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pdfNCVS Redesign Usability Testing Attachments
Attachment 1 UT Items to be Tested ……………………………………………………………………………………………..2
Attachment 2 UT protocol ……………………………………………………………………………………………………………..124
Attachment 3 UT Issue log ……………………………………………………………………………………………………………..133
Attachment 4 Recruitment Screener (adult and youth) ………………………………………………………………….134
Attachment 5 UT Craigslist Ad ………………………………………………………………………………………………………..142
Attachment 6 UT Adult consent form …………………………………………………………………………………………….143
Attachment 7 UT Parental permission form …………………………………………………………………………………..145
Attachment 8 UT Youth Assent form ……………………………………………………………………………………………..148
Attachment 9 Adult Resources ……………………………………………………………………………………………………...150
Attachment 10 Youth Resources ……………………………………………………………………………………………………151
Attachment 11 Sample Screenshots for Usability Testing ………………………………………………………………152
Attachment 1
NCVS Redesign
Draft Master Instrument for Usability Testing
Introduction .................................................................................................................................................. 3
Household/Individual Characteristics ........................................................................................................... 4
Person Characteristics I................................................................................................................................. 5
Police Ask-All Items ....................................................................................................................................... 7
Community Measures ................................................................................................................................. 10
Victimization Screener (Long Cues, Bounded, Interleaved) ....................................................................... 13
Victimization Screener: Vehicle Theft ..................................................................................................... 14
Victimization Screener: Vehicle Part Theft ............................................................................................. 18
Victimization Screener: Theft.................................................................................................................. 22
Victimization Screener: Break-In............................................................................................................. 27
Victimization Screener: Vandalism ......................................................................................................... 31
Victimization Screener: Attack ................................................................................................................ 35
Victimization Screener: Unwanted Sexual Contact ................................................................................ 40
Crime Incident Report (Adults and Youth) .................................................................................................. 46
Series Crimes ............................................................................................................................................... 48
What Happened: Module SV – Unwanted Sexual Contact (NEW) ......................................................... 49
What Happened: Module A – Attack/Threatened Attack ...................................................................... 53
Consequences I: Injury ............................................................................................................................ 57
What Happened: Module MV. Motor Vehicle Theft/Parts Theft/Attempted Theft .............................. 61
What Happened: Module B – Break-ins ................................................................................................. 63
What Happened: Module T. Theft ......................................................................................................... 65
What Happened: Module V. Vandalism ................................................................................................. 68
Location Series ............................................................................................................................................ 70
Presence Series ........................................................................................................................................... 74
Victim-offender Relationship ...................................................................................................................... 75
Offender Characteristics ............................................................................................................................. 83
Self-Protection ............................................................................................................................................ 87
Hate Crimes................................................................................................................................................. 91
Police Involvement Series ........................................................................................................................... 93
Workplace Violence Series........................................................................................................................ 100
Consequences II: Socio-emotional Problems............................................................................................ 102
Consequences III: Economic Consequences ............................................................................................. 104
Victim Services (VS) Series ........................................................................................................................ 109
Narrative ................................................................................................................................................... 113
Person Characteristics II............................................................................................................................ 114
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DRAFT Master Instrument for Usability Testing
2
Introduction
Westat is conducting this project on behalf of the Bureau of Justice Statistics (BJS) as part of
efforts to redesign the National Crime Victimization Survey.
On each screen, you will be asked about experiences that have happened to you recently. Click
on your answer or type in an answer, and then click the NEXT button to continue to the next
screen. You can skip any question you don’t know the answer to or prefer not to answer by
leaving the question blank and clicking the NEXT button.
(UT ONLY) The interviewer will observe you as you complete the survey and will occasionally
stop you to gather feedback on the screen or on how you came up with your answer.
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Household/Individual Characteristics
The first set of questions is about you and the people you live with.
H15.
Are you male or female? [CC, 19]
Male ...................................................................................... 1
Female ................................................................................... 2
H12.
How old are you? [CC, 17]
_____ years
H26. (IF AGE >=18: Not counting yourself,) How many (IF AGE >=18: other) people ages 18 or
older live with you? (NEW for UT only)
_____
H27. (IF AGE<18: Not counting yourself,) How many (IF AGE<18: other) people under the age of
18 live with you? (NEW for UT only)
_____
H28. (IF ONE OR MORE IN H27) Is anyone who lives with you… (NEW for UT only)
a. Ages 0 to 11?
b. Ages 12 to 14?
c. Ages 15 to 17?
Yes
1
1
1
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No
2
2
2
4
Person Characteristics I
P2.
Have you lived at your current address . . . [NCVS-1, 33c]
Less than 6 months ............................................................... 1 (P3)
At least 6 months, but less than 1 year ................................ 2 (P4)
At least 1 year, but less than 5 years .................................... 3 (P4)
5 years or more ..................................................................... 4 (P5)
ASK P3 IF P2 IS LESS THAN 6 MONTHS
P3.
Have you been homeless at any time in the past 6 months, that is, since (DATE 6
MONTHS AGO)? [NEW]
Yes ......................................................................................... 1
No .......................................................................................... 2
P3a.
Which of the following BEST describes the type of housing where you are currently
living? [NEW]
1
2
3
4
Single-family home or townhouse
A building with 2 or more apartments or units
Mobile home
A boat, RV, van, etc.
If P2 is 5 years or more, skip to P5
P4.
How many times have you moved in the past 5 years, that is, since [[CURRENT YEAR
MINUS 5]? [NCVS-1, 33e]
______ times
P5-P7 asked of those age 16 or older
P5.
In the past 7 days, did you have a job or work at a business? Do not include volunteer
work or work around the house. [NCVS-1, 75a]
Yes ......................................................................................... 1 (P6A)
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No .......................................................................................... 2 (P6)
P6.
AT ANY TIME during the past 6 months, that is, since (DATE 6 MONTHS AGO), did you
have a job or work at a business ? [NCVS-1, 75b]
Yes ......................................................................................... 1 (P6a)
No .......................................................................................... 2 (go to next module)
P6A.
Have you worked at this same job for all of the past 6 months? (NEW)
Yes ......................................................................................... 1 (next module)
No .......................................................................................... 2 (P7)
P7.
At any time in the past 6 months, have you been unemployed (New)
Yes ......................................................................................... 1
No .......................................................................................... 2
P8.
(IF AGE 18+) At any time in the past 6 months, have you been a student? (FOR UT ONLY)
Yes ......................................................................................... 1
No .......................................................................................... 2
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Police Ask-All Items
Programmer note: ½ sample gets this series, other ½ sample gets Community Measures
Series
Next are some questions about experiences you may have had with the police in your area
during the past 6 months, that is, since [DATE 6 MONTHS AGO]. Please include experiences with
police officers, sheriff’s deputies, or state troopers, but not with guards or other security
personnel who are not part of the police.
PQ1a. During the past 6 months, have you contacted the police in your area to report a crime,
disturbance or suspicious activity? [NEW]
1
2
Yes
No
PQ1b. During the past 6 months, have you contacted the police in your area to report
something else, such as a traffic accident or medical emergency? [NEW]
1
2
Yes
No
PQ2. During the past 6 months, that is, since [DATE 6 MONTHS AGO] have you… Mark one
answer in each row. [NEW]
a. been stopped by the police when you were
driving or when you were a passenger in a motor
vehicle?
b. been stopped or approached by the police for
some other reason?
c. been at a community meeting, neighborhood
watch, or other anti-crime activity where the
police took part?
PQ3.
Yes
1
No
2
1
2
1
2
The next questions ask for your views of the police in your area (IF ALL NO IN PQ1 AND
PQ2: even though you may not have had direct contact with them recently). [NEW]
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Please draw on everything you know about them and give your best judgments when
you respond to these questions.
a. How respectfully do you think the police in your area treat people?
1.
2.
3.
4.
5.
Very respectfully
Somewhat respectfully
Neither respectfully or disrespectfully
Somewhat disrespectfully
Very disrespectfully
b. In your opinion, how much time and attention do the police in your area give to what
people have to say?
1.
2.
3.
4.
5.
A great deal of time
A lot of time
A moderate amount of time
A little time
No time at all
c. In your opinion, how fairly do the police in your area treat people, regardless of who
they are?
1.
2.
3.
4.
5.
Very fairly
Somewhat fairly
Neither fairly nor unfairly
Somewhat unfairly
Very unfairly
d. How effective are the police at preventing crime in your area?
1.
2.
3.
4.
5.
Very effective
Somewhat effective
Neither effectively nor ineffective
Somewhat ineffective
Very ineffective
e. How much do you trust the police in your area?
1. Trust completely
2. Somewhat trust
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3. Neither trust nor distrust
4. Somewhat distrust
5. Distrust completely
f. Taking everything into account, how would you rate the job the police in your area are
doing?
1.
2.
3.
4.
5.
A very good job
A somewhat good job
Neither a good nor a bad job
A somewhat bad job
A very bad job
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Community Measures
Programmer note: ½ sample gets this series, other ½ sample gets Police Ask-All Series
Next are some questions about your local area.
CM1. How worried are you about each of the following: [NEW]
a. being mugged or robbed in your local area?
1
Extremely worried
2
Very worried
3
Somewhat worried
4
Slightly worried
5
Not at all worried
b. being threatened or attacked in your local area?
1
Extremely worried
2
Very worried
3
Somewhat worried
4
Slightly worried
5
Not at all worried
c. having something stolen from inside your home?
1
Extremely worried
2
Very worried
3
Somewhat worried
4
Slightly worried
5
Not at all worried
d. having something stolen from your porch, lawn, garage, or other part of your
property?
1
Extremely worried
2
Very worried
3
Somewhat worried
4
Slightly worried
5
Not at all worried
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CM2. How often does concern about crime prevent you from doing things you would like to do?
[NEW]
1
2
3
4
5
Every day
Several times a week
Several times a month
Once a month or less
Never
CM3. In your local area, how common a problem is each of the following: [NEW]
a. vandalism, graffiti or other deliberate damage to property?
1
Extremely common
2
Very common
3
Somewhat common
4
Not too common
5
Not common at all
b. people being drunk or rowdy in public places?
1
Extremely common
2
Very common
3
Somewhat common
4
Not too common
5
Not common at all
c. burned, abandoned or boarded-up buildings?
1
Extremely common
2
Very common
3
Somewhat common
4
Not too common
5
Not common at all
d. people using or dealing drugs illegally?
1
Extremely common
2
Very common
3
Somewhat common
4
Not too common
5
Not common at all
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CM4. If children or teenagers in your local area were skipping school and hanging out on a
street corner, how likely is it that any of your neighbors would do something about it?
[NEW]
1
Very likely
2
Somewhat likely
3
Neither likely nor unlikely
4
Somewhat unlikely
5
Very unlikely
CM5. If children or teenagers were damaging others’ property, how likely is it any of your
neighbors would do something about it? [NEW]
1
Very likely
2
Somewhat likely
3
Neither likely nor unlikely
4
Somewhat unlikely
5
Very unlikely
CM6. If there was a crime in your local area, how likely is it that any of your neighbors would
call the police? [NEW]
1
Very likely
2
Somewhat likely
3
Neither likely nor unlikely
4
Somewhat unlikely
5
Very unlikely
CM7. Next are some statements that may or may not apply to your local area. For each one,
please mark how much you agree or disagree. [NEW]
a.
People around here are willing to help their neighbors.
1
Strongly agree
2
Somewhat agree
3
Neither agree nor disagree
4
Somewhat disagree
5
Strongly disagree
b.
People in this local area can be trusted.
1
Strongly agree
2
Somewhat agree
3
Neither agree nor disagree
4
Somewhat disagree
5
Strongly disagree
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Victimization Screener (Long Cues, Bounded, Interleaved)
INTRO1a.
[ADULTS] The next questions ask about things that may have happened to you in the past 12
months, that is, since (TODAY’S DATE ONE YEAR AGO). The questions will cover theft, break-ins,
vandalism, physical attacks, and unwanted sexual contact.
[IF R IS AGE 18+, GO TO #1]
[YOUTH] The next questions will ask about things that may have happened to you in the past 12
months, that is, since (TODAY’S DATE ONE YEAR AGO). The questions will cover theft, physical
attacks, and unwanted sexual contact.
[IF R IS AGES 12 TO 17, GO TO #3A]
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Victimization Screener: Vehicle Theft
S_01. At any point in the past 12 months, have you or someone you live with owned a car, van,
truck, motorcycle, or other motor vehicle? [Revision to NCVS-1, item 38]
1
2
Yes
No
If code 1 in S_01, go to S_01A.
If code 2 or missing in S_01, go to S_03.
S_01A. How many motor vehicles have you or someone you live with owned over the past 12
months? Please include any that are no longer owned by you or someone you live with.
[Revision to NCVS-1, item 38]
_____________ motor vehicles
S_01B. In the past 12 months … [Revision to NCVS-1, item 39a]
S_01B1 (If S_01A=1) did anyone steal the vehicle or use it without
permission?/(If S_01A>1 or missing) Did anyone steal any of these
vehicles or use it without permission?
S_01B2 did anyone TRY to steal [If S_01A=1: the vehicle/If S_01A>1
or missing: any of these vehicles] but not actually steal it?
Yes
No
Yes
No
If YES in S_01B1 OR S_01B2, go to S_01C.
If NO in both S_01B1 AND S_01B2, go to S_02.
S_01c. The next question asks about the past 6 months, as marked in the calendar below.
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You said that (IF S_01B1=YES: someone stole a vehicle or used it without permission/(IF
NEEDED: and) IF S_01B1=YES: someone tried to steal a vehicle) in the past 12 months. Looking
at the calendar above to help you remember the date, did (IF YES IN S_01B1 OR S_01B2, BUT
NOT BOTH: this happen/IF YES TO BOTH S_01B1 AND S_01B2: either of these things happen) in
the past 6 months, that is, since [DATE 6 MONTHS AGO]? [Revision to NCVS-1, item 39a]
1
2
Yes, in the past 6 months
No, not in the past 6 months
If YES in S_01C, go to S_01C1.
Otherwise, go to S_02.
S_01C1.
In the past 6 months, how many times (IF YES IN S_01B1 OR S_0 1B2, BUT
NOT BOTH: did this happen/IF YES TO BOTH S_01B1 AND S_01B2: was a vehicle stolen
or did someone try to steal a vehicle)? [Revision to NCVS-1, item 39b]
1
2
Once
Two or more times (TYPE IN A NUMBER _____)
IF S_01C1 is missing or S_01C1 =2 and no numerical response is provided, soft prompt to
collect response. Else go to note before S_01C2.
If still blank in S_01C1, SET TO SERIES=1. GO TO S_01D AND ASK ONLY ABOUT MOST RECENT
INCIDENT.
If one to three times in S_01C1, go to note before S_01D. If four or more in S_01C1, continue.
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S_01C2.
Do you recall enough details about each incident to be able to distinguish
them from each other? [Adapted from CIR5b]
1
2
Yes
No – SET SERIES=1
If yes in S_01C2, ask for up to four most recent dates in S_01D (depending on response to
S_01C). If no in S_01C2, ask only about most recent incident in S_01D.
ASK ALL ITEMS FROM S_01D THROUGH S_01G (AS APPROPRIATE) FOR MOST RECENT
INCIDENT, THEN MOVE TO NEXT MOST RECENT INCIDENT, AND SO ON.
S_01D. [IF S_01C1>1, DISPLAY FOR 2ND AND ADDITIONAL INCIDENTS: You said that
someone (IF S_01B1=YES: stole/(IF NEEDED: or) IF S_01B2=YES: tried to steal) a vehicle
(FILL ANSWER FROM S_01C1 times) in the past 6 months.] In what month did the (most
recent/next most recent) incident happen? If you don’t remember the exact month,
please give your best estimate. [NEW]
(CURRENT MONTH)
(CURRENT MONTH MINUS 1)
(CURRENT MONTH MINUS 2)
(CURRENT MONTH MINUS 3)
(CURRENT MONTH MINUS 4)
(CURRENT MONTH MINUS 5)
(CURRENT MONTH MINUS 6)
Before (CURRENT MONTH MINUS 6)
If S_01D is blank, soft prompt to collect response, adding a “don’t know” option. Otherwise,
go to S_01E.
