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2014 Identity Theft Supplement Questionnaire – Final (7/22/14)
SECTION A. Screen Questions
INTRO 1. Now, we are conducting a special supplement on identity theft and I would like to ask you
questions about identity theft. Identity theft means someone else using your personal information
without your permission to buy something, get cash or services, pay bills, or avoid the law. We will
not ask you for any specific account information. Your answers will be kept confidential. INTRO_1
First, I’d like to ask you some questions about your EXISTING ACCOUNTS and the misuse of any of
these accounts. INTRO_EXISTING
1. During the past 12 months, since ___ 20___, have you had at least one active checking or savings
account through a bank or financial institution?
YES
NO (skip to Q2) ACTIVE_BANK_ACCT
1a. During the past 12 months, since ______, 20__ has someone, without your permission, used or
attempted to use your existing checking or savings account, including any debit or ATM cards?
YES
NO EXISTING_BANK
2. Do you currently have at least one credit card in your name? Include major credit cards such as a
Mastercard or Visa, and store credit cards such as a Macy’s card. Please do not include debit cards.
YES
NO (ask follow up) CREDIT_CARD_CURR
Have you had one in the past year, since ___20__?
YES
NO (skip to Q3) CREDIT_CARD_PAST_YR
2a. Since ______, 20__ has someone used or attempted to use one or more of your existing credit
cards without your permission? Please do not include debit cards.
YES
NO EXISTING_CREDIT_CARD
3. Since ___, 20__ has someone misused or attempted to misuse another type of existing account such
as your telephone, cable, gas or electric accounts, online payment account like Paypal, insurance
policies, entertainment account like ITunes or something else?
YES
NO (skip to Q4) OTHER_EXISTING_ACCTS
2
Which of the following types of your EXISTING accounts, other than credit card or banking accounts
did the person run up charges on, take money from, or otherwise misuse? Did they use or attempt to
use one or more of your…
3a. Medical insurance accounts? YES NO EX_MEDICAL
3b. Telephone accounts? YES NO EX_PHONE
3c. Utilities accounts, such as cable, gas or electric accounts? YES NO EX_UTILITY
3d. Online payment accounts such as Paypal? YES NO EX_PAYPAL
3e. Investment accounts? YES NO EX_INVEST
3f. Some other type of accounts? YES______________________(specify) NO OTHER_EX
Intro: Next, I have some questions about any NEW ACCOUNTS someone might have opened.
INTRO_NEW_ACCOUNTS
4. Since ________, 20___, has someone, without your permission, used or attempted to use your
personal information to open any NEW accounts such as wireless telephone accounts, credit card
accounts, loans, bank accounts, online payment accounts, or something else?
YES
NO (skip to Q 5) OPEN_NEW_ACCOUNT
Which of the following types of new accounts did someone open or attempt to open? Did someone
open or attempt to open…
4a. New telephone accounts? YES NO NEW_PHONE
4b. New credit card accounts? YES NO NEW_CREDIT_CARD
4c. New checking or savings accounts? YES NO NEW_BANK
4d. New loans or mortgages? YES NO NEW_LOAN
4e. New medical insurance policies? YES NO NEW_MEDICAL
4f. New automobile insurance policies? YES NO NEW_AUTO_INS
4g. New online payment accounts such as Paypal? YES NO NEW_PAYPAL
4h. Some other type of new account? YES___________________________(Specify) NO NEW_OTHER
Intro: Next, I have some questions about any other misuses of your personal information.
INTRO_SOME_OTHER_FRAUD
5. Since________ 20__, has someone used or attempted to use your personal information for some
other fraudulent purpose, such as getting medical care, a job, or government benefits; renting an
apartment or house; giving your information to the police when they were charged with a crime or
traffic violation, or something else?
YES
NO (skip to check item A) SOME_OTHER_FRAUD
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As far as you know did the person use or attempt to use your personal information in any of the
following ways. Did they use or attempt to use your personal information…
5a.To file a fraudulent tax return? YES NO
TAX_RETURN_FRAUD
5b.To get medical treatment? YES NO
OBTAIN_MEDICAL
5c.To apply for a job? YES NO
APPLY_FOR_JOB
5d. To provide false information to the police? YES NO FALSE_INFO_TO_LAW
5e. To rent an apartment or house? YES NO
RENT_APARTMENT
5f. To apply for government benefits? YES NO
GOVT_BENEFITS
5g. In some other way we haven’t already mentioned? YES______(Specify) NO MISUSED_OTHER_WAY
CHECK ITEM A
Is “no” marked for Q1a, Q2a, Q3, Q4, and Q5
YES Skip to Section G, on Page 15
NO Read Check Item B
CHECK ITEM B
Is only one response marked “yes” from questions 1a, 2a, 3, 4, and 5?
YES Ask Q6a
NO Ask Q6b
6a. Now we would like to know how many times you were a victim of identity theft in the past 12
months. An incident of identity theft occurs when your identity is stolen. A stolen credit card or debit
card may be used multiple times but this should be considered a single incident.
You said that someone, in the past year, that is since _______________20__, . Did this happen to you once or more than once?
More than once (Skip to Section B)
Once (Skip to Section B) TIMES_VICTIM_YEAR
If respondent states “I don’t know,” instruct him/her to select what he/she believes to be the best
response.
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6b. Now we would like to know how many times you were a victim of identity theft in the past 12
months. An incident of identity theft occurs when your identity is stolen. A stolen credit card or debit
card may be used multiple times but this should be considered a single incident. Also, if multiple
credit card numbers and a social security number were obtained at the same time, this should be
considered a single incident.
You said that someone
in the past year, that is, since _______________20__. Were all these thefts the result of one related
incident, or was your personal information stolen multiple times in separate unrelated incidents?
Multiple Incidents (ask Q7)
One related incident (Skip to Section B) MULTIPLE_INCIDENTS
If respondent states “I don’t know,” instruct him/her to select what he/she believes to be the best
response.
7. You said that there were in the past year. Which of
these happened during the most recent incident in which someone misused or attempted to misuse
your personal information? MOST_RECENT_INCIDENT
(Mark all that apply, and only read response items that match autofill in this question)
___Misuse or attempted misuse of an existing credit card account
___Misuse or attempted misuse of an existing banking account (debit, checking, ATM, savings)
___Misuse or attempted misuse of other type of existing account
___Misuse or attempted misuse of personal information to open a NEW account
___Misuse or attempted misuse of personal information for other fraudulent purpose.
SECTION B. HOW/WHEN IDENTITY THEFT DISCOVERED
INTRO: For those with more than one incident: For the remainder of the survey, I will ask you to
consider only the most recent incident during the past 12 months in which you discovered that
someone misused or attempted to misuse your personal information.
For everyone: Thinking about incident, the next couple of questions I have are
about how and when you discovered the misuse of your personal information. INTRO_DISCOVERED
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8. How did you FIRST find out someone had misused or attempted to misuse your personal
information?
(SELECT A SINGLE RESPONSE)
DISCOVERED BY RESPONDENT
a.
I contacted the credit card company or bank to report a theft and was told that fraudulent
charges had already been made.
b.
I noticed money missing from my account.
c.
I noticed fraudulent charges on my account.
d.
I received merchandise or a card that I did not order.
e.
I had problems using my card or account because it was declined, closed, or had insufficient
funds (bounced check)
f.
I applied for credit, a bank account or loan, telephone service, employment, or government
benefits, etc. and had problems.
g.
I checked my credit report
h.
I received a bill that I did not owe.
i. I had a problem with my income taxes.
NOTIFIED BY FINANCIAL INSTITUTION
j.
Credit card company or bank contacted me about suspicious activity on my account.
k.
My credit monitoring service contacted me.
l.
A collection agency, credit card company, or other company contacted me about late or
unpaid bills
NOTIFIED BY OTHER PARTY
m. A law enforcement agency notified me.
n.
A company or agency notified me. HOW_DISCOVERED
OTHER
o.
Discovered in another way ‐ (specify) DISCOVERED_SP
9. In what month did you first discover that someone had misused or attempted to misuse your
personal information?
Enter month: _________Month (01‐12) WHEN_DISCOVERED_MON
10. How long had your personal information been misused before you discovered it?
1. One day or less (1‐24 hours)
2. More than a day, but less than a week (25 hours‐6 days)
3. At least a week, but less than one month (7‐30 days)
4. One month to less than three months
5. Three months to less than six months
6. Six months to less than one year
7. One year or more
8. Don’t know
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9. Not applicable, it was not actually misused LENGTH_MISUSE
11. Do you have any idea of HOW your personal information was obtained, even if you are not
completely certain?
1. Yes ‐ Ask Q12
2. No – Skip to Q13 HOW_PI_OBTAINED
12. How do you think your personal information was obtained?
(SELECT A SINGLE RESPONSE)
1. I lost it and someone found it
2. It was stolen from my wallet or checkbook
3. It was stolen from a place where I stored it (home, office, car)
4. Someone stole it from my postal mail
5. Someone stole it from my garbage
6. It was stolen during an online purchase/ transaction
7. Someone stole it during an in‐person purchase/ transaction (including through the use of a
skimmer or card reader)
8. Someone hacked into my computer
9.I responded to a scam email/phone call
10. Stolen from personnel files at place of employment
11. Stolen from an office/company that had my personal information in its files. THINK_PI_OBTAINED
12. Obtained in some other way ‐ (specify) ____________________________ HOW_OBTAINED_SP
SECTION C. VICTIM RESPONSE
13. Were you in contact with anyone at a credit card company, bank, or other financial institution
about misuse or attempted misuse of your personal information?
YES
NO CONTACT_ANYONE
14. Did you contact a credit bureau about the misuse or attempted misuse of your personal
information?
YES
NO – Skip to Q 18 TALK_CREDIT_BUREAU
15. When you contacted the credit bureau, did you....
a. Request your credit report? YES NO CONTCB_REQUESTRPT
b. Request corrections to your credit report? YES NO CONTCB_CORRECTCR
c. Place a fraud alert on your credit report? YES NO (skip to 15d INTRO) CONTCB_PLACEALERT
c.1. Was it a seven year fraud alert? YES NO DON’T KNOW CONTCB_PLACE7YR
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Did you....
d. Send a police report to the credit bureau? YES NO CONTCB_POLICERPT
e. Place a freeze on your credit report, which prevents the credit bureaus from sending your credit
report to anyone without your permission? YES NO CONTCB_FREEZE
f. Take some other action with the credit bureau? YES___(Specify)NO CONTCB_OTHR_ACTION
CONTCB_OTHR_SP
16. After you told a credit bureau that your personal information had been misused, how satisfied
were you with the credit bureau’s response? Were you very satisfied, somewhat satisfied, somewhat
dissatisfied, or very dissatisfied?
1. Very satisfied – Skip to Q18
2. Somewhat satisfied – Skip to Q18
3. Somewhat dissatisfied – Ask Q17
4. Very dissatisfied – Ask Q17
5. Neither satisfied or dissatisfied – Skip to Q18 SATISFY_WITH_CB
17. Why were you dissatisfied with the credit bureau’s response? (MARK ALL THAT APPLY)
1. My credit report was not corrected
2. It was hard to communicate with the credit bureau
3. I could not place a fraud alert
4. I could not obtain a credit report
5. I could not place a freeze
6. The credit reporting bureaus would not accept my police report DISSATISFY_W_CB
7. Some other reason ‐ (specify) DISSATISFYCB_OTH_SP
18. Did you contact any law enforcement agencies, such as the local police, a sheriff or a federal law
enforcement agency, to report misuse or attempted misuse of your personal
information?
YES – Ask Q19
NO – Skip to Q24 CONTACT_LAW
19. Did the law enforcement agency take a police report from you about the misuse or attempted
misuse of your personal information?
YES ‐ Ask Q20
NO ‐ SKIP to Q21 REPORT_TAKEN
20. Did you get a copy of that police report?
YES
NO GET_COPY_REPORT
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21. How satisfied were you with the law enforcement agency’s response when you reported the
misuse of your personal information? Were you very satisfied, somewhat satisfied, somewhat
dissatisfied, or very dissatisfied? (ENTER A SINGLE RESPONSE)
Very Satisfied – Skip to Q23
Somewhat Satisfied – Skip to Q23
Somewhat Dissatisfied ‐ Ask Q22
Very Dissatisfied ‐ Ask Q22
Neither satisfied nor dissatisfied ‐ Skip to Q23 SATISFY_W_LAW
22. Why were you dissatisfied with the law enforcement agency’s response? (MARK ALL THAT APPLY)
1. Police didn’t or couldn’t do anything
2. Police only filled out a report
3. Police didn’t see it as a crime
4. Police said the crime did not fall in their jurisdiction
5. Police gave me no information on what I should do about the crime
6. Police never got back in contact with me/never learned outcome
7. Didn’t feel my concerns/complaints were taken seriously
8. Police unable to catch the offender DISATISFY_W_LAW
9.Other (Specify) _____________________ DISATISFY_OTH_SP
ALL RESPONSES 1‐9 – SKIP to Q23
23. Did the law enforcement agency provide you with any additional printed information, such as a
pamphlet or prevention material, on what to do when you’ve experienced identity theft?
