Screener Instrument for Supplement Fraud Survey

Research to support the National Crime Victimization Survey (NCVS)

Screener Instrument

Cognitive Testing of Supplemental Fraud Survey - Crowdsourcing

OMB: 1121-0325

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Screener Instrument


These next questions refer to experiences in which someone convinced you to pay, invest, or donate money by intentionally misrepresenting, lying about, or hiding information about something they promised that you would receive. Please only tell us about things you experienced in the past 12 months -- that is since [autofill date a year ago from survey date].


A1a) In the past 12 months, that is, since [autofill date a year ago from survey date], have you invested in something that was supposed to give you a high rate of return, but the investment caused you to lose money or did not provide the return you expected?


Yes 1

No 2


A1b) In the past 12 months, that is, since [autofill date a year ago from survey date], has anyone convinced you to invest your money in something by promising a high or guaranteed rate of return, but the investment turned out to be made up, or you suspect your money was never invested at all?

Yes 1

No 2


A2a) Since [autofill date a year ago from survey date], have you lost money by paying for any products or services that turned out to be different from or of lesser quality than what had been advertised or what you expected?


Yes 1

No 2


A2b) In the past 12 months, that is, since [autofill date a year ago from survey date], have you lost money by paying for any products or services that you never received or that turned out to be a scam?


Yes 1

No 2

A3a) Since [autofill date a year ago from survey date], has someone used one of your existing accounts, such as a banking or credit account, without your permission?

Yes 1

No 2


A3b) Since [autofill date a year ago from survey date], has someone, without your permission, used your personal information to open a new account or for other illegal purposes, such as filing a false tax return or submitting false medical claims?


Yes 1

No 2



A3c) In the past 12 months, that is, since [autofill date a year ago from survey date], have you lost money because you were charged for something you did not agree to buy or you were intentionally charged more for something than the amount that you agreed to pay?


Yes 1

No 2


A4) In the past 12 months, that is, since [autofill date a year ago from survey date], have you lost money by selling a product or service to a deceptive buyer who never actually paid you, or only pretended to pay you using a check that bounced or a fake account?


Yes 1

No 2


A5) Since [autofill date a year ago from survey date], have you lost money by paying for a job, business opportunity, or aother way to earn money that in the end did not exist, was a scam, or turned out to be illegal?



Yes 1

No 2



A6) In the past 12 months, that is, since [autofill date a year ago from survey date], have you lost money by paying to receive a prize, sweepstakes, grant, inheritance, lottery, loan, or other large sum of money that you were told was yours, but you never received or later discovered did not exist?


Yes 1

No 2


# A7) Since [autofill date a year ago from survey date], have you lost money by paying a person or an organization that claimed you owed them money, but you later found out their claim was false or you had already paid it off?


Yes 1

No 2


# A8) In the past 12 months, that is, since [autofill date a year ago from survey date], have you donated money to a charity or a charitable cause that later turned out to be fake or that you later suspected was fake?


Yes 1

No 2


# A9a) Since [autofill date a year ago from survey date], have you paid money to help a family member or friend who mislead you about what they were using the money for or did not pay you back as they said they would?


Yes 1

No 2



A9b) In the past 12 months, that is, since [autofill date a year ago from survey date], have you lost money because you were convinced to help someone who pretended to be a family member, friend, caregiver, or someone interested in you romantically, but that person turned out to be an imposter?


Yes 1

No 2


A10) Since [autofill date a year ago from survey date], did you send money to someone who claimed they would pay you to help with transferring or accessing money, but they just kept your money and did not pay you what you had been promised?


Yes 1

No 2



A11) Besides what we have already asked you about, in the past 12 months, that is, since [autofill date a year ago from survey date], what else happened to you that involved someone convincing you to pay them money by misrepresenting, lying about, or hiding information?


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AuthorAdams, Devon
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File Created2021-01-24

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