If S_01D is missing or don’t know:
S_01D2. Did this incident happen before, after, or on [6-MO ANCHORDATE]? [NEW]
It happened before [6-MO ANCHORDATE] – GO TO S_02
It happened after or on [6-MO ANCHORDATE] – GO TO S_01E
I don’t know when it happened – GO TO NEXT INCIDENT IN S_01D
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Still thinking about this (IF S_01C1 GT 2 AND SERIES NOT EQ 1 AND S_01D IS MISSING: most
recent/second most recent/third most recent/fourth most recent/ IF RESPONSE PROVIDED IN
S_01D: MONTH, YEAR) incident when someone (IF S_01B1=YES: stole/(IF NEEDED: or) IF
S_01B2=YES: tried to steal) a vehicle, [NEW]
S_01E. Was anything stolen from the vehicle,
such as a cell phone, money, or anything else
in the vehicle?
S_01F. Were you physically attacked, or
threatened with an attack, during this
incident?
S_01G. (IF CODE 1 IN S_01F) Did anyone have,
or try to have, sexual contact with you that
you DID NOT CONSENT TO and that YOU DID
NOT WANT to happen as part of this incident?
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
GO BACK TO S_01D IF MORE INCIDENTS. OTHERWISE GO TO S_02.
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Victimization Screener: Vehicle Part Theft
S_02. {IF YES TO S_01B1 OR S_01B2 OR ANY IN S_01E: Other than the thefts or attempted
thefts you have mentioned already} In the past 12 months …[Revision to NCVS-1, item 39a]
S_02A1. Did anyone steal any vehicle parts such as a tire, car
stereo, GPS, hubcap, or battery from [If S_01A=1: the vehicle/If
S_01A>1 or missing: any of these vehicles]?
S_02A2. Did anyone steal any gas from [If S_01A=1: the vehicle/If
S_01A>1 or missing: any of these vehicles]?
S_02A3. Did anyone TRY to steal vehicle parts from [If S_01A=1:
the vehicle/If S_01A>1 or missing: any of these vehicles]?
Yes
No
Yes
No
Yes
No
If YES TO ANY in S_02A1-A3, go to S_02B.
Otherwise, go to S_03.
S_02B. The next question asks about the past 6 months, as marked in the calendar below.
You said that (IF S_02A1=YES: someone stole vehicle parts/(IF NEEDED: and) IF S_02A2=YES:
someone stole gas/(IF NEEDED: and) IF S_02A3=YES: someone tried to vehicle parts) in the past
12 months. Looking at the calendar above to help you remember the date, did (IF YES TO ONLY
ONE IN S_02A1-A3: this happen/IF YES TO MORE THAN ONE IN S_02A1-A3: any of these things
happen) in the past 6 months, that is, since [DATE 6 MONTHS AGO]? [Revision to NCVS-1, item
39a]
1
2
Yes, in the past 6 months
No, not in the past 6 months
If YES in S_02B, go to S_02B1.
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Otherwise, go to S_03.
S_02B1.
(IF YES TO BOTH (S_02A1 OR S_02A2) AND S_02A3: Thinking about the
times when someone stole or tried to steal vehicle parts,) How many times did (IF YES
TO ONLY ONE IN S_02A1-A3: this happen/IF YES TO MORE THAN ONE IN S_02A1-A3: any
of these things happen) in the past 6 months? [Revision to NCVS-1, item 39b]
1
2
Once
Two or more times (TYPE IN A NUMBER _____)
IF S_02B1 is missing or S_02B1 =2 and no numerical response is provided, soft prompt to
collect response. Else go to note before S_02B2.
If still blank in S_02B1, SET TO SERIES=1. GO TO S_02C AND ONLY ASK ABOUT MOST RECENT
INCIDENT.
If one to three times in S_02B1, go to programmer note just before S_02C. If four or more in
S_02B1, continue.
S_02B2.
Do you recall enough details about each incident to be able to distinguish
them from each other? [Adapted from CIR5b]
1
2
Yes
No – SET SERIES=1
If yes in S_02B2, ask for up to four most recent dates in S_02C (depending on response to
S_02B1). If no in S_02B2, ask only about most recent incident in S_02C.
ASK ALL ITEMS FROM S_02C THROUGH S02_G (AS APPROPRIATE) FOR MOST RECENT
INCIDENT, THEN MOVE TO NEXT MOST RECENT INCIDENT, AND SO ON.
S_02C. [IF S_01C1>1, DISPLAY FOR 2ND AND ADDITIONAL INCIDENTS: You said that
someone (IF S_02A1 OR S_02A2=YES: stole/(IF NEEDED: or) IF S_02A3=YES: tried to
steal) vehicle parts (FILL ANSWER FROM S_02B1 times) in the past 6 months.] In what
month did the (most recent/next most recent) incident happen? If you don’t remember
the exact month, please give your best estimate. [NEW]
(CURRENT MONTH)
(CURRENT MONTH MINUS 1)
(CURRENT MONTH MINUS 2)
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(CURRENT MONTH MINUS 3)
(CURRENT MONTH MINUS 4)
(CURRENT MONTH MINUS 5)
(CURRENT MONTH MINUS 6)
Before (CURRENT MONTH MINUS 6)
If S_02C is blank, soft prompt for a response, with a don’t know option. Otherwise, go to
S_2DD1.
If S_02C is still blank or don’t know, continue to S_02C2.
S_02C2. Did this incident happen before, after, or on [6-MO ANCHORDATE]? [NEW]
It happened before [6-MO ANCHORDATE] – GO TO S_03
It happened after or on [6-MO ANCHORDATE] – GO TO S_2DD1
I don’t know when it happened – GO TO NEXT INCIDENT
S_2DD1. PROGRAMMER NOTE: Ask S_2DD2 if any of the following conditions are true:
•
•
•
If MONTH/YEAR of the current incident matches or is within one month (plus or minus)
of the MONTH/YEAR of any previously reported incidents, or if there are any previously
reported incidents for which a date was not collected
If no date was provided but the current incident was confirmed to have happened on or
after anchor date, and (a prior incident was also confirmed to have happened on or
after anchor date, or if there are any previously reported incidents for which a date was
not collected)
If no date was provided and a prior incident was reported, regardless of date
S_2DD2. Is this incident part of any other incident you have already mentioned? [NEW]
Yes - GO TO S_2DD3
No – GO TO S_02E
S_2DD3. Which incident was this part of? [NEW]
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•
(DISPLAY EACH INCIDENT PREVIOUSLY MENTIONED THAT IT COULD MATCH TO
BY DISPLAYING MONTH/YEAR (IF PROVIDED) AND SHORT DESCRIPTION OF
DETAILS OF INCIDENT, SUCH AS “May 2017 vehicle theft with an attack”)
ALL IN S_2DD3, GO TO S_02C FOR NEXT INCIDENT. IF NO MORE INCIDENTS, GO TO NEXT
SCREENING ITEM.
Still thinking about this (IF S_02B1 GT 2 AND SERIES NOT EQ 1 AND S_02C IS MISSING: most
recent/second most recent/third most recent/fourth most recent/ IF RESPONSE PROVIDED IN
S_02C: MONTH, YEAR) incident in which someone (IF S_02A1 OR S_02A2=YES: stole/(IF
NEEDED: or) IF S_02A3=YES: tried to steal vehicle parts), [NEW]
S_02E. Other than the vehicle parts, was
anything else stolen from the vehicle, such as a
cell phone, money, or anything else in the
vehicle?
S_02F. Were you physically attacked, or
threatened with an attack, during this incident?
S_02G. (IF CODE 1 IN S_02F) Did anyone
have, or try to have, sexual contact with you
that you DID NOT CONSENT TO and that
YOU DID NOT WANT to happen as part of
this incident?
1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
GO BACK TO S_02C IF MORE INCIDENTS. OTHERWISE GO TO S_03.
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Victimization Screener: Theft
S_03. The questions below ask about different things that might have been stolen from you.
This may have happened to you while you were at home, (IF AGES 15+: at work or) school, or
somewhere else.
{IF YES TO ANY IN S_01B1, S_01B2, S_02A1, S_02A2, S_02A3, S_01E OR S_02E: Other than the
thefts or attempted thefts you have mentioned already} In the past 12 months did anyone
steal… [Revision to NCVS-1, item 36a]
S_03A1. Something that you carry, like a cell phone, money, a
wallet, purse, or backpack?
S_03A2. Something that you wear, like clothing, jewelry, or shoes?
S_03A3. Something in your home, like a TV, laptop, tools, or guns?
S_03A4. Something from your porch, lawn, garage, or other part of
your property, such as a bicycle, garden hose or lawn furniture?
S_03A5. Something out of a vehicle, such as a package or groceries?
S_03A6. (IF H28a=yes) Something belonging to the children who
live here?
S_03A7. Anything else?
Yes
No
Yes
Yes
Yes
No
No
No
Yes
Yes
No
No
Yes
No
S_03b. {IF YES TO ANY IN S_03A1- S_03A7: Other than what you have already mentioned,} In
the past 12 months, did anyone TRY to steal anything that belongs to you (IF H28a=yes: or the
children who live with you), but not actually steal it? [Revision to NCVS-1, item 36a]
1
2
Yes
No
If YES TO ANY in S_03A1-A7 or S_03b, go to S_03C.
Otherwise, go to S_04.
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S_03C. The next question asks about the past 6 months, as marked in the calendar below.
You said that (IF YES TO ANY IN S_03A1- S_03A7: someone stole something /(IF NEEDED: and) IF
S_03B=YES: someone tried to steal something) in the past 12 months. Looking at the calendar
above to help you remember the date, did (IF YES TO ONLY ONE ITEM IN S_03A1-S_03B: this
happen/IF YES TO MORE THAN ONE ITEM IN S_03A1-S_03B: any of these things happen) in the
past 6 months, that is, since [DATE 6 MONTHS AGO]? [Revision to NCVS-1, item 36a]
1
2
Yes, in the past 6 months
No, not in the past 6 months
If YES in S_03C, go to S_03C1.
Otherwise, go to S_04.
S_03C1.
In the past 6 months, how many times did someone (IF YES TO ANY IN
S_03A1-S_03A7: steal/(IF NEEDED: or) IF S_03B=YES: try to steal) something? [Revision
to NCVS-1, item 36b]
1
2
Once
More than once (TYPE IN A NUMBER _____)
IF S_03C1 is missing or S_03C1 =2 and no numerical response is provided, soft prompt to
collect response. Else go to note before S_03C2.
If still blank in S_03C1, SET TO SERIES=1. GO TO S_03D AND ONLY ASK ABOUT MOST RECENT
INCIDENT.
If one to three times in S_03C1, go to note before S_03D. If four or more in S_03C1, continue.
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S_03C2.
Do you recall enough details about each incident to be able to distinguish
them from each other? [Adapted from CIR5b]
1
2
Yes
No – SET SERIES=1
If yes in S_03C2, ask for up to four most recent dates in S_03D (depending on response to
S_03C1). If no in S_03C2, ask only about most recent incident in S_03D.
ASK ALL ITEMS FROM S_03D THROUGH S_03G (AS APPROPRIATE) FOR MOST RECENT
INCIDENT, THEN MOVE TO NEXT MOST RECENT INCIDENT, AND SO ON.
S_03D. [IF S_03C1>1, DISPLAY FOR 2ND AND ADDITIONAL INCIDENTS: You said that
someone (IF YES TO ANY IN S_03A1-S_03A7: stole/(IF NEEDED: or) IF S_03B=YES: tried to
steal) something (FILL ANSWER FROM S_01C1 times) in the past 6 months.] In what
month did the (most recent/next most recent) incident happen? If you don’t remember
the exact month, please give your best estimate. [NEW]
(CURRENT MONTH)
(CURRENT MONTH MINUS 1)
(CURRENT MONTH MINUS 2)
(CURRENT MONTH MINUS 3)
(CURRENT MONTH MINUS 4)
(CURRENT MONTH MINUS 5)
(CURRENT MONTH MINUS 6)
Before (CURRENT MONTH MINUS 6)
If S_03D is blank, soft prompt with a don’t know option. Otherwise, go to S_3DD1.
If S_03D is still blank or don’t know, continue to S_03D2.
S_03D2. Did this incident happen before, after, or on [6-MO ANCHORDATE]? [NEW]
It happened before [6-MO ANCHORDATE] – GO TO S_04
It happened after or on [6-MO ANCHORDATE] – GO TO S_3DD1
I don’t know when it happened – GO TO NEXT INCIDENT IN S_03D
S_3DD1. PROGRAMMER NOTE: Ask S_3DD2 if any of the following conditions are true:
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•
•
•
If MONTH/YEAR of the current incident matches or is within one month (plus or minus)
of the MONTH/YEAR of any previously reported incidents, or if there are any previously
reported incidents for which a date was not collected
If no date was provided but the current incident was confirmed to have happened on or
after anchor date, and (a prior incident was also confirmed to have happened on or
after anchor date, or if there are any previously reported incidents for which a date was
not collected)
If no date was provided and a prior incident was reported, regardless of date
S_3DD2. Is this incident part of any other incident you have already mentioned? [NEW]
Yes - GO TO S_3DD3
No – GO TO S_03E
S_3DD3. Which incident was this part of? [NEW]
•
(DISPLAY EACH INCIDENT PREVIOUSLY MENTIONED THAT IT COULD MATCH TO
BY DISPLAYING MONTH/YEAR (IF PROVIDED) AND SHORT DESCRIPTION OF
DETAILS OF INCIDENT, SUCH AS “May 2017 vehicle theft with an attack”)
ALL IN S_3DD3, GO TO S_03D FOR NEXT INCIDENT. IF NO MORE INCIDENTS, GO TO NEXT
SCREENING ITEM.
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Still thinking about this (IF S_03C1 GT 2 AND SERIES NOT EQ 1 AND S_03D IS MISSING: most
recent/second most recent/third most recent/fourth most recent/ IF RESPONSE PROVIDED IN
S_03D: MONTH, YEAR) incident when someone (IF YES TO ANY IN S_03A1-S_03A7: stole/(IF
NEEDED: or) IF S_03B=YES: tried to steal) something, [NEW]
S_03E. Did anyone break in, or try to break in, to your
home or another building on your property as part of this
incident?
S_03F. Were you physically attacked, or threatened with
an attack, during this incident?
S_03G. (IF CODE 1 IN S_03F) Did anyone have, or try
to have, sexual contact with you that you DID NOT
CONSENT TO and that YOU DID NOT WANT to
happen as part of this incident?
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1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
26
Victimization Screener: Break-In
[IF ADULT AGE 18+, CONTINUE. IF YOUTH AGE 12-17, SKIP TO S_06A]
S_04. The next few questions ask about break-ins. {IF YES TO S_03E: Other than break-in(s) you
have mentioned already, } in the past 12 months, did anyone… [Revision to NCVS-1, item 37a]
S_04A1. Break in or try to break into your home by forcing a door or
window, pushing past someone, jimmying a lock, cutting a screen, or
coming through an open door or window?
S_04A2. Break in or try to break into your garage, shed, or storage
room?
S_04A3. Break in or try to break into a hotel or motel room or vacation
home where you were staying?
Yes
No
Yes
No
Yes
No
If YES TO ANY in S_04A1-S_04A3 go to S_04B.
Otherwise, go to S_05A11.
S_04B. The next question asks about the past 6 months, as marked in the calendar below.
You said that someone broke in or tried to break in during the past 12 months. Looking at the
calendar above to help you remember the date, did (IF YES TO ONLY ONE IN S_04A1-S_04A3:
this happen/IF YES TO MORE THAN ONE IN S_04A1-S_04A3: any of these things happen) in the
past 6 months, that is, since [DATE 6 MONTHS AGO]? [Revision to NCVS-1, item 37a]
1
2
Yes, in the past 6 months
No, not in the past 6 months
If YES in S_04B, go to S_04B1.
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Otherwise, go to S_05A1.
S_04B1.