YES‐ Skip to 25
NO‐ Skip to 25 LAW_PROVIDE_INFO
24. We would like to learn more about why people who experience identity theft do not report it to
law enforcement. Why did you decide not to contact a law enforcement agency? (MARK ALL THAT
APPLY)
DIDN’T KNOW I COULD
a. Didn’t know that I could report it
b. Didn’t think about reporting it
c. Didn’t know what agency was responsible for identity theft crimes
NOT IMPORTANT ENOUGH
d. I didn’t lose any money /It was an attempt
e. Not important enough to report/small loss
HANDLED IT ANOTHER WAY
f. Reported it to someone else such as credit card company/bank/insurance company or other
organization
g. Took care of it myself
DIDN’T THINK THE POLICE COULD HELP
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h. Didn’t think police would do anything
i. Didn’t want to bother police
j. Didn’t find out about the crime until long after it happened/too late for police to help
k. Couldn’t identify the offender or provide much information that would be helpful to the police
PERSONAL REASONS
l. I was afraid to report it
m. The person responsible was a friend or family member and I didn’t want to get them in trouble
n I was embarrassed
o. Too inconvenient/didn’t want to take the time
OTHER WHY_NOT_REPORTED
p. Other (specify) ______________________ WHY_NOT_REPORTED_SP
25. Next, I'm going to read you a list of other people and organizations that someone might contact
when their personal information is misused. Which of the following people or organizations, if any,
did you contact about misuse or attempt misuse of your personal information?
Did you...
a. Hire a lawyer? YES NO HIRE_LAWYER
b. Contact a State or local government consumer affairs agency, such as the State Attorney
General's office? YES NO CONT_STATE_ATTORNEY
c. Contact the Federal Trade Commission? YES NO CONT_FTC
d. Contact a consumer agency, such as the Better Business Bureau or the National Consumer
League? YES NO CONT_CONSMRAGNCY
e. Contact an agency or company that issues documents like driver's licenses, social security
cards, or insurance cards? YES NO CONT_GOVTAGNCY
f. Contact your credit monitoring service or identity theft insurance company? YES NO
CONT_CRDT_MNTRNG
g. Contact an office or agency – other than the police – that deals with victims of crime? YES NO
CONT_VICTIM_AGENCY
h. Contact some other group or organization that we have not already mentioned? YES NO
CONT_OTH_GROUP
If yes, specify_____________________________ CONT_OTH_GROUP_SP
SECTION D. VICTIM IMPACT
26. The misuse of personal information affects people in different ways. Next, I would like to ask you
some questions about how misuse or attempted misuse of your personal
information may have affected you.
Did the misuse or attempted misuse of your personal information lead you to have significant
problems with your job or schoolwork, or trouble with your boss, coworkers, or peers?
YES
NO IMPACT_JOB
27. Did the misuse or attempted misuse of your personal information lead you to have significant
problems with family members or friends, including getting into more arguments or fights than you
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did before, not feeling you could trust them as much, or not feeling as close to them as you did
before?
YES
NO IMPACT_FAMILY
28. How distressing was the misuse or attempted misuse of your personal information to you? Was it
not at all distressing, mildly distressing, moderately distressing, or severely distressing?
(ENTER A SINGLE RESPONSE)
1. Not at all distressing ‐ Skip to Section E
2. Mildly distressing ‐ Skip to Section E
3. Moderately distressing ‐ Go to Check Item C
4. Severely distressing ‐ Go to Check Item C HOW_DISTRESSING
CHECK ITEM C.
Is “yes” marked in Q26 or Q27 or are categories ‘3' or ‘4' marked in Q28?
