. NOTREPORTIMPORTANT Reported to another official (guard, apt. manager, school official, etc.) 1 808 Which of these would you say was the most important reason why the incident was not reported to the police? * Private or personal matter or took care of it myself or informally; told offender's parent 2 3 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 4 5 No insurance, loss less than deductible, etc. 6 All codes, SKIP to 130 Didn't find out until too late 7 Could not recover or identify property Could not find or identify offender, lack of proof 8 9 Police wouldn't think it was important enough, wouldn't want to be bothered or get involved 10 11 Police would be inefficient, ineffective (they'd arrive late or not at all, wouldn't do a good job, etc.) 12 Police would be biased, would harass/ insult respondent, cause respondent trouble, etc.) Offender was police officer 13 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 14 15 16 Did not want to or could not take time - too inconvenient 17 Other 18 30 No one reason more important 119a. REASONREPORT TO GET HELP WITH THIS INCIDENT Stop or prevent THIS incident from happening Needed help after incident due to injury, etc. 1 809 Besides the fact that it was a crime, did YOU have any other reason for reporting this incident to the police? Probe: Any other reason? Enter all that apply. STRUCTURED PROBE - Did you report it to get help with this incident, to recover your loss, to stop or punish the offender, to let police know about it, or was there some other reason? * 2 TO RECOVER LOSS To recover property 3 To collect insurance 4 TO GET OFFENDER To prevent further crimes against respondent/ respondent's household by this offender SKIP to 119c 5 To stop this offender from committing other crimes against anyone 6 To punish offender 7 810 Catch or find offender - other reason or no reason given 8 * TO LET POLICE KNOW To improve police surveillance of respondent's home, area, etc. 9 Duty to let police know about crime 10 OTHER Other reason - Specify - ASK 119b 11 811 No other reason - SKIP to 121 * 12 119b. REASONREPORT_SPEC Specify Please specify other reason for reporting this incident to the police. 119c. Is more than one reason marked in 119a? Yes - ASK 120 CHECK 1 ITEM Q No - SKIP to 121 2 Notes Page 26 120. REPORTIMPORTANT Stop or prevent THIS incident from happening Needed help after incident due to injury, etc. 813 1 Which of these would you say was the most important reason why the incident was reported to the police? 2 To recover property 3 To collect insurance 4 To prevent further crimes against respondent/ respondent's household by this offender 5 To stop this offender from committing other crimes against anyone 6 To punish offender 7 Catch or find offender - other reason or no reason given 8 To improve police surveillance of respondent's home, area, etc. 9 Duty to let police know about crime 10 Other reason 11 No one reason more important 21 Because it was a crime was most important 22 121. POLICEARRIVE Yes - ASK 122 1 814 No 2 Did the police come when they found out about the incident? SKIP to 124 Don't know 3 Respondent went to police - SKIP to 123a 4 122. TIMEPOLICEARRIVE Within 5 minutes 1 815 Within 10 minutes 2 How soon after the police found out did they respond? Was it within 5 minutes, within 10 minutes, an hour, a day, or longer? Enter the code for the first answer category respondent is sure of. Within an hour 3 Within a day 4 Longer than a day 5 Don't know how soon 6 123a. POLICEACTION Took report 1 816 Searched/looked around Took evidence (fingerprints, inventory, etc.) Questioned witnesses or suspects 2 * What did they do while they were (there/here)? Probe: Anything else? Enter all that apply. SKIP to 124 3 4 Promised surveillance 5 6 Promised to investigate 7 Made arrest 817 Other - Specify - ASK 123b 8 * Don't know - SKIP to 124 9 Specify 123b. POLICEACTION_SPEC Please specify what they did while they were (there/ here). 