How many times did someone break in or try to break in during the past
6 months? [Revision to NCVS-1, item 37b]
1
2
Once
More than once (TYPE IN A NUMBER _____)
IF S_04B1 is missing or S_04B1 =2 and no numerical response is provided, soft prompt to
collect response. Else go to note before S_04B2.
If still blank in S_04B1, SET TO SERIES=1. GO TO S_04C AND ONLY ASK ABOUT MOST RECENT
INCIDENT.
If one to three times in S_04B1, go to programmer note just before S_04C. If four or more in
S_04B1, continue.
S_04B2. Do you recall enough details about each incident to be able to distinguish them
from each other? [Adapted from CIR5b]
1
2
Yes
No – SET SERIES=1
If yes in S_04B2, ask for up to four most recent dates in S_04C (depending on response to
S_04B1). If no in S_04B2, ask only about most recent incident in S_04C.
ASK ALL ITEMS FROM S_04C THROUGH S_04G (AS APPROPRIATE) FOR MOST RECENT
INCIDENT, THEN MOVE TO NEXT MOST RECENT INCIDENT, AND SO ON.
S_04C. [IF S_04B1>1, DISPLAY FOR 2ND AND ADDITIONAL INCIDENTS: You said that
someone broke in or tried to break in (FILL ANSWER FROM S_04B1 times) in the past 6
months.] In what month did the (most recent/next most recent) incident happen? If you
don’t remember the exact month, please give your best estimate. [NEW]
(CURRENT MONTH)
(CURRENT MONTH MINUS 1)
(CURRENT MONTH MINUS 2)
(CURRENT MONTH MINUS 3)
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(CURRENT MONTH MINUS 4)
(CURRENT MONTH MINUS 5)
(CURRENT MONTH MINUS 6)
Before (CURRENT MONTH MINUS 6)
If S_04C is blank, soft prompt with a don’t know option. Otherwise, go to S_4DD1.
If S_04C is still blank or DK, continue to S_04D2.
S_04D2. Did this incident happen before, after, or on [6-MO ANCHORDATE]? [NEW]
It happened before [6-MO ANCHORDATE] – GO TO S_05A
It happened after or on [6-MO ANCHORDATE] – GO TO S_4DD1
I don’t know when it happened – GO TO NEXT INCIDENT IN S_04C
S_4DD1. PROGRAMMER NOTE: Ask S_4DD2 if any of the following conditions are true:
•
•
•
If MONTH/YEAR of the current incident matches or is within one month (plus or minus)
of the MONTH/YEAR of any previously reported incidents, or if there are any previously
reported incidents for which a date was not collected
If no date was provided but the current incident was confirmed to have happened on or
after anchor date, and (a prior incident was also confirmed to have happened on or
after anchor date, or if there are any previously reported incidents for which a date was
not collected)
If no date was provided and a prior incident was reported, regardless of date
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S_4DD2. Is this incident part of any other incident you have already mentioned? [NEW]
Yes - GO TO S_4DD3
No – GO TO S_04E
S_4DD3. Which incident was this part of? [NEW]
•
(DISPLAY EACH INCIDENT PREVIOUSLY MENTIONED THAT IT COULD MATCH TO
BY DISPLAYING MONTH/YEAR (IF PROVIDED) AND SHORT DESCRIPTION OF
DETAILS OF INCIDENT, SUCH AS “May 2017 vehicle theft with an attack”)
ALL IN S_4DD3, GO TO S_04C FOR NEXT INCIDENT. IF NO MORE INCIDENTS, GO TO NEXT
SCREENING ITEM.
Still thinking about this (IF S_04B1 GT 2 AND SERIES NOT EQ 1 AND S_04C IS MISSING: most
recent/second most recent/third most recent/fourth most recent/ IF RESPONSE PROVIDED IN
S_04C: MONTH, YEAR) incident when someone broke in or tried to break in, [NEW]
S_04E. Was anything stolen as part of this incident?
S_04F. Were you physically attacked, or threatened with
an attack, during this incident?
S_04G. (IF YES IN S_04F) Did anyone have, or try to
have, sexual contact with you that you DID NOT
CONSENT TO and that YOU DID NOT WANT to
happen as part of this incident?
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1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
30
Victimization Screener: Vandalism
S_05A1. Vandalism is when someone deliberately damages or destroys something belonging to
you. Examples are breaking windows, slashing tires, or painting graffiti on walls. In the past 12
months, did anyone vandalize your home, car, or something else that belongs to you or
someone else you live with? [NEW]
1
2
Yes
No
S_05A2. In the past 12 months, did someone deliberately injure or kill an animal, such as a pet
or livestock, that belongs to you or someone you live with? [NEW]
1
2
Yes
No
If code 1 in S_05A1 or S_05A2, go to S_05B.
Otherwise, go to S_06A.
S_05B. The next question asks about the past 6 months, as marked in the calendar below.
You said that something (IF S05_A1=1: was vandalized/(IF NEEDED: and) IF S05_A2=1: someone
deliberately injured or killed an animal) in the past 12 months. Looking at the calendar above
to help you remember the date, did (IF YES TO ONLY ONE IN S05_A1 AND S05_A2: this
happen/IF YES TO BOTH S05_A1 AND S05_A2: any of these things happen) in the past 6
months, that is, since [DATE 6 MONTHS AGO]? [NEW]
1
2
Yes, in the past 6 months
No, not in the past 6 months
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If YES in S_05B, go to S_05B1.
Otherwise, go to S_06A.
S_05B1.
In the past 6 months, how many times did (IF YES TO ONLY ONE IN
S05_A1 AND S05_A2: this happen/IF YES TO BOTH S05_A1 AND S05_A2: any of these
things happen)? [NEW]
1
2
Once
Two or more times (TYPE IN NUMBER _____)
IF S_05B1 is missing or S_05B1 =2 and no numerical response is provided, soft prompt to
collect response. Else go to note before S_05B2.
If still blank in S_05B1, SET TO SERIES=1. GO TO S_05C AND ONLY ASK ABOUT MOST RECENT
INCIDENT.
If one to three times in S_05B1, go to note before S_05C. If four or more in S_05B1, continue.
S_05B2.
Do you recall enough details about each incident to be able to distinguish
them from each other? [Adapted from CIR5b]
1
2
Yes
No – SET SERIES=1
If yes in S_05B2, ask for up to four most recent dates in S_05C (depending on response to
S_05B1). If no in S_05B2, ask only about most recent incident in S_05C.
ASK ALL ITEMS FROM S_05C THROUGH S_05G (AS APPROPRIATE) FOR MOST RECENT
INCIDENT, THEN MOVE TO NEXT MOST RECENT INCIDENT, AND SO ON.
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S_05C. [IF S_05B1>1, DISPLAY FOR 2ND AND ADDITIONAL INCIDENTS: You said that (IF
S05_A1=1: something was vandalized/(IF NEEDED: and) IF S05_A2=1: someone
deliberately injured or killed an animal) (FILL ANSWER FROM S_05B1 times) in the past 6
months.] In what month did the (most recent/next most recent) incident happen? If
you don’t remember the exact month, please give your best estimate. [NEW]
(CURRENT MONTH)
(CURRENT MONTH MINUS 1)
(CURRENT MONTH MINUS 2)
(CURRENT MONTH MINUS 3)
(CURRENT MONTH MINUS 4)
(CURRENT MONTH MINUS 5)
(CURRENT MONTH MINUS 6)
Before (CURRENT MONTH MINUS 6)
If S_05C is blank, soft prompt with a DK option. Otherwise, go to S_5DD1.
If S_05C is still blank or DK, continue to S_05C2.
S_05C2. Did this incident happen before, after, or on [6-MO ANCHORDATE]? [NEW]
It happened before [6-MO ANCHORDATE] – GO TO S_06A
It happened after or on [6-MO ANCHORDATE] – GO TO S_5DD1
I don’t know when it happened – GO TO NEXT INCIDENT IN S_05C
S5_DD1. PROGRAMMER NOTE: Ask S_5DD2 if any of the following conditions are true:
•
•
•
If MONTH/YEAR of the current incident matches or is within one month (plus or minus)
of the MONTH/YEAR of any previously reported incidents, or if there are any previously
reported incidents for which a date was not collected
If no date was provided but the current incident was confirmed to have happened on or
after anchor date, and (a prior incident was also confirmed to have happened on or
after anchor date, or if there are any previously reported incidents for which a date was
not collected)
If no date was provided and a prior incident was reported, regardless of date
S_5DD2. Is this incident part of any other incident you have already mentioned? [NEW]
Yes - GO TO S_5DD3
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No – GO TO S_05E
S_5DD3. Which incident was this part of? [NEW]
•
(DISPLAY EACH INCIDENT PREVIOUSLY MENTIONED THAT IT COULD MATCH TO
BY DISPLAYING MONTH/YEAR (IF PROVIDED) AND SHORT DESCRIPTION OF
DETAILS OF INCIDENT, SUCH AS “May 2017 vehicle theft with an attack”)
ALL IN S_5DD3, GO TO S_05C FOR NEXT INCIDENT. IF NO MORE INCIDENTS, GO TO S_06A.
Still thinking about this (IF S_05B1 GT 2 AND SERIES NOT EQ 1 AND S_05C IS MISSING: most
recent/second most recent/third most recent/fourth most recent/ IF RESPONSE PROVIDED IN
S_05C: MONTH, YEAR) incident when (IF S05_A1=1: something was vandalized/(IF NEEDED: or)
IF S05_A2=1: someone deliberately injured or killed an animal), [NEW]
S_05E. Was anything stolen as part of the incident?
S_05F. Were you physically attacked, or threatened with an attack,
during this incident?
S_05G. (IF YES IN S_05F) Did anyone have, or try to have, sexual
contact with you that you DID NOT CONSENT TO and that YOU
DID NOT WANT to happen as part of this incident?
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1 Yes
2 No
1 Yes
2 No
1 Yes
2 No
34
Victimization Screener: Attack
S_06A. The next few questions ask about any physical attacks against you personally. These
may have happened at your home or while you were (IF AGES 15+: at work,) at school, or away
from home.
{IF YES TO S_01F, S_02F, S_03F, S_04F, or S_05F: Other than the attacks or threatened attacks
you have already mentioned,} in the past 12 months, did anyone attack or try to attack you…
[Revision to NCVS-1, item 41a]
S_06A1. With a weapon, for instance, a gun or knife?
S_06A2. With something else used as a weapon, like a baseball bat,
scissors, or a stick?
S_06A3. By throwing something at you, such as a rock or bottle?
S_06A4. By hitting, slapping, grabbing, kicking, punching, or
choking you?
Yes
Yes
No
No
Yes
Yes
No
No
S_06A5. In the past 12 months, did anyone attack, try to attack, or use force against you in any
other way? Click “Yes” even if you are not certain it was a crime.
1
Yes
2
No
S_06A6. In the past 12 months, did anyone THREATEN to attack you, but not actually do it, {IF
YES TO ANY IN 6A1-6A5: do not include incidents you have already mentioned}? [Revision to
NCVS-1, item 41a]
1
Yes
2
No
If YES IN S_06A6, go to S_06A7.
Otherwise go to S_06A8.
S_06A7. How were you threatened? [Revision to NCVS-1, item 41a]
1
Face to face
2
By phone or text
3
Online (email or social media)
4
Some other way
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If NO or MISSING TO ALL IN S_06A1-S_06A5 AND CODES 2-4 IN S_06A7, go to S_07A.
OTHERWISE, CONTINUE.
S_06A8. People sometimes don’t think of attacks by someone they know, like (ADULTS: a
current or former spouse or partner)/(YOUTH: a boyfriend or girlfriend), someone (AGES 15+: at
work or at school)/(AGES 12-14: at school), a friend, or a family member.
{IF YES TO ANY IN S_06A1-S_06A6: Other than what you have already mentioned,} In the past
12 months, has anyone you know used any kind of physical force against you? Examples are if
someone you know choked you, slapped you, hit you with something other than a fist, attacked
you with a weapon, or otherwise physically hurt you. [Revision to NCVS-1, item 42a]
1
Yes
2
No
If yes to any in S_06A1- S_06A6, or S_06A8, go to S_06B.
Otherwise, go to S_07.
S_06B. The next question asks about the past 6 months, as marked in the calendar below.
You said that (IF YES TO ANY IN S_06A1- S_06A5 OR S_06A8: someone attacked you or tried to
attack you/(IF NEEDED: and) IF S_06A6=YES: someone threatened to attack you) in the past 12
months. Looking at the calendar above to help you remember the date, did (IF YES TO ONLY
ONE ACROSS S_06A1- S_06A5, S_06A6 AND S_06A8: this happen/IF YES TO MORE THAN ONE IN
S_06A1- S_06A5, S_06A6 AND S_06A8: any of these things happen) in the past 6 months, that
is, since [DATE 6 MONTHS AGO]? [Revision to NCVS-1, item 41a, 42a]
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1
2
Yes, in the past 6 months
No, not in the past 6 months
If YES in S_06B, go to S_06B1.
Otherwise, go to S_07.
S_06B1.
In the past 6 months, how many times did someone (IF YES TO ANY IN
S_06A1- S_06A5 OR S_06A8: attack you or try to attack you/(IF NEEDED: or) IF
S_06A6=YES: threaten to attack you) you? [Revision to NCVS-1, item 41b, 42b]
1
2
Once
Two or more times (TYPE IN NUMBER _____)
IF S_06B1 is missing or S_06B1 =2 and no numerical response is provided, soft prompt to
collect response. Else go to note before S_06B2.
If still blank in S_06B1, SET TO SERIES=1. GO TO S_06C AND ONLY ASK ABOUT MOST RECENT
INCIDENT.
If one to three times in S_06B1, go to S_6DD1. If four or more in S_06B1, continue.
S_06B2.
Do you recall enough details about each incident to be able to distinguish
them from each other? [Adapted from CIR5b]
1
2
Yes
No – SET SERIES=1
If yes in S_06B2, ask for up to four most recent dates in S_06C (depending on response to
S_06B1). If no in S_06B2, ask only about most recent incident in S_06C.
ASK ALL ITEMS FROM S_06C THROUGH S_06E (AS APPROPRIATE) FOR MOST RECENT
INCIDENT, THEN MOVE TO NEXT MOST RECENT INCIDENT, AND SO ON.
S_06C. [IF S_04B1>1, DISPLAY FOR 2ND AND ADDITIONAL INCIDENTS: You said that (IF
YES TO ANY IN S_06A1- S_06A5 OR S_06A8: someone attacked you or tried to attack
you/(IF NEEDED: and) IF S_06A6=YES: someone threatened to attack you) (FILL ANSWER
FROM S_06B1 times) in the past 6 months.] When did the (most recent/next most
recent) incident happen? If you don’t remember the exact month, please give your best
estimate. [NEW]
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(CURRENT MONTH)
(CURRENT MONTH MINUS 1)
(CURRENT MONTH MINUS 2)
(CURRENT MONTH MINUS 3)
(CURRENT MONTH MINUS 4)
(CURRENT MONTH MINUS 5)
(CURRENT MONTH MINUS 6)
Before (CURRENT MONTH MINUS 6)
If S_06C is blank, Soft prompt with DK option. Otherwise, go to S_6DD1.
If S_06C is still blank or DK, continue to S_06D2.
S_06D2. Did this incident happen before, after, or on [6-MO ANCHORDATE]? [NEW]
It happened before [6-MO ANCHORDATE] – GO TO NEXT SCREENING ITEM
It happened after or on [6-MO ANCHORDATE] – GO TO S_6DD1
I don’t know when it happened – GO TO NEXT INCIDENT IN S_06C
S_6DD1. PROGRAMMER NOTE: Ask S_6DD2 if any of the following conditions are true:
•
•
•
If MONTH/YEAR of the current incident matches or is within one month (plus or minus)
of the MONTH/YEAR of any previously reported incidents, or if there are any previously
reported incidents for which a date was not collected
If no date was provided but the current incident was confirmed to have happened on or
after anchor date, and (a prior incident was also confirmed to have happened on or
after anchor date, or if there are any previously reported incidents for which a date was
not collected)
If no date was provided and a prior incident was reported, regardless of date
S_6DD2. Is this incident part of any other incident you have already mentioned? [NEW]
Yes - GO TO S_6DD3
No – GO TO S_06E
S_6DD3. Which incident was this part of? [NEW]
•
(DISPLAY EACH INCIDENT PREVIOUSLY MENTIONED THAT IT COULD MATCH TO
BY DISPLAYING MONTH/YEAR (IF PROVIDED) AND SHORT DESCRIPTION OF
DETAILS OF INCIDENT, SUCH AS “May 2017 vehicle theft with an attack”)
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ALL IN S_6DD3, GO TO S_06C FOR NEXT INCIDENT. IF NO MORE INCIDENTS, GO TO NEXT
SCREENING ITEM.
