Survey of Neighborhoods

Attachment F2 - Approach 2C Mail Screener (generic version)

Survey of
Neighborhoods

Department of Justice
O ffi ce

of

J us ti ce P ro g r a ms

Bureau of Justice Statistics

Title 42, Section 3732, United States Code, authorizes the Bureau of Justice Statistics, Department of Justice, to collect
information using this survey and requires us to keep all information about you and your household strictly confidential. Under
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. The valid OMB control number for this information collection is 7418-85F2. Comments
regarding any other aspect of this data collection may be sent to, to DOJ Clearance Officer, Bureau of Justice Statistics, 810
Seventh Street, NW Washington, DC 20531 or by calling toll-free 1-800-937-8285

!"##"$%&'()*+,'-.+)/0"$)'
!"#$%&'%$"(%)*+*%,-.(#-%/0%1-'$&2(%+$#$&'$&2'%+-.3(4%/0%5(&6"7/."//8'9%
!
"#$!%&'&!()*$+)!,-!.)/012$!3(.'4!')*5$6!,-!7$18#9,*#,,:/!1/!+!/)*5$6!,-!#,)/$#,;:/!0,!,90+1,+*0=$<0!,-!.)/[email protected]&!"#$!
/)*5$6!1/!2,<:)20$:!)<:$*!0#$!+)0#,*106!,-!"10;$!BC?!%<10$:!'0+0$/!D,:$?!'$201,&)/:,H&8,5I9H/&!
%
/;6%=&>>%&$%$#?(%$/%2/@:>($(%$"&'%'-.3(49%
!
J$!+<0121>+0$!0#+0!=,/0!#,)/$#,;:/!G1;;!9$!+9;$!0,!2,=>;$0$!0#$!=+1;$:!/)*5$6!1($(%$"&'%'-.3(49%
!
N+*0121>+01,$<+;01$/!-,*!*$-)/1<8!0,!+;$!/)*5$6?!+<:!6,)!2+<<,0!9$!*$>;+2$:!G10#!+<,0#$*!
#,)/$#,;:&!P,)*!2,,>$*+01,,*0+<0!0,!#$;>!$;$0$<$//!+<:!+22)*+26!,-!
0#1/!=)2#!<$$:$:!1<-,*=+01,<&!
%
!"/%=&>>%-'(%$"&'%&;0/.@#$&/;9%
!
R$/);0/!-*,=!0#1/!/)*5$6!3+<:!/1=1;+*!/)*5$6/!2,<:)20$:!96!"#$!%&'&!@$>+*0=$<0!,-!.)/012$4!will be!)/$:!!
0,!9$00$*!)<:$*/0+<:!0#$!<$$:/!,-!<$18#9,*#,,:!*$/1:$<0/.!!
%
!"/%2#;%B%2#>>%=&$"%C-('$&/;'9%
!
U-!6,)!G,);:!;1T$!-)*0#$*!1<-,*=+01,8%2"/'(;%0/.%$"&'%'$-849%
!
O,)/$#,;:/!G$*$!/$;$20$:!+0!*+<:,=!-*,=!+;;!*$/1:$<01+;!+::*$//$/&!(6!/$;$201<8!#,)/$#,;:/!*+<:,=;6?!
G$!G1;;!9$!+9;$!0,!2*$+0$!/21$<01-12!$/01=+0$/!+9,)0!#,)/$#,;:/!1,*0+<0!0,!
>+*0121>+0$?!/,!0#+0!G$!#+5$!+120)*$!,-!+;;!2,==)<101$/&!
%
>%?((:%@4%&;0/.@#$&/;%2/;0&8(;$&#>9%
!
The information you provide will be used for statistical purposes only and may not be disclosed, or used, in
identifiable form for any other purpose as required by law (Title 42, U.S. Code, Sections 3789g). Your
responses will be combined with those of others to produce statistical summaries about crime and safety.
After the study is completed, identifying information - your address and phone number - are destroyed.

Survey of Ne ighborhoods
INSTRUCTIONS
â Please use a black or blue pen to complete this form.
â Mark

to indicate your answer.

â If you want to change your answer, darken the box

and mark the correct answer.

START HERE

Your Neighborhood
The following questions ask about your neighborhood.
By neighborhood, we mean the general area around
your house or the building you live in, where you might
do things such as shopping, going to the park, or
visiting with neighbors.
1. O
 n the whole, is this neighborhood a good place
to live?