124. POLICECONTACT Yes - ASK 125a 1 818 No 2 Did you (or anyone in your household) have any later contact with the police about the incident? SKIP to 128 Don't know 3 125a. POLICEINTOUCH Police contacted respondent or other HHLD member Respondent (or other HHLD member) contacted police Both 1 819 SKIP to 126 Did the police get in touch with you or did you get in touch with them? 2 3 Don't know 4 Other - Specify - ASK 125b 5 125b. POLICEINTOUCH_SPEC Specify Please specify did the police get in touch with you or did you get in touch with them. 126. HOWPOLICECONTACT In person 1 820 Not in person (by phone, mail, etc.) Both in person and not in person 2 Was that in person, by phone, or some other way? 3 Don't know 4 Notes Page 27 127a. POLICEFOLLOWUP Took report 1 821 Questioned witnesses or suspects Did or promised surveillance/investigation Recovered property 2 SKIP to 128 * What did the police do in following up this incident? Probe: Anything else? Enter all that apply. 3 4 Made arrest 5 Stayed in touch with respondent/household Other - Specify - ASK 127b 6 7 822 Nothing (to respondent's knowledge) Don't know 8 * SKIP to 128 9 127b. POLICEFOLLOWUP_SPEC Specify Please specify what the police did in following up this incident. 128. SIGNCOMPLAINT Yes 1 825 No 2 Did you (or someone in your household) sign a complaint against the offender(s) to the police department or the authorities? 129. ARRESTMADE Yes 1 826 No 2 Ask or verify: As far as you know, was anyone arrested or were charges brought against anyone in connection with this incident? Don't know 3 130. AGENCYHELP Yes - ASK 131a 1 827 No 2 Did you (or someone in your household) receive any help or advice from any office or agency - other than the police - that deals with victims of crime? SKIP to 131b Don't know 3 131a. TYPEOFAGENCY Government 1 828 Private 2 Was that a government or private agency? Don't know 3 131b. Were the police informed? (Is "Yes" marked in 115? Yes - ASK 132 CHECK 1 ITEM R No - SKIP to 135a 2 132. CONTACTAUTHORITIES Yes - ASK 133a 1 829 No 2 Have you (or someone in your household) had contact with any other authorities about this incident (such as a prosecutor, court, or juvenile officer)? SKIP to 134a Don't know 3 133a. AUTHORITIES Prosecutor, district attorney Magistrate 1 830 2 * Which authorities? Probe: Any others? Enter all that apply. SKIP to 134a Court 3 Juvenile, probation or parole officer Other - Specify - ASK 133b 4 5 Specify 133b. AUTHORITIES_SPEC Please specify which authorities. 134a. ANYTHINGFURTHER Yes - Specify - ASK 134b 1 831 No 2 Do you expect the police, courts, or other authorities will be doing anything further in connection with this incident? SKIP to 135a Don't know 3 134b. ANYTHINGFURTHER_SPEC Specify Please specify what you expect the police, courts, or other authorities will be doing (further) in connection with this incident. Page 28 135a. DOINGATINCIDENTTIME Working or on duty - SKIP to 138a On the way to or from work - SKIP to 142b On the way to or from school 1 832 2 Ask or verify: What were you doing when this incident (happened/started)? 3 4 On the way to or from other place Shopping, errands SKIP to 136 5 Attending school 6 Leisure activity away from home Sleeping 7 8 Other activities at home 9 Other - Specify - ASK 135b 10 Don't know - SKIP to 136 11 135b. DOINGATINCIDENTTIME_SPEC Specify Please specify what you were doing when this incident (happened/started). Yes - SKIP to 142b No - ASK 137a 136. JOBDURINGINCIDENT 1 840 2 Ask or verify: Did you have a job at the time of the incident? 137a. MAJORACTIVITY Looking for work 1 841 Keeping house 2 What was your major activity the week of the incident - were you looking for work, keeping house, going to school, or doing something else? Going to school 3 SKIP to 151 Unable to work 4 Retired 5 Other - Specify - SKIP to 137b 6 137b. MAJORACTIVITY_SPEC Specify - SKIP to 151 Please specify what was your major activity the week of the incident. A private company, business, or individual for wages? - Ask 138b 138a. EMPLOYERTYPE 1 843 Now I have a few questions about the job at which you worked during the time of the incident. Were you employed by - (Read each category - then enter appropriate code) 2 The Federal government? A State, county, or local government? 