Still thinking about this (IF S_06B1 GT 2 AND SERIES NOT EQ 1 AND S_06C IS MISSING: most
recent/second most recent/third most recent/fourth most recent/ IF RESPONSE PROVIDED IN
S_06C: MONTH, YEAR) incident when (IF YES TO ANY IN S_06A1- S_06A5 OR S_06A8: someone
attacked you or tried to attack you/IF S_06A6=YES: someone threatened to attack you), [NEW]
S_06E. Did anyone have, or try to have, sexual contact
with you that you DID NOT CONSENT TO and that YOU
DID NOT WANT to happen as part of this incident?
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1 Yes
2 No
39
Victimization Screener: Unwanted Sexual Contact
[ADULTS, USE THIS PAGE. YOUTH, GO TO NEXT PAGE]
S_07A. The next questions are about any sexual contact in the past 12 months that you DID
NOT CONSENT TO and that YOU DID NOT WANT to happen. The information you provide is
confidential.
Sexual contact includes someone touching your sexual body parts, unwanted kissing or
penetrating your (IF FEMALE: vagina or)/ anus with a penis, mouth, tongue, fingers, or object.
This could have been done by someone you knew well, someone you casually knew, or a
stranger and can happen to both men and women.
{IF YES TO S_01G, S_02G, S_03G, S_04G, S_05G, or S_06E: Other than the unwanted sexual
contact you have already mentioned,} in the past 12 months… [NEW]
S_07A1. Did anyone touch or grab your sexual body parts against
your will – or TRY to do this?
S_07A2. Did anyone force you to have sexual contact by holding
you down with his or her body, pinning your arms, hitting or kicking
you, or using some other type of force – or TRY to do this?
S_07A3. Did anyone threaten to hurt you or someone close to you
if you did not have sexual contact?
S_07A4. Did anyone have sexual contact with you – or try to have
sexual contact with you – while you were passed out, unconscious,
asleep, or unable to consent because you were drunk or high?
Yes
No
Yes
No
Yes
No
Yes
No
If YES TO ANY in S_07A1-S_07A4, go to S_07B.
Otherwise, go to instructions before S_08.
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[YOUTH ONLY]
S_07Y. The next questions are about any sexual contact in the past 12 months that you DID NOT
CONSENT TO and that YOU DID NOT WANT to happen. The information you provide is
confidential.
Sexual contact includes someone touching your private parts, unwanted kissing, or sex. This
could have been done by someone you know well, someone you casually know, or a stranger
and can happen to both boys and girls.
{IF YES TO S_01G, S_02G, S_03G, S_04G, S_05G, or S_06E: Other than the unwanted sexual
contact you have already mentioned,} in the past 12 months… [NEW]
S_07A1. Did anyone touch or grab your private parts when you
didn’t want them to – or TRY to do this?
S_07A2. Did anyone force you to have sexual contact by holding
you down with his or her body weight, pinning your arms, hitting or
kicking you, or using some other type of force – or TRY to do this?
S_07A3. Did anyone threaten to hurt you or someone close to you
if you did not have sexual contact?
S_07A4. Did anyone have sexual contact with you – or try to have
sexual contact with you – while you were passed out, asleep, or
unable to consent because you were drunk or high?
Yes
No
Yes
No
Yes
No
Yes
No
If YES TO ANY in S_07A1-S_07A4, go to S_07B.
Otherwise, go to instructions before S_08.
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S_07B. The next question asks about the past 6 months, as marked in the calendar below.
You said that someone had, or tried to have unwanted sexual contact with you in the past 12
months. Looking at the calendar above to help you remember the date, did (IF YES TO ONLY
ONE IN S_07A1-S_07A4: this happen/IF YES TO MORE THAN ONE ACROSS S_07A1-S_07A4: any
of these things happen) in the past 6 months, that is, since [DATE 6 MONTHS AGO]? [NEW]
1
2
Yes, in the past 6 months
No, not in the past 6 months
If YES in S_07B, go to S_07B1.
Otherwise, go to instructions before S_08.
S_07B1.
In the past 6 months, how many times did someone have, or try to have
these types of sexual contact with you? [NEW]
1
2
Once
More than once (TYPE IN A NUMBER _____)
IF S_07B1 is missing or S_07B1 =2 and no numerical response is provided, soft prompt to
collect response. Else go to note before S_07B2.
If still blank in S_07B1, SET TO SERIES=1. GO TO S_07C AND ONLY ASK ABOUT MOST RECENT
INCIDENT.
If one to three times in S_07B1, go to note before S_07C. If four or more in S_07B1, continue.
S_07B2.
Do you recall enough details about each incident to be able to distinguish
them from each other? [Adapted from CIR5b]
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1
2
Yes
No – SET SERIES=1
If yes in S_07B2, ask for up to four most recent dates in S_07C (depending on response to
S_07B1). If no in S_07B2, ask only about most recent incident in S_07C.
ASK ALL ITEMS FROM S_07C THROUGH S_7DD3 (AS APPROPRIATE) FOR MOST RECENT
INCIDENT, THEN MOVE TO NEXT MOST RECENT INCIDENT, AND SO ON.
S_07C. [IF S_07B1>1, DISPLAY FOR 2ND AND ADDITIONAL INCIDENTS: You said that
someone had, or tried to have these types of sexual contact with you (FILL ANSWER
FROM S_07B1 times) in the past 6 months.] In what month did the (most recent/next
most recent) incident happen? If you don’t remember the exact month, please give
your best estimate.
(CURRENT MONTH)
(CURRENT MONTH MINUS 1)
(CURRENT MONTH MINUS 2)
(CURRENT MONTH MINUS 3)
(CURRENT MONTH MINUS 4)
(CURRENT MONTH MINUS 5)
(CURRENT MONTH MINUS 6)
Before (CURRENT MONTH MINUS 6)
If S_07C is blank, soft prompt with a DK option. Otherwise, go to S_7DD1.
If _S07C is still blank or DK, continue to S_07C2.
S_07C2. Did this incident happen before, after, or on [6-MO ANCHORDATE]? [NEW]
It happened before [6-MO ANCHORDATE] – GO TO S_08
It happened after or on [6-MO ANCHORDATE] – GO TO S_7DD1
I don’t know when it happened – GO TO NEXT INCIDENT IN S_07C
S_7DD1. PROGRAMMER NOTE: Ask S_7DD2 if any of the following conditions are true:
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•
•
•
If MONTH/YEAR of the current incident matches or is within one month (plus or minus)
of the MONTH/YEAR of any previously reported incidents, or if there are any previously
reported incidents for which a date was not collected
If no date was provided but the current incident was confirmed to have happened on or
after anchor date, and (a prior incident was also confirmed to have happened on or
after anchor date, or if there are any previously reported incidents for which a date was
not collected)
If no date was provided and a prior incident was reported, regardless of date
S_7DD2. Is this incident part of any other incident you have already mentioned? [NEW]
Yes - GO TO S_7DD3
No – GO TO S_08
S_7DD3. Which incident was this part of? [NEW]
•
(DISPLAY EACH INCIDENT PREVIOUSLY MENTIONED THAT IT COULD MATCH TO
BY DISPLAYING MONTH/YEAR (IF PROVIDED) AND SHORT DESCRIPTION OF
DETAILS OF INCIDENT, SUCH AS “May 2017 vehicle theft with an attack”)
All, go to S_08.
(IF ANY PAST 6 MONTH INCIDENTS HAVE BEEN REPORTED: You have said that the following
things happened to you in the past 6 months:
•
(DISPLAY EACH INCIDENT PREVIOUSLY MENTIONED BY DISPLAYING
MONTH/YEAR (IF PROVIDED) AND SHORT DESCRIPTION OF DETAILS OF
INCIDENT, SUCH AS “May 2017 vehicle theft with an attack”)
S_08. To make sure this survey has captured everything that has happened to you, is there
anything (else) that you might think of as a crime that happened to you, personally, in the past
6 months, that is, since (DATE 6 MONTHS AGO) that you haven’t mentioned? It could be
something you called the police about, or something you didn’t report to the police. [NEW]
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1
2
Yes
No
If code 1 in S_08, go to S_08a.
If code 2 in S_08, go to instruction before CIR1.
S_08a. Please describe what else happened to you since (ANCHOR DATE). [NEW]
(OPEN-ENDED VERBATIM RESPONSE FOR PURPOSES OF FIELD TEST)
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Crime Incident Report (Adults and Youth)
PROGRAMMER NOTE: Prioritize most serious incident first, then most recent within most
serious.
CIR1. For these next questions, please focus on what happened in the incident (in FILL
MONTH/YEAR OF INCIDENT IF PROVIDED) when you said [DISPLAY ALL KNOWN INFORMATION
ABOUT INCIDENT USING TEXT BELOW IN BULLETED LIST – PULL FROM INTERLEAVING AND DEDUPING INFORMATION FOR EACH INCIDENT].
Display text for CIR1
Module
Someone stole or tried to steal a vehicle
1
MV
Someone stole or tried to steal vehicle parts
2
MV
Someone stole something else
3
T
Someone tried to steal something else
4
AT
Someone broke in, or tried to break in to your property
5
B
Someone vandalized something of yours
6
V
Someone attacked or threatened to attack you personally
7
A
Someone had or tried to have sexual contact with you that you did
not agree to and did not want to happen
8
SV
[Verbatim from S_8a]
9
None
COMPLETE EACH MODULE BASED ON THE CODES MARKED IN CIR1. ONCE ALL ELIGIBLE
MODULES HAVE BEEN COMPLETED, GO TO LOCATION MODULE.
IF P1 OR P2 IS LESS THAN 6 MONTHS, CONTINUE. ELSE SKIP TO NEXT MODULE
CIR1a. Did this incident happen while you were living at your current address, or before you
moved to this address?
1
2
While living at current address
Before moved to this address
DISPLAY TEXT:
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Some of the next questions will refer to the “offender(s),” which means, the person or people
who did this to you.
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Series Crimes
If SERIES=1 FOR THIS INCIDENT, GO TO SC1
Else go to next MODULE
Earlier in this survey, you said [DESCRIPTION OF TYPE OF CRIME] happened to you more than
once in the past 6 months.
SC1. Did all, some, or none of these incidents occur in the same place? [CIR156]
1
2
3
All in the same place
Some in the same place
None in the same place
SC2 Were all of these incidents, some of them, or none of them done by the same offender(s)?
[CIR157]
1
2
3
All by same offender
Some by same offender
None by same offender
The rest of the questions will now ask you to focus on the most recent time this happened (in
MONTH/YEAR).
GO TO NEXT MODULE BASED ON CIR1
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What Happened: Module SV – Unwanted Sexual Contact (NEW)
IF CIR1=8 CONTINUE. ELSE GO TO NEXT MODULE.
Earlier, you said someone had unwanted sexual contact with you during (IF MORE THAN ONE
CIR: this/IF ONE CIR: the) incident (IF DATE PROVIDED: in (MONTH)/IF NO DATE PROVIDED: in
the past 6 months).
For these questions, please focus on the things that you did not want to happen. It may seem
like you’ve already answered these questions, but it is important to understand what happened
to you during (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident.
SV1.
a.
b.
c.
d.
e.
In this particular incident, …Mark one answer in each row. [NEW]
Was there unwanted vaginal sex?
Was there unwanted oral sex? Oral sex means that
someone put their mouth or tongue on a vagina, anus or
penis.
Was there unwanted anal sex? Anal sex is a man or boy
putting his penis in someone else’s anus.
Was there unwanted sexual penetration with a finger or
object in your [FEMALE: vagina or] anus or in the
offender’s vagina or anus?
Was there unwanted sexual touching, such as kissing,
touching of [sexual body/private] parts, or grabbing,
fondling, or rubbing up against you in a sexual way, even if
it was over your clothes?
Yes
Yes
No
No
Yes
No
Yes
No
Yes
No
SV1f. [IF YES TO ANY IN SV1A-D] You said that there was (DISPLAY ALL YES RESPONSES FROM
SV1) when you did not want it to happen. Did the offender penetrate or touch your [sexual
body/private] parts, were you forced to penetrate or touch the offender’s [sexual body/private]
parts, or did both happen?
1
2
3
The offender penetrated or touched you
You were forced to penetrate or touch the offender
Both
PROGRAMMER NOTE: Display language for SV1F and subsequent items:
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(IF SV1a=YES) unwanted vaginal sex
(IF SV1b=YES) unwanted oral sex
(IF SV1c=YES) unwanted anal sex
(IF SV1d=YES) unwanted penetration with finger or object
(IF SV1e=YES) unwanted sexual touching or kissing
SV2. (If any in SV1a-SV1e=yes) During (IF MORE THAN ONE CIR: this/IF ONE CIR: the)
incident… Mark one answer in each row. [NEW]
a.
b.
c.
d.
Did the offender use physical force, such as holding or
pinning you, hitting or kicking you, or using a weapon?
Did the offender threaten to hurt you or someone close
to you?
Were you blacked out, unconscious, or asleep?
Were you unable to consent because you were too drunk
or high?
Yes
No
Yes
No
Yes
Yes
No
No
[IF SV1e=YES AND SV2a-d=no]
SV2e. During (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident, did the offender use force
to kiss you, or grab, grope or touch your [sexual body/private] parts? (NEW)
1
2
Yes
No
[IF NO TO ALL IN SV2a-e]
SV2f. Did the offender use some other type of pressure, such as threatening to cut off
financial support, threatening to cause problems for you, or promising rewards?
1
2
Yes
No
[IF NO TO ALL IN SV2a-f]
SV2g. What did the offender do that made it unwanted or against your will (specify)?
If SV1a = yes and SV2a, b, c, d, or e = yes, go to next MODULE
If SV1b = yes and SV2a, b, c, d, or e = yes, go to next MODULE
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If SV1c = yes and SV2a, b, c, d, or e = yes, go to next MODULE
If SV1d = yes and SV2a, b, c, d, or e = yes, go to next MODULE
SV3. Did the offender verbally THREATEN or physically TRY to do any of the following, BUT
DID NOT ACTUALLY DO IT? Mark one answer in each row. [NEW]
a. (if SV1a = no) Have vaginal sex with you
b. (if SV1b = no) Have oral sex with you
c. (if SV1c = no) Have anal sex with you
d. (IF SV1d=no) Sexually penetrate you with a finger or object
in your [FEMALE: vagina or] anus or make you put your finger
or an object in the offender’s vagina or anus?
e. (if SV1e = no) Kiss or touch your [sexual body/private]
parts?
Yes
Yes
Yes
Yes
No
No
No
No
Yes
No
IF ALL OF SV3a – SV3e = NO OR MISSING GO TO NEXT MODULE. ELSE GO TO SV4a
SV4a. [If any of SV3a – SV3d=yes: You said that the offender threatened to or tried to (READ
ALL YES RESPONSES FROM #SV3: have vaginal sex, have oral sex, have anal sex, sexually
penetrate you with a finger or object) when you did not want it to happen.]
[Otherwise, if SV3e=yes: You said that the offender threatened to or tried to kiss, touch your
[sexual body/private] parts, or grab, fondle, or rub up against you in a sexual way, when you did
not want it to happen] Mark one answer in each row. [NEW]
a. Did the offender use physical force in doing this?
b. Did the offender threaten to hurt someone else in doing
this?
c. Did the offender try to do it while you were asleep,
unconscious, or unable to consent because you were high on
alcohol or drugs?
Yes
Yes
No
No
Yes
No
If ‘no’ or missing to all in SV4a_a-c, go to SV4b. Else, go to next MODULE.
SV4b. You said that the offender threatened to or tried to (DISPLAY ALL YES RESPONSES FROM
#SV3: have vaginal sex, have oral sex, have anal sex, sexually penetrate you with a finger
or object, kiss or touch your [sexual body/private] parts) when you did not want it to
happen. Did the offender verbally tell you they wanted to do it? [NEW]
Yes (go to SV4c)
No (go to SV4d)
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SV4c.
[IF YES IN SV4b AND MORE THAN ONE YES IN SV3a-e: You said the person verbally told
you that they wanted to (BEHAVIORS FROM SV3).] At the time, how likely do you think
it was that the offender would [IF ONLY ONE YES IN SV3: BEHAVIOR(s) FROM SV3/IF
MORE THAN ONE YES IN SV3: do any of these] during (IF MORE THAN ONE CIR: this/IF
ONE CIR: the) incident? [NEW]
1
2
3
4
Very likely
Somewhat likely
Somewhat unlikely
Very unlikely
ALL IN S4C, GO TO NEXT MODULE.
SV4d. (IF ANY OF SV3a – SV3e = yes) How did the offender threaten to [IF ONLY ONE YES IN
SV3: BEHAVIOR(s) FROM SV3/IF MORE THAN ONE YES IN SV3: do any of these]? [NEW]
SPECIFY ____________________________
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What Happened: Module A – Attack/Threatened Attack
IF CIR1=7 OR 8 (AND MODULE A HAS NOT BEEN ASKED YET) CONTINUE. ELSE GO TO NEXT
MODULE.
A1.
[IF CIR1<>8: You said someone (attacked/or/threatened to attack you) during (IF MORE
THAN ONE CIR: this/IF ONE CIR: the) incident (IF DATE PROVIDED: in (MONTH)/IF NO
DATE PROVIDED: in the past 6 months).] (IF S_06A1-A3=YES: Just to confirm,) (Did/did)
the offender(s) have a weapon such as a gun or knife, or something to use as a weapon,
such as a baseball bat, scissors, or a stick ? [CIR22]
1
2
Yes
No
If code 1 in A1, continue.
If code 2 in A1, go to A3.
What was the weapon? Mark all that apply. [CIR23a]
A2.
1
2
3
4
5
A gun
A knife
Some other sharp object, such as scissors or an axe
A blunt object, such as a rock or bat
Something else - Specify - ____________________________________
IF A2=1, CONTINUE. ELSE TO GO NOTE BEFORE A2C.
A2a. Was it a handgun or some other kind of gun, such as a rifle or shotgun? [CIR23a,
modified]
1 Hand gun
2 Some other kind of gun
A2b.
Did the offender(s): Mark one answer in each row. [CIR29a modified]
a. Shoot you?
b. Shoot at you, but miss?
c. Hit you with the gun?
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Yes
Yes
No
No
No
53
If A2b_a=yes or A2b_c=yes, go to next MODULE.
If A2=2 or 3, go to A2c. Else go to A3.
A2c. You said the offender(s) had a knife or other sharp object. Did the offender(s): Mark one
answer in each row. [CIR29a modified]
a. Stab or cut you?
b. Try to stab or cut you?
Yes
Yes
No
No
If A2c_a=yes, go to next MODULE.
If SV2a=yes, go to A9. If SV4a_a=yes, go to next MODULE.
Otherwise, go to A3.
A3.
[IF A2b_b=yes or A2c_b=yes: In addition to trying to [shoot/stab or cut] you, did the
offender(s) hit you, grab you, knock you down or attack you in any other way?/ OTHERWISE:
Did the offender(s) hit you, grab you, knock you down or attack you in any way?] [CIR24]
1
2
Yes
No
If code 1 in A3, go to A9.
If code 2 in A3 and (A2b_b=yes or A2c_b=yes), go to next MODULE.
Otherwise, if code 2 or missing in A3, go to A4.
A4.
Did the offender(s) TRY to hit you, grab you, knock you down or try to attack you in any
way? [CIR25 -modified]
1
2
Yes
No
If code 1 in A4, go to A7.
If code 2 in A4, go to A5.
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A5.
Did the offender(s) THREATEN to hit you, grab you, knock you down or threaten to
attack you in any way? [CIR26 - modified]
1
Yes
2
No
If code 1 in A5, go to A7.
If code 2 in A5, go to A6.
A6.
What did the offender do? Mark all that apply. [CIR27a - modified]
1
2
3
4
5
6
7
Took something without your permission
Attempted or threatened to take something
Bothered you verbally, argued with you or used abusive language
Broke in or tried to break in to your home
Broke in or tried to break in to your vehicle
Damaged or destroyed your property
Something else _______________________________________________
All in A6, skip to next MODULE.
A7.
Did the offender(s) TRY or THREATEN to attack you by… Mark one answer in each row.
[CIR28a - modified]
A.
B.
C.
D.
E.
F.
G.
H.
saying they would attack or kill you?
(IF A1=1) threatening you with a weapon?
(IF A2=4 or 5) trying to attack you with a weapon other
than gun, knife or sharp weapon?
throwing something at you?
following you or surrounding you?
trying to choke you?
trying to hit, slap, knock down, grab, hold, trip, jump, or
push you?
Something else
_______________________________________________?
Yes
Yes
Yes
No
No
No
Yes
Yes
Yes
Yes
No
No
No
No
Yes
No
If A7=1 or 2 and screener item S_06A7 is blank, continue. Else go to next MODULE.
A8a.
How were you threatened? Mark all that apply. [NEW]
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1
Face to face
2
By phone or text
3
Online (email or social media)
4
Some other way
If A8a=2, 3 or 4 and CIR1 only =7, skip to Narrative.
Otherwise, skip to next MODULE.
A9. [If SV2a=yes: Earlier you said the offender used physical force [If A1=yes: and had a
weapon] during the incident.] Did the offender(s) [also] do any of the following? Mark one
answer in each row. [CIR29a modified]
a. Hit you with an object other than a gun
Yes
No
b. Throw something at you
Yes
No
c. Attack you with a weapon other than gun, knife or
sharp weapon
Yes
No
d. Choke you
Yes
No
e. Hit you, slap you, or knock you down
Yes
No
f. Grab, hold, trip, jump, or push you
Yes
No
g. Do something else to attack you? (If so, what?)
_________________
Yes
No
All continue to next MODULE
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Consequences I: Injury
IF CIR1=7 or 8, CONTINUE. ELSE GO TO NEXT MODULE.
I_INTRO This section asks about any injuries you may have had during this incident.
CI1.
During (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident, (IF SHOT OR STABBED IN
MODULE A: besides being (shot and/or stabbed),) were you physically injured in any (IF
SHOT OR STABBED IN MODULE A: other) way? Injuries include things such as bruises,
black eyes, cuts, broken bones or more serious injuries. [CIR 31a, modified]
1. Yes (CI2)
2. No (PN CI4)
CI2.
Were you injured in any of these ways? Mark all that apply. [CIR 31a, modified]
1. Broken or cracked bones
2. Broken nose
3. Dislocated joints
4. A concussion
5. Knocked unconscious
6. (IF YES TO ANY IN SV1A-D) Injury from sexual intercourse, such as to vagina or anus
7. (IF YES TO ANY IN SV1A-D: Other) Internal injuries, such as internal bleeding or
damage to internal organs
8. Some other way
IF CI2 = 8 OR MISSING:
CI2a. Were you injured in any of these other ways? Mark all that apply. [CIR 31a, modified]
1.
2.
3.
4.
5.
6.
7.
8.
Bruising, swelling, welts, black eye
Bite mark or bite wound
Cuts or scratches
Sore muscles, sprains, strains, pulls
Burns
Nose bleed or bloody lip
Broken, chipped, or lost teeth
Other (SPECIFY) ______________________
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PN CI3 If: sex=female, age=12-55, A3=yes or any in SV1a-e=yes, ask CI3a; else go to PN CI4.
CI3a. Were you pregnant at the time? [CIR40]
1. Yes (CI3b)
2. No (PN CI4)
CI3b
Did (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident cause you to have a
miscarriage or some other complication of pregnancy? [NEW]
1. Yes
2. No
PN CI4 If: sex=female, age=12-55, and YES TO SV1A, ask CI4; else go to PN CI5.
CI4.
Did (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident cause you to become
pregnant? [NEW]
1. Yes
2. No
PN CI4 If: yes to any in SV1a-e, ask CI5; else, go to PN CI6.
CI5
Did the offender(s) give you a sexually transmitted disease or other infection? [NEW]
1. Yes
2. No
PN CI6 If YES to injuries, pregnancy, STD or other infection, OR miscarriage questions, ask CI6;
else go to next MODULE.
CI6
Did you receive any care from a medical or dental professional as a result of (IF MORE
THAN ONE CIR: this/IF ONE CIR: the) incident? [CIR 33a, modified]
1. Yes (CI7)
2. No (Next section)
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CI7.
Did you receive this care at the location where the incident happened, somewhere else,
or both? [CIR33b - modified]
1. Only where the incident happened
2. Only somewhere else
3. Both
If codes 2 or 3 to CI7, continue. Else go to PN CI8
CI7a
Where did you receive this care? Mark all that apply. [CIR33b - modified]
1.
2.
3.
4.
At your home or the home of a relative, friend, or neighbor
At a hospital emergency room (ER) or an emergency clinic
At some other kind of medical or dental place
Somewhere else (specify)
PN CI8 If CI7a = 2, 3 or 4, ask CI8; else go to next section.
CI8
Did you stay overnight in the hospital? [CIR 34a]
1. Yes (CI9)
2. No (CI10)
CI9
How many nights did you stay in the hospital? [CIR 34b, modified]
______ nights
PN CI10:
CI10
If CI6 = 1 (medical care received), ask CI10; else, go to next section
Have you had any out–of–pocket expenses for your medical or dental care that you do
not expect to get paid back from insurance or some other source? [NEW]
1. Yes (CI11)
2. No (Next section)
CI11
How much were these out-of-pocket expenses? [NEW]
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1
2
3
4
5
Less than $100
$100 to less than $500
$500 to less than $1000
$1000 to less than $5000
$5000 or more
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What Happened: Module MV. Motor Vehicle Theft/Parts Theft/Attempted Theft
IF CIR1=1 or 2, AND MODULE MV HAS NOT BEEN ASKED YET CONTINUE. ELSE GO TO NEXT
MODULE.
IF CIR1=1 AND S_01C>1, GO TO MV1a. OTHERWISE IF CIR1=1, GO TO MV2a. ELSE GO TO NOTE
BEFORE MV1b.
MV1a. You said someone [stole /or/ tried to steal] a vehicle during (IF MORE THAN ONE CIR:
this/IF ONE CIR: the) incident (IF DATE PROVIDED: in (MONTH)/IF NO DATE PROVIDED:
in the past 6 months). (Did / did) the offender(s) actually take the vehicle? [NEW]
1
2
Yes
No
MV2a. [IF MV1a WAS SKIPPED: You said someone [stole /or/ tried to steal] a vehicle during (IF
MORE THAN ONE CIR: this/IF ONE CIR: the) incident (IF DATE PROVIDED: in (MONTH)/IF
NO DATE PROVIDED: in the past 6 months).] Who did the vehicle belong to? [CIR 97a,
modified]
1
2
3
4
5
You
Someone else you live with
Both you and someone else you live with
Someone you don’t live with
Other ______________________________________________________
IF CIR1=2 AND S_02B>1, GO TO MV1b. ELSE GO TO NOTE BEFORE MV3.
MV1b. You said someone [stole or tried to steal] vehicle parts during (IF MORE THAN ONE CIR:
this/IF ONE CIR: the) incident (IF DATE PROVIDED: in (MONTH)/IF NO DATE PROVIDED:
in the past 6 months). (Did / did) the offender(s) actually take any vehicle parts? [NEW]
1
2
Yes
No
MV2b. (IF MV1b WAS SKIPPED) You said someone [stole /or/ tried to steal] vehicle parts during
(IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident (IF DATE PROVIDED: in
(MONTH)/IF NO DATE PROVIDED: in the past 6 months). Who did the vehicle parts
belong to? [CIR 97a, modified]
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1
2
3
4
5
You
Someone else you live with
Both you and someone else you live with
Someone you don’t live with
Other ______________________________________________________
If CIR1=1 and code 1 in MV1a, go to MV3.
Otherwise, Go to NEXT MODULE.
MV3. Did anyone ever tell the offender(s) they could use the vehicle? [CIR 98, modified]
1
2
Yes
No
If code 1 in MV3, go to MV4.
If code 2 in MV3, go to NEXT MODULE.
MV4. Did the offender(s) return the vehicle? [CIR 99, modified]
1
2
Yes
No
If MV4=yes and CIR1 is only=1 for this incident, skip to Narrative.
If MV4=2, go to NEXT MODULE.
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What Happened: Module B – Break-ins
IF CIR1=5, AND MODULE B HAS NOT BEEN ASKED YET CONTINUE. ELSE GO TO NEXT MODULE.
B1.
You said someone (broke in or tried to break in) during (IF MORE THAN ONE CIR: this/IF
ONE CIR: the) incident (IF DATE PROVIDED: in (MONTH)/IF NO DATE PROVIDED: in the
past 6 months). During (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident did
someone break in or try to break into…? Mark one answer in each row. [CIR10b,
modified]
a. Your (house/apartment)?
b. A garage, shed, or other detached building on
your property?
c. A second home or vacation home?
d. A hotel or motel room where you or someone
you live with was staying?
e. A car or motor vehicle?
f. Some other place?
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
No
No
If B1e=yes or all in B1 is missing, go to next MODULE.
Otherwise, go to B2.
B2.
Did the offender(s) actually get inside? [CIR12, modified]
1
2
B3.
Yes
No
Were there any signs that the offender(s) got in or tried to get in by force? Signs of force
include things like broken locks or windows. [CIR14, modified]
1
2
Yes
No
If code 1 in B3, go to B4.
Otherwise, go to next MODULE.
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What were these signs? Mark all that apply. [CIR15a, modified]
B4.
1
2
3
4
5
6
7
8
9
A window was damaged
A window screen was damaged or removed
A lock on a window was damaged or tampered with
There was some other damage to a window
A door was damaged
A screen door was damaged or removed
A lock or a door handle was damaged or tampered with
There was some other damage to a door
Something else ____________________
Go to next MODULE
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What Happened: Module T. Theft
IF CIR1=3 or 4 AND MODULE T HAS NOT BEEN ASKED YET, CONTINUE. ELSE GO TO NEXT
MODULE.
If S_03b=1 and any in (S03_A1-A7 or S_01E or S_02E or S_04E=1), ask T1. Otherwise, go to T2
T1. You said someone (stole /or/ tried to steal) something from you during (IF MORE THAN ONE
CIR: this/IF ONE CIR: the) incident (IF DATE PROVIDED: in (MONTH)/IF NO DATE PROVIDED: in
the past 6 months). (Did / did) the offender actually steal something or did they only TRY to
steal something? [NEW]
1
2
The offender actually stole something
The offender only tried to steal something
IF T1=2 or S_03b=1, GO TO LOCATION SERIES
T2a.