YES ‐ Ask Q29
NO ‐ Skip to Section E
29. Still thinking about your distress associated with misuse of your personal
information did you feel any of the following ways for A MONTH OR MORE? Did you feel....
a. Worried or anxious? YES NO FEEL_WORRIED
b. Angry? YES NO FEEL_ANGRY
c. Sad or depressed? YES NO FEEL_SAD
d. Vulnerable? YES NO FEEL_VULNERABLE
e. Violated? YES NO FEEL_VIOLATED
f. Like you couldn’t trust people? YES NO FEEL_MISTRUST
g. Unsafe? YES NO FEEL_UNSAFE
h. Some other way? YES NO FEEL_OTHER_WAY
IF yes, Specify ____________________________ FEEL_OTH_WAY_SP
SKIP TO Q31 if ALL (a‐h) are NO
30a. Did you seek any kind of professional help for the feelings you experienced as a result of misuse or attempted misuse of your personal information?
Yes ‐ Ask Q30b
No ‐ Skip to Q31 SEEK_PRO_HELP
30b. What kind of professional help did you seek? (MARK ALL THAT APPLY)
a. Counseling/therapy
b. Medication
c. Visited doctor or nurse
d. Visited ER/ hospital/clinic PRO_HELP_SOUGHT
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e. Other specify ___________________ HELP_SOUGHT_SP
31. Did you experience any of the following physical problems associated with
misuse or attempted misuse of your personal information for A MONTH OR MORE? Did you
experience.....
a. Headaches? YES NO HAVE_HEADACHES
b. Trouble sleeping? YES NO TRBL_SLEEPING
c. Changes in your eating or drinking habits? YES NO EATING_PROBS
d. Upset stomach? YES NO UPSET STOMACH
e. Fatigue? YES NO FATIGUE
f. High blood pressure? YES NO HIGH_BLOOD_PRESSURE
g. Muscle tension or back pain? YES NO MUSCLE_TENSION
h. Some other problem? YES NO OTHER_PHYSICAL
IF YES, SPECIFY________________________ OTH_PHY_SP
SKIP TO Section E if ALL (a‐h) are NO
32. Did you seek any kind of professional or medical help for the physical problems you just reported?
YES ‐ Ask Q33
NO ‐ Skip to Section E SEEK_HELP_PHYPROBS
33. What kind of professional or medical help did you seek?
(MARK ALL THAT APPLY)
a. Counseling/therapy
b. Medication
c. Visited doctor or nurse
d. Visited ER/ hospital/clinic KIND_HELP_PHYPROBS
e. Other specify ___________________ KIND_HELP_PHYOTH_SP
SECTION E. OFFENDERS
34. Do you know, or have you learned, anything at all about person or persons
who misused or attempted your personal information?
YES ‐Ask Q35
NO ‐Skip to Section F IDENTIFY_OFFENDER
35. How well do you know this person or these people? For example, was it a family member, friend,
acquaintance, salesperson, or somebody else?
RELATIVE
a. Spouse (ex‐spouse)
b. Parent or step‐parent
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c. Brother or sister or step‐brother/step‐sister HOW_OFFENDER_KNOWN
d. Child or step‐child
e. Other relative (specify) ___________________ HOW_OFF_KNOWN_REL
NONRELATIVE
f. Boyfriend or girlfriend (ex‐boyfriend or ex‐girlfriend)
g. Friend or ex‐friend
h. Housemate
i. Neighbor
j. Co‐worker (current and former, supervisor or other employee)
k. Someone working in my home (babysitter, housecleaner, etc.)
l. Casual acquaintance
m. Salesperson
n. Waiter
o. Other non‐relative (specify) _______________ HOW_OFF_KNOWN_NREL
STRANGER
p. Do not recall seeing the person before
SECTION F. FINANCIAL IMPACT
36. What is the approximate total dollar value of what someone obtained during incident of the misuse or attempted misuse of your personal information? Include the value
of goods, services, credit, loans, cash, and anything else the person may have obtained. (IF THE
RESPONDENT PROVIDES A RANGE, ASK THE RESPONDENT TO PROVIDE THEIR BEST ESTIMATE)
RECORD THE ESTIMATED AMOUNT. $__________.00 (IF OVER $1,000, PROBE: I just want to verify that
the total amount is (INSERT AMOUNT RESPONDENT INDICATED)
IF response = $0, skip to Q38b. TOTAL_LOSS
37. Of this that was obtained during misuse
of your personal information, how much of that money did you personally lose? That is, how much
did you lose that was not covered or reimbursed by insurance or a credit card company?
RECORD ESTIMATED AMOUNT. $___________.00 (IF “NONE,” PROBE: Just to confirm, you didn’t
personally lose anything?) PERSONAL_LOSS
CHECK ITEM D.
Is answer to Q37 equal to $0 (the respondent did not lose anything or did not have to pay anything
personally)?
YES – Ask Q38b
NO – Skip to Q38a
38a. Other than the costs you already told me about, , how much, IF ANY,
additional costs did YOU incur as a result of misuse or attempted misuse of
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your personal information? Include costs for things such as legal fees, bounced check fees, and any
miscellaneous expenses, such as postage, phone calls, or notary fees. Do not include lost wages.
ADD_COSTS_INCUR
OR
38b. How much, IF ANY, costs did YOU incur during misuse or attempted
misuse of your personal information? Include costs for things such as legal fees, bounced check fees,
and any miscellaneous expenses, such as postage, phone calls, or notary fees. Do not include lost
wages. NO_PERSONAL_LOSS
RECORD ESTIMATED AMOUNT. $___________.00 SKIP to Q39
(IF OVER $1,000, PROBE: I just want to verify that the total amount is (INSERT AMOUNT RESPONDENT
INDICATED).
39. Have you been successful in clearing up all of the financial and credit problems associated with
misuse of your personal information?
YES ‐ Ask Q40
NO ‐ Skip to Q41
Don’t Know ‐ Skip to Q41
RESOLVE_PROBS
40. How long did it take you to clear up all of the financial and credit problems associated with the
misuse after you discovered it? (ENTER A SINGLE RESPONSE.)
1. One day or less (1‐24 hours)
2. More than a day, but less than a week (25 hours‐6 days)
3. At least a week, but less than one month (7‐30 days)
4. One month to less than three months
5. Three months to less than six months
6. Six months to less than one year
7. One year or more
TIME_TO_RESOLVE
41. How many hours clearing up financial or credit problems
associated with misuse of your personal information?
_________ Number of hours HOURS_RESOLVING
42. Other than anything we have already talked about, have you experienced any of the following
problems as a result of misuse or attempted misuse of your personal
information? Have you…
a. Had credit related problems, such as having to repeatedly correct the same information on
your credit report, being turned down for credit or loans, or having to pay higher rates?
YES NO CREDIT_PROBS
b. Had banking problems, such as being turned down for a checking account or having checks
bounce? YES NO BANK_PROBS
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As a result of the misuse or attempted misuse of your personal information, have you...
c. Had debt collectors or collections departments contact you? YES NO COLLECTION_PROBS
d. Had utilities cut off or been denied new service? YES NO UTILITY_PROBS
e. Been turned down for a job or lost a job? YES NO EMPLOYMENT_PROBS
f. Had a lawsuit filed against you? YES NO LEGAL_PROBS
g. Been the subject of an arrest or criminal proceedings? YES NO ARREST_PROBS
h. Had some other type of problems? YES NO OTH_PROBS
If yes, Specify _________________________ OTH_PROBS_SP
CHECK ITEM E.
Did respondent experience more than one incident of identity theft during the past 12 months (6a or 6b
is marked ‘Twice or more’)?
YES – Ask Q43
NO – Skip to Section G, Page 15
43. For the next few questions please think about ALL of the misuses of your personal information
during the last year, that is, since _________, 20____. Including every incident that occurred over the
past 12 months, not just the most recent, what is the approximate total dollar value of what someone
obtained while misusing your personal information? Include the value of goods, services, credit,
loans, cash, and anything else the person may have obtained.
(IF THE RESPONDENT PROVIDES A RANGE, ASK THE RESPONDENT TO PROVIDE THEIR BEST ESTIMATE)
RECORD THE ESTIMATED AMOUNT. $__________.00
(IF LESS THAN the amount reported in item 36 PROBE: I just want to verify that the total amount is
(INSERT AMOUNT RESPONDENT INDICATED) TOTAL_EVERY_INCIDENT
44. Not counting the dollars that were obtained during ALL incidents of
identity theft in the past 12 months, what were the total additional costs, that YOU incurred as a
result of the misuses or attempted misuses of your personal information? Include costs for things
such as legal fees, bounced check fees, and any miscellaneous expenses, such as postage, phone calls,
or notary fees. Do not include lost wages.
RECORD ESTIMATED AMOUNT. $___________.00 (IF Less than 38, PROBE: I just want to verify that the
total amount is (INSERT AMOUNT RESPONDENT INDICATED).