3 SKIP to 138c Yourself (Self-employed) in your own business, professional practice, or farm? 4 SKIP to 138c A private, not-for-profit, tax-exempt, or charitable organization? 5 Yes 138b. INCORPORATED 1 953 No 2 Is this business incorporated? Don't know 3 138c. EMPLOYERNAME 954 What is the name of the (company/government agency/business/non-profit organization) for which you worked at the time of the incident? 138d. TYPEBUSINESS 955 What kind of business or industry is this? Read if necessary: What do they make or do where you worked at the time of the incident? 138e. BUSINESSSECTOR Manufacturing? 1 956 Retail trade? 2 Is this mainly... (Read answer categories) - Wholesale trade? 3 Something else? 4 138f. OCCUPATIONDESC 957 What kind of work did you do, that is, what was your occupation at the time of the incident? (For example: plumber, typist, farmer) Page 29 139. USUALJOBDUTIES 958 What were your usual activities or duties at this job? 140. JOBMSATYPE A city? 1 844 Suburban area? 2 While working at this job, did you work mostly in - (Read category - then enter the appropriate code). Rural area? 3 Combination of any of these? 4 141a. INCIDENTHAPPENATWORK Yes 1 845 SKIP to 141c No 2 Ask or verify: Did this incident happen at your work site? Don't know 3 Other - Specify - ASK 141b 4 141b. INCIDENTHAPPENATWORK_SPEC Specify Please specify 141c. WORKDAYNIGHT Days 1 846 Nights 2 Did you usually work days or nights? Both days and nights/rotating shifts 3 142a. ISCURRENTJOB 959 Yes 1 No 2 Is this your current job? 142b. Was the respondent injured in this incident? (Is box 2-11 marked in 31a?) Yes (injury marked in 31a - ASK 143 CHECK 1 ITEM S No (blank or "None" marked in 31a - SKIP to 147a 2 143. LOSTWORKTIME Yes - ASK 144 1 870 No - SKIP to 147a 2 Did YOU lose time from work because of the injuries you suffered in this incident? 144. AMOUNTTIMELOST ____________ Number of days - ASK 145 871 How much time did you lose because of injuries? Less than one day - SKIP to 147a 0 145. LOSTPAYNOMEDINS Yes - ASK 146 1 872 No - SKIP to 147a 2 During these days, did you lose any pay that was not covered by unemployment insurance, sick leave, or some other source? 146. AMOUNTLOSTPAYNOMED 873 $ ____________ . 00 Amount of pay lost About how much pay did you lose? 147a. LOSTOTHERWORKTIME Police related activities 1 874 Court related activities 2 ASK 148 Did YOU lose any (other) time from work because of this incident for such things as cooperating with a police investigation, testifying in court, or repairing or replacing damaged or stolen property? Probe: Any other reason? Enter all that apply. * Repairing damaged property 3 Replacing stolen items 4 Other - Specify - ASK 147b 5 6 None (did not lose time from work for any of these reasons) - SKIP to 151 147b. LOSTOTHERWORKTIME_SPEC Specify Please specify the (time/other time) lost from work because of this incident. 148. DAYSLOSTWORK ____________ Number of days - ASK 149 875 How much time did you lose altogether because of (name all reasons marked in 147a)? Less than one day - SKIP to 151 0 Page 30 149. LOSTPAYNOEMPINS Yes - ASK 150 1 876 No - SKIP to 151 2 During these days, did you lose any pay that was not covered by unemployment insurance, paid leave, or some other source? 150. AMOUNTLOSTNOPAYEMP 877 $ ____________ . 00 Amount of pay lost About how much pay did you lose? 151. HHMEMLOSTWORKTIME Yes - ASK 152a 1 878 No - SKIP to 152b 2 Were there any (other) household members 16 years or older who lost time from work because of this incident? 152a. AMOUNTHHMEMTIMELOST 879 ____________ Number of days How much time did they lose altogether? Less than one day 0 152b. Was the respondent on the way to or from work, school, or some other place when the incident (happened/started)? (Is box 2, 3, or 4 marked in 135a?) Yes - ASK 153a CHECK 1 ITEM T No - SKIP to 153c 2 Car, truck or van 153a. TYPETRANSPORTATION 1 881 Motorcycle 2 Ask or verify: You told me earlier you were on the way (to/ from) (work/school/some place) when the incident happened. What means of transportation were you using? Bicycle 3 On foot Skip to 153c 4 School bus (private or public) Bus or trolley 5 6 Subway or rapid transit 7 Train 8 Taxi 9 Other - Specify - Ask 153b 10 153b. TYPETRANSPORTATION_SPEC Specify Please specify what means of transportation you were using. 