[IF T1 IS BLANK: You said someone stole something from you during (IF MORE THAN
ONE CIR: this/IF ONE CIR: the) incident (IF DATE PROVIDED: in (MONTH)/IF NO DATE
PROVIDED: in the past 6 months). What was stolen? Mark all that apply. [CIR96a modified]
IF S_03A1 OR S_03A5 OR S_01E or S02E=YES
1
Cash
2
Credit cards, a check, or bank cards
3
A purse or wallet
4
A backpack, briefcase, or luggage
5
A cell phone
6
A tablet, a laptop, or other personal electronics
IF S_03A2 or S_03A3=YES
7
Clothing, furs, or shoes
8
Jewelry, a watch, or keys
IF S_03A3=YES
9
A TV, a computer, or appliances
10
Other home furnishings, such as china or rugs
11
A handgun or other firearm
12
Tools, machines, or office equipment
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IF S_03A4 or S_03A6=YES
13
A bicycle or bicycle parts
14
A garden hose or lawn furniture
15
Toys, or sports and recreation equipment
IF S_03A5 OR S_01E or S02E =YES
16
Something you kept in your vehicle, such as a GPS device or a phone charger
17
A package or groceries
ALL
18
Something else
T2b. (IF SOMETHING ELSE) You said something else was stolen. What was it? Mark all that
apply. (Display categories not shown in T2a, plus other specify) [CIR96a, modified]
IF S_03A1 AND S_01E AND S02E <>YES
1
Cash
2
Credit cards, check, bank cards
5
Purse/wallet
6
Backpack, briefcase, luggage
3
Cell phone
4
Other personal and portable electronics
6
Other personal and portable objects
IF S_03A2<>YES
6
Clothing, furs, shoes
7
Jewelry, watch, keys
IF S_03A3<>YES
9
TV, computer, appliances
10
Other home furnishings (silver, china, art objects, furniture, rugs, etc.)
11
Handgun or other firearm
12
Tools, machines, office equipment
IF S_03A4 AND S_03A6<>YES
13
Bicycle or parts
14
Garden hose or lawn furniture
15
Toys, sports, recreation equipment
IF S_03A5 AND S_01E AND S02E <>YES
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16
17
19
Unattached motor vehicle accessories (GPS device, phone chargers, etc.)
A package or groceries
ALL
Something else ___________________________________
IF T1=2 or (T1 is missing and S_03b=1), go to next MODULE.
If code 1 in T2, go to T3.
Otherwise, go to T4.
T3.
How much cash was taken? [CIR96e]
IF YOUTH:
1.
2.
3.
4.
5.
Less than 10 dollars
$10 or more, but less than $20
$20 or more, but less than $30
$30 or more, but less than $50
$50 or more
IF ADULT:
1.
2.
3.
4.
5.
6.
Less than 10 dollars
$10 or more, but less than $50
$50 or more, but less than $200
$200 or more, but less than $500
$500 or more, but less than $1,000
$1,000 or more
All, go to T4.
T4. Who did the stolen property or money belong to? [CIR97a, modified]
1
2
3
4
5
You
Someone else you live with
Both you and someone else you live with
Someone you don’t live with
Other __________________________________________________________
Go to next MODULE.
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What Happened: Module V. Vandalism
If CIR1=6 and no other codes are marked in CIR1, continue. Else go to next MODULE.
IF S_05A2=yes and S_05A1=no, skip to V3. Else continue.
V1.
You said someone damaged or destroyed your property during (IF MORE THAN ONE CIR:
this/IF ONE CIR: the) incident (IF DATE PROVIDED: in (MONTH)/IF NO DATE PROVIDED:
in the past 6 months). (What/what) kind of property did the offender damage or
destroy? Mark all that apply. [2009 Supplement, 61a]
1.
2.
3.
4.
5.
6.
7.
8.
A vehicle (including parts)
Something inside your home or apartment
A mailbox
Something outside of your home or apartment, such as doors, windows, or walls
Fences, walls, gates or items in a garden
A garage, shed, greenhouse or other structure on your property
An animal such as a pet or livestock
Other ____________________________________________________________
All in V1, go to V2.
V2.
What kind of damage did the offender do? Mark all that apply. [2009 Supplement, 62a]
1
2
3
4
5
6
7
Broke glass, such as a window or mirror
Defaced something, such as painting graffiti, keying a car, or dirtying something
Burned something
Drove into or ran over something with a vehicle
Broke or destroyed something else
(IF CODE 7 IN V1) Injured or killed animals
Other _____________________________________________________________
If single person household, go to next MODULE. Otherwise, continue.
V3. [IF S_05A2=yes and V1 and V2 are missing: You said someone injured or killed an animal
during (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident (IF DATE PROVIDED: in
(MONTH)/IF NO DATE PROVIDED: in the past 6 months).] Did the offender attack or threaten
anyone (else) who was living with you during (IF MORE THAN ONE CIR: this/IF ONE CIR: the)
incident? [2009 Supplement, 64a, modified]
1
2
Yes
No
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V4. Did the offender steal or try to steal something that belonged to anyone (else) who lived
with you during (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident? [2009 Supplement,
64a, modified]
1
2
Yes
No
Go to next MODULE.
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Location Series
The next questions ask about where (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident (in
MONTH) took place.
If B1 is code 3, 4 or 6, go to Loc1
If B1 is code 5, continue.
If CIR1=1 or 2, continue.
Otherwise, go to note before L3.
L1.
Where was the (car/vehicle) when this happened? [NEW]
1. On your property, such as your driveway or garage
2. (IF P3A=2) In your building’s garage or parking lot
3. In some other garage or parking lot
4. On the street near where you live
5. On the street but not near where you live
6. Somewhere else
If L1 is code 1, 2 or 4 and CIR1a=2, go to Loc1. Otherwise, if L1 is code 1, 2, or 4, go to Module
PR
If L1 is code 3, 5 or 6, go to Loc1
If CIR1 is codes 3, 4, 5, 6, 7, or 8, continue. Otherwise, go to Module PR.
L3.
Where did (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident happen? [CIR10a
modified]
1. Inside your home
2. (IF P3a=2) In a common area where you live, such as a stairwell, hallway, or storage
area
3. On your porch, lawn, garage, or other part of (IF P3a<>2: your/(IF P3a=2): your
building’s) property
4. Inside somewhere else where you were staying overnight or longer
5. (IF AGES 15+) At your place of work
6. (IF AGE<18) At school
7. (IF P8=yes) In a campus building such as a classroom or a lab
8. Somewhere else
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If L3 is code 1, 2 or 3 and CIR1a=2, go to Loc1
Otherwise, if L3 is code 1 or 2 or 3, and P8=yes, go to Loc5.
Otherwise, if L3 is code 1 or 2 or o 3, go to Module PR.
Otherwise, continue.
Loc1. Did this happen in the city, town or village where you live (now)? [CIR7a, modified]
1. Yes - Go to Loc2
2. No – Continue
Loc1a. Did this happen in the U.S. or in another country? [CIR7a, modified]
1. In the U.S. - Continue
2. In another country – go to Module PR
Loc1b. Did this happen on an American Indian Reservation or on American Indian Lands? [CIR9]
1. Yes
2. No
If L1 is code 1, 2, 3, or 4 and P8=1, go to Loc 5.
If L1 is code 1,2, 3 or 4 or L3 is code 1, 2, 3 or 5, go to Loc8
If L3 is code 6 go to Loc3
Otherwise, continue
Loc2. Which of the following BEST describes where this happened. [CIR10a, modified]
1. At, in or near someone else’s home
2. At a business, such as a store, restaurant, bar, or office building
3. At a public building, such as a hospital or library
4. In a parking lot or garage
5. In an open area, on the street, or on public transportation
6. Or somewhere else? (specify) _________________________
If code 2 in Loc2, continue to Loc2e.
If (age = 12-18 or P8=yes) and L3 ne 6 (did not occur at school) continue.
Else Go to programmer note before Loc3.
L4. Did (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident occur when you were on the
way to or from school? [CIR135a, modified]
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1
2
Yes
No
All in L4, go to Loc8.
Loc2e. At what type of a business did (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident
happen? [CIR10e, modified]
1. A restaurant, bar, nightclub
2. A bank
3. A gas station
4. A store or shopping mall
5. An office
6. A factory or warehouse
7. Other (specify) ________________________________________
All in Loc2e, go to Loc8.
If code 6 in L3 and CIR1<>1, continue. Else go to Loc8.
Loc3. You said this happened at school. Did this happen inside a school building or somewhere
else on school property (school parking area, play area, school bus, etc)? [CIR 10g,
modified]
1. Inside a school building
2. On school property outside the school building (school parking area, play area, school
bus, etc.)
3. Other (specify) ________________________________________
If code 1 in Loc3, continue.
If code 2 or 3 in Loc3, go to Loc8
Loc4. Was it your school? [CIR17a]
1. Yes
2. No
All in Loc4, go to Loc8
Loc5. Where did this happen?
1
In or on the property of a university residence hall or dorm
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2
3
In or on the property of a fraternity or sorority house
In or on the property of other residential housing around the university
Loc8. How far from your home was it? [CIR19, modified]
1.
2.
3.
4.
A mile or less
More than a mile up to five miles
More than 5 miles up to fifty miles
More than 50 miles
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Presence Series
If CIR1=7 or 8, go to next MODULE. Otherwise, continue.
The next questions ask about who was there when (IF MORE THAN ONE CIR: this/IF ONE CIR:
the) incident (in MONTH) took place.
PR1.
Did you [IF H26+H27>1: or anyone you live with] see, hear, or have any contact with the
offender(s) as the incident was happening? [CIR20a, modified]
1
2
Yes
No
If code 1 in PR1 and H26+H27>1, go to PR2.
If code 2 to PR1, go to next MODULE.
PR2.
Who saw, heard, or had contact with the offender(s) as the incident was happening?
[CIR20b, modified]
1
2
3
Only you
Only someone else you live with
Both you and someone else you live with
All go to next MODULE.
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Victim-offender Relationship
VOINTRO This section asks about what you know about the offender(s).
VO1.
(IF PR1=no or PR2=2: To the best of your knowledge,) Was the crime committed by
only one or by more than one offender? [CIR60]
1
2
3
One
More than one
(IF PR1=no or PR2=2: Don’t know)
If no response to VO1, soft prompt to answer VO1, adding “To the best of your
knowledge,…”. If don’t know or still missing, go to VO2.
VO1a. Do you know who (the offender was/the offenders were)? [CIR 61, modified]
1
2
Yes
No
If code 2 in VO1a, continue. Else go to note before VO3.
VO2.
Do you know anything about any of the offenders? [CIR 61, modified]
1
2
Yes
No
If code 1 in VO2, go to note before VO3.
If code 2 in VO2, go to next MODULE.
IF CIR1=7 or 8, go to VO6.
Otherwise, go to VO3.
VO3.
(IF VO2=1: How did you learn what you know about the offender/offenders?)/(ELSE:
How did you find out who the [offender was/offenders were]? Mark all that apply. [CIR
58a]
1
2
3
You saw or heard the offender(s)
Someone you live with saw or heard the offender(s)
Someone else saw or heard the offender(s)
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4
5
6
7
8
9
You figured it out yourself
The police told you
The offender(s) admitted it
The offender(s) had threatened to do it, or had done it before
(IF CIR1=1-4) The stolen item(s) were found on the offender(s) or at the
offender(s) home
Other - Specify ______________________________________________
If code 1 in VO1 or VO2, go to VO6.
If code 2 in VO1, go to VO14.
VO6. Was the offender someone you knew, even slightly, or a complete stranger? [CIR62,
modified]
1
2
Someone you knew
Complete stranger
If code 1 in VO6, go to VO8.
If code 2 in VO6, go to VO7.
VO7.
Would you be able to recognize the offender if you saw him/her? [CIR63]
1
2
3
Yes
Not sure (possibly)
No
If code 1 or 2 in VO7, go to VO9.
If code 3 in VO7, go to VO11.
VO8.
Was the offender someone you knew by sight only, a casual acquaintance, or someone
you knew well? [CIR64, modified]
1
2
3
Knew by sight only
Someone you knew, but not well
Someone you knew well
If code 1 in VO8, go to VO9.
If codes 2 or 3 in VO8, go to VO10.
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VO9.
Did you know how the offender might be found, for instance, where he/she lived,
worked, went to school, or spent time? [CIR65a, modified]
1
2
Yes
No
All in VO9, go to VO11.
VO10. At the time of the incident, which of the following BEST describes how you knew the
offender? [CIR66a, modified]
1
(IF AGES 15+) A spouse or ex-spouse
2
Someone you were romantically involved with, dating, or casually seeing at the
time of the incident
3
An ex-boyfriend, ex-girlfriend, former fiancé(e), or someone you were no longer
dating or seeing
4
A relative
5
Someone else
VO10a.Specifically, how did you know the offender at the time of the incident? [CIR66a,
modified]
IF CODE 1 IN VO10, DISPLAY:
1
A husband or wife
2
An ex-husband or ex-wife
IF CODE 2 IN VO10, DISPLAY:
3
(IF AGES 15+) A live-in partner
4
(IF AGES 15+) A fiancé(e)
5
A boyfriend, girlfriend, or dating partner
6
Someone you were casually seeing
IF CODE 3 IN VO10, DISPLAY:
7
An ex-boyfriend, ex-girlfriend, or former fiancé(e)
8
Someone you were no longer dating or seeing
IF CODE 4 IN VO10, DISPLAY:
9
A parent or step-parent
10
(IF AGES 15+) A child or step-child
11
A brother, sister, step-brother, or step-sister
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12
Some other relative _______________________________________________
IF CODE 5 IN VO10, DISPLAY:
13
A friend or ex-friend
14
An acquaintance or a friend of a friend
15
A roommate or boarder
16
A schoolmate
17
A neighbor
18
(IF AGES 15+) A customer or client
19
(IF AGES 15+) A patient
20
(IF AGES 15+) A supervisor or former supervisor
21
(IF AGES 15+) An employee or co-worker or former employee or co-worker
22
A teacher or school staff
23
Some other non-relative______________________________________________
If code 3 or 15 in VO10a, go to VO13.
Otherwise, go to VO12.
VO11. Which of these BEST describes how you knew, or knew of, the offender? [NEW]
1
2
3
4
5
6
7
8
9
A friend of a friend
A schoolmate
A neighbor
(IF AGE 15+) A customer or client
(IF AGE 15+) A patient
(IF AGE 15+) Someone who worked at the same place as you
A teacher or school staff
Other – Specify
A stranger or someone of whom you have no knowledge
All in VO11, go to next MODULE.
VO12. Had you ever lived with this person? [2006 SVS 10b, modified]
1
2
Yes
No
If code 1 in VO12, go to VO13.
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If code 2 in VO12, go to next MODULE.
VO13. Were you living with this person at the time of (IF MORE THAN ONE CIR: this/IF ONE CIR:
the) incident in (MONTH/YEAR)? [2006 SVS, 10c modified]
1
2
Yes
No
All in VO13, go to next MODULE.
VO14. How many offenders were there? [CIR74]
__________
DON’T KNOW. Don’t know number of offenders
All, go to VO15.
VO15. Were any of the offenders someone you knew, even slightly, or were all of them
complete strangers? [CIR62, modified]
1
2
At least one was someone you knew
All were complete strangers
If code 1 in VO15, go to VO17.
If code 2 in VO15, go to VO16.
VO16. Would you be able to recognize any of them if you saw them? [CIR76]
1
2
3
Yes
Not sure (possibly)
No
If code 1 or 2 in VO16, go to VO18
If code 3 in VO16, go to note before VO20
VO17. Were any of the offenders someone you knew by sight only, casual acquaintances, or
someone you knew well? Mark all that apply. [CIR77a, modified]
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1
2
3
Knew by sight only
A casual acquaintance (IF AGE 12-17: (someone you knew, but not well))
Someone you knew well
If only code 1 in VO17, go to VO18.
If code 2 or 3 in VO17, go to VO19.
VO18. Did you know how any of the offenders might be found, for instance, where they lived,
worked, went to school, or spent time? [CIR78a, modified]
1
2
Yes
No
All in VO18, go to note before VO20.
VO19. At the time of the incident, did you know any of the offenders in any of the following
ways? (Mark yes or no to each) [CIR79a, modified]
a.
b.
(IF AGES 15+) A spouse or ex-spouse
Someone you were romantically involved with, dating, or casually seeing at the
time of the incident, but not a spouse or ex-spouse
c.
An ex-boyfriend, ex-girlfriend, former fiancé(e), or someone you were no longer
dating or seeing
d.
A relative
e.
Someone else
VO19a.