ANY RESPONSE – Skip to Section G TOTAL_ADD_COST
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G. LONG‐TERM VICTIMIZATION AND CONSEQUENCES
INTRO: Now I’m going to ask you to think about any identity theft that may have occurred more than
1 year ago, that is prior to __________, 201_. Again, identity theft means someone else using your
personal information without your permission to buy something, get cash or services, pay bills, or
avoid the law. INTRO_LONG_TERM
45. Outside of the past year, has anyone ever, without your permission:
misused one of your existing accounts,
used your personal information to open a new account,
or used your personal information for some other fraudulent purpose, such as getting
medical care, a job, government benefits or something else?
YES
NO (Skip to section H) OUTSIDE_PAST_YEAR
46. Which of the following types of identity theft did you experience prior to _______, 20__?
(Mark all that apply)
__Misuse of an existing banking account (debit, checking, ATM, savings)
__Misuse of an existing credit card account
__Misuse of other type of existing account
__Misuse of personal information to open a NEW account
__Misuse of personal information for other fraudulent purpose. TYPES_ID_THEFT_PRIOR
47. Thinking about the identity theft that happened to you more than 12 months ago, are you still
experiencing any credit card or other financial problems, legal problems, relationship problems with
friends or family, problems at work or school, physical problems or emotional distress as a result of
this identity theft?
YES
NO (Ask Q48a) STILL_EXPERIENCE_PROB
48a. At any point during the past year did you experience credit card or other financial problems, legal
problems, relationship problems with family or friends, problems at work or school, physical
problems, or emotional distress as a result of the identity theft that happened to you more than 12
months ago?
YES
NO (Skip to Section H, page 17) PROB_PAST_YEAR_PRIOR
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49. During the past year, have you experienced any of the following consequences as a result of the
identity theft that occurred more than a year ago? Have you had….
a. Significant problems with your job or schoolwork, or trouble with your boss, coworkers, or
peers during the past year? PROB_SCHOOL_JOB_PRIOR
b. Significant problems during the past year with family members or friends, including getting
into more arguments or fights than you did before, not feeling you could trust them as much,
or not feeling as close to them as you did before? PROB_FAMILY_PRIOR
As a result of the identity theft that occurred more than a year ago have you ….
c. Experienced any of the following feelings for a month or more during the past year: worry,
anger, sadness or depression, vulnerability, feelings of violation, like you couldn’t trust
people, or feelings that you were unsafe? EXPERIENCE_FEEL_PRIOR
d. Sought professional help during the past year for the feelings you experienced as a result of
the identity theft? SOUGHT_HELP_PRIOR
e. Had physical problems during the past year resulting from the misuse of your personal
information, such as headaches, trouble sleeping, changes in your eating or drinking habits, an
upset stomach, high blood pressure or some other problem? PHYSICAL_PROB_PRIOR
f. Had credit related problems during the past year, such as having to repeatedly correct the
same information on your credit report, being turned down for credit or loans or having to
pay higher rates? CREDIT_PROB_PRIOR
g. Had banking problems during the past year, such as being turned down for a checking account
or having checks bounce? BANK_PROB_PRIOR
As a result of the identity theft that occurred more than a year ago, have you...
h. Had debt collectors or collections departments contact you during the past
year? DEBT_COLLECT_PRIOR
i. Had utilities cut off or been denied new service during the past year? UTILITIES_OFF_PRIOR
j. Been turned down for a job or lost a job during the past year? JOB_PROBLEMS_PRIOR
k. Had legal problems, such as having a lawsuit filed against you or being the subject of an arrest
or criminal proceedings, during the past year? LEGAL_PROB_PRIOR
l. Had some other type of problems during the past year? OTH_TYPE_PROB_PRIOR
SPECIFY ____________________________________ OTH_TYPE_PROB_SP
50. How much, IF ANY, costs did you incur from the incident or incidents of identity theft that
occurred more than a year ago? Include cost for things such as legal fees, bounced check fees, and any
miscellaneous expenses, such as postage, phone calls, or notary fees. Do not include lost wages or loss
covered by your credit card company, insurance company, or other organization. (ENTER A SINGLE
RESPONSE.)
$0 ‐ $50
$51‐ $100
$101‐ $500
$501 ‐ $1,000
$1,000 ‐ $5,000
COSTS_INCUR_PRIOR
$5,000 or more
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51. How long did it take you to clear up all of the financial and credit problems associated with the
misuse after you discovered it? (ENTER A SINGLE RESPONSE.)
1. One day or less (1‐24 hours)
2. More than a day, but less than a week (25 hours‐6 days)
3. At least a week, but less than one month (7‐30 days)
4. One month to less than three months
5. Three months to less than six months
6. Six months to less than one year
7. One year or more
ANY RESPONSE, SKIP TO Section H HOW_LONG_CLEAR_PRIOR
52. How much time have you spent trying to clear up all of the financial and credit problems
associated with the misuse that occurred more than a year ago? (ENTER A SINGLE RESPONSE.)
1. One day or less (1‐24 hours)
2. More than a day, but less than a week (25 hours‐6 days)
3. At least a week, but less than one month (7‐30 days)
4. One month to less than three months
5. Three months to less than six months
6. Six months to less than one year
7. One year to five years
8. More than five years TIME_SPENT_CLEAR_PROB
H. COMMERCIAL AND CREDIT BEHAVIORS
INTRO: Now I’m going to ask you about any actions taken to prevent someone from obtaining your
personal information. Please consider whether you have taken any of these actions during the past 12
months. INTRO_BEHAVIORS
53a. During the past 12 months have you checked your credit report?
YES
NO(Skip to Q53b) CHCKD_CR_PAST_YR
i. Did you do this in response to any previous misuse of your personal information?
YES
NO CHCKD_CR_PAST_YR_RESP
53b. During the past 12 months, have you changed passwords on any of your financial accounts?
YES
NO (Skip to Q53c) CHNG_PASSWORDS
i. Did you do this in response to any previous misuse of your personal information?
YES
18
NO CHNG_PASSWORDS_RESP
53c. During the past 12 months, have you purchased credit monitoring services or identity theft
insurance?
YES
NO (Skip to Q53d) PURCHASE_IDTHFT_INS
i. Did you do this in response to any previous misuse of your personal information?
YES
NO PURCHASE_IDTHFT_INS_RESP
53d. During the past 12 months, have you shredded or destroyed documents that contained personal
identifying information?
YES
NO (Skip to Q53e) SHRED_DOCS
i. Did you do this in response to any previous misuse of your personal information?
YES
NO SHRED_DOCS_RESP
53e. During the past 12 months, have you checked your banking or credit card statements for
unfamiliar charges?
YES
NO (Skip to Q53f) VERIFY_CHARGES
i. Did you do this in response to any previous misuse of your personal information?
YES
NO VERIFY_CHARGES_RESP
53f. During the past 12 months, have you used any type of security software program on your
computer to protect it against loss of credit cards/card theft?
YES
NO (Skip to Q53g) PROTECT_COMPUTER
i. Did you do this in response to any previous misuse of your personal information?
YES
NO PROTECT_COMPUTER_RESP
53g. During the past 12 months, have you purchased identity theft protection from a company that
offers protection services?
YES
NO (Skip to Q54) PURCHASE_IDTHFT_PROT
i. Did you do this in response to any previous misuse of your personal information?
YES
NO PURCHASE_IDTHFT_PROT_RESP
19
54. Do you know that you can get a free credit report from the national credit bureaus every year?
1. Yes, respondent knows
2. No, respondent does not know FREE_ANNUAL_CR
55. During the past 12 months, has a company, government agency, or some other organization that
has your personal information on file ever notified you that paper or electronic files containing your
personal information may have been lost, stolen, or posted on a publicly available website?
YES
NO ‐ Skip to Q57
NOTIFY_BREACH
56. Did this notification indicate that your social security number was included in the information that
was lost, stolen, or posted on a publicly available website?
YES
NO BREACH_INC_SOCIAL
57. My final questions have to do with your Internet activity. During the past 12 months, have you
used the Internet to purchase anything online?
YES – ASK Q58
NO‐ Skip to end of survey
INTERNET_USE
58. About how many times did you purchase something online, during the past year?
___________________ Number of times
(IF THE RESPONDENT OFFERS A RANGE ASK THEM TO PROVIDE THEIR BEST ESTIMATE WITHIN THAT
RANGE) ONLINE_PURCHASES
59a. Do you use a credit card, a debit card, or both for online purchases?
Only Credit Card – End Survey
Only Debit Card – End Survey
Both – End Survey USE_CARD_ONLINE
END OF SURVEY
| File Type | application/pdf |
| File Title | Microsoft Word - A1.its14.pdf |
| Author | harrelle |
| File Modified | 2015-06-04 |
| File Created | 2015-06-04 |