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pdfOMB 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
| File Type | text/plain |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |