Form CJ-11 Quarterly Summary of Deaths in Law Enforcement Custody

CJ-11
RETURN TO: State reporting coordinator
(See back of this form for
a national listing.)

OMB No. 1121-0249 Approval Expires 12/31/2012

FORM CJ-11
(10-13-2009)

QUARTERLY SUMMARY OF
ARREST-RELATED DEATHS, 2009

DRAFT

DATA SUPPLIED BY
NAME

TITLE

TELEPHONE Area Code Number

FAX
Area Code Number
NUMBER

E-MAIL
ADDRESS

Reporting Period (Mark only one.)

State

‰ Quarter 1 (January 1 — March 31)
‰ Quarter 2 (April 1 — June 30)
‰ Quarter 3 (July 1 — September 30)
‰ Quarter 4 (October 1 — December 31)

What deaths should be reported?

During the reporting quarter marked above, how many
persons died while in the process of arrest or in the custody
of law enforcement agencies in your State?

• INCLUDE deaths of ALL persons in process of arrest
— Killed by any use of force by law enforcement officers;
— In the physical custody, or under the physical restraint of law
enforcement officers, even if the person was not formally under
arrest at the time;
— At crime/arrest scene or medical facility prior to booking;
— Killed in vehicular pursuit accidents during which law enforcement officers took direct action against the driver or vehicle
(e.g., shooting at the suspect, forcing the vehicle off the road
with an obstruction, spike strip, or the officer’s own vehicle).
— While in transit to or from law enforcement facilities;
— While confined in lockups or booking centers (facilities from
which arrestees are ususally transferred within 72 hours and not
held beyond arraignment).

Number of deaths
Instructions:

• EXCLUDE deaths of ALL persons
— Confined in local jails (facilities which typically house inmates
for periods beyond 72 hours and after arraignment); please
report jail deaths using a CJ-9 form (contact BJS staff for assistance at 202-307-0765 or [email protected]);
— Confined in State prisons, State juvenile correctional facilities,
or private correctional facilities;
— Killed in the course of law enforcement activities against whom
no charges were intended (e.g., innocent bystanders, hostages,
law enforcement personnel).
— Who die before coming into contact with any law enforcement
officers (e.g., subjects of arrest warrants who died before any
arrest process began).
— Killed in vehicular accidents during which law enforcement officers did NOT take any direct action against the driver or vehicle
(see 4th item under “INCLUDE” for examples of such actions).

• If no deaths occurred, please enter a count of zero
and fax the completed CJ-11 form to your state
reporting coordinator (see back of this sheet).
• For each death reported, complete an Arrest-Related
Death Report (CJ-11A). Please complete items 1
through 23 for each death, plus the remaining items
for all deaths at a booking center or police lockup
facility.
• Enter the name of the deceased in the space
provided at the top of each page of the CJ-11A.
• If you need assistance, contact your state reporting
coordinator, or the Bureau of Justice Statistics
at 202-307-0765.
• Return this quarterly summary and each associated
CJ-11A form to your state reporting coordinator
within 60 days of the end of each quarter.

Burden Statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response, including reviewing instructions, searching existing data sources, gathering necessary data, and
completing and reviewing this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to the
Director, Bureau of Justice Statistics, 810 Seventh Street, N.W., Washington, DC 20531.

National listing of state reporting coordinators
Alabama: Becki Goggins
Alabama Criminal Justice Info. Center
PH: (334) 242-4937 FX: (334) 242-0577

Kentucky: Emily Koyagi
Kentucky Justice & Public Safety Cabinet
PH: (502) 564-7554 FX: (502) 564-6686

North Dakota: Collen Weltz
Office of Attorney General
PH: (701) 328-5527 FX: (701) 328-5510

Alaska: Alan McKelvie
Alaska Statistical Analysis Center
PH: (907) 786-1810 FX: (907) 786-7777

Louisiana: Kim Eiland
Louisiana Department of Corrections
PH: (225) 342-6630 FX: (225) 342-3095

Ohio: Lisa Shoaf
Office of Criminal Justice Services
PH: (614) 466-5997 FX: (614) 466-0308

Arizona: Phillip Stevenson
Arizona Criminal Justice Commission
PH: (602) 364-1157 FX: (602) 364-1175

Maine: James Ferland
Office of the Chief Medical Examiner
PH: (207) 624-7180 FX: (207) 624-7178

Oklahoma: Angie Baker
Oklahoma Criminal Justice Research Ctr.
PH: (405) 524-2059 FX: (405) 524-2792

Arkansas: Regina Wilson
Arkansas Crime Information Center
PH: (501) 682-7418 FX: (501) 682-2530

Maryland: Christina Lentz
Office of Crime Control & Prevention
PH: (410) 821-2843 FX: (410) 321-3116

Oregon: Lee Anna Bennett-Ashworth
Office of Public Health
PH: (971) 673-0129 FX: (971) 673-0990

California: Sidney Davis
Criminal Justice Statistics Center
PH: (916) 227-3545 FX: (916) 227-0427