153c. Is this incident part of a series of crimes? (Is box 2 (is a "series") marked in 5c?) Yes - ASK 154a CHECK 1 ITEM U No - SKIP to 161 2 154a. SERIESNUMTIMES ____________ Number of incidents - SKIP to 155a 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? Don't know - ASK 154b 154b. SERIESDK No way of knowing 1 884 SKIP to 155a Happened too many times Some other reason - Specify - ASK 154c 2 Is that because there is no way of knowing, or because it happened too many times, or is there some other reason? 3 154c. SERIESDKSPEC Specify Please specify the other reason the respondent doesn't know the number of times. Notes Page 31 155a. SERIESWHICHMONTHQ1 Number of incidents per quarter In what month or months did these incidents take place? Probe: How many in (name months)? Jan., Feb., or Mar. 885 (Qtr. 1) 155b. SERIESWHICHMONTHQ2 In what month or months did these incidents take place? Probe: How many in (name months)? 886 Apr., May, or Jun. (Qtr. 2) 155c. SERIESWHICHMONTHQ3 In what month or months did these incidents take place? Probe: How many in (name months)? Jul., Aug., or Sept. 887 (Qtr. 3) 155d. SERIESWHICHMONTHQ4 In what month or months did these incidents take place? Probe: How many in (name months)? Oct., Nov., or Dec. 888 (Qtr. 4) 156. SERIESLOCATION All in the same place 1 889 Some in the same place 2 Did all, some, or none of these incidents occur in the same place? None in the same place 3 157. SERIESOFFENDER All by same person 1 890 Some by same person 2 Were all, some, or none of these incidents done by the same person(s)? None by same person 3 Don't know - SKIP to 159a 4 158a. SERIESOFFENDERRELATION RELATIVE Spouse at time of incident Ex-spouse at time of incident Parent or step-parent 1 What (was/were) the relationship(s) of the offender(s) to you? For example, friend, spouse, schoolmate, etc? Probe: Anything else? Enter all that apply. 891 2 SKIP to 159a * 3 Own child or step-child 16 Brother/sister 17 Other relative - Specify - ASK 158b 4 NONRELATIVE Boyfriend or girlfriend, ex-boyfriend or ex-girlfriend Friend or ex-friend 18 892 * 5 Roommate, boarder 8 Schoolmate 7 Neighbor 6 SKIP to 159a Customer/client 11 Patient 12 13 Supervisor (current or former) Employee (current or former) Co-worker (current or former) 14 15 19 Teacher/school staff Other nonrelative - Specify - ASK 158c 10 158b. SERIESOFFENDERRELATION14SPEC Specify - SKIP to 159a Please specify the other relative. Specify 158c. SERIESOFFENDERRELATION26SPEC Please specify the other nonrelative. 159a. SAMETHINGEACHTIME Yes - SKIP to 160a 1 893 No - ASK 159b 2 Did the same thing happen each time? 159b. HOWINCIDENTSDIFFER Specify How did the incidents differ? Page 32 160a. TROUBLEONGOING Yes - SKIP to 160c 1 894 No - ASK 160b 2 Is the trouble still going on? 160b. WHATENDEDIT Specify What ended it? SERIESCONTACTORNOT CONTACT CRIMES 160c. 895 CHECK ITEM V1 Completed or threatened violence in the course of the victim's job (police officer, security guard, psychiatric social worker, etc.) 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. SKIP to 161 Completed or threatened violence between spouses, other relatives, friends, neighbors, etc. 2 Completed or threatened violence at school or on school property 3 Other contact crimes (other violence, pocket picking, purse snatching, etc.) - Specify - ASK 160d 4 NONCONTACT CRIMES 5 Theft or attempted theft of motor vehicles Theft or attempted theft of motor vehicle parts (tire, hubcap, battery, attached car stereo, etc.) 6 Theft or attempted theft of contents of motor vehicle, including unattached parts 7 SKIP to 161 Theft or attempted theft at school or on school property 8 Illegal entry of, or attempt to enter, victim's home, other building on property, second home, hotel, motel 9 Theft or attempted theft from victim's home or vicinity by person(s) KNOWN to victim (roommate, babysitter, etc.) 10 Theft or attempted theft from victim's home or vicinity by person(s) UNKNOWN to victim 11 Other theft or attempted theft (at work, while shopping, etc.) - Specify - ASK 160e 12 160d. SERIESCONTACTORNOT14SPEC Specify - SKIP to 161 Please specify the other contact crime. 