Appendix C - All attachments

Appendix C. Attachment Table of Contents
Attachment A.

BJS authorizing legislation (42 USC 3732) …..

p. 2-6

Attachment B.

2000 Death in Custody Reporting Act (P.L. 106-297) …

p. 7-8

Attachment C.

2011 Death in Custody Reporting Act (H.R. 2189) …

p. 9-16

Attachment D. BJS confidentiality regulations …
(Title 42, USC, Sections 3789g and 3735)

p. 17-19

Attachment E. 2012 CJ9A Annual Summary on Inmates …
p. 20-37
Under Jail Jurisdiction;
2012 CJ-10A Annual Summary on Inmates in Private and Multi-Jurisdictional Jails;
2012 NPS-4 Annual Summary of Inmate Deaths in State Prisons;
2013 CJ-9 Death Report on Inmates Under Jail Jurisdiction;
2013 CJ-10 Death Report on Inmates in Private and Multi-Jurisdictional Jails;
2013 NPS-4A State Prison Inmate Death Report
Attachment F. 2013 CJ-11 Arrest-Related Deaths Summary of Incidents …
p. 38-52
2013 CJ-11A Arrest-Related Deaths Incident Report;
2013 CJ-11A Arrest-Related Deaths Incident Report (CJ-11A) Question-by-Question
Guide
Attachment G. Example of arrest-related death program launch email…..
to state reporting coordinator;

p. 53-77

Attachment H. Example of arrest-related death ‘status report’ to a state …..
reporting coordinator;

p. 78-81

Attachment I.
Example of jail and prison DCRP program launch …..
mailing to jail and prison respondents;
Attachment J. Example of letters, emails and telephone scripts for …..
data quality and non-response follow-up for DCRP jail respondents

p. 82-119

p. 120-129

Attachment A. BJS authorizing legislation (42 USC
3732)

Attachment B. 2000 Deaths in Custody Reporting Act
(P.L. 106-297)

PUBLIC LAW 106–297—OCT. 13, 2000

114 STAT. 1045

Public Law 106–297
106th Congress
An Act
To amend the Violent Crime Control and Law Enforcement Act of 1994 to ensure
that certain information regarding prisoners is reported to the Attorney General.

Oct. 13, 2000
[H.R. 1800]

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.

This Act may be cited as the ‘‘Death in Custody Reporting
Act of 2000’’.

Death in Custody
Reporting Act of
2000.
42 USC 13701
note.

SEC. 2. REPORTING OF INFORMATION.

Section 20104(a) of the Violent Crime Control and Law Enforcement Act of 1994 (42 U.S.C. 13704(a)) is amended—
(1) in paragraph (1)—
(A) by inserting ‘‘(A)’’ after ‘‘(1)’’; and
(B) by redesignating subparagraphs (A) and (B) as
clauses (i) and (ii), respectively;
(2) in paragraph (2), by striking ‘‘(2)’’ and inserting ‘‘(B)’’;
(3) in paragraph (3)—
(A) by striking ‘‘(3)’’ and inserting ‘‘(C)’’;
(B) by redesignating subparagraphs (A) and (B) as
clauses (i) and (ii), respectively; and
(C) by striking the period and inserting ‘‘; and’’; and
(4) by adding at the end the following new paragraph:
‘‘(2) such State has provided assurances that it will follow
guidelines established by the Attorney General in reporting,
on a quarterly basis, information regarding the death of any
person who is in the process of arrest, is en route to be incarcerated, or is incarcerated at a municipal or county jail, State
prison, or other local or State correctional facility (including
any juvenile facility) that, at a minimum, includes—
‘‘(A) the name, gender, race, ethnicity, and age of the
deceased;
‘‘(B) the date, time, and location of death; and
‘‘(C) a brief description of the circumstances surrounding the death.’’.
Approved October 13, 2000.
LEGISLATIVE HISTORY—H.R. 1800:
CONGRESSIONAL RECORD, Vol. 146 (2000):
July 24, considered and passed House.
Oct. 3, considered and passed Senate.

Æ

VerDate 11-MAY-2000

01:24 Oct 20, 2000

Jkt 069139

PO 00000

Frm 00001

Fmt 6580

Sfmt 6580

E:\PUBLAW\PUBL297.106

APPS27

PsN: PUBL297

Attachment C. H.R. 2189 Death in Custody Reporting
Act of 2011

Attachment D. BJS confidentiality regulations (Title 42,
USC, Sections 3789g and 3735).

Attachment E. 2012 CJ-9A (Annual Summary on
Inmates Under Jail Jurisdiction); 2012 CJ-10A (Annual
Summary on Inmates in Private and MultiJurisdictional Jails); 2012 NPS-4 (Annual Summary on
Inmate Deaths in State Prisons); 2013 CJ-9 (Death
Report on Inmates Under Jail Jurisdiction); 2013 CJ-10
(Death Report on Inmates in Private and MultiJurisdictional Jails); 2013 NPS-4A (State Prison
Inmate Death Report)

OMB No. 1121-0249 Approval Expires MO/DAY/YEAR

DEATHS IN CUSTODY—2012
ANNUAL SUMMARY ON INMATES
UNDER JAIL JURISDICTION

Form CJ-9A

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Instructions for Completion
IF YOUR JURISDICTION DID NOT HAVE A DEATH IN CALENDAR YEAR 2012:


Complete this form and return it to RTI International. Once you complete EVERY question, your submission will be
complete for 2012.

IF YOUR JURISDICTION DID HAVE ONE OR MORE DEATHS IN CALENDAR YEAR 2012:



Please ensure that you have completed a 2012 CJ-9 (individual death report) form for each death reported.
If you need additional CJ-9 forms, please go to the DCRP Web site (https://bjsdcrp.rti.org), call 1-800-344-1387, or
send an e-mail to [email protected].

General Information
Please submit your completed form within 30 days of receipt. You may submit your annual summary in one of these ways:
ONLINE: Complete this form online at: https://bjsdcrp.rti.org
E-MAIL: [email protected]

MAIL: RTI International, Attn: Data Capture
Project Number: 0212335.001.302.200
PO Box 12194
Research Triangle Park, NC 27709-2194

FAX (TOLL-FREE): 1-866-800-9179
If you need assistance, contact Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected].

What facilities are included in this data collection?
INCLUDE…
 Confinement facilities usually administered by a local law
enforcement agency, intended for adults but sometimes holding
juveniles

EXCLUDE…
 Facilities that are exclusively used as temporary holding or
lockup facilities, where inmates are generally held for less than
72 hours and not held beyond arraignment

 All jails and city/county correctional centers that hold inmates
beyond arraignment. Report data on all inmates, including those
held in separate holding or lockup areas within your facility

 Privately operated jails and facilities operated by two or more
jurisdictions (i.e., multi-jurisdictional facilities; these jails will be
contacted directly for data on deaths in their custody)

 Special jail facilities (e.g., medical/treatment/release centers,
halfway houses, and work farms)

 Deaths of persons in the process of arrest by your agency if
they have not yet been booked into your jail facility. Arrestrelated deaths should be reported using a CJ-11A form

 Inmates held for other jurisdictions, including federal authorities,
state prison authorities and other local jail jurisdictions

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

form to this address.
«AGENCY ID»

INMATE COUNTS AND DEATHS

1. How many males and females under the supervision of
your jail jurisdiction were confined in your jail facilities on
December 31, 2012?

When exact numeric answers are not available, provide
estimates and mark () in the box beside each figure.

INCLUDE:




Persons on transfer to treatment facilities but who
remain under your jurisdiction
Persons out to court while under your jurisdiction
Persons held for other jurisdictions

EXCLUDE:
X
X
X

Persons housed in facilities operated by two or more
jurisdictions or those held in privately operated jails
Inmates who are AWOL, escaped, or on long-term
transfer to other jurisdictions
All persons in nonresidential community-based
programs run by your jails (e.g., electronic
monitoring, house arrest, community service, day
reporting, work programs)

When exact numeric answers are not available, provide
estimates and mark () the box beside each figure.
Inmates on
December 31,
2012

Males:

Estimate

Females:

Estimate

2. How many males and females under the supervision of
your jail jurisdiction were admitted to your jail facilities
during 2012?
INCLUDE:




New admissions only (i.e., persons officially booked
into and housed in your facilities by formal legal
document and by the authority of the courts or some
other official agency)
Repeat offenders booked on new charges

EXCLUDE:
X

Returns from escape, work release, medical
appointments/treatment facilities, bail, and court
appearances

When exact numeric answers are not available, provide
estimates and mark () the box beside each figure.
New ANNUAL
admissions
during 2012

3. On December 31, 2012, how many persons were confined
in your jail facilities on behalf of any of the following:

Males:

Estimate

Females:

Estimate

a.

U.S. Immigration and
Customs Enforcement:

Estimate

b.

U.S. Marshals Service:

Estimate

c.

All other holds (state and
federal prison, Bureau of
Indian Affairs, or any holds
for other jail jurisdictions):

Estimate

4. Between January 1, 2012, and December 31, 2012, what
was the average daily population of all jail confinement
facilities operated by your jurisdiction?
To calculate the average daily population, add the number of
persons for each day during the period January 1, 2012,
through December 31, 2012, and divide the result by 365.
If daily counts are not available, estimate the average daily
population by adding the number of persons held on the same
day of each month and divide the result by 12.
If average daily population cannot be calculated as directed
above, then estimate the typical number of persons held in
your jail confinement facilities each day.
When exact numeric answers are not available, provide
estimates and mark () the box beside each figure.
Average daily
population
during 2012

Males:

Estimate

Females:

Estimate

5. Between January 1, 2012, and December 31, 2012, how
many persons died while under the supervision of your
jail jurisdiction?
INCLUDE:
 Deaths of ALL persons CONFINED in your jail
facilities; or UNDER YOUR JURISDICTION but out to
court or in special facilities (e.g., hospitals, halfway
houses, work farms, and medical/treatment/ release
centers); or WHILE IN TRANSIT to or from your
facilities while under your jurisdiction.
Number of
inmate deaths
during 2012

Males:
Females:

NOTE: BEFORE COMPLETING THIS FORM, PLEASE BE
SURE THAT THERE ARE ENTRIES FOR ALL RESPONSE
BOXES. FOR EXAMPLE, IF YOU HAVE ZERO FEMALE
DEATHS IN QUESTION 5, PLEASE ENTER 0 IN THE BOX
RATHER THAN LEAVING IT BLANK.
«AGENCY ID»

OMB No. 1121-0249 Approval Expires MO/DAY/YEAR

DEATHS IN CUSTODY—2012
ANNUAL SUMMARY ON INMATES IN
PRIVATE AND MULTI-JURISDICTION JAILS

Form CJ-10A

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Instructions for Completion
IF YOUR JURISDICTION DID NOT HAVE A DEATH IN CALENDAR YEAR 2012:


Complete this form and return it to RTI International. Once you complete EVERY question, your submission will be
complete for 2012.

IF YOUR JURISDICTION DID HAVE ONE OR MORE DEATHS IN CALENDAR YEAR 2012:



Please ensure that you have completed a 2012 CJ-10 (individual death report) form for each death reported.
If you need additional CJ-10 forms, please go to the DCRP Web site (https://bjsdcrp.rti.org), call 1-800-344-1387,
or send an e-mail to [email protected].

General Information
Please submit your completed form within 30 days of receipt. You may submit your annual summary in one of these ways:
ONLINE: Complete this form online at: https://bjsdcrp.rti.org
E-MAIL: [email protected]

MAIL: RTI International, Attn: Data Capture
Project Number: 0212335.001.302.200
PO Box 12194
Research Triangle Park, NC 27709-2194

FAX (TOLL-FREE): 1-866-800-9179
If you need assistance, contact Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected].