Specifically, how did you know them? Mark all that apply. [CIR79a, modified]
IF YES IN VO19.a, DISPLAY:
1
A husband or wife
2
An ex-husband or ex-wife
IF YES IN VO19.b, DISPLAY:
3
(IF AGES 15+) A live-in partner
4
(IF AGES 15+) A fiancé(e)
5
A boyfriend, girlfriend, or dating partner
6
Someone you were casually seeing
IF YES IN VO19.c, DISPLAY:
7
An ex-boyfriend, ex-girlfriend, or former fiancé(e)
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8
Someone you were no longer dating or seeing
IF YES IN VO19.d, DISPLAY:
9
A parent or step-parent
10
(IF AGES 15+) A child or step-child
11
A brother, sister, step-brother, or step-sister
12
Some other relative _______________________________________________
IF YES IN VO19.e, DISPLAY:
13
A friend or ex-friend
14
An acquaintance or a friend of a friend
15
A roommate or boarder
16
A schoolmate
17
A neighbor
18
(IF AGES 15+) A customer or client
19
(IF AGES 15+) A patient
20
(IF AGES 15+) A supervisor or former supervisor
21
(IF AGES 15+) An employee or co-worker or former employee or co-worker
22
A teacher or school staff
23
Some other non-relative______________________________________________
If code 3 or 15 in VO19a, go to VO22.
Otherwise, go to VO21.
If code 1 in VO15 or code 1 in VO17, continue. Otherwise, go to next MODULE.
VO20. How did you know, or know of, the offender(s)? Mark all that apply. [NEW]
1
2
3
4
5
6
7
8
9
A friend of a friend
A schoolmate
A neighbor
(IF AGE 15+) A customer or client
(IF AGE 15+) A patient
(IF AGE 15+) Someone who worked at the same place as you
A teacher or school staff
Other – Specify
A stranger or someone of whom you have no knowledge
All in VO20, go to next MODULE.
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VO21. Had you ever lived with any of them? [2006 SVS 10b, modified]
1
2
Yes
No
If code 1 in VO21, go to VO22.
If code 2 in VO21, go to next MODULE.
VO22. Were you living with any of them at the time of (IF MORE THAN ONE CIR: this/IF ONE
CIR: the) incident? [2006 SVS 10c, modified]
1
2
Yes
No
All in VO22, go to next MODULE.
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Offender Characteristics
IF VO1=1 OR PR2 = 1 or 3 THEN GO TO OCINTRO; Else go to next MODULE
IF VO1=1, GO TO OCINTRO.
IF VO1=2, GO TO OCINTRO_MULT.
OCINTRO This section asks for details about the offender.
OC1. Was the offender male or female? [CIR67]
1
2
Male
Female
OC2. How old would you say the offender was? [CIR68, modified]
1
2
3
4
Under 18
18 to 20
21 to 29
30 or older
IF OC2=1, CONTINUE. ELSE GO TO OC3
OC2a. Would you say the offender was…[CIR68, modified]
1
2
3
Under 12
12 to 14
15 to 17
OC3. Was the offender Hispanic or Latino? [CIR69]
1
2
Yes
No
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OC4. What race or races was the offender? You may select more than one. Mark all that apply.
[CIR70]
1.
2.
3.
4.
5.
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
OC6. Was the offender drinking or on drugs at the time of the incident? [CIR72a, modified]
1
2
3
Yes, the offender was drinking or on drugs
No, the offender was not drinking or on drugs
Don't know
ALL IN OC6, GO TO NEXT MODULE.
OCINTRO_MULT This section asks for more details about the offenders.
OC9. Were the offenders male or female? [CIR80a, modified]
1
2
3
All were male GO TO OC11
All were female GO TO OC11
They were both male and female
IF VO14=2, GO TO OC11.
OC10. Were most of the offenders male or were most of them female? [CIR80b]
1
Most were male
2
Most were female
3
They were evenly divided
OC11. How old would you say the youngest was? [CIR81, modified]
1
2
3
4
Under 18
18 to 20
21 to 29
30 or older
IF OC11=1, CONTINUE. ELSE GO TO OC12
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OC11a. Would you say the youngest offender was…[CIR81, modified]
1
2
3
Under 12
12 to 14
15 to 17
OC12. How old would you say the oldest was? [CIR82, modified]
1
2
3
4
Under 18
18 to 20
21 to 29
30 or older
IF OC12=1, CONTINUE. ELSE GO TO OC13
OC12a. Would you say the oldest offender was…[CIR82, modified]
1
2
3
Under 12
12 to 14
15 to 17
OC13. Were any of the offenders Hispanic or Latino? [CIR83a]
1
2
Yes GO TO OC14
No GO TO OC15
OC14. Were most of the offenders Hispanic, non-Hispanic, or were roughly an equal number
Hispanic and non-Hispanic? [CIR83b, modified]
1
2
3
Most of the offenders were Hispanic
Most of the offenders were non-Hispanic
A roughly equal number were Hispanic and non-Hispanic
OC15 Were the offenders… Mark all that apply. [CIR84a]
a.
b.
c.
White?
Black or African American?
American Indian or Alaska Native?
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d.
e.
Asian?
Native Hawaiian or Other Pacific Islander?
IF MORE THAN BOX MARKED IN OC15, GO TO OC16
ELSE, GO TO OC17
OC16. What race were most of the offenders? [CIR84c, modified]
(ONLY DISPLAY YES RESPONSES FROM OC15)
1
Most were White
2
Most were Black or African American
3
Most were American Indian or Alaska Native
4
Most were Asian
5
Most were Native Hawaiian or Other Pacific Islander
6
Roughly equal numbers of two or more races
OC18. Were any of the offenders drinking or on drugs at the time of the incident? [CIR86a,
modified]
1
2
3
Yes, some or all of the offenders were drinking or on drugs
No, none were drinking or on drugs
Don’t know
GO TO NEXT MODULE
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Self-Protection
If CIR1=7 or 8 (Attack or Sexual Contact) or PR2=1 or 3, continue. Otherwise go to next
MODULE.
IF VO1=1, USE “OFFENDER” IN THIS SERIES. IF VO1=2, USE “OFFENDERS”.
These next questions are about what you did when (IF MORE THAN ONE CIR: this/IF ONE CIR:
the) incident (in MONTH) occurred.
People may react differently to certain situations and it’s often not clear how one should react.
Everyone is different and every situation is different. These questions will help us get a better
picture of the range of things people have done in similar situations.
SP1. Which of the following BEST describes how you reacted during the incident? Mark all
that apply. [CIR41a, modified]
1
2
3
4
You did what the person told you to do
You didn’t do anything, froze or didn’t move
You did something or tried to do something to protect yourself or your belongings
You did or tried to do something else during the incident
If only a code 1 or 2 in SP1, go to SP3a.
If code 3 or 4 in SP1, go to SP2.
SP2. You said that you took some action during the incident. What did you do? Mark all that
apply. [CIR42a, modified]
1
2
3
4
5
6
7
8
9
10
You threatened or attacked the offender
You ducked or tried to avoid the offender(s)
You chased or warned the offender(s) off
You argued, reasoned, or pleaded with the offender
You got away or tried to get away, hid, or locked a door
You called the police or a guard
You tried to get someone else’s attention
You held onto your belongings
You stalled or distracted the offender(s)
Something else
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If code 1 in SP2, continue. Else go to note before SP2b.
SP2a. What did you do to attack or threaten the offender(s)? Mark all that apply. [CIR42a,
modified]
1
2
3
4
5
6
7
You attacked the offender(s) with a gun or fired a gun
You attacked the offender(s) with another weapon
You hit, kicked, or attacked the offender(s) in some other way
You threatened the offender(s) with a gun
You threatened the offender(s) with another weapon
You threatened the offender(s) in some other way
Something else _____________________________
If code 10 in SP2, continue. Else go to note before SP3.
SP2b. What other actions did you take during the incident? [CIR42b]
__________________________________________________
If CI1=1 ask SP3. Else go to SP3a.
SP3. Earlier, you said you were injured during (IF MORE THAN ONE CIR: this/IF ONE CIR: the)
incident. Did you (take that action/take any of these actions) …Mark one answer in each row.
[CIR43a, modified]
a.
b.
c.
Before you were injured
After you were injured
At the same time you were injured
Yes
Yes
Yes
No
No
No
SP3a. Overall, do you think that what you did helped the situation, made it worse, or had no
impact? [CIR48, modified]
1
2
3
Helped the situation
Made the situation worse
Had no impact on the situation
If PR2=2 or 3, go to SP5.
Otherwise, go to SP4.
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SP4. Besides you and the offender(s), was anyone age 12 or older present during the
incident? [CIR47, modified]
1
2
Yes
No
If SP4=1, go to SP5.
If SP4=2, go to next MODULE.
SP5. Did anyone else do or try to do anything to help you while the incident was going on?
[NEW]
1
2
Yes
No
If SP5=1, go to SP6.
If SP5=2, go to SP9.
SP6.
Who took these actions? Mark all that apply. [NEW]
1
2
3
Someone who was with you
Someone who was with the offender(s)
Someone who was there, but was not part of the incident
SP7. What did the person or people try to do to help you? Mark all that apply. [CIR49a,
modified]
1
2
3
4
5
6
They attacked or tried to attack the offender(s)
They defended you or your property without physically attacking the offender(s)
They chased or warned off the offender(s)
They argued, reasoned, pleaded or bargained with the offender(s)
They tried to get help
They did something else (specify)
SP8. Overall, did the actions of this person or people help the situation, make it worse, or
have no impact? [CIR48]
1
Helped the situation
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2
3
Made the situation worse
Had no impact on the situation
If PR2=2 or 3, or if SP4=1, continue. Else go to next MODULE.
SP9. (IF OC2a=1 or OC11a=1: Not including the offender,) W/were any of the other persons
who were present during the incident under the age of 12?
1
2
Yes
No
SP9a. Not counting yourself, (or) the offender (IF YES IN SP9: , or children under 12), did
anyone else get harmed, threatened with harm, or have any belongings taken or damaged in (IF
MORE THAN ONE CIR: this/IF ONE CIR: the) incident? [CIR52, modified]
1
2
Yes – How many? ________
No
If SP9=1, go to SP10.
If SP9=2, go to next MODULE.
SP10. [(IF RESPONSE TO COUNT IN SP9a: Of these (FILL) people, how many of them live with
you now?)/(IF NO RESPONSE TO COUNT IN SP9a: Thinking just about the other persons who
were present during the incident who were harmed, threatened with harm, or had property
taken or damaged … How many of these persons live with you now? (Do not include yourself,
the offender(s) or children under 12 years of age.)] [CIR54a, modified]
________
All, go to next MODULE.
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Hate Crimes
A hate crime is a crime of prejudice or bigotry that occurs when an offender targets someone
because of one or more of their characteristics or religious beliefs, such as:
•
•
•
•
•
•
Race
Religion
Ethnic background or national origin
A disability
Gender or gender identity
Sexual orientation
This could happen even if the offender falsely thinks you have certain characteristics or
religious beliefs.
HC2 Do you have any reason to suspect that this was a hate crime targeted at you? [CIR162,
modified]
1 Yes
2 No
If HC2=1, continue. Else go to HC3.
HC2a. Please indicate if you think each of the following was a reason you were targeted, even if
the offender falsely thought something about you. Mark one answer in each row. [CIR162,
modified]
A.
B.
C.
D.
E.
F.
Because of your race?
Because of your religion?
Because of your ethnic background or national origin?
Because of any disability you may have?
Because of your gender or gender identity?
Because of your sexual orientation?
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
All in HC2a, go to HC4
HC3. Do you have any reason to suspect this was a hate crime targeted at any of the people
you spend time with? [CIR163, modified]
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1 Yes
2 No
IF YES TO HC2 OR HC3, CONTINUE. ELSE GO TO NEXT MODULE.
HC4 Did the offender(s) say something, write anything, or leave anything behind at the crime
scene that would suggest it was a hate crime? [CIR164b]
1
2
Yes
No
IF HC4=1 THEN GO TO HC5
ELSE GO TO NEXT MODULE
HC5 Did any of the following things happen? Mark one answer in each row. [CIR165, modified]
a. The offender(s) made fun of you, made negative
comments, or used hurtful words, or abusive language
b. There was something at the scene, such as a swastika or a
burning cross, that made you think this was a hate crime
c. The police told you that this was a hate crime
d. From what you know, the offender(s) had committed
similar hate crimes in the past
Yes
No
Yes
No
Yes
Yes
No
No
e. The incident happened around a holiday, event, or place
commonly associated with a specific group, such as a Gay
Pride March, an ethnic church, or a special ed classroom
f. Other hate crimes had occurred in your local area
g. Some other reason _______________
Yes
No
Yes
Yes
No
No
GO TO NEXT MODULE
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Police Involvement Series
The next questions ask about whether the police got involved in (IF MORE THAN ONE CIR:
this/IF ONE CIR: the) incident (in MONTH).
PI1.
Did the police find out about (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident ?
[CIR 115, modified]
1. Yes
2. No
If code 1 in PI1, go to PI4
If code 2 in PI1, continue
If PI1 is missing, go to next MODULE
PI2a. Why did you decide not to contact the police? Mark all that apply. [CIR117a, modified]
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
You didn’t think it was important enough to report
You didn’t think the police would do anything about it
You weren’t sure who did it
It was too personal to report
You took care of it yourself
You reported it to an official other than the police
You didn’t think the police would believe you
You didn’t want to get into trouble with the police
You didn’t want the offender to get in trouble or face harsh consequences
You were worried the offender might get back at you
You weren’t sure it was a crime
Some other reason
If code 12 in PI2a, continue. Else go to PI3.
PI2b. What was the other reason why you did not contact the police? [CIR117a, modified]
1. You didn’t trust the police
2. You didn’t find out until it was too late to report
3. It would have been too much trouble to report it
4. You thought someone else would contact the police
5. Some other reason ____________
PI2c.
1.
2.
Check item. Is more than one reason marked in PI2 and PI2a? [CIR 117c]
Yes - CONTINUE
No - GO TO PI19
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PI3.
Which of these would you say was the most important reason why you did not contact
the police? [CIR 118, modified]
plus “No one reason is most important”
___________________________________
If PI2a=6 and (L3=6 or loc21=yes) then continue (school crime reported to someone other
than the police).
If PI2a ne 6 and (L3=6 or loc21=yes) then go to PI16a (not reported to someone other than
police and is a school crime)
Else go to PI19
PI2c. Did you report the incident to a school official or School Resource Officer? [NEW]
1. Yes (Go to PI19)
2. No
PI2d. Why did you decide not to contact a school official or School Resource Officer? Mark all
that apply. [CIR117a, modified]
1.
2.
3.
4.
5.
6.
7.
9.
10.
11.
12.
You didn’t think it was important enough to report
You didn’t think the Official or School Resource Officer would do anything about it
You weren’t sure who did it
It was too personal to report
You took care of it yourself
You didn’t think the police would believe you
You didn’t want to get into trouble with the Official or the School Resource Officer
You didn’t want the offender to get in trouble or face harsh consequences
You were worried the offender might get back at you
You weren’t sure it was a crime
Some other reason
ALL, GO TO PI19.
PI4.
Which of the following BEST describes who informed the police? [CIR 116a, modified]
1.
You informed the police yourself
2.
Someone you live with
3.
A school employee or School Resource Officer
4.
Some other official such as a security guard or a building manager
5.
The police were at scene
7.
Someone else told the police– specify ________________________________
If code 1, 2, 3, 4 or 7 in PI4, continue.
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If code 5, 6 in PI4, go to note before PI16b .
PI5.
(IF CODE 1 IN PI4: How did you first notify the police?/IF CODES 2-5 IN PI4: How did they
notify the police?) [New]
1.
2.
3.
4.
5.
6.
[You/They] called the police
[You/They] approached an officer or police car
[You/They] went to the police station
[You/They] used the Internet or a social media app
Some other way – specify ________________________________
(IF CODES 2-5 IN PI4) Don’t know
If code 1, 2, or 3 in PI5, go to PI9.
If code 4, 5 or 6 in PI5, go to PI10
PI9.
Which of the following BEST describes when the police were first contacted? [New]
1.
2.
3.
4.
5.
While the crime was happening
Within 10 minutes after the crime occurred
Within an hour after the crime occurred
Within a day after the crime occurred
Longer than a day after the crime occurred
PI10. What did the police do when they found out about the incident? Mark all that apply.
[CIR 121, modified]
1.
They came to you
2.
(IF PI5 ne 3) They told you to go to a police station
3.
They took a report over the phone
4.
They dealt with it through the mail
5.
They dealt with it through the Internet or a social media app
6.
Something else ______________________________________
7.
The police did nothing
If code 1 in PI10, go to PI13
If code 3 in PI10, continue
Otherwise, go to note before PI12
PI11. How satisfied were you with how the phone report was taken? [New]
1.
Very satisfied
2.
Somewhat satisfied
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3.
4.
5.
6.
Neither satisfied or dissatisfied
Somewhat dissatisfied
Very dissatisfied
IF CODES 2-5 IN PI4: Don’t know
If code 2-7 in PI10
PI12. Do you think the police should have come to you when they were contacted? [New]
1
Yes
2
No
All in PI12, go to note before PI16b.
If code 1 in PI10:
PI13. How satisfied were you with the time it took the police to get to you after they were
contacted? [New]
1.
Very satisfied
2.
Somewhat satisfied
3.
Neither satisfied or dissatisfied
4.
Somewhat dissatisfied
5.
Very dissatisfied
6.
IF CODES 2-5 IN PI4: Don’t know
PI14. Had the police told (you/the person who contacted them) how long it would take them
to get there? [New]
1.
Yes
2.
No
3.
IF CODES 2-5 IN PI4: Don’t know
PI15. Did the police do any of the following while they were there? Mark all that apply. [CIR
123a, modified]
1.
2.
3.
4.
5.
6.
7.
8.
They asked you questions about what happened
They questioned other witnesses or suspects
They looked around
They took evidence, such as fingerprints or a list of what was taken
They promised to watch over the crime scene
They promised to investigate
They made one or more arrests
They did not do any of these things
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PI16. Did the police do any of the following other things while they were there? Mark all that
apply. [NEW]
1.
2.
3.
4.
5.
6.
7.
8.
They calmed people down
They resolved the conflict
They gave advice about insurance
They gave information about your rights as a victim
They gave information about services that could help victims
They contacted emergency medical services
They did something else to help __________________________
They did not do anything to help
If (L3=6 or loc21=yes) and (PI2a ne 6 and PI4 ne 3) continue (school crime and did not report
to school official). Else go to note before PI16b.
PI16a. Did anyone report the incident to a school official or School Resource Officer (SRO)?
[NEW]
1. Yes
2. No
If HC2 or HC3=yes, ask PI16b. Otherwise go to PI17.
PI16b Did you tell the police that you believe the incident was a hate crime? [CIR166, modified]
1
2
Yes
No
Ask all:
PI17. Did you (or anyone you live with) have any later contact with the police about the
incident? [CIR124]
1.
Yes
2.
No
If code 1 in PI17, continue.
If code 2 in PI17 and code 1 in PI1, go to statement before PI20
If code 2 in PI17 and code 2 or 3 in PI1 , go to next MODULE
PI18. Thinking about these later contacts, did the police get in touch with you or did you get
in touch with them? [CIR125a]
1.
Police contacted you (or someone else you live with)
2.
You (or someone else you live with) contacted the police
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3.
PI19
Both
What did the police do to follow up on (IF MORE THAN ONE CIR: this/IF ONE CIR: the)
incident? Mark all that apply. [CIR 127a, modified]
1.
2.
3.
4.
5.
6.
7.
8.
They took a report on what happened
They questioned other witnesses or suspects
They watched over or promised to watch over the crime scene
(IF CIR1=3) They got your belongings back
They made one or more arrests
They stayed in touch
They did something else (specify)
They did not do anything to your knowledge
Next are some questions about how you feel the police handled (IF MORE THAN ONE CIR:
this/IF ONE CIR: the) incident. If more than one officer was involved, please think about how
you would rate them as a group.
PI20.
1.
2.
3.
4.
5.
How respectfully did the police treat you? [New]
Very respectfully
Somewhat respectfully
Neither respectfully or disrespectfully
Somewhat disrespectfully
Very disrespectfully
PI21. How satisfied were you with the amount of time the police gave you to tell your story?
[New]
1.
Very satisfied
2.
Somewhat satisfied
3.
Neither satisfied or dissatisfied
4.
Somewhat dissatisfied
5.
Very dissatisfied
PI22. How satisfied were you that the police did everything they could? [New]
1.
Very satisfied
2.
Somewhat satisfied
3.
Neither satisfied or dissatisfied
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4.
5.
Somewhat dissatisfied
Very dissatisfied
PI23. Taking the whole experience into account, how effectively did the police handle the
incident? [New]
1.
Very effectively
2.
Somewhat effectively
3.
Neither effectively nor ineffectively
4.
Somewhat ineffectively
5.
Very ineffectively
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Workplace Violence Series
If P5=1 or P6=1 then continue. Else go to next MODULE.
WV1. Did (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident occur while you were working
or on duty? [CIR135a, modified]
1
2
Yes
No
If WV1=1, continue. Else go to next MODULE.
If L1 ne 1 or L3 ne 1, 3, 5 (Did not occur on own property, inside home, at place of work)
WV2. Did (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident happen when you were on
your way to or from work? [CIR135a, modified]
1
2
Yes
No
IF L3=5 or WV=1 or WV2=1 (WORKPLACE VIOLENCE), CONTINUE
ELSE GO TO next MODULE.
WV3. The next questions are about the job you had at the time of (IF MORE THAN ONE CIR:
this/IF ONE CIR: the) incident. Were you employed by . . . [CIR138a]
1
2
3
4
5
A private company, business, or individual for wages
The Federal government
A State, county, or local government
Yourself (self-employed) in your own business, professional practice, or farm
A private not-for-profit, tax-exempt, or charitable organization?
IF WV3=1 or 4, continue. Else go to WV5.
WV4. Was this business incorporated? [CIR138b]
1
2
Yes
No
WV5. What is the name of the (company/government agency/business/non-profit
organization) where you were working at the time of (IF MORE THAN ONE CIR: this/IF ONE CIR:
the) incident? Remember, all answers to this survey are confidential. [CIR138c]
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_________________________
WV6. What kind of business or industry is this? What do they make or do where you were
working at the time of (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident? [CIR138d]
_________________________
WV7. Is this mainly . . . [CIR138e, modified]
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Agriculture
Forestry
Construction
Healthcare and Social Assistance
Manufacturing
Mining
Oil and Gas Extraction
Public Safety
Services
Transportation
Warehousing
Utilities
Retail trade
Wholesale trade
Something else
WV8. What kind of work were you doing at this job at the time of (IF MORE THAN ONE CIR:
this/IF ONE CIR: the) incident, that is, what was your occupation? [CIR138f]
_________________________
WV9. What were your usual activities or duties at this job? [NCVS-2, 138g]
_________________________
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Consequences II: Socio-emotional Problems
Being a victim of crime affects people in different ways. The next questions are about how (IF
MORE THAN ONE CIR: this/IF ONE CIR: the) incident may have affected you.
CS1
Did (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident lead you to have serious
problems with your (age 15+: job or) schoolwork, or trouble with people (age 15+: at
work or) at school? [CIR 36a, modified]
1. Yes
2. No
CS2
Did (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident lead you to have serious
problems with family members or friends, such as having more arguments with them,
losing trust in them, or feeling more distant from them? [CIR 36b, modified]
1. Yes
2. No
CS3
How upsetting has (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident been to you?
[CIR 36c, modified]
1. Not at all upsetting
2. Mildly upsetting
3. Moderately upsetting
4. Severely upsetting
If CS1=1 or CS2=1 or CS3=3 or 4, continue to CS4.
CS4
Here is a list of things you may have felt because of the incident. For each, please mark
whether you didn’t feel this way at all, you felt this way for less than a month, or you
felt this way for a month or longer. Mark one answer in each row. [CIR 37, modified]
Didn’t feel
Yes, for less Yes, for 1 month
this way
than 1 month or more
a. Angry
□
□
□
b. Shocked
□
□
□
c. Fearful
□
□
□
d. Depressed
□
□
□
e. Anxious or panicked
□
□
□
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f.
g.
h.
i.
CS5
Less confident
Sad
Annoyed
Empty
□
□
□
□
□
□
□
□
□
□
□
□
Have you felt any other emotions as a result of (IF MORE THAN ONE CIR: this/IF ONE
CIR: the) incident? [CIR37h/i, modified]
1. Yes What was it? __________
2. No
CS5a. Did you have difficulty sleeping because of the incident? [CIR38b, modified]
1
2
3
CS6
No
Yes, for less than one month
Yes, for one month or more
Have you talked to a psychologist, psychiatrist, counselor, or other mental health
professional about (IF MORE THAN ONE CIR: this/IF ONE CIR: the) incident? [New]
1. Yes (CS7)
2. No (PN CE1)
CS7
Did you have any out–of–pocket expenses for your mental health care, that is, expenses
that you do not expect to get paid back from insurance or some other source? [New]
1. Yes (CS8)
2. No (PN CE1)
CS8
How much were these out-of-pocket expenses? [New]
1
2
3
4
5
Less than $100
$100 to less than $500
$500 to less than $1000
$1000 to less than $5000
$5000 or more
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Consequences III: Economic Consequences
PN CE1 If CIR1=1 AND MV1=1 (vehicle was actually taken), ask CE1; else go to PN CE5:
CE1
What would you estimate was the value of the vehicle that was stolen or taken without
permission? [CIR 104b, modified]
1
2
3
4
5
CE2
Less than $500
$500 to less than $1,000
$1,000 to less than $5,000
$5,000 to less than $10,000
$10,000 or more
Did you get the vehicle back? [CIR 99, modified]
1. Yes (CE3)
2. No (PN CE4)
CE3
Was the vehicle damaged in any way? [New]
1. Yes, it was damaged beyond repair
2. Yes, there was some damage
3. No, there was no damage
PN CE4a
CE4
If MV1a=1 AND T1=1 GO TO CE4. ELSE GO TO PN CE5
Earlier you said some items were stolen along with the vehicle. What was the value of
these other items, including the value of anything you got back? [CIR 104b, modified]
1
2
3
4
5
Less than $25
$25 to less than $50
$50 to less than $100
$100 to less than $500
$500 or more
PN CE4b
After CE4, go to PN CE6.
PN CE5:
IF T1=1 OR MV1b=1, GO TO CE5. ELSE GO TO PN CE6.
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CE5
(Including cash) what would you estimate was the total value of the stolen items,
including the value of anything you got back? [CIR 104b, modified]
1
2
3
4
5
6
Less than $25
$25 to less than $50
$50 to less than $100
$100 to less than $500
$500 to less than $1,000
$1,000 or more
PN CE6 : If MV1a=1 or MV1b=1 or T1=1, ask CE6:
CE6
[Apart from the stolen vehicle did/Otherwise: Did] you get any of the stolen (money)
(or) (items) back? [CIR 106, modified]
1. Yes, you got all of it back (CE8)
2. Yes, you got some of it back (CE7)
3. No, you got none of it back (CE8)
CE7
(Apart from the cost of the vehicle,) What would you estimate was the total value of the
(other) items you got back? [CIR 108, modified]
1
2
3
4
5
6
Less than $25
$25 to less than $50
$50 to less than $100
$100 to less than $500
$500 to less than $1,000
$1,000 or more
Property damage
PN CE8 If CIR1=6, skip to CE13.
CE8
(Other than any stolen property) was anything that belonged to you or someone you
live with damaged or destroyed in (IF MORE THAN ONE CIR: this/IF ONE CIR: the)
incident? [CIR 110, modified]
1. Yes (CE9)
2. No (PN CE15)
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CE9
What was damaged (other than any stolen property)? Mark all that apply. [New]
1.
A vehicle (including parts)
2.
3.
4.
5.
6.
7.
8.
Something inside your home or apartment
A mailbox
Something outside of your home or apartment, such as doors, windows, or walls
Fences, walls, gates or items in a garden
A garage, shed, greenhouse or other structure on your property
An animal such as a pet or livestock
Other ____________________________________________________________
PN CE10
If CE9 = 1, ask CE10:
CE10 Was any of the damage a result of the offender trying to get into the vehicle? [New]
1
2
PN CE11
Yes
No
If CE9 = 3 or 4, ask CE11:
CE11 Was any of the damage to your house or apartment a result of the offender trying to get
inside? [New]
1
2
PN CE12
Yes
No
If CE9 = 6, ask CE12:
CE12 Was any of the damage to your garage, shed, greenhouse or other structure on your
property a result of the offender trying to get into the structure? [New]
1
2
Yes
No
CE13 (Excluding any costs you have already mentioned,) what was the total value of the
damage done (IF CIR1=6: in this vandalism)? If you don’t know the exact amount, please
give your best estimate. [New]
1
Less than $100
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2
2
3
4
$100 to less than $500
$500 to less than $1,000
$1,000 to less than $5,000
$5,000 or more
CE14 Did you need to stay somewhere else or move to a new home as a result of (IF MORE
THAN ONE CIR: this/IF ONE CIR: the) incident? [New]
1. Yes
2. No
Lost Work and Wages
PN CE15
If P6=1 or P6A=1 , ask CE15; else, go to next MODULE.
CE15 Have you taken any time off from work because of (IF MORE THAN ONE CIR: this/IF ONE
CIR: the) incident? [CIR 143 and 147a, modified]
1. Yes (CE16)
2. No (Next section)
CE16 How many days did you take off work? [CIR 144 and 148, modified]
1.
2.
3.
4.
5.
Less than one day
1 or 2 days
3 days to less than one full week
1 full week to less than a month
A month or more
CE17 Did you lose any pay for the time you took off? [CIR 145 and 149, modified]
1. Yes (CE18)
2. No (CE19)
CE18 About how much pay did you lose? [CIR 146 and 150]
1
2
Less than $100
$100 to less than $500
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3
4
$500 to less than $1000
$1000 or more
CE19 Did you lose your job or have to give up work as a result of (IF MORE THAN ONE CIR:
this/IF ONE CIR: the) incident? [New]
1. Yes
2. No
If CE19=No, continue. Otherwise, go to next section.
CE19a. Did you have to change your job as a result of (IF MORE THAN ONE CIR: this/IF ONE CIR:
the) incident?
1. Yes
2. No
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Victim Services (VS) Series
If A3=yes or (any in SV1a-e=yes and any in SV2a-e=yes) or CI1=yes or MV1=1 or B2=1 or CS3=3
or 4, continue. Else go to next MODULE.
The next questions ask about any help you might have gotten after (IF MORE THAN ONE CIR:
this/IF ONE CIR: the) incident (in MONTH) took place.
VS1a. Have you told any family, friends, co-workers or neighbors about the incident? [NEW]
1. Yes
2. No
VS1b. (IF VS1a=1: Other than [IF PI1=yes: the police or] family/friends) Have you told anyone in
a leadership or professional position about the incident who you thought might be able to help
you? Mark all that apply. [NEW]
1. (STUDENT=YES) Teacher, school counselor or school administrator
2. (AGES 15+) Employer or supervisor
3. Medical or mental health professional
4. Leader of a religious or community organization
5. Security guard or personnel, other than the police
6. Other (specify) ______________________
7. No, have not told anyone else
VS2. Besides any help you might have gotten from friends or family, have you received the
following kinds professional services because of the incident? Mark one answer in each row.
[NEW]
A. Hotline, helpline, or crisis line intervention?
B. Counseling, therapy, support groups, or help from a mental
health provider?
C. (If A3=yes or (any in SV1a-e=yes and any in SV2a-e=yes or
CI1=yes) Help or advocacy with medical care or medical
exams?
D. (If any in SV1a-e=yes and any in SV2a-e=yes) Sexual assault
exam by a doctor, nurse or other medical professional?
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Yes
No
No
Yes
No
Yes
No
109
E. Free or low cost legal services from an attorney?
F. Help with the legal process, such as with police interviews,
preparing for court, or going to court?
G. Help applying for victim compensation?
H. Help getting a restraining, protection, or no-contact order?
I. Short term or emergency financial assistance?
J. (If N_YOUTH>0 OR N_KIDS>0) Free or reduced cost childcare
for victims?
K. Housing, shelter or safehouse services?
L. Help getