Attachment 4a CATI CAPI screener

OMB No.
FORM

: Approval Expires MM/DD/YYYY

SCV-1

RTI International

Implementation
Date: (MM/DD/YYY)

ACTING AS COLLECTING AGENT FOR THE
BUREAU OF JUSTICE STATISTICS

S
C

U.S. DEPARTMENT OF JUSTICE

SURVEY OF
CRIME VICTIMIZATION

V

SCV-1 BASIC SCREEN QUESTIONNAIRE
RESPONDENT'S PERSONAL CHARACTERISTICS
1. To begin, let's colllect some information about you:

1

First Name
Last Name

2. Age at last
Birthday

2
3
4

6. What is your race?

5. Are you of Hispanic
Origin?

1

18-29
30-49
50-69
70+

1

3. Marital status 4. Sex

2
3
4
5

Married
Widowed
Divorced
Separated
Never
married

7. Please provide your phone numbers, so

that we may contact you again in six
months. PROBE FOR UP TO THREE NUMBERS

Please select one or more.

1

Male

1

Yes

1

White

2

Female

2

No

2

Black or African American

Home:

3

Asian

4

Native Hawaiian or Other

Cell:

Pacific Islander
American Indian or

Work:

5

Alaska Native

HOUSEHOLD RESPONDENT ONLY
8. Not inlcluding yourself, how many people 18 years of age or older are living at this address?
Include all persons 18 years if age and older, currently living at this address;
Include all persons 18 years if age and older, who usually live at this address, but who are temporarily away for reasons such as visiting friends or
relatives, travelling for their jobs, or in "general" hospitals;
Include any lodgers, servants, hired hands, and other persons who usually live at this address.
Do not include any persons who live in another dwelling unit at this address or within this structure, such as a separate apartment with a separate
entrance.
Number of people

8a. Please start with your spouse or partner; include unmarried children 18 years of age or older (from oldest to youngest), include married children, their
spouses and children 18 years of age or older (from oldest to youngest) , include other persons related t o you, as well as lodgers and non-relatives
staying at this address.
What is the person's first and last name?
First Name
Last Name

8b. What is this person's
relationship to you?

1

Husband/Wife

2

Son/Daughter

3

Father/Mother

4

Brother/Sister

5

Other relative

6

Not a relative

8f. Is this person Spanish, Hispanic,
or Latino?
1

Yes

2

No

8c. What was this person's
age at their last birthday?

1

18-29

2

30-49

3

50-69

4

70+

8g. What is this person's race? Are
they...
Please select one or more.
1

White

2
3

Black or African American
Asian

4

Native Hawaiian or Other

5

8d. What is this person's
marital status?

Pacific Islander
American Indian or
IAlaska Native

8e. What is this person's
sex?

1

Married

1

Male

2

Widowed

2

Female

3

Divorced

4

Separated

5

Never married

9. DISPLAY ROSTER. Any more ADULT household members to add?
1

Yes

2

No

RESPONDENT'S SCREEN QUESTIONS
17a. SQTHEFT
I'm going to read some examples that will give you an idea of the
kinds of crimes this study covers.
As I go through them, tell me if any of these happened to you in the
last 6 months, that is since __________ ______, 20 ____.
Was something belonging to YOU stolen, such as Read each category.
(a) Things that you carry, like luggage, a wallet, purse, briefcase
book (b) Clothing, jewelry, or cellphone (c) Bicycle or sports equipment (d) Things in your home - like a TV, stereo, or tools (e) Things outside your home such as a garden hose or lawn
furniture (Asked of Household Respondent only)
(f) Things belonging to children in the household (Asked of Household Respondent only)
(g) Things from a vehicle, such as a package, groceries, camera, or
CDs OR
(h) Did anyone ATTEMPT to steal anything belonging to you?
532

1

Yes - ASK 17b

2

No - If Household Respondent SKIP to 18a; Else
SKIP to 21a

Did any incidents of this type happen to you?
Ask only if necessary

17b. SQTHEFTTIMES

533

How many times?

Number of times (17b)

17c. SQTHEFTSPEC

Briefly describe incident(s)

What happened?

If Household Respondent ASK 18a; else SKIP to 21a

18a. SQBREAKIN (Asked of Household Respondent Only)
(Other than any incidents already mentioned,) has anyone Read each category.
(a) Broken in or ATTEMPTED to break into your home by forcing a
door or window, pushing past someone, jimmying a lock, cutting
a screen, or entering through an open door or window?
(b) Has anyone illegally gotten in or tried to get into a garage, shed,
or storage room?
OR
(c) Illegally gotten in or tried to get into a hotel or motel room or
vacation home where you were staying?
534
Did any incidents of this type happen to you?
Ask only if necessary

18b.SQBREAKINTIMES (Asked of Household Respondent Only)
How many times?

18c. SQBREAKINSPEC (Asked of Household Respondent Only)
What happened?

Page 2

1

Yes - ASK 18b

2

No - SKIP to 19

535
Number of times (18b)

Briefly describe incident(s)

RESPONDENT'S SCREEN QUESTIONS
19.SQTOTALVEHICLES (Asked of Household Respondent Only)

536

4

None - SKIP to 21a
1
2
3
4 or more

1

Yes - ASK 20b

2

No - SKIP to 21a

0
1

What was the TOTAL number of cars, vans, trucks, motorcycles, or
other motor vehicles owned by you or any other member of this
household during the last 6 months? Include those you no longer
own.

2
3

20a. SQMVTHEFT (Asked of Household Respondent Only)
During the last 6 months, (other than any incidents already
mentioned,) (was the vehicle/were any of the vehicles) Read each category.
(a) Stolen or used without permission?
(b) Did anyone steal any parts such as a tire, car stereo, hubcap, or
battery?
(c) Did anyone steal any gas from (it/them)?
OR
(d) Did anyone ATTEMPT to steal any vehicle or parts attached to
(it/them)?
537
Did any incidents of this type happen to you?
Ask only if necessary

20b.SQMVTHEFTTIMES (Asked of Household Respondent Only)

538

How many times?

Number of times (20b)

20c. SQMVTHEFTSPEC (Asked of Household Respondent Only)

Briefly describe incident(s)

What happened?

21a. SQATTACKWHERE
(Other than any incidents already mentioned,) since __________
______, 20 ____, were you attacked or threatened OR did you have
something stolen from you Read each category.
(a) At home including the porch or yard (b) At or near a friend's, relative's, or neighbor's home (c) At work or school d) In places such as a storage shed or laundry room, a shopping
mall, restaurant, bank, or airport (e) While riding in any vehicle (f) On the street or in a parking lot (g) At such places as a party, theater, gym, picnic area, bowling
lanes, or while fishing or hunting OR
(h) Did anyone ATTEMPT to attack or ATTEMPT to steal
anything belonging to you from any of these places?
539
Did any incidents of this type happen to you?
Ask only if necessary

21b. SQATTACKWHERETIMES
How many times?

21c. SQATTACKWHERESPEC

1

Yes - ASK 21b

2

No - SKIP to 22a

540
Number of times (21b)

Briefly describe incident(s)

What happened?

Page 3

RESPONDENT'S SCREEN QUESTIONS
22a. SQATTACKHOW
(Other than any incidents already mentioned,) has anyone attacked
or threatened you in any of these ways (Exclude telephone threats) Read each category.
(a)
With any weapon, for instance, a gun or knife (b) With anything like a baseball bat, frying pan, scissors, or stick (c) By something thrown, such as a rock or bottle -

(d)
Include any grabbing, punching, or choking,
(e) Any rape, attempted rape or other type of sexual attack (f) Any face to face threats OR
(g) Any attack or threat or use of force by anyone at all? Please
mention it even if you are not certain it was a crime.
541
Did any incidents of this type happen to you?
Ask only if necessary

22b. SQATTACKHOWTIMES

1

Yes - ASK 22b

2

No - SKIP to 23a

542

How many times?

Number of times (22b)

22c. SQATTACKHOWSPEC

Briefly describe incident(s)

What happened?

23a. SQTHEFTATTACKKNOWNOFF
People often don't think of incidents committed by someone they
know. (Other than any incidents already mentioned,) did you have
something stolen from you OR were you attacked or threatened by (Exclude telephone threats)
Read each category.
(a) Someone at work or school (b) A neighbor or friend (c) A relative or family member (d) Any other person you've met or known?
543
Did any incidents of this type happen to you?
Ask only if necessary

23b. SQTHEFTATTACKKNOWNOFFTIMES
How many times?

23c. SQTHEFTATTACKKNOWNOFFSPEC
What happened?

Page 4

1

Yes - ASK 23b

2

No - SKIP to 24a

544
Number of times (23b)

Briefly describe incident(s)

RESPONDENT'S SCREEN QUESTIONS
24a. SQSEXUAL
Incidents involving forced or unwanted sexual acts are often
difficult to talk about. (Other than any incidents already
mentioned,) have you been forced or coerced to engage in
unwanted sexual activity by Read each category.
(a) Someone you didn't know (b) A casual acquaintance OR
(c) Someone you know well?
545
Did any incidents of this type happen to you?
Ask only if necessary

1

Yes - ASK 24b

2

No - SKIP to 25a

546

24b. SQSEXUALTIMES
How many times?

Number of times (24b)

24c. SQSEXUALSPEC

Briefly describe incident(s)

What happened?

25a. SQCALLPOLICECRIME

547

1

Yes - ASK 25b

2

No - SKIP to 26a

During the last 6 months, (other than any incidents already
mentioned,) did you call the police to report something that
happened to YOU which you thought was a crime?

25b. SQCALLPOLICESPEC

Briefly describe incident(s)

What happened?