What facilities are included in this data collection?
INCLUDE…
 All confinement facilities, including detention centers, jails, and
other correctional facilities, intended for adults but sometimes
holding juveniles which are either privately owned and operated
or administered by two or more governments (or a board
composed of representatives from two or more governments)
 All jails and city/county correctional centers that hold inmates
beyond arraignment. Report data on all inmates, including
those held in separate holding or lockup areas within your
facility

EXCLUDE…
 Facilities that are exclusively used as temporary holding or
lockup facilities, where inmates are generally held for less
than 72 hours and not held beyond arraignment. If your facility
holds inmates beyond arraignment, report data on ALL
inmates, including those held in separate holding or lockup
areas within your facility
 Deaths of persons in the process of arrest by your agency if
they have not yet been booked into your jail facility. Arrestrelated deaths should be reported using a CJ-11A form

 Special jail facilities (e.g., medical/treatment/release centers,
halfway houses, and work farms)
 Inmates held for jurisdictions other than the participating
jurisdictions
BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

«AGENCY ID»

INMATE COUNTS AND DEATHS

1. How many males and females under the supervision of
your jail facility were confined in your jail facility on
December 31, 2012?
INCLUDE:




Persons on transfer to treatment facilities but who
remain under your jurisdiction
Persons out to court while under your jurisdiction
Persons held for other jurisdictions

3. On December 31, 2012, how many persons were confined
in your jail facilities on behalf of any of the following:
When exact numeric answers are not available, provide
estimates and mark () in the box beside each figure.
a.

U.S. Immigration and
Customs Enforcement:

Estimate

b.

U.S. Marshals Service:

Estimate

c.

All other holds (state and
federal prison, Bureau of
Indian Affairs, or any holds
for other jail jurisdictions):

Estimate

EXCLUDE:
X

Inmates who are AWOL, escaped, or on long-term
transfer to other jurisdictions

When exact numeric answers are not available, provide
estimates and mark () the box beside each figure.
Inmates on
December 31,
2012

Males:

Estimate

Females:

Estimate

4. Between January 1, 2012, and December 31, 2012, what
was the average daily population of all jail confinement
facilities operated by your jail?
To calculate the average daily population, add the number of
persons for each day during the period January 1, 2012,
through December 31, 2012, and divide the result by 365.

2. How many males and females under the supervision of
your jail facility were admitted to your jail facilities during
2012?
INCLUDE:




New admissions only (i.e., persons officially booked
into and housed in your facilities by formal legal
document and by the authority of the courts or some
other official agency)
Repeat offenders booked on new charges

EXCLUDE:
X

Returns from escape, work release, medical
appointments/treatment facilities, bail, and court
appearances

When exact numeric answers are not available, provide
estimates and mark () the box beside each figure.

New ANNUAL
admissions
during 2012

Males:

Estimate

Females:

Estimate

If daily counts are not available, estimate the average daily
population by adding the number of persons held on the same
day of each month and divide the result by 12.
If average daily population cannot be calculated as directed
above, then estimate the typical number of persons held in
your jail confinement facilities each day.
When exact numeric answers are not available, provide
estimates and mark () the box beside each figure.
Average daily
population
during 2012

Males:

Estimate

Females:

Estimate

5. Between January 1, 2012, and December 31, 2012, how
many persons died while under the supervision of your
jail?
INCLUDE:
 Deaths of ALL persons CONFINED in your jail
facilities; or UNDER YOUR JURISDICTION but out to
court or in special facilities (e.g., hospitals, halfway
houses, work farms, and medical/treatment/ release
centers); or WHILE IN TRANSIT to or from your
facilities while under your jurisdiction.
Number of
inmate deaths
during 2012

Males:
Females:

NOTE: BEFORE COMPLETING THIS FORM, PLEASE BE
SURE THAT THERE ARE ENTRIES FOR ALL RESPONSE
BOXES. FOR EXAMPLE, IF YOU HAVE ZERO FEMALE
DEATHS IN QUESTION 5, PLEASE ENTER 0 IN THE BOX
RATHER THAN LEAVING IT BLANK.

«AGENCY ID»

OMB No. 1121-0249 Approval Expires MO/DAY/YEAR

DEATHS IN CUSTODY—2012
ANNUAL SUMMARY OF INMATE DEATHS
IN STATE PRISONS

Form NPS-4

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

What deaths should be reported?
INCLUDE deaths of ALL persons…


Confined in your correctional facilities, whether housed
under your jurisdiction or that of another state



Under your jurisdiction but housed in private correctional
facilities, whether located in or out of state



Under your jurisdiction but in special facilities (e.g.,
medical/ treatment/release centers, halfway houses,
police/court lockups, and work farms)



EXCLUDE deaths of ALL persons…


Executed in your state



Confined in local jail facilities, whether located in or out of
state



Under your jurisdiction but housed in a state-operated
correctional facility in another state or in a federal facility



Under probation or parole supervision in your state

In transit to or from your facilities while under your
supervision

During 2012, how many persons died while in the custody of your state correctional facilities?
Number of deaths in 2012
Please fill out the number of deaths that occurred in calendar year 2012 above and submit this form and corresponding NPS-4A forms
to RTI International. You may submit these data in one of these ways:
ONLINE: Complete this form online at: https://bjsdcrp.rti.org
E-MAIL: [email protected]

MAIL:

RTI International, Attn: Data Capture
Project Number: 0212335.001.302.200
PO Box 12194
Research Triangle Park, NC 27709-2194

FAX (TOLL-FREE): 1-866-800-9179
For each inmate death, please ensure that you have submitted a STATE PRISON INMATE DEATH REPORT (NPS-4A) form.
IF NO DEATHS OCCURRED, it is still important that you complete this form and return it to RTI International.
If you need assistance, contact Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or send an e-mail to [email protected]

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The
burden of this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including
reviewing instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden
estimate or any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW,
Washington, DC 20531. Do not send your completed form to this address.

«AGENCY ID»

OMB No. 1121-0249 Approval Expires MO/DAY/YEAR

DEATHS IN CUSTODY—2013
DEATH REPORT ON INMATES
UNDER JAIL JURISDICTION

Form CJ-9

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Instructions for Completion
If no deaths occurred in 2013:

You do not need to report anything at this time.

At the beginning of 2014, you will be asked to complete a summary form whether or not you had a death occurrence in 2013.
If you had more than one death in 2013:

Make copies of this form for each additional death.

Complete the entire form for each inmate death.

Once your death records are complete, there are several ways to submit a death report:
ONLINE: Complete the report online at: https://bjsdcrp.rti.org

MAIL: RTI International, Attn: Data Capture
Project Number: 0212335.001.302.200
PO Box 12194
Research Triangle Park, NC 27709-2194

E-MAIL: [email protected]
FAX (TOLL-FREE): 1-866-800-9179

If you need assistance, contact Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected]

What deaths should be reported?
INCLUDE deaths of ALL persons…

EXCLUDE deaths of ALL persons…



Confined in your jail facilities, whether housed under
your own or another jurisdiction



Confined in facilities operated by two or more
jurisdictions or those held in privately operated jails



Under your jurisdiction but housed in special jail
facilities (e.g., medical/treatment/release centers,
halfway houses, and workfarms); or on transfer to
treatment facilities



Under your jurisdiction but in nonresidential communitybased programs run by your jails (e.g., electronic
monitoring, house arrest, community service, day
reporting, work programs)



Under your jurisdiction but out to court





In transit to or from your facilities while under your
jurisdiction

Under your jurisdiction but AWOL, escaped, or on longterm transfer to another jurisdiction



In the process of arrest by your agency, but not yet
booked into your jail facility

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

form to this address.
«AGENCY ID»

LOCAL JAIL INMATE DEATH REPORT

1. What was the inmate’s name?
LAST

8. On what date was the inmate admitted to a facility
under your jurisdiction?

FIRST

MI
MONTH

DAY

YEAR

2. On what date did the inmate die?
2
MONTH

DAY

0

1

9. Was the inmate being confined in your jail facility
on behalf of any of the following?

3

YEAR

PLEASE PROVIDE A RESPONSE FOR EACH ITEM (a–c)

3. What was the name and location of the correctional
facility involved?
Facility Name:

Facility City:

Facility State:

DON’T
YES NO KNOW
a. U.S. Immigration and
Customs Enforcement................................ ...........
b. U.S. Marshals Service ................................ ...........
c. State or federal prison,
Bureau of Indian Affairs,
or any other jail jurisdiction......................... ...........

10. For what offense(s) was the inmate being held?
4. What was the inmate’s date of birth?

a.
b.

MONTH

DAY

YEAR

c.
5. What was the inmate’s sex?
Male
Female

6. Was the inmate of Hispanic, Latino, or Spanish
origin?
Yes
No
7. In addition, what was the inmate’s race? Please
select one or more of the following racial
categories:
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Some other race

d.
e.

11. What was the inmate’s legal status at time of
death? (For inmates with more than one status, report
the status associated with the most serious offense.)
Convicted—new court commitment
Convicted—returned probation/parole violator
Unconvicted
Other
Please Specify:

12. Since admission, did the inmate ever stay
overnight in a mental health observation unit or an
outside mental health facility?
Yes
No
Don’t Know

«AGENCY ID»

13. Where did the inmate die?
In a general housing unit within the jail facility or on jail grounds
In a segregation unit
In a special medical unit/infirmary within jail facility
In a special mental health services unit within jail facility
In a medical center outside jail facility
In a mental health center outside jail facility
While in transit
Elsewhere
Please Specify:

14. Are the results of a medical examiner’s or coroner’s evaluation (such as an autopsy, postmortem exam, or
review of medical records) available to establish an official cause of death?
YES
CONTINUE TO Q15
Evaluation complete—results are pending
SKIP REMAINING QUESTIONS AND SUBMIT THIS FORM—YOU WILL BE CONTACTED AT A LATER
TIME FOR THE CAUSE OF DEATH
No evaluation is planned
15. What was the cause of death?

CONTINUE TO Q15
*** Please SPECIFY cause of death—it is critical information ***

Illness—Exclude AIDS-related deaths [Specify]
Acquired Immune Deficiency Syndrome (AIDS)
Accidental alcohol/drug intoxication [Describe]
Accidental injury to self [Describe]
Accidental injury by other (e.g., vehicular
accidents during transport) [Describe]
Suicide (e.g., hanging, knife/cutting instrument,
intentional drug overdose) [Describe]
Homicide [Describe]
Other cause(s) [Specify]

16. Where did the incident (e.g., accident, suicide, or homicide) causing the death take place?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
In the jail facility or on the jail grounds
In the inmate’s cell/room
In a temporary holding area/lockup
In a common area within the facility (e.g., yard, library, cafeteria)
[PLEASE
In a segregation unit
SPECIFY]
In a special medical unit/infirmary
In a special mental health services unit
Elsewhere within the jail facility
Please Specify:

Outside the jail facility (e.g., while on work release or on work detail)
Elsewhere
Please Specify:
«AGENCY ID»

17. When did the incident (e.g., accident, suicide, or homicide) causing the death occur?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
Morning (6 am to Noon)
Afternoon (Noon to 6 pm)
Evening (6 pm to Midnight)
Overnight (Midnight to 6 am)
18. Excluding emergency care provided at the time of death, did the inmate receive any of the following medical
services for the medical condition that caused his/her death after admission to your correctional facilities?
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
a.
b.
c.
d.
e.
f.

YES
NO
DON’T KNOW
Evaluation by physician/medical staff ......................................................
PLEASE PROVIDE A
Diagnostic tests (e.g., X-rays, MRI) .........................................................
RESPONSE FOR
Medications ...............................................................................................
EACH ITEM (a–f)
Treatment/care other than medications ....................................................
Surgery ......................................................................................................
Confinement in special medical unit. ........................................................

19. Was the cause of death the result of a pre-existing medical condition or did the inmate develop the condition
after admission? (If multiple conditions caused the death and any of the conditions were pre-existing, mark
―Pre-existing medical condition.‖)
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
Pre-existing medical condition
Deceased developed condition after admission
Could not be determined
Please add any additional notes regarding this death here:

«AGENCY ID»

OMB No. 1121-0249 Approval Expires MO/DAY/YEAR

DEATHS IN CUSTODY—2013
DEATH REPORT ON INMATES IN
PRIVATE AND MULTI-JURISDICTIONAL JAILS

Form CJ-10

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Instructions for Completion
If no deaths occurred in 2013:

You do not need to report anything at this time.

At the beginning of 2014, you will be asked to complete a summary form whether or not you had a death occurrence in 2013.
If you had more than one death in 2013:

Make copies of this form for each additional death.

Complete the entire form for each inmate death.

Once your death records are complete, there are several ways to submit a death report:
ONLINE: Complete the report online at: https://bjsdcrp.rti.org

MAIL: RTI International, Attn: Data Capture
Project Number: 0212335.001.302.200
PO Box 12194
Research Triangle Park, NC 27709-2194

E-MAIL: [email protected]
FAX (TOLL-FREE): 1-866-800-9179

If you need assistance, contact Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected]

What deaths should be reported?
INCLUDE deaths of ALL persons…


Confined in your jail facilities, even if housed for
another jurisdiction



Under your jurisdiction but housed in special jail
facilities (e.g., medical/treatment/release centers,
halfway houses, and work farms); or on transfer to
treatment facilities



Under your jurisdiction but out to court



In transit to or from your facilities while under your
supervision

EXCLUDE deaths of ALL persons…


Under your jurisdiction but in nonresidential communitybased programs run by your jails (e.g., electronic
monitoring, house arrest, community service, day
reporting, work programs)



Under your jurisdiction but AWOL, escaped, or on longterm transfer to another jurisdiction



In the process of arrest by your agency, but not yet
booked into your jail facility

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

form to this address.
«AGENCY ID»

JAIL INMATE DEATH REPORT
1. What was the inmate’s name?
LAST

8. On what date was the inmate admitted to your jail
facility?

FIRST

MI
MONTH

2. On what date did the inmate die?
2

2
MONTH

DAY

0

0

1

1

3

DAY

YEAR

9. Was the inmate being confined in your jail facility
on behalf of any of the following?

3

YEAR

PLEASE PROVIDE A RESPONSE FOR EACH ITEM (a–c)

3. What was the name and location of the correctional
facility involved?
FacilityName:
Name:
Facility
Facility Location:
Facility City:

Facility State:

DON’T
YES NO KNOW
a. U.S. Immigration and
Customs Enforcement ................................ ..........
b. U.S. Marshals Service ................................ ..........
c. State or federal prison,
Bureau of Indian Affairs,
or any other jail jurisdiction ......................... ..........

10. For what offense(s) was the inmate being held?
4. What was the inmate’s date of birth?
MONTH

DAY

YEAR

a.
b.
c.

5. What was the inmate’s sex?
Male
Female

d.
e.

6. Was the inmate of Hispanic, Latino, or Spanish
origin?
Yes
No

7. In addition, what was the inmate’s race? Please
select one or more of the following racial
categories:
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Some other race

11. What was the inmate’s legal status at time of
death? (For inmates with more than one status, report
the status associated with the most serious offense.)
Convicted—new court commitment
Convicted—returned probation/parole violator
Unconvicted
Other
Please Specify:

12. Since admission, did the inmate ever stay
overnight in a mental health observation unit or an
outside mental health facility?
Yes
No
Don’t Know

«AGENCY ID»

13. Where did the inmate die?
In a general housing unit within the jail facility or on jail grounds
In a segregation unit
In a special medical unit/infirmary within jail facility
In a special mental health services unit within jail facility
In a medical center outside jail facility
In a mental health center outside jail facility
While in transit
Elsewhere
Please Specify:

14. Are the results of a medical examiner’s or coroner’s evaluation (such as an autopsy, postmortem exam, or
review of medical records) available to establish an official cause of death?
YES
CONTINUE TO Q15
Evaluation complete—results are pending
SKIP REMAINING QUESTIONS AND SUBMIT THIS FORM - YOU WILL BE CONTACTED AT A LATER
TIME FOR THE CAUSE OF DEATH
No evaluation is planned
CONTINUE TO Q15

15. What was the cause of death?

*** Please SPECIFY cause of death—it is critical information ***

Illness—Exclude AIDS-related deaths [Specify]
Acquired Immune Deficiency Syndrome (AIDS)
Accidental alcohol/drug intoxication [Describe]
Accidental injury to self [Describe]
Accidental injury by other (e.g., vehicular
accidents during transport) [Describe]
Suicide (e.g., hanging, knife/cutting instrument,
intentional drug overdose) [Describe]
Homicide [Describe]
Other cause(s) [Specify]
16. Where did the incident (e.g., accident, suicide, or homicide) causing the death take place?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
In the jail facility or on the jail grounds
In the inmate’s cell/room
In a temporary holding area/lockup
In a common area within the facility (e.g., yard, library, cafeteria)
[PLEASE
In a segregation unit
SPECIFY]
In a special medical unit/infirmary
In a special mental health services unit
Elsewhere within the jail facility
Please Specify:

Outside the jail facility (e.g., while on work release or on work detail)
Elsewhere
Please Specify:

«AGENCY ID»

17. When did the incident (e.g., accident, suicide, or homicide) causing the death occur?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
Morning (6 am to Noon)
Afternoon (Noon to 6 pm)
Evening (6 pm to Midnight)
Overnight (Midnight to 6 am)
18. Excluding emergency care provided at the time of death, did the inmate receive any of the following medical
services for the medical condition that caused his/her death after admission to your correctional facilities?
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
a.
b.
c.
d.
e.
f.

YES
NO
DON’T KNOW
Evaluation by physician/medical staff ......................................................
PLEASE PROVIDE A
Diagnostic tests (e.g., X-rays, MRI) .........................................................
RESPONSE FOR EACH
Medications ...............................................................................................
ITEM (a–f)
Treatment/care other than medications ....................................................
Surgery ......................................................................................................
Confinement in special medical unit. ........................................................

19. Was the cause of death the result of a pre-existing medical condition or did the inmate develop the condition
after admission? (If multiple conditions caused the death and any of the conditions were pre-existing, mark
―Pre-existing medical condition.‖)
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
Pre-existing medical condition
Deceased developed condition after admission
Could not be determined
Please add any additional notes regarding this death here:

«AGENCY ID»

OMB No. 1121-0249 Approval Expires MO/DAY/YEAR

DEATHS IN CUSTODY—2013
STATE PRISON INMATE
DEATH REPORT

Form NPS-4A
(Addendum)

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Instructions for Completion
If no deaths occurred in 2013:

You will not need to report anything at this time.

At the beginning of 2014, you will be asked to complete a summary form whether or not you had a death occurrence in 2013.
If you had more than one death in 2013:

Make copies of this form for each additional death.

Complete the entire form for each inmate death.

Once your death records are complete, there are several ways to submit a death report:
ONLINE: Complete the report online at: https://bjsdcrp.rti.org

MAIL: RTI International, Attn: Data Capture
Project Number: 0212335.001.302.200
PO Box 12194
Research Triangle Park, NC 27709-2194

E-MAIL: [email protected]
FAX (TOLL-FREE): 1-866-800-9179

If you need assistance, call Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected]

What deaths should be reported?
INCLUDE deaths of ALL persons…






Confined in your correctional facilities, whether housed
under your jurisdiction or that of another state
Under your jurisdiction but housed in private correctional
facilities, whether located in or out of state
Under your jurisdiction but in special facilities (e.g.,
medical/treatment/release centers, halfway houses,
police/court lockups, and work farms)
In transit to or from your facilities while under your
supervision

EXCLUDE deaths of ALL persons…


Executed in your state



Confined in local jail facilities, whether located in or out of
state



Under your jurisdiction but housed in a state-operated
correctional facility in another state or in a federal facility



Under probation or parole supervision in your state



Under your jurisdiction but on AWOL or escape-status at
the time of death

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The
burden of this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including
reviewing instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden
estimate or any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW,
Washington, DC 20531. Do not send your completed form to this address.

«AGENCY ID»

STATE PRISON INMATE DEATH REPORT
1.

8.

What was the inmate’s name?

LAST

FIRST

On what date was the inmate admitted to one of
your correctional facilities?

MI
MONTH

2.

DAY

YEAR

On what date did the inmate die?
2
MONTH

DAY

0

1

9.

3

For what offense(s) was the inmate being held?
a.

YEAR

b.
3.

What was the name and location of the
correctional facility involved?

c.
d.

Facility Name:

e.

Facility City:

Facility State:
10. Since admission, did the inmate ever stay
overnight in a mental health facility?

4.

What was the inmate’s date of birth?

MONTH

DAY

Yes
No
Don’t Know

YEAR

11. Where did the inmate die?
5.

What was the inmate’s sex?
Male
Female

6.

Was the inmate of Hispanic, Latino, or Spanish
origin?
Yes
No

In a general housing unit in the facility or on
prison grounds
In a segregation unit
In a special medical unit/infirmary within your
facility
In a special mental health services unit within
your facility
In a medical center outside your facility
In a mental health center outside your facility
While in transit
Elsewhere
Please Specify:

7.

In addition, what was the inmate’s race? Please
select one or more of the following racial
categories:
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Some other race
Please Specify:

«AGENCY ID»

12. Are the results of a medical examiner’s or coroner’s evaluation (such as an autopsy, postmortem exam, or
review of medical records) available to establish an official cause of death?
YES
CONTINUE TO Q13
Evaluation complete—results are pending
SKIP REMAINING QUESTIONS AND SUBMIT THIS FORM—YOU WILL BE CONTACTED AT A
LATER TIME FOR THE CAUSE OF DEATH
No evaluation is planned
13. What was the cause of death?

CONTINUE TO Q13

*** Please SPECIFY cause of death—it is critical information***

Illness—Exclude AIDS-related deaths [Specify]
Acquired Immune Deficiency Syndrome (AIDS)
Accidental alcohol/drug intoxication [Describe]
Accidental injury to self [Describe]
Accidental injury by other (e.g., vehicular accidents
during transport) [Describe]
Suicide (e.g., hanging, knife/cutting instrument,
intentional drug overdose) [Describe]
Homicide [Describe]
Other cause(s) [Specify]

0

14. Where did the incident (e.g., accident, suicide, or homicide) take place?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
In the prison facility or on the prison grounds
In the inmate’s cell/room
In a temporary holding area/lockup
In a common area within the facility (e.g., yard, library, cafeteria)
In a special medical unit/infirmary
[PLEASE
In a special mental health services unit
SPECIFY]
In a segregation unit
On death row, special unit awaiting capital punishment
Elsewhere within the prison facility
Please Specify:

Outside the prison facility (e.g., while on work release or on work detail)
Elsewhere
Please Specify:

15. When did the incident (e.g., accident, suicide, or homicide) causing the inmate’s death occur?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
Morning (6 am to Noon)
Afternoon (Noon to 6 pm)
Evening (6 pm to Midnight)
Overnight (Midnight to 6 am)
«AGENCY ID»

16. Excluding emergency care provided at the time of death, did the inmate receive any of the following medical
services for the medical condition that caused his/her death after admission to your correctional facilities?
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
a.
b.
c.
d.
e.
f.

YES
NO
DON’T KNOW
Evaluated by physician/medical staff ..........................  ...............................
PLEASE PROVIDE A
Diagnostic tests (e.g., X-rays, MRI) ............................  ...............................
RESPONSE FOR
EACH ITEM (a–f)
Medications .................................................................  ...............................
Treatment/care other than medications ......................  ...............................
Surgery ........................................................................  ...............................
Confinement in special medical unit ...........................  ...............................

17. Was the cause of death the result of a pre-existing medical condition or did the inmate develop the condition
after admission? (If multiple conditions caused the death and any of the conditions were pre-existing, mark
―Pre-existing medical condition.‖)
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
Pre-existing medical condition
Deceased developed condition after admission
Could not be determined

Please add any additional notes regarding this death here:

«AGENCY ID»

Attachment F. 2013 CJ-11 (Arrest-Related Deaths
Summary of Incidents); 2013 CJ-11A (Arrest-Related
Death Incident Report); Arrest Related Deaths Incident
Report (CJ-11A) Question by Question Guide

Attachment G. Example of arrest-related death program
launch email to state reporting coordinator

Attachment H. Example of arrest-related death ‘status
report’ to state reporting coordinator

Attachment I. Example of jail and prison DCRP
program launch mailing to jail and prison respondents

Conducted by the U.S. Department of Justice - Bureau of Justice Statistics (BJS) and RTI International (RTI)

Over the past decade, BJS has collaborated with local jails and state departments of corrections to
collect and disseminate statistics on mortality data.