Yes

No

2. H
 ow much of a problem is litter, broken glass or
trash on the sidewalks and streets?

Never a problem

Almost never a problem

Sometimes a problem

Almost always a problem

Always a problem

3. H
 ow much of a problem is crime in your
neighborhood?

Never a problem

Almost never a problem

Sometimes a problem

Almost always a problem

Always a problem

For each of the following statements, please indicate
whether you strongly agree, agree, neither agree nor
disagree, disagree, or strongly disagree.
4. P
 eople around here are willing to help their
neighbors.

Strongly Agree

Agree

Neither Agree nor Disagree

Disagree

Strongly Disagree

Don’t know

5. This is a close-knit neighborhood.

Strongly Agree

Agree

Neither Agree nor Disagree

Disagree

Strongly Disagree

Don’t know

6. People in this neighborhood can be trusted.

Strongly Agree

Agree

Neither Agree nor Disagree

Disagree

Strongly Disagree

Don’t know

57483

7. People in this neighborhood generally get
along with each other.

Strongly Agree

Agree

Neither Agree nor Disagree

Disagree

Strongly Disagree

Don’t know

8. People in this neighborhood share the same
values.

Strongly Agree

Agree

Neither Agree nor Disagree

Disagree

Strongly Disagree

Don’t know

Experiences of People in Your Household
The next questions ask about whether you or anyone in
your household has experienced a crime in the past 12
months. Please include all crimes, no matter where it
happened and even if it was not reported to the police.
9. In the last 12 months, has something belonging
to anyone in this household been stolen, such
as a TV, sports equipment, tools, lawn furniture,
bicycle, wallet, purse, jewelry, or cell phone?

Yes

No

10. In the last 12 months, did anyone break into
or attempt to break into your residence, or a
garage, shed, or storage room that you own
or rent?

Yes

No

11. In the last 12 months, were any cars, vans,
trucks or other motor vehicles owned by
anyone in this household stolen or used
without permission?

Yes

No

12. In the last 12 months, did anyone steal or
attempt to steal any parts from a vehicle owned
by anyone in this household, like a tire, car
stereo, hubcap or battery, or anything that was
left in a vehicle?

Yes

No

The following questions ask about incidents in which
someone in your household has been confronted,
attacked, or threatened. Such incidents might be
between people that don’t know each other, but often
involve people who do know each other. Please include
all incidents, whether or not the people involved knew
each other.
13. In the last 12 months, did anyone take or try to
take something by force or threat of force from
anyone in the household?

Yes

No

14. In the last 12 months, has anyone in this
household been attacked with some type of
weapon, such as a gun, knife, baseball bat, or
rock?

Yes

No

15. In the last 12 months, has anyone in this
household been attacked in another way, such
as someone grabbing, forcing unwanted sexual
activity, punching, or choking?

Yes

No

57483

16. In the last 12 months, has anyone in this
household been threatened with any kind of
attack?

Yes

No

Your Household
19. Please think about everyone who currently lives
in your household. In the table below, please
indicate how many females and how many
males are in each age range provided.

Police and 911 Services

Age
Range

Please indicate whether you strongly agree, agree,
neither agree nor disagree, disagree, or strongly
disagree with each of the following statements.

Agree

Neither Agree nor Disagree

Disagree

Strongly Disagree

Don’t know

18. When people in your neighborhood call 911,
does help arrive quickly?

Yes

No

Don’t Know

Number
of Males

Under 18
years old
18 through
24 years old

17. The police are doing a good job in dealing with
problems that really concern people in this
neighborhood.

Strongly Agree

Number
of Females

25 through
34 years old
35 through
54 years old
55 years old
and older
20. In your household, is any adult not working
who would like to find a job? (Do not include
students or retired persons.)

Yes

No

21. Does anyone in your household work in the
following fields?

Medical or Health Field?

Yes

No

Mental Health Services Field?

Yes

No

Law Enforcement or Security
Field?

Yes

No

Retail Sales?

Yes

No

Transportation Field?

Yes

No

57483

22. Do you own or rent the place where you’re
living?

Own

24. How many times have you moved in the past 5
years?

0 times

Rent

1 times

Other

2 times

3 or more times

23. How long have you lived at this address?

1 year or less

1 to 5 years

5 or more years (skip to 26)

25. W
 hat is the best phone number to use to
contact you? (This phone number will only be
used for the purpose of this research study.)

-

-

Thank you for completing this survey. Please return your form in the postage paid
envelope provided or mail to:

Mail
to:

Name
Address
City, State Zip

57483