25c.

CHECK

ITEM A

SQCALLPOLICEATTACKTHREAT

549

1

Yes - ASK 25d

2

No - SKIP to 26a

If not sure ask:
Were you attacked or threatened, or was something stolen or an
attempt made to steal something that belonged to you or another
household member?

25d. SQCALLPOLICEATTCKTHREATTIMES

550

How many times?

Number of times (25d)

26a. SQNOCALLPOLICECRIME

551

1

Yes - ASK 26b

2

No - SKIP to Screener Summary

During the last 6 months, (other than any incidents already
mentioned,) did anything which you thought was a crime happen to
YOU, but you did NOT report to the police?

26b. SQNOCALLPOLICESPEC

Briefly describe incident(s)

What happened?

26c.

CHECK

SQNOCALLPOLICEATTACKTHREAT

553

ITEM B

1

Yes - ASK 26d

2

No - SKIP to Screener Summary

If not sure ask:
Were you attacked or threatened, or was something stolen or an
attempt made to steal something that belonged to you or another
household member?

26d. SQNOCALLPOLICEATTACKTHREATTIMES
How many times?

554
Number of times (26d)

Page 5

SUMMARY
IF ONLY 1 CRIME REPORTED IN SCREENER (ONLY ONE SCREENER ITEM=YES AND "HOW MANY TIMES" FOLLOW-UP=1), GO TO CIR2. ONLY 1 CIR WILL BE REQUIRED.
THE "WHAT HAPPENED" TEXT BECOMES THE INCIDENT 1 DESCRIPTION.
ELSE, IF >1 CRIME REPORTED IN SCREENER, ASK:
S1. Please think about ALL the crimes you experienced in the past 6 months. You told us you experienced the following:
[LIST DESCRIPTION TEXT FROM EACH "WHAT HAPPENED" BOX THAT WAS COMPLETED. DO NOT INCLUDE ANY COUNTS.]
[RESPONSE BOX LABEL: TEXT IN BOX.]
[RESPONSE BOX LABEL: TEXT IN BOX.]
[RESPONSE BOX LABEL: TEXT IN BOX.]
Total reported crimes: [SHOULD EQUAL NUMBER OF BOXES COMPLETED]
Did these crimes ALL happen at the same time, that is, during one crime incident, or did they happen at different times?
1

Crimes all happened at the same time - SKIP TO S2

2

Cirmes happened at different times - SKIP TO S3

S2. [LIST DESCRIPTION TEXT FROM EACH "WHAT HAPPENED" BOX AT TOP OF SCREEN FOR REFERENCE]
INTERVIEWER: R REPORTED ALL OF THESE CRIMES HAPPENED AT THE SAME TIME. CREATE 1 BRIEF DESCRIPTION OF THE CRIME INCIDENT.
PROGRAMMER: PROVIDE BOX FOR INTERVIEWER TO TYPE NEW DESCRIPTION . THIS WILL BE USED AS THE FILL FOR CIR2 AND THE BANNER THROUGHOUT THE CIR.
THIS INTERVIEW WILL REQUIRE ONE CIR.
INCIDENT 1: _______________________________________________________________________________________________________________________

S3. [LIST DESCRIPTION TEXT FROM EACH "WHAT HAPPENED" BOX AT TOP OF SCREEN FOR REFERENCE]
Crimes can happen in different ways. You might experience:
- A single crime incident, such as your car being stolen;
- More than 1 type of crime happening at the same time, such as your home being broken into AND your car being stolen, all in the same crime
incident;
- Or you might experience multiple crime incidents at different times. For example, you might have had your home broken into in June and your car
stolen in August.
How many different crime incidents did you experience in the past 6 months?

Number of different crime incidents
ROGRAMMER: THIS WILL DRIVE THE NUMBER OF TOTAL CIRs (ALLOWING UP TO 10 CIRs). BASED ON ANSWER TO THIS QUESTION, THE SAME NUMBER OF BOXES
SHOULD APPEAR FOR INTERVIEWER TO ENTER BRIEF DESCRIPTIONS. THESE INTERVIEWER DESCRIPTIONS WILL BE USED AS THE FILL FOR CIR2 AND THE BANNER
THROUGHOUT THE CIRs.

S4. You told me that you experienced [FILL NUMBER] different crime incidents in the past 6 months. Let me make sure I have a good description of
each of these before we continue with the survey. This will help us keep track of which crime incident we are discussing.
INTERVIEWER: CREATE A BRIEF DESCRIPTION OF EACH CRIME INCIDENT FROM RESPONDENT'S "WHAT HAPPENED" RESPONSES. IF MULTIPLE CRIMES HAPPENED IN
THE SAME INCIDENT, COMBINE THESE INTO ONE DESCRIPTION.
INCIDENT 1: _______________________________________________________________________________________________________________________
INCIDENT 2: _______________________________________________________________________________________________________________________
ETC...

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