How are the Deaths in Custody Reporting
Program (DCRP) data used?
• Over the years BJS has published several reports on
corrections-related mortality, providing the corrections
community with important statistics that help policymakers and jail administrators address key public health
issues facing jails and prisons. Some examples include—
a. Prison and Jail Deaths in Custody, 2000-2009 - Statistical Tables,
NCJ 236219

Want to test your knowledge about DCRP?
Take the following quiz!
(Answers are available further below.)
1. What is the leading natural cause of death
among jail inmates?
a. Cancer

b. Heart disease

c. AIDS/HIV

b. Mortality in Local Jails, 2000-2007 (Revised), NCJ 222988

2. Between 2000 and 2009, has the rate of
inmate jail deaths from HIV/AIDS increased or
decreased?

c. Medical Causes of Death in State Prisons, 2001-2004, NCJ
216340

3. Approximately what percentage of jail deaths
occur within the first 7 days of admission?

d. Suicide and Homicide in State Prisons and Local Jails, NCJ
210036
Please visit the BJS website at http://www.bjs.gov to
access these and other statistical reports.
• BJS occasionally fields questions from local jail
administrators who need to know how the death
rates in their jails compare with jails of a similar size or
within their state.
• BJS provides information to state departments of
corrections that need death information from previous
years for special or routine reports.

For more
information on
BJS or the DCRP,
please contact—

Margaret Noonan
Program Manager
U.S. Department of Justice
Bureau of Justice Statistics
810 7th Street, NW
Washington, DC 20531
(202) 353-2060
[email protected]

For more
information about
the DCRP or data
collection, please
contact—

Kim Aspinwall
DCRP Data Collection Task Leader
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709
(800) 344-1387
[email protected]

a. 18%

b. 28% c. 38%

4. True or False: Between 2001 and 2009, illnessrelated deaths accounted for 9 out of 10 prison
deaths.
5. Between 2000 and 2009, were mortality rates
among whites higher or lower than those for
other race or ethnic groups?
6. About what percentage of the nation’s
approximately 2,800 jail jurisdictions
participated in the Deaths in Custody
Reporting Program in 2010?
a. 90%

b. 95% c. 97%

Source: Prison and Jail Deaths in Custody, 2000-2009-Statistical
Tables, BJS Web, December 2011, NCJ 236219.

(1) Heart disease. Heart disease represented approximately
22% of all jail deaths from 2000 to 2009. (2) Decreased. AIDSrelated deaths in jails declined by 54% between 2000 and 2009.
(3) About 38%. Between 2000 and 2009, the percentage of jail
deaths that took place within a week of admission ranged from
36.2% (2006) to 40.3% (2003). (4) True. Only 10% of reported
deaths are due to suicide, accidental injury, or homicide. (5) Higher.
The rate of mortality among whites is higher than that of other
races or ethnic groups. In prisons, white mortality rates were
between 1.4 and 1.8 times higher in comparison to other ethnic or
racial groups. In jails, whites had a mortality rate between 1.6 and
4.7 times higher than other ethnic or racial groups. (6) 97%. If your
jail hasn’t previously participated in DCRP, please contact RTI.

3040 Cornwallis Road n PO Box 12194
Research Triangle Park, NC 27709-2194
ATTN: Tim Flanigan 0212335.001.302.100

2011

ACTION REQUESTED

Completion of reporting for the
2011 DCRP

This packet includes:







Cover letter
Instructions for reporting data
2011 Annual Summary Form
2011 Death Report Form
Postage-paid Return Envelope

2011 Reporting Instructions
 All agencies should submit a 2011 Annual Summary
form, even if no deaths occurred in your custody
during 2011. It only takes about 5 minutes to complete
the summary form.
 Please be sure that the total number of deaths you report
on the Annual Summary form matches the number of
individual death reports you submit for 2011.
 You may submit your data online by logging onto the
Deaths and Custody Reporting Program (DCRP) Web
site (https://bjsdcrp.rti.org) using the login credentials in
your cover letter.
 We have enclosed a paper version of the 2011 Annual
Summary and Death Report forms if you prefer to
submit by mail or fax. Please disregard the paper forms
if you plan to submit data online.
 If you had more than one inmate death, and are unable to
use the Web option, additional Death Report forms are
available for download by logging onto the DCRP Web
site as described above.

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

DEATHS IN CUSTODY—2011
ANNUAL SUMMARY ON INMATES
UNDER JAIL JURISDICTION

Form CJ-9A

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

DATA SUPPLIED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Please correct any error in name or mailing address

General Information


There are several ways to submit a death report:
ONLINE: Complete this form online at: https://bjsdcrp.rti.org

MAIL: RTI International, Attn: Kim Aspinwall

E-MAIL: [email protected]

Project Number: 0212335.001.302.200

FAX (TOLL-FREE): 1-866-800-9179

3040 Cornwallis Road, PO Box 12194
Research Triangle Park, NC 27709-2194



Please return your completed form within 30 days of receipt. You may complete this form ONLINE or complete the
hardcopy form and return by FAX or MAIL.



If you need assistance, call Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected].

What facilities are included in this data collection?
INCLUDE:
 Confinement facilities usually administered by a local law
enforcement agency, intended for adults but sometimes holding
juveniles;

EXCLUDE:
 Facilities that are exclusively used as temporary holding or
lockup facilities from which inmates are usually transferred
within 72 hours and not held beyond arraignment;

 All jails and city/county correctional centers that hold inmates
beyond arraignment. Report data on all inmates, including those
held in separate holding or lockup areas within your facility;

 Privately operated jails and facilities operated by two or more
jurisdictions (i.e., multi-jurisdictional facilities; these jails will
be contacted directly for data on deaths in their custody);

 Special jail facilities (e.g., medical/treatment/release centers,
halfway houses, and work farms);

 Deaths of persons in the process of arrest by your agency if
they have not yet been booked into your jail facility. Arrestrelated deaths should be reported using a CJ-11A form.

 Inmates held for other jurisdictions, including federal authorities,
state prison authorities and other local jail jurisdictions.


BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

form to this address.

INMATE COUNTS AND DEATHS
INSTRUCTIONS FOR COMPLETION
IF YOUR JURISDICTION DID NOT HAVE A DEATH IN CALENDAR YEAR 2011:


Simply complete this form and return it to RTI International. The address is located on the front page of this
document. Once you complete EVERY question below, your submission will be complete for 2011.

IF YOUR JURISDICTION DID HAVE ONE OR MORE DEATHS IN CALENDAR YEAR 2011:



Please ensure that you have completed a CJ-9 (individual death report) form for each death reported below.
If you need additional CJ-9 forms, please go to the DCRP Web site (https://bjsdcrp.rti.org), call 1-800-3441387, or send an e-mail to [email protected].

1. How many persons under the supervision of your jail
jurisdiction were…
1a. CONFINED in your jail facilities on December 31, 2011?
2010?
INCLUDE:




persons on transfer to treatment facilities but who remain
under your jurisdiction
persons out to court while under your jurisdiction
persons held for other jurisdictions

EXCLUDE
X
X
X

persons housed in facilities operated by two or more
jurisdictions or those held in privately operated jails
inmates who are AWOL, escaped, or on long-term
transfer to other jurisdictions
all persons in nonresidential community-based programs
run by your jails (e.g., electronic monitoring, house
arrest, community service, day reporting, work programs)

When exact numeric answers are not available, provide estimates
and mark (⌧) the box beside each figure.
Inmates on
December 31, 2011
2010

Male

Estimate

Female

Estimate

1b. ADMITTED to your jail facilities during 2011?
2010?



new admissions only (i.e., persons officially booked into
and housed in your facilities by formal legal document
and by the authority of the courts or some other official
agency)
repeat offenders booked on new charges

returns from escape, work release, medical
appointments/treatment facilities, bail, and court
appearances

New ANNUAL
admissions during
2011

If daily counts are not available, estimate the average daily
population by adding the number of persons held on the same
day of each month and divide the result by 12.
If average daily population cannot be calculated as directed
above, then estimate the typical number of persons held in your
jail confinement facilities each day.
When exact numeric answers are not available, provide
estimates and mark (⌧) the box beside each figure.
Average daily
population

Male

Estimate

Female

Estimate
Estimate

Male

Estimate

Female

Estimate

3. Between January 1, 2011, and December 31, 2011, how
many persons died while under the supervision of your
jail jurisdiction?
INCLUDE:
deaths of ALL persons CONFINED in your jail
facilities; or UNDER YOUR JURISDICTION but out
to court or in special facilities (e.g., hospitals,
halfway houses, work farms, and medical/treatment/
release centers); or WHILE IN TRANSIT to or from
your facilities while under your jurisdiction.

Number of
inmate deaths

EXCLUDE
X

To calculate the average daily population, add the number of
persons for each day during the period January 1, 2011,
through December 31, 2011, and divide the result by 365.



INCLUDE


2. Between January 1, 2011, and December 31, 2011, what
was the average daily population of all jail confinement
facilities operated by your jurisdiction?

Male

Estimate

Female

Estimate

NOTE: BEFORE COMPLETING THIS FORM, PLEASE
BE SURE THAT THERE ARE ENTRIES FOR ALL
RESPONSE BOXES. FOR EXAMPLE, IF YOU HAVE
ZERO FEMALE DEATHS IN QUESTION 3, PLEASE
ENTER 0 IN THE BOX RATHER THAN LEAVING IT
EMPTY.

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

DEATHS IN CUSTODY—2011
DEATH REPORT ON INMATES
UNDER JAIL JURISDICTION

Form CJ-9

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

DATA SUPPLIED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Please correct any error in name or mailing address

Instructions for Completion


If no deaths occurred, you will not need to report anything at this time. At the beginning of the next calendar year, you will
be asked to complete a summary form whether you had a death occurrence or not.



If you had more than 1 death, make copies of pages 2 and 3 for each additional death.



Complete questions 1 through 16 for each inmate death.



Once your death records are complete, there are several ways to submit a death report:
ONLINE: Complete the report online at: https://bjsdcrp.rti.org

MAIL: RTI International, Attn: Kim Aspinwall

E-MAIL: [email protected]

Project Number: 0212335.001.302.200

FAX (TOLL-FREE): 1-866-800-9179

3040 Cornwallis Road, PO Box 12194
Research Triangle Park, NC 27709-2194



If you need assistance, call Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected]

What deaths should be reported?
INCLUDE deaths of ALL Persons

EXCLUDE deaths of ALL Persons

Confined in your jail facilities, whether housed under your own or
another jurisdiction;

Confined in facilities operated by two or more jurisdictions or those
held in privately operated jails;

Under your jurisdiction but housed in special jail facilities
(e.g., medical/treatment/release centers, halfway houses, and work
farms); or on transfer to treatment facilities;

Under your jurisdiction but in non-residential community-based
programs run by your jails (e.g., electronic monitoring, house
arrest, community service, day reporting, work programs);

Under your jurisdiction but out to court;

Under your jurisdiction but on AWOL, escape, or long-term transfer to
other jurisdiction;

In transit to or from your facilities while under your jurisdiction.

In the process of arrest by your agency, but not yet booked into your jail
facility.

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

form to this address.

LOCAL JAIL INMATE DEATH REPORT

8. What was the inmate’s legal status at time of death?
(For persons with more than one status, report the
status associated with the most serious offense.)

1. What was the inmate’s name?

LAST

FIRST

MI

2. On what date did the inmate die?
2011
MONTH

DAY

DAY

Please Specify:

YEAR

3. What was the inmate’s date of birth?

MONTH

Convicted—new court commitment
Convicted—returned probation / parole violator
Unconvicted
Other

YEAR

4. What was the inmate’s sex?
Male
Female

9. Since admission, did the inmate ever stay overnight in
a mental health observation unit or an outside mental
health facility?
Yes
No
Don’t Know
10. Where did the inmate die?

5. What was the inmate’s race/ethnic origin?
White (not of Hispanic origin)
Black or African American (not of Hispanic origin)
Hispanic or Latino
American Indian/Alaska Native (not of Hispanic
origin)
Asian (not of Hispanic origin)
Native Hawaiian or Other Pacific Islander (not of
Hispanic origin)
Two or more races
Additional categories in your information system

In a general housing within the jail facility or on jail
grounds
In a segregation unit
In a special medical unit/infirmary within jail facility
In a special mental health services unit within jail
facility
In a medical center outside jail facility
In a mental health center outside jail facility
While in transit
Elsewhere
Please Specify:

Please Specify:

Race/Ethnicity Not Known
6. On what date had the inmate been admitted to a
facility under your jurisdiction?

MONTH

DAY

YEAR

7. For what offense(s) was the inmate being held?
a.

11. Where did the incident (e.g., accident, suicide, or
homicide) causing the death take place?
NOT APPLICABLE—Cause of death was illness,
intoxication, or AIDS-related
In the jail facility or on the jail grounds
In the inmate’s cell/room
In a temporary holding area/lockup
[SPECIFY]
In a common area within the facility (e.g.,
yard, library, cafeteria, etc.)
In a segregation unit
In a special medical unit/infirmary
In a special mental health services unit
Elsewhere within the jail facility

b.
c.
d.

Please Specify:

Outside the jail facility (e.g., while on work release or
on work detail, etc.)
Elsewhere

e.

Please Specify:

«OrganizationID»

12. Had the deceased been receiving treatment for the medical condition after admission to your correctional facilities?
Exclude emergency care provided at time of death.
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
a.
b.
c.
d.
e.
f.

YES
NO
DON’T KNOW
Evaluated by physician/medical staff ...................................................................
Had diagnostic tests (e.g., X-rays, MRI) ..............................................................
Received medications ...........................................................................................
PLEASE PROVIDE A
Received treatment/care other than medications .................................................
RESPONSE FOR EACH
Had surgery ..........................................................................................................
ITEM (a – f).
Confined in special medical unit. ..........................................................................

13. When did the incident (e.g., accident, suicide, or
homicide) causing the death occur?
NOT APPLICABLE—Cause of death was illness,
intoxication, or AIDS-related

14. Are the results of a medical examiner’s or coroner’s
evaluation (such as an autopsy, post-mortem exam, or
review of medical records) available in order to establish
an official cause of death?
YES

Morning (6 am to Noon)
Afternoon (Noon to 6 pm)
Evening (6 pm to Midnight)
Overnight (Midnight to 6 am)

CONTINUE TO Q15

Evaluation complete—results are pending
SKIP REMAINING QUESTIONS—YOU WILL
BE CONTACTED AT A LATER TIME FOR THE
CAUSE OF DEATH
No evaluation is planned

15. What was the cause of death?

CONTINUE TO Q15

*** Please SPECIFY cause of death as it is critical information ***

Illness—Exclude AIDS-related deaths [Specify]
Acquired Immune Deficiency Syndrome (AIDS)
Accidental alcohol/drug intoxication [Specify]
Accidental injury to self [Describe]
Accidental injury by other (e.g., vehicular
accidents during transport) [Describe]
Suicide (e.g., hanging, knife/cutting instrument,
intentional drug overdose) [Describe]
Homicide [Please provide description]
Other cause(s) [Specify]

16. Was the cause of death the result of a pre-existing
medical condition or did the inmate develop the
condition after admission? If multiple conditions
caused the death, select “Pre-existing medical
condition.”
NOT APPLICABLE—Cause of death was
accidental injury, intoxication, suicide, or
homicide
Pre-existing medical condition
Deceased developed condition after admission
Could not be determined

Please add any additional notes here:

IMPORTANT: DO NOT ENLARGE, REDUCE OR MOVE the FIM and POSTNET barcodes. They are only valid as printed!
Special care must be taken to ensure FIM and POSTNET barcode are actual size AND placed properly on the mail piece
to meet both USPS regulations and automation compatibility standards.

3040 Cornwallis Road ■ PO Box 12194
Research Triangle Park, NC 27709-2194

■

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

USA

BUSINESS REPLY MAIL
FIRST-CLASS MAIL

PERMIT NO. 593

DURHAM, NC

POSTAGE WILL BE PAID BY ADDRESSEE

RTI INTERNATIONAL

ATTN: TIM FLANIGAN 0212335.001.302.100

PO BOX 12194
RESEARCH TRIANGLE PARK NC 27709-9935

Artwork for Envelope, Business, #10, 4 1/8 x 9 1/2 in (4.125" x 9.5")
Layout: sample BRM Env with IMB.lyt
February 23, 2011

Produced by DAZzle Designer, Version 9.0.05
(c) 1993-2009, Endicia, www.Endicia.com
U.S. Postal Service, Serial #

3040 Cornwallis Road n PO Box 12194
Research Triangle Park, NC 27709-2194
ATTN: Tim Flanigan 0212335.001.302.100

2012

FOR FUTURE REFERENCE

Announcing the start of reporting for the
2012 Deaths in Custody Reporting Program.
** No action is requested at this time. **

This packet includes:





Instructions for reporting data
2012 Death Report Form
Postage-paid Return Envelope

2012 Reporting Instructions
 We have enclosed a 2012 death report form for your
convenience. If no deaths have occurred within your jail
jurisdiction to date in 2012, you have nothing to report at
this time.
 Please submit a report for any deaths that occur within your
jail jurisdiction in 2012 as soon as the autopsy or other
official death investigation results are available.
 Please complete ALL form questions, including “Specify”
fields, if applicable.
 You may submit your data online by logging onto the
Deaths and Custody Reporting Program (DCRP) Web site
(https://bjsdcrp.rti.org) using the login credentials in your
cover letter.
 We have enclosed a paper version of the 2012 Death
Report form if you prefer to submit by mail or fax. Please
disregard the paper form if you plan to submit data online.
 If you have more than one inmate death, and are unable to
use the Web option, additional Death Report forms are
available for download by logging onto the DCRP Web site
as described above.

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

DEATHS IN CUSTODY—2012
DEATH REPORT ON INMATES
UNDER JAIL JURISDICTION

Form CJ-9

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

DATA SUPPLIED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Please correct any error in name or mailing address

Instructions for Completion


If no deaths occurred, you will not need to report anything at this time. At the beginning of the next calendar year, you will
be asked to complete a summary form whether you had a death occurrence or not.



If you had more than 1 death, make copies of pages 2 and 3 for each additional death.



Complete questions 1 through 16 for each inmate death.



Once your death records are complete, there are several ways to submit a death report:
ONLINE: Complete the report online at: https://bjsdcrp.rti.org

MAIL: RTI International, Attn: Kim Aspinwall

E-MAIL: [email protected]

Project Number: 0213149.001.102

FAX (TOLL-FREE): 1-866-800-9179

3040 Cornwallis Road, PO Box 12194
Research Triangle Park, NC 27709-2194



If you need assistance, call Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected]

What deaths should be reported?
INCLUDE deaths of ALL Persons

EXCLUDE deaths of ALL Persons

 Confined in your jail facilities, whether housed under your own or
another jurisdiction;

 Confined in facilities operated by two or more jurisdictions or those
held in privately operated jails;

 Under your jurisdiction but housed in special jail facilities (e.g.,
medical/treatment/release centers, halfway houses, and work farms);
or on transfer to treatment facilities;

 Under your jurisdiction but in non-residential community-based
programs run by your jails (e.g., electronic monitoring, house
arrest, community service, day reporting, work programs);

 Under your jurisdiction but out to court;

 Under your jurisdiction but on AWOL, escape, or long-term transfer to
other jurisdiction;



In transit to or from your facilities while under your jurisdiction.

 In the process of arrest by your agency, but not yet booked into your
jail facility.

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

form to this address.

LOCAL JAIL INMATE DEATH REPORT

8. What was the inmate’s legal status at time of death?
(For persons with more than one status, report the
status associated with the most serious offense.)

1. What was the inmate’s name?

LAST

FIRST

MI

2. On what date did the inmate die?
2012
MONTH

DAY

DAY

Please Specify:

YEAR

3. What was the inmate’s date of birth?

MONTH

Convicted—new court commitment
Convicted—returned probation / parole violator
Unconvicted
Other

YEAR

4. What was the inmate’s sex?
Male
Female

9. Since admission, did the inmate ever stay overnight in
a mental health observation unit or an outside mental
health facility?
Yes
No
Don’t Know
10. Where did the inmate die?

5. What was the inmate’s race/ethnic origin?
White (not of Hispanic origin)
Black or African American (not of Hispanic origin)
Hispanic or Latino
American Indian/Alaska Native (not of Hispanic
origin)
Asian (not of Hispanic origin)
Native Hawaiian or Other Pacific Islander (not of
Hispanic origin)
Two or more races
Additional categories in your information system

In a general housing within the jail facility or on jail
grounds
In a segregation unit
In a special medical unit/infirmary within jail facility
In a special mental health services unit within jail
facility
In a medical center outside jail facility
In a mental health center outside jail facility
While in transit
Elsewhere
Please Specify:

Please Specify:

Race/Ethnicity Not Known
6. On what date had the inmate been admitted to a
facility under your jurisdiction?

MONTH

DAY

YEAR

7. For what offense(s) was the inmate being held?
a.

11. Where did the incident (e.g., accident, suicide, or
homicide) causing the death take place?
NOT APPLICABLE—Cause of death was illness,
intoxication, or AIDS-related
In the jail facility or on the jail grounds
In the inmate’s cell/room
In a temporary holding area/lockup
[SPECIFY]
In a common area within the facility (e.g.,
yard, library, cafeteria, etc.)
In a segregation unit
In a special medical unit/infirmary
In a special mental health services unit
Elsewhere within the jail facility

b.
c.
d.

Please Specify:

Outside the jail facility (e.g., while on work release or
on work detail, etc.)
Elsewhere

e.

Please Specify:

<< AGENCY ID >>

12. Had the deceased been receiving treatment for the medical condition after admission to your correctional facilities?
Exclude emergency care provided at time of death.
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
a.
b.
c.
d.
e.
f.

YES
NO
DON’T KNOW
Evaluated by physician/medical staff ...................................................................
Had diagnostic tests (e.g., X-rays, MRI) ..............................................................
Received medications ...........................................................................................
PLEASE PROVIDE A
Received treatment/care other than medications .................................................
RESPONSE FOR EACH
Had surgery ..........................................................................................................
ITEM (a – f).
Confined in special medical unit. ..........................................................................

13. When did the incident (e.g., accident, suicide, or
homicide) causing the death occur?
NOT APPLICABLE—Cause of death was illness,
intoxication, or AIDS-related

14. Are the results of a medical examiner’s or coroner’s
evaluation (such as an autopsy, post-mortem exam, or
review of medical records) available in order to establish
an official cause of death?
YES

Morning (6 am to Noon)
Afternoon (Noon to 6 pm)
Evening (6 pm to Midnight)
Overnight (Midnight to 6 am)

CONTINUE TO Q15

Evaluation complete—results are pending
SKIP REMAINING QUESTIONS—YOU WILL
BE CONTACTED AT A LATER TIME FOR THE
CAUSE OF DEATH
No evaluation is planned

15. What was the cause of death?

CONTINUE TO Q15

*** Please SPECIFY cause of death as it is critical information ***

Illness—Exclude AIDS-related deaths [Specify]
Acquired Immune Deficiency Syndrome (AIDS)
Accidental alcohol/drug intoxication [Specify]
Accidental injury to self [Describe]
Accidental injury by other (e.g., vehicular
accidents during transport) [Describe]
Suicide (e.g., hanging, knife/cutting instrument,
intentional drug overdose) [Describe]
Homicide [Please provide description]
Other cause(s) [Specify]

16. Was the cause of death the result of a pre-existing
medical condition or did the inmate develop the
condition after admission? If multiple conditions
caused the death, select “Pre-existing medical
condition.”

Please add any additional notes here:

NOT APPLICABLE—Cause of death was
accidental injury, intoxication, suicide, or
homicide
Pre-existing medical condition
Deceased developed condition after admission
Could not be determined

<>

IMPORTANT: DO NOT ENLARGE, REDUCE OR MOVE the FIM and POSTNET barcodes. They are only valid as printed!
Special care must be taken to ensure FIM and POSTNET barcode are actual size AND placed properly on the mail piece
to meet both USPS regulations and automation compatibility standards.

3040 Cornwallis Road ■ PO Box 12194
Research Triangle Park, NC 27709-2194

■

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

USA

BUSINESS REPLY MAIL
FIRST-CLASS MAIL

PERMIT NO. 593

DURHAM, NC

POSTAGE WILL BE PAID BY ADDRESSEE

RTI INTERNATIONAL

ATTN: TIM FLANIGAN 0213149.001.102

PO BOX 12194
RESEARCH TRIANGLE PARK NC 27709-9935

Artwork for Envelope, Business, #10, 4 1/8 x 9 1/2 in (4.125" x 9.5")
Layout: sample BRM Env with IMB.lyt
February 23, 2011

Produced by DAZzle Designer, Version 9.0.05
(c) 1993-2009, Endicia, www.Endicia.com
U.S. Postal Service, Serial #

Conducted by the U.S. Department of Justice - Bureau of Justice Statistics (BJS) and RTI International (RTI)

Over the past decade, BJS has collaborated with local jails and state departments of corrections to
collect and disseminate statistics on mortality data.

How are the Deaths in Custody Reporting
Program (DCRP) data used?
• Over the years BJS has published several reports on
corrections-related mortality, providing the corrections
community with important statistics that help policymakers and jail administrators address key public health
issues facing jails and prisons. Some examples include—
a. Prison and Jail Deaths in Custody, 2000-2009 - Statistical Tables,
NCJ 236219

Want to test your knowledge about DCRP?
Take the following quiz!
(Answers are available further below.)
1. What is the leading natural cause of death
among jail inmates?
a. Cancer

b. Heart disease

c. AIDS/HIV

b. Mortality in Local Jails, 2000-2007 (Revised), NCJ 222988

2. Between 2000 and 2009, has the rate of
inmate jail deaths from HIV/AIDS increased or
decreased?

c. Medical Causes of Death in State Prisons, 2001-2004, NCJ
216340

3. Approximately what percentage of jail deaths
occur within the first 7 days of admission?

d. Suicide and Homicide in State Prisons and Local Jails, NCJ
210036
Please visit the BJS website at http://www.bjs.gov to
access these and other statistical reports.
• BJS occasionally fields questions from local jail
administrators who need to know how the death
rates in their jails compare with jails of a similar size or
within their state.
• BJS provides information to state departments of
corrections that need death information from previous
years for special or routine reports.

For more
information on
BJS or the DCRP,
please contact—

Margaret Noonan
Program Manager
U.S. Department of Justice
Bureau of Justice Statistics
810 7th Street, NW
Washington, DC 20531
(202) 353-2060
[email protected]

For more
information about
the DCRP or data
collection, please
contact—

Kim Aspinwall
DCRP Data Collection Task Leader
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709
(800) 344-1387
[email protected]

a. 18%

b. 28% c. 38%

4. True or False: Between 2001 and 2009, illnessrelated deaths accounted for 9 out of 10 prison
deaths.
5. Between 2000 and 2009, were mortality rates
among whites higher or lower than those for
other race or ethnic groups?
6. About what percentage of the nation’s
approximately 2,800 jail jurisdictions
participated in the Deaths in Custody
Reporting Program in 2010?
a. 90%

b. 95% c. 97%

Source: Prison and Jail Deaths in Custody, 2000-2009-Statistical
Tables, BJS Web, December 2011, NCJ 236219.

(1) Heart disease. Heart disease represented approximately
22% of all jail deaths from 2000 to 2009. (2) Decreased. AIDSrelated deaths in jails declined by 54% between 2000 and 2009.
(3) About 38%. Between 2000 and 2009, the percentage of jail
deaths that took place within a week of admission ranged from
36.2% (2006) to 40.3% (2003). (4) True. Only 10% of reported
deaths are due to suicide, accidental injury, or homicide. (5) Higher.
The rate of mortality among whites is higher than that of other
races or ethnic groups. In prisons, white mortality rates were
between 1.4 and 1.8 times higher in comparison to other ethnic or
racial groups. In jails, whites had a mortality rate between 1.6 and
4.7 times higher than other ethnic or racial groups. (6) 97%. If your
jail hasn’t previously participated in DCRP, please contact RTI.

3040 Cornwallis Road n PO Box 12194
Research Triangle Park, NC 27709-2194
ATTN: Tim Flanigan 0212335.001.302.100

2011

ACTION REQUESTED

Completion of reporting for the
2011 DCRP

This packet includes:







Cover letter
Instructions for reporting data
2011 Annual Summary Form
2011 Death Report Form
Postage-paid Return Envelope

2011 Data Collection Forms and
Reporting Instructions
 All agencies should submit a 2011 Annual Summary
form. The form has one question asking the number of
deaths that occurred in 2011.
 Please be sure that the total number of deaths you report
on the Annual Summary form matches the number of
individual death reports you submit for 2011.
 You may submit your data online by logging onto the
Deaths and Custody Reporting Program (DCRP) Web
site (https://bjsdcrp.rti.org) using the login credentials on
your cover letter.
 We have enclosed a paper version of the 2011 Annual
Summary and Death Report forms if you prefer to
submit by mail or fax. Please disregard the paper forms
if you plan to submit data online.
 If you had more than one inmate death, and are unable to
use the Web option, additional Death Report forms are
available for download by logging onto the DCRP Web
site as described above.

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

DEATHS IN CUSTODY—2011
ANNUAL SUMMARY OF INMATE DEATHS
IN STATE PRISONS

Form NPS-4

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

DATA SUPPLIED BY:
Name
:
Official
Address

Title
Telephone
FAX

City
State

Zip

E-mail

Please correct any error in name or mailing address

What deaths should be reported?
INCLUDE Deaths of ALL Persons

EXCLUDE Deaths of ALL Persons

 Confined in your correctional facilities, whether housed under
your jurisdiction or that of another state;

 Deaths by execution that were carried out in your state;

 Under your jurisdiction but housed in private correctional
facilities, whether located in or out of state;

 Under your jurisdiction but housed in a state-operated
correctional facility in another state or in a federal facility;

 Under your jurisdiction but in special facilities (e.g., medical/
treatment/release centers, halfway houses, police/court
lockups, and work farms);

 Confined in local jail facilities, whether located in or out of state;

 Under probation or parole supervision in your state.

 In transit to or from your facilities while under your supervision.

During 2011, how many persons died while in the custody of your state correctional facilities?
Number of deaths in 2011


Please fill out the number of deaths that occurred in calendar year 2011 above and submit this form and corresponding NPS-4A
forms to RTI International. There are several ways to submit these data:
ONLINE: Complete this form online at: https://bjsdcrp.rti.org

MAIL: RTI International, Attn: Kim Aspinwall

E-MAIL: [email protected]

Project Number: 0212335.001.302.200

FAX (TOLL-FREE): 1-866-800-9179

3040 Cornwallis Road, PO Box 12194
Research Triangle Park, NC 27709-2194





For each inmate death, please ensure that you have submitted a STATE PRISON INMATE DEATH REPORT (NPS-4A) form.
IF NO DEATHS OCCURRED, it is still important that you complete this form and return it to RTI International.
If you need assistance, call Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or send an e-mail to [email protected].



If you need assistance, call Tim Flanigan of RTI International toll-free at 1-800-344-1387 or [email protected]

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

form to this address.

OMB No. 1121-0249 Approval Expires 12/31/2012
U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:

DEATHS IN CUSTODY— 2011
STATE PRISON INMATE
DEATH REPORT

Form NPS-4A
(Addendum)

RTI INTERNATIONAL

DATA SUPPLIED BY:
Name
:
Official
Address

Title
Telephone
FAX

City
State

Zip

E-mail

Please correct any error in name or mailing address

Instructions for Completion


If no deaths occurred, you will not need to report anything at this time. At the beginning of the next calendar year, you will
be asked to complete a summary form whether you had a death occurrence or not.



If you had more than 1 death, make copies of pages 2 and 3 for each additional death.



Complete questions 1 through 16 for each inmate death.



Once your death records are complete, there are several ways to submit a death report:
ONLINE: Complete the report online at: https://bjsdcrp.rti.org

MAIL: RTI International, Attn: Kim Aspinwall

E-MAIL: [email protected]

Project Number: 0212335.001.302.200

FAX (TOLL-FREE): 1-866-800-9179

3040 Cornwallis Road, PO Box 12194
Research Triangle Park, NC 27709-2194



If you need assistance, call Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected]

What deaths should be reported?
INCLUDE deaths of ALL Persons
Confined in your correctional facilities, whether housed under
your jurisdiction or that of another state;
Under your jurisdiction but housed in private correctional
facilities, whether located in or out of state;
Under your jurisdiction but in special facilities (e.g., medical/
treatment/release centers, halfway houses, police/court lockups,
and work farms);

EXCLUDE deaths of ALL Persons
Deaths by execution that were carried out in your state;
Confined in local jail facilities, whether located in or out of state;
Under your jurisdiction but housed in a state-operated
correctional facility in another state or in a federal facility;
Under probation or parole supervision in your state.

In transit to or from your facilities while under your supervision.
BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

form to this address.

STATE PRISON INMATE DEATH REPORT

8. For what offense(s) was the inmate being held?

1. What was the inmate’s name?

a.
LAST

FIRST

MI

2. On what date did the inmate die?
2011
MONTH

DAY

b.
c.
d.

YEAR

e.
3. What was the name and location of the correctional
facility involved?
Please Specify:

Yes
No
Don’t Know

4. What was the inmate’s date of birth?

MONTH

DAY

YEAR

5. What was the inmate’s sex?
Male
Female
6. What was the inmate’s race/ethnic origin?
White (not of Hispanic origin)
Black or African American (not of Hispanic origin)
Hispanic or Latino
American Indian/Alaska Native (not of Hispanic
origin)
Asian (not of Hispanic origin)
Native Hawaiian or Other Pacific Islander (not of
Hispanic origin)
Two or more races
Additional categories in your information system
Please Specify:

Race/Ethnicity Not Known
7. On what date had the inmate been admitted to one of
your correctional facilities?

YEAR

9. Since admission, did the inmate ever stay overnight in
a mental health facility?

10. Where did the inmate die?
In a general housing in the facility or on prison
grounds
In a segregation unit
In a special medical unit/infirmary within your
facility
In a special mental health services unit within your
facility
In a medical center outside your facility
In a mental health center outside your facility
While in transit
Please Specify:
Elsewhere
11. Where did the incident (e.g., accident, suicide, or
homicide) take place?
NOT APPLICABLE—Cause of death was illness,
intoxication, or AIDS-related
In the prison facility or on the prison grounds
In the inmate’s cell/room
In a temporary holding area/lockup
[SPECIFY]
In a common area within the facility (e.g.,
yard, library, cafeteria, etc.)
In a special medical unit/infirmary
In a special mental health services unit
In a segregation unit
On death row, special unit awaiting capital
punishment
Elsewhere within the prison facility
Please Specify:

Outside the prison facility (e.g., while on work release
or on work detail, etc.)
Elsewhere

Please Specify:

12. Had the inmate been receiving treatment for the medical condition after admission to your correctional facilities?
Exclude emergency care provided at time of death.
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
a.
b.
c.
d.
e.
f.

YES
NO
DON’T KNOW
Evaluated by physician/medical staff ....................................................................
Had diagnostic tests (e.g., X-rays, MRI) ...............................................................
Received medications ...........................................................................................
PLEASE PROVIDE A
Received treatment/care other than medications .................................................
RESPONSE FOR EACH
Had surgery ..........................................................................................................
ITEM (a – f).
Confined in special medical unit ..........................................................................

13. When did the incident (e.g., accident, suicide, or
homicide) causing the inmate’s death occur?
NOT APPLICABLE—Cause of death was illness,
intoxication, or AIDS-related

14. Are the results of a medical examiner’s or coroner’s
evaluation (such as an autopsy, post-mortem exam, or
review of medical records) available in order to establish
an official cause of death?
YES

Morning (6 am to Noon)
Afternoon (Noon to 6 pm)
Evening (6 pm to Midnight)
Overnight (Midnight to 6 am)

CONTINUE TO Q15

Evaluation complete—results are pending
SKIP REMAINING QUESTIONS—YOU WILL
BE CONTACTED AT A LATER TIME FOR THE
CAUSE OF DEATH
No evaluation is planned

15. What was the cause of death?

CONTINUE TO Q15

*** Please SPECIFY cause of death as it is critical information ***

Illness—Exclude AIDS-related deaths [Specify]
Acquired Immune Deficiency Syndrome (AIDS)
Accidental alcohol/drug intoxication [Specify]
Accidental injury to self [Describe]
Accidental injury by other (e.g., vehicular
accidents during transport) [Describe]
Suicide (e.g., hanging, knife/cutting instrument,
intentional drug overdose) [Describe]
Homicide [Please provide description]
Other cause(s) [Specify]

16. Was the cause of death the result of a pre-existing
medical condition or did the inmate develop the
condition after admission? If multiple conditions
caused the death, select “Pre-existing medical
condition.”
NOT APPLICABLE—Cause of death was
accidental injury, intoxication, suicide, or
homicide
Pre-existing medical condition
Deceased developed condition after admission
Could not be determined

Please add any additional notes here:

IMPORTANT: DO NOT ENLARGE, REDUCE OR MOVE the FIM and POSTNET barcodes. They are only valid as printed!
Special care must be taken to ensure FIM and POSTNET barcode are actual size AND placed properly on the mail piece
to meet both USPS regulations and automation compatibility standards.

3040 Cornwallis Road ■ PO Box 12194
Research Triangle Park, NC 27709-2194

■

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

USA

BUSINESS REPLY MAIL
FIRST-CLASS MAIL

PERMIT NO. 593

DURHAM, NC

POSTAGE WILL BE PAID BY ADDRESSEE

RTI INTERNATIONAL

ATTN: TIM FLANIGAN 0212335.001.302.100

PO BOX 12194
RESEARCH TRIANGLE PARK NC 27709-9935

Artwork for Envelope, Business, #10, 4 1/8 x 9 1/2 in (4.125" x 9.5")
Layout: sample BRM Env with IMB.lyt
February 23, 2011

Produced by DAZzle Designer, Version 9.0.05
(c) 1993-2009, Endicia, www.Endicia.com
U.S. Postal Service, Serial #

3040 Cornwallis Road n PO Box 12194
Research Triangle Park, NC 27709-2194
ATTN: Tim Flanigan 0212335.001.302.100

2012

FOR FUTURE REFERENCE

Announcing the start of reporting for the
2012 Deaths in Custody Reporting Program.
** No action is requested at this time. **

This packet includes:





Instructions for reporting data
2012 Death Report Form
Postage-paid Return Envelope

2012 Reporting Instructions
 We have enclosed a 2012 Death Report form for your
convenience. If no deaths have occurred within your
prisons to date in 2012, you have nothing to report at this
time.
 Please submit a report for any deaths that occur within your
prisons in 2012 as soon as the autopsy or other official
death investigation results are available.
 Please complete ALL form questions, including “Specify”
fields, if applicable.
 You may submit your data online by logging onto the
Deaths and Custody Reporting Program (DCRP) website
(https://bjsdcrp.rti.org) using the login credentials in your
cover letter.
 We have enclosed a paper version of the 2012 Death
Report form if you prefer to submit by mail or fax. Please
disregard the paper form if you plan to submit data online.
 If you have more than one inmate death, and are unable to
use the Web option, additional Death Report forms are
available for download by logging onto the DCRP Web site
as described above.

OMB No. 1121-0249 Approval Expires 12/31/2012
U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:

DEATHS IN CUSTODY— 2012
STATE PRISON INMATE
DEATH REPORT

Form NPS-4A
(Addendum)

RTI INTERNATIONAL

DATA SUPPLIED BY:
Name
:
Official
Address

Title
Telephone
FAX

City
State

Zip

E-mail

Please correct any error in name or mailing address

Instructions for Completion


If no deaths occurred, you will not need to report anything at this time. At the beginning of the next calendar year, you will
be asked to complete a summary form whether you had a death occurrence or not.



If you had more than 1 death, make copies of pages 2 and 3 for each additional death.



Complete questions 1 through 16 for each inmate death.



Once your death records are complete, there are several ways to submit a death report:
ONLINE: Complete the report online at: https://bjsdcrp.rti.org

MAIL: RTI International, Attn: Kim Aspinwall

E-MAIL: [email protected]

Project Number: 0213149.001.102

FAX (TOLL-FREE): 1-866-800-9179

3040 Cornwallis Road, PO Box 12194
Research Triangle Park, NC 27709-2194



If you need assistance, call Kim Aspinwall of RTI International toll-free at 1-800-344-1387 or [email protected]

What deaths should be reported?
INCLUDE deaths of ALL Persons


Confined in your correctional facilities, whether housed
under your jurisdiction or that of another state;



Under your jurisdiction but housed in private correctional
facilities, whether located in or out of state;



Under your jurisdiction but in special facilities (e.g., medical/
treatment/release centers, halfway houses, police/court
lockups, and work farms);



In transit to or from your facilities while under your
supervision.

EXCLUDE deaths of ALL Persons


Deaths by execution that were carried out in your state;



Confined in local jail facilities, whether located in or out of
state;



Under your jurisdiction but housed in a state-operated
correctional facility in another state or in a federal facility;



Under probation or parole supervision in your state.

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 5 minutes per response for jurisdictions reporting zero deaths and 30 minutes per each reported death, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any
aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

form to this address.

STATE PRISON INMATE DEATH REPORT

8. For what offense(s) was the inmate being held?

1. What was the inmate’s name?

a.
LAST

FIRST

MI

2. On what date did the inmate die?
2012
MONTH

DAY

b.
c.
d.

YEAR

e.
3. What was the name and location of the correctional
facility involved?
Please Specify:

Yes
No
Don’t Know

4. What was the inmate’s date of birth?

MONTH

DAY

YEAR

5. What was the inmate’s sex?
Male
Female
6. What was the inmate’s race/ethnic origin?
White (not of Hispanic origin)
Black or African American (not of Hispanic origin)
Hispanic or Latino
American Indian/Alaska Native (not of Hispanic
origin)
Asian (not of Hispanic origin)
Native Hawaiian or Other Pacific Islander (not of
Hispanic origin)
Two or more races
Additional categories in your information system
Please Specify:

Race/Ethnicity Not Known
7. On what date had the inmate been admitted to one of
your correctional facilities?

MONTH

DAY

9. Since admission, did the inmate ever stay overnight in
a mental health facility?

YEAR

10. Where did the inmate die?
In a general housing in the facility or on prison
grounds
In a segregation unit
In a special medical unit/infirmary within your
facility
In a special mental health services unit within your
facility
In a medical center outside your facility
In a mental health center outside your facility
While in transit
Please Specify:
Elsewhere
11. Where did the incident (e.g., accident, suicide, or
homicide) take place?
NOT APPLICABLE—Cause of death was illness,
intoxication, or AIDS-related
In the prison facility or on the prison grounds
In the inmate’s cell/room
In a temporary holding area/lockup
[SPECIFY]
In a common area within the facility (e.g.,
yard, library, cafeteria, etc.)
In a special medical unit/infirmary
In a special mental health services unit
In a segregation unit
On death row, special unit awaiting capital
punishment
Elsewhere within the prison facility
Please Specify:

Outside the prison facility (e.g., while on work release
or on work detail, etc.)
Elsewhere

<< AGENCY ID >>

Please Specify:

12. Had the inmate been receiving treatment for the medical condition after admission to your correctional facilities?
Exclude emergency care provided at time of death.
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
a.
b.
c.
d.
e.
f.

YES
NO
DON’T KNOW
Evaluated by physician/medical staff ....................................................................
Had diagnostic tests (e.g., X-rays, MRI) ...............................................................
Received medications ...........................................................................................
PLEASE PROVIDE A
Received treatment/care other than medications .................................................
RESPONSE FOR EACH
Had surgery ..........................................................................................................
ITEM (a – f).
Confined in special medical unit ..........................................................................

13. When did the incident (e.g., accident, suicide, or
homicide) causing the inmate’s death occur?
NOT APPLICABLE—Cause of death was illness,
intoxication, or AIDS-related

14. Are the results of a medical examiner’s or coroner’s
evaluation (such as an autopsy, post-mortem exam, or
review of medical records) available in order to establish
an official cause of death?
YES

Morning (6 am to Noon)
Afternoon (Noon to 6 pm)
Evening (6 pm to Midnight)
Overnight (Midnight to 6 am)

CONTINUE TO Q15

Evaluation complete—results are pending
SKIP REMAINING QUESTIONS—YOU WILL
BE CONTACTED AT A LATER TIME FOR THE
CAUSE OF DEATH
No evaluation is planned

15. What was the cause of death?

CONTINUE TO Q15

*** Please SPECIFY cause of death as it is critical information ***

Illness—Exclude AIDS-related deaths [Specify]
Acquired Immune Deficiency Syndrome (AIDS)
Accidental alcohol/drug intoxication [Specify]
Accidental injury to self [Describe]
Accidental injury by other (e.g., vehicular
accidents during transport) [Describe]
Suicide (e.g., hanging, knife/cutting instrument,
intentional drug overdose) [Describe]
Homicide [Please provide description]
Other cause(s) [Specify]

16. Was the cause of death the result of a pre-existing
medical condition or did the inmate develop the
condition after admission? If multiple conditions
caused the death, select “Pre-existing medical
condition.”

Please add any additional notes here:

NOT APPLICABLE—Cause of death was
accidental injury, intoxication, suicide, or
homicide
Pre-existing medical condition
Deceased developed condition after admission
Could not be determined

<>

IMPORTANT: DO NOT ENLARGE, REDUCE OR MOVE the FIM and POSTNET barcodes. They are only valid as printed!
Special care must be taken to ensure FIM and POSTNET barcode are actual size AND placed properly on the mail piece
to meet both USPS regulations and automation compatibility standards.

3040 Cornwallis Road ■ PO Box 12194
Research Triangle Park, NC 27709-2194

■

NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES

USA

BUSINESS REPLY MAIL
FIRST-CLASS MAIL

PERMIT NO. 593

DURHAM, NC

POSTAGE WILL BE PAID BY ADDRESSEE

RTI INTERNATIONAL

ATTN: TIM FLANIGAN 0213149.001.102

PO BOX 12194
RESEARCH TRIANGLE PARK NC 27709-9935

Artwork for Envelope, Business, #10, 4 1/8 x 9 1/2 in (4.125" x 9.5")
Layout: sample BRM Env with IMB.lyt
February 23, 2011

Produced by DAZzle Designer, Version 9.0.05
(c) 1993-2009, Endicia, www.Endicia.com
U.S. Postal Service, Serial #

Attachment J. Example of letters, emails and telephone
scripts for data quality and non-response follow-up for
DCRP jail respondents

Directed Email Prompt
September 29, 2011

Dear {Salutation}{Last Name}:
We are in the process of finalizing data collection for the 2010 U.S. Department of Justice’s Deaths in Custody Reporting
Program (DCRP). We recently contacted you by telephone because we have not received your 2010 Annual Summary Form.
We ask ALL agencies to complete the Annual Summary form (i.e., a CJ9A or a CJ10A) regardless if whether they
have experienced a death in custody during 2010.
The Annual Summary form has 4 short questions that should take you a few minutes to complete. We have enclosed this
form for you to complete and mail using the enclosed return envelope or fax back to us at 1-866-800-9179. Furthermore, if
you have experienced a death in custody during 2010, we ask that you complete the enclosed death report. Please make
copies of this form if needed for multiple deaths to report for 2010.
We would appreciate your response on or before: October 10, 2011.
If you would prefer to complete the form(s) online, our web page may be found here: https://bjsdcrp.rti.org/. Once there,
you will be instructed to enter a username and password:
Username:
Password:

«username»
«password»

After logging in, please select the green button: “Submit 2010 Deaths in Custody Data.” Next, click on the blue button to fill
out your 2010 Annual Summary Form. If you have any deaths to report, please click the green button entitled “Add a 2010
Death Report” so that you can begin entering death record data.
If you have any questions or concerns, please contact Tim Flanigan, the RTI Data Collection Task Leader, at 1-800-3348571, or [email protected]
We would appreciate your participation, as the continued success of this program depends on you.
Sincerely,