160e. SERIESCONTACTORNOT22SPEC Specify Please specify the other noncontact crime. 161. INCIDENTHATECRIME Yes - ASK 162 910 1 No - SKIP to 167a 2 Hate crimes or crimes of prejudice or bigotry occur when (an offender/offenders) target(s) people because of one or more of their characteristics or religious beliefs. Do you have any reason to suspect the incident just discussed was a hate crime or crime of prejudice or bigotry? Notes Page 33 162. An offender/Offenders can target people for a variety of reasons, but we are only going to ask you about a few today. Do you suspect the offender(s) targeted you because of... (a) INCHATETARGETREASONS_RELIGION Yes Your race? 1 2 No 3 Don't know 896 (b) INCHATETARGETREASONS_RELIGION Your religion? Yes 1 2 No 3 Don't know 897 (c) INCHATETARGETREASONS_ETHNICITY Your ethnic background or national origin (for example, people of Hispanic origin)? Yes 1 2 No 3 Don't know 898 (d) INCHATETARGETREASONS_DISABILITY Any disability (by this I mean physical, mental, or developmental disabilities) you may have? Yes 1 2 No 3 Don't know 899 (e) INCIDENTHATETARGETREASONS_GENDER 900 Your gender? Yes 1 2 No 3 Don't know (f) INCIDENTHATETARGETREASONS_SEXUAL 901 Your sexual orientation? If "Yes," SAY - (by this we mean homosexual, bisexual, or heterosexual) Yes 1 2 No 3 Don't know 163. Some offenders target people because they associate with certain people or the (offender perceives/offenders perceive) them as having certain characteristics or religious beliefs. Do you suspect you were targeted because of... (a) INCIDENTHATETARGETWHOYOUKNOW Yes - Specify - ASK 163b 911 1 No 2 Your association with people who have certain characteristics or religious beliefs (for example, a multiracial couple)? SKIP to 163c Don't know 3 (b) INCHATETARGETWHOYOUKNOW_SPEC Specify 912 Please specify why you suspect you were targeted because of your association with people who have certain characteristics or religious beliefs. (c) INCIDENTHATETARGETRELIGION Yes - Specify - ASK 163d 913 1 No 2 The offender(s)'s perception of your characteristics or religious beliefs (for example, the offender(s) thought you were Jewish because you went into a synagogue)? SKIP to 163e Don't know 3 (d) INCIDENTHATETARGETRELIGION_SPEC Specify 914 Please specify why you suspect you were targeted because of the offender(s)'s perception of your characteristics or religious beliefs. 163e. Are one or more boxes marked "Yes" in 162a through 163c? Yes - ASK 164a CHECK 1 ITEM V2 No - SKIP to 167a 2 164a. INCIDENTHAVEEVIDENCEHATE Yes - SKIP to 165 1 915 No 2 Do you have any evidence that this incident was a hate crime or crime of prejudice or bigotry? ASK 164b Don't know 3 1 Yes - ASK 165 164b. INCIDENTHAVEEVIDENCEHATE_SUGGEST No - SKIP to 167a 2 Did the offender(s) say something, write anything, or leave anything behind at the crime scene that would suggest you were targeted because of your characteristics or religious beliefs? Page 34 165. The next questions ask about the evidence you have that makes you suspect this incident was a hate crime or a crime of prejudice or bigotry. As I read the following questions, please tell me if any of the following happened: (a) INCIDENTEVIDENCEHATE_MAKEFUN Did the offender(s) make fun of you, make negative comments, use slang, hurtful words, or abusive language? Yes 1 2 No 3 Don't know 916 (b) INCIDENTEVIDENCEHATE_SYMBOLS Were any hate symbols present at the crime scene to indicate the offender(s) targeted you for a particular reason (for example, a swastika, graffiti on the walls of a temple, a burning cross, or written words)? Yes 1 2 No 3 Don't know 917 (c) INCEVIDENCEHATE_POLICETARGET Did a police investigation confirm the offender(s) targeted you (for example, did the offender(s) confess a motive, or did the police find books, journals, or pictures that indicated the offender(s) (was/were) prejudiced against people with certain characteristics or religious beliefs)? Yes 1 2 No 3 Don't know 918 (d) INCEVIDENCEHATE_OFFENDERDIDSAME Do you know if the offender(s) (has/have) committed similar hate crimes or crimes of prejudice or bigotry in the past? Yes 1 2 No 3 Don't know 919 (e) INCIDENTEVIDENCEHATE_NEARHOLIDAY Did the incident occur on or near a holiday, event, location, gathering place, or building commonly associated with a specific group (for example, at the Gay Pride March or at a synagogue, Korean church, or gay bar)? Yes 1 2 No 3 Don't know 920 (f) INCEVIDENCEHATE_OTHERLIKECRIMES Have other hate crimes or crimes of prejudice or bigotry happened to you or in your area/ neighborhood where people have been targeted? Yes 1 2 No 3 Don't know 921 (g) INCEVIDENCEHATE_FELT_BELIEVED Do your feelings, instincts, or perception lead you to suspect this incident was a hate crime or crime of prejudice or bigotry, but you do not have enough evidence to know for sure? Yes 1 2 No 3 Don't know 922 166. TELLPOLICEHATECRIME 1 Yes 908 No 2 At any time, did you tell the police that you believed the incident was a hate crime or crime of prejudice or bigotry? 167a. Is this the first incident reported for this respondent? Yes - SKIP to 168 CHECK 925 1 ITEM V3 No - FILL 167b 2 167b. Is 171 marked "Yes" for the first incident reported for this respondent? (That is, has the respondent previously indicated that he/she has a health condition or disability?) Yes - SKIP to 172 CHECK 926 1 ITEM V4 No - SKIP to 174 2 168. DISABILITY_INTRO Research has shown that people with disabilities may be more vulnerable to crime victimization. The next questions ask about any health conditions, impairments, or disabilities you may have. Notes Page 35 169a. HEARING Yes 1 dis_hearing No 2 Are you deaf or do you have serious difficulty hearing? Yes 169b. VISION 1 dis_vision No 2 Are you blind or do you have serious difficulty seeing even when wearing glasses? 170a. Because of a physical, mental, or emotional condition, do you have serious difficulty: Yes (1) LEARN_CONCENTRATE 1 dis_learn_concentrate No 2 Concentrating, remembering or making decisions? (2) PHYSICAL_LIMIT Yes 1 dis_physical_limit No 2 Walking or climbing stairs? (3) DRESS_BATH Yes 1 dis_dress_bath No 2 Dressing or bathing? 170b. LEAVING_HOME Yes 1 dis_leaving_home No 2 Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping? 171. Is "Yes" marked in any of 169a - 170b? (That is, has the respondent indicated that he/ she has a health condition or disability?) Yes - ASK 172 CHECK 943 1 ITEM V5 No - SKIP to 174 2 172. VICTIMDUETODISABLE Yes - ASK 173a 944 1 No 2 During the incident you just told me about, do you have reason to suspect you were victimized because of your health condition(s), impairment(s), or disability(ies)? SKIP to 174 Don't know 3 173a. WHICHDISABILITYTARGET_1 946 (First Condition) What health conditions, impairments, or disabilities do you believe caused you to be targeted for this incident? Please specify the first type of health condition, impairment, or disability. If multiple health conditions, impairments, or disabilities mentioned enter only the first one mentioned here. 173b. WHICHDISABILITYTARGETELSE_1 Yes - ASK 173c 1 No 2 Any other conditions, impairments, or disabilities? SKIP to 174 Don't know 3 Notes Page 36 173c. WHICHDISABILITYTARGET_2 947 (Second Condition) What other health conditions, impairments, or disabilities do you believe caused you to be targeted for this incident? Please specify the second type of health condition, impairment, or disability. If multiple health conditions, impairments, or disabilities mentioned enter only the second one mentioned here. 173d. WHICHDISABILITYTARGETELSE_2 Yes - ASK 173e 1 No 2 Any other conditions, impairments, or disabilities? SKIP to 174 Don't know 3 173e. WHICHDISABILITYTARGET_3 948 (Third Condition) What other health conditions, impairments, or disabilities do you believe caused you to be targeted for this incident? Please specify the third type of health condition, impairment, or disability. If multiple health conditions, impairments, or disabilities mentioned enter only the third one mentioned here. SUMMARY 174. CHECK ITEM W 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. Notes Page 37