Pennsylvania: Darlene Hurley
Massachusetts: Shelley Penman
Executive Office of Public Safety and Security Office of Research, Eval. & Strategic Policy
PH: (717) 265-8522 FX: (717) 705-4566
PH: (617) 725-3361 FX: (617) 725-0260

Colorado: Kim English
Colorado Department of Public Safety
PH: (303) 239-4453 FX: (303) 239-4491

Michigan: Theresa Page
Michigan State Police
PH: (517) 322-1424 FX: (517) 322-5385

Rhode Island: Thomas Mongeau
Governor’s Justice Commission
PH: (401) 222-2620 FX: (401) 222-1294

Connecticut: Ivan Kuczyk
Connecticut Office of Policy & Management
PH: (860) 418-6238 FX: (860) 418-6496

Minnesota: Timothy O’Malley
Minnesota Bureau of Criminal Apprehension
PH: (651) 793-1000 FX: (651) 793-1001

South Carolina: Robert McManus
South Carolina Department of Public Safety
PH: (803) 896-8717 FX: (803) 896-8393

Delaware: John O’Connell
Delaware Statistical Analysis Center
PH: (302)739-4846 FX: (302) 739-4630

Mississippi: Bill Greenleaf
Mississippi Department of Corrections
PH: (601) 359-5646 FX: (601) 359-5629

South Dakota: Brenda Manning
Division of Criminal Investigation
PH: (605) 773-6312 FX: (605) 773-6471

District of Columbia: Sgt. Harry Hill
Office of the Assistant Chief of Police
PH: (202) 576-3394 FX: (202) 727-3307

Missouri: Ronald Beck
Missouri State Highway Patrol
PH: (573) 751-9000 FX: (573) 526-6274

Tennessee: Maggi Duncan
TN Assoc. of Chiefs of Police
PH: (615) 726-8227 FX: (615) 244-0057

Florida: Susan Burton
Florida Department of Law Enforcement
PH: (850) 410-7140 FX: (850) 410-7150

Montana: Jimmy Steyee
Montana Department of Justice
PH: (406) 444-4298 FX: (406) 444-4722

Texas: Renee Gray
Office of the Attorney General
PH: (512) 305-8882 FX: (512) 494-8283

Georgia: Jean Gearing
Criminal Justice Coordinating Council
PH: (404) 657-1967 FX: (404) 657-1956

Nebraska: Mike Overton
Nebraska Crime Commission
PH: (402) 471-2194 FX: (402) 471-2837

Utah: Christine Mitchell
Commission on Criminal & Juvenile Justice
PH: (801) 538-1047 FX: (801) 538-9609

Hawaii: Cheryl Rodrigues
Hawaii Department of Public Safety
PH: (808) 587-1235 FX: (808) 587-1244

Nevada: Timothy Hart
Center for Analysis of Crime Statistics
PH: (702) 895-0233 FX: (702) 895-0252

Vermont: Max Schlueter
Vermont Crime Information Center
PH: (802) 244-8727 FX: (802) 241-5552

Idaho: Tammy Majors
Idaho Department of Corrections
PH: (208) 658-2129 FX: (208) 327-7007

New Hampshire: Timothy Brackett
Office of the Attorney General
PH: (603) 271-8090 FX: (603) 271-6290

Virginia: James McDonough
Department of Criminal Justice Services
PH: (804) 371-0532 FX: (804) 225-3853

Illinois: Mark Powers
Illinois Criminal Justice Information Authority
PH: (312) 793-8550 FX: (312) 793-8422

New Jersey: Jean Petherbridge
Division of Criminal Justice
PH: (609) 984-5693 FX: (609) 984-3381

Washington: Tonya Todd
Association of Sheriffs & Chiefs of Police
PH: (360) 486-2380 FX: (360) 486-2381

Indiana: Katie Knutson
Indiana Department of Corrections
PH: (317) 232-2249 FX: (317) 233-1474

New Mexico: Tim Stepetic
Office of the Medical Investigator
PH: (505) 272-0733 FX: (505) 272-0727

West Virginia: Monika Sterling
Division of Criminal Justice Services
PH: (304) 558-8814 FX: (304) 558-0391

New York: Zachary Morton
Iowa: Paul Stageberg
Iowa Div. of Criminal & Juvenile Justice Plan. Division of Criminal Justice Services
PH: (518) 457-1149 FX: (518) 485-8039
PH: (515) 242-6122 FX: (515) 242-6119

Wisconsin: Kristi Waits
Wisconsin Office of Justice Assistance
PH: (608) 261-2437 FX: (608) 266-6676

North Carolina: Dr. John Butts
Office of the Chief Medical Examiner
PH: (800) 672-7024 FX: (919) 962-6263

Wyoming: Rodney A. Wambeam
Office of the Attorney General
PH: (307) 760-8928 FX: (307) 766-2759

Kansas: Jan Brasher
Kansas Sentencing Commission
PH: (785) 296-0923 FX: (785) 296-0927