Margaret E. Noonan, Program Manager
Deaths in Custody Reporting Program
202-353-2060
[email protected]

William J. Sabol, Chief
Corrections Statistics Program
202-514-1062
[email protected]

Enclosures:
Annual Summary on Inmates Under Jail Jurisdiction (CJ-9A)
Annual Death Report on Inmates under Jail Jurisdiction (CJ-9)

Telephone script – missing or incomplete annual summary form
Good morning/afternoon, [Respondent].
My name is [your name] with RTI International and I’m calling on the behalf of the Bureau of Justice Statistics’ Deaths in
Custody Program.. Would you have a few moments to discuss the Deaths in Custody Reporting Program?
If the respondent indicates you’ve caught them at a bad time:
I understand. I can call you back at a more convenient time. What day and time would work best for you?
Make note of the respondents instructions.
Just to confirm, tomorrow afternoon at 2:00 is a time that works best for you? Thank you. I look forward to speaking to you
then.
If the respondent indicates that they have time to talk
Specifically, I’m calling about that status of your agency’s Annual Summary Form.
As you may recall, we ask all jails to complete this form even if your jail has no deaths to report. The data on this form is
critical to calculating mortality rates for all jails. It should take about five minutes for you to complete. If you would prefer I
can take this information over the phone.
If the respondent would like to enter the data on their own.
Our online tool is the easiest way to enter your data. Go to bjsdcrp.rti.org/ and enter your username and password to complete
your form.
Be prepared to provide the respondent with this information.
If the respondent would prefer to fax or mail their data, give them the fax number or the mailing address.
When you’re ready, you can fax your survey to 1-866-800-9179, which is a toll-free number. Please address the fax to Kim
Aspinwall.
When you’re ready you can mail your survey to RTI International, Attn: Kim Aspinwall. Project number
0212335.001.302.200, PO Box 12194, Research Triangle Park, NC 27709-2194.
If the respondent can provide the information over the phone:
That’s great. We can begin when you are ready.
Go through the items in order. Once complete thank the respondent for their time.
If you would like, I can provide you with a copy of your submission for your records.
Offer to provide a copy via email, or if they prefer arrange to fax or mail them a copy.
Thank you so much for your time and for participating in the Deaths in Custody Reporting Program.

Telephone script – missing death forms
Good morning/afternoon, [Respondent].
My name is [your name] with RTI International and I’m calling on the behalf of the Bureau of Justice Statistics’ Deaths in
Custody Program.. Would you have a few moments to discuss the Deaths in Custody Reporting Program?
If the respondent indicates you’ve caught them at a bad time:
I understand. I can call you back at a more convenient time. What day and time would work best for you?
Make note of the respondents instructions.
Just to confirm, tomorrow afternoon at 2:00 is a time that works best for you? Thank you. I look forward to speaking to you
then.
If the respondent indicates that they have time to talk
Specifically, I’m calling about that status of an inmate death that your jail reported. On your Annual Summary Form, you
indicated that your jail had an inmate death, but we have yet to receive the death form. Is it correct that your jail has an
inmate death to report?
If no, do the following:
OK, we’re going to edit your annual summary form to reflect the true count of zero. If you would like, I can provide you with
a copy of your submission for your records.
Thank you so much for your time and for participating in the Deaths in Custody Reporting Program.
If yes, follow the script below. If yes, but they’re waiting on data from the medical examiner or coroner, advise them that they
can begin the death record and complete it once the final cause of death ruling is available.
When you’re ready to enter your death record, our online tool is the easiest way to enter your data. Go to bjsdcrp.rti.org/ and
enter your username and password to complete your form.
Be prepared to provide the respondent with this information.
If the respondent would prefer to fax or mail their data, give them the fax number or the mailing address.
When you’re ready, you can fax your survey to 1-866-800-9179, which is a toll-free number. Please address the fax to Kim
Aspinwall.
When you’re ready you can mail your survey to RTI International, Attn: Kim Aspinwall. Project number
0212335.001.302.200, PO Box 12194, Research Triangle Park, NC 27709-2194.
If the respondent can provide the information over the phone:
That’s great. We can begin when you are ready.
Go through the items in order. Once complete thank the respondent for their time.
If you would like, I can provide you with a copy of your submission for your records.
Offer to provide a copy via email, or if they prefer arrange to fax or mail them a copy.
Thank you so much for your time and for participating in the Deaths in Custody Reporting Program.

Telephone script – death form missing information
Good morning/afternoon, [Respondent].
My name is [your name] with RTI International and I’m calling on the behalf of the Bureau of Justice Statistics’ Deaths in
Custody Program.. Would you have a few moments to discuss the Deaths in Custody Reporting Program?
If the respondent indicates you’ve caught them at a bad time:
I understand. I can call you back at a more convenient time. What day and time would work best for you?
Make note of the respondents instructions.
Just to confirm, tomorrow afternoon at 2:00 is a time that works best for you? Thank you. I look forward to speaking to you
then.
If the respondent indicates that they have time to talk
Specifically, I’m calling about that status of an inmate death that your jail reported. The inmate’s name is John Doe, and his
date of death is 12/31/2012. You indicated that you were awaiting the results of the autopsy. Are those results currently
available?
If no, do the following:
I understand. Do you have an idea as to when this information will be available? Make a note of the expected date. Once you
receive this information, please complete the record for John Doe at your earliest convenience.
Thank you so much for your time and for participating in the Deaths in Custody Reporting Program.
If yes, follow the script below.
If you prefer, I can take that information from you over the phone.
If the respondent can provide the information over the phone: You can also offer to set up a time to call them back if they’d
like to do it over the phone but don’t have the information in front of them.
That’s great. We can begin when you are ready.
Go through the items in order. Once complete thank the respondent for their time.
If you would like, I can provide you with a copy of your submission for your records.
Offer to provide a copy via email, or if they prefer arrange to fax or mail them a copy.
Thank you so much for your time and for participating in the Deaths in Custody Reporting Program.
If the respondent would rather enter the data on their own.
When you’re ready to enter your death record, our online tool is the easiest way to enter your data. Go to bjsdcrp.rti.org/ and
enter your username and password to complete your form.
Be prepared to provide the respondent with this information.
If the respondent would prefer to fax or mail their data, give them the fax number or the mailing address.

When you’re ready, you can fax your survey to 1-866-800-9179, which is a toll-free number. Please address the fax to Kim
Aspinwall. It’s not necessary to complete a new form, just reference your jail, the inmate’s name and date of death and
provide the final cause of death.
.
When you’re ready you can mail your survey to RTI International, Attn: Kim Aspinwall. Project number
0212335.001.302.200, PO Box 12194, Research Triangle Park, NC 27709-2194.
If you have any questions or concerns during this process, please don’t hesitate to contact me at (provide contact
information). Thank you for participating in the Deaths in Custody Reporting Program.

FIRST REMINDER MAILING – SENT USPS PRIORITY MAIL FOR THOSE WITHOUT EMAILS

Dear <>:
We appreciate your continued support of the Bureau of Justice Statistics’ (BJS) Deaths in Custody
Reporting Program (DCRP). As a reminder, you can report an inmate death at any time through the year.
If you have already entered some death reports in response to our letter in October, thank you for your
initial response.
If you have zero deaths to report, you have nothing to do at this time.
If you have any deaths to report at the close of calendar year 2011, please report these at your earliest
convenience. Submitting your forms online is the most efficient method of reporting the death records.
In order to report online, please log onto the DCRP website (https://bjsdcrp.rti.org) and use the
following login credentials:
USERNAME: <>
PASSWORD: <>
In early 2012, we will ask all jails to complete a brief annual summary form that collects population data
for your facilities and a final count of the number of deaths that occurred in your jurisdiction during
2011. This survey should take about five minutes to complete and the information collected is necessary
to calculate mortality in jails.
If you have any questions, please contact Kim Aspinwall at 1-800-344-1387, or e-mail us
at [email protected]. Please don’t hesitate to contact BJS directly at any time, using the contact
information below.
We thank you for your participation and look forward to our continued work together.
Sincerely,

Margaret E. Noonan, Program Manager
Deaths in Custody Reporting Program
202-353-2060
[email protected]

William J. Sabol, Deputy Director
Statistical Collections & Analysis
202-514-1062
[email protected]

NONRESPONSE EMAIL TARGETING “0” DEATH REPORT AGENCIES

We recently sent you 2011 reporting materials for the U.S. Department of Justice’s Deaths in Custody Reporting
Program (DCRP). We appreciate your participation, as the continued success of this program depends on you. To
date, we have not received your 2011 annual summary form. If you have recently submitted this, no further
action is requested.
Below are some questions you may have about our request.
What if we had no deaths in custody during 2011?
We would still like for you to complete the attached CJ9A form. This should take about five minutes
of your time. These data are critical to estimating mortality in jails. Please note that estimates for the
population/count questions on the form are acceptable.
What if we had one or more deaths in custody during 2011?
Upon completing the CJ9A, please also complete the first page of the attached CJ9 form and a
corresponding death report (CJ9 pages 2 and 3) for each inmate death.
How do I submit my reports?
ONLINE: https://bjsdcrp.rti.org/. I’ve included your username and password below for your convenience.
USER NAME: {FILL} PASSWORD: {FILL}
FAX: Fax (toll free): (866) 800–9179

MAIL: RTI International, Attn: Data Capture
Project Number: 0212335.001.302.200
3040 Cornwallis Road, P.O. Box 12194,
Research Triangle Park, NC 27709-2194

EMAIL: You can email your completed reports to: [email protected]
_____________________________________
Please submit your completed reports no later than June 30, 2012.
If you have any questions about the 2011 collection or have difficulty accessing the website, please contact Kim
Aspinwall, the RTI Data Collection Task Leader at 1-800-334-1387, or [email protected].
Thank you for your time.
Margaret E. Noonan, DCRP Project Manager

Example of an email exchange with the field
From: Noonan, Margaret [mailto:[email protected]]
Sent: Tuesday, January 31, 2012 2:02 PM
To: Amy Hall
Subject: RE: Death in Custody Report

Hi [Retracted],
It was nice talking to you today. Sorry for the confusion about the separate collections. The CJ11 forms are the
arrest-related death forms, which I don’t work on.
Just as an FYI, if you ever need information on that collection, you can talk to Andrea Burch, here at BJS. Her
email is [email protected].
The packet you received has to do with death occurring in jails. We ask all jails, even those that have zero deaths
to report, to fill out our brief annual summary forms (the CJ9a). I’ve attached a copy of your agency’s CJ9A form
from 2010. It should take about five minutes for you to complete. It asks four questions on one-day inmate counts,
annual admissions, average daily population and number of inmate deaths, which is zero in your agency’s case.
Take a look at the attachment, and when you’re ready, you can fill it out online by going to the Deaths in Custody
Reporting Program website: https://bjsdcrp.rti.org/
Username: [retracted]
Password: [retracted]
Alternately, you can fax or mail your data following the instructions on the front of the CJ9A form.
Please don’t hesitate to contact me if you have any questions or concerns.
Thank you for participating in the Deaths in Custody Reporting Program.
Take care,
Margaret
Margaret Noonan
Statistician
U.S. Department of Justice
Bureau of Justice Statistics
810 7th Street, NW
Washington, DC 20531
(202) 353-2060

From: Amy Hall [mailto:[email protected]]
Sent: Tuesday, January 31, 2012 2:29 PM
To: Noonan, Margaret
Subject: Death in Custody Report
Ms. Noonan,

I am writing inquiring the status of the DCRP for Crawford County Kansas. I emailed the report form CJ-11
to [email protected] on January 6, 2012. We received a packet in the mail today that includes forms for
2011 and 2012. I just need to be certain that our report for 2011 has indeed been received. Thank you in advance
for your time looking into this matter.
Amy Hall
Records Clerk
Crawford County Sheriff’s Department
P.O. Box 157
225 N. Enterprise Drive
Girard, Kansas 66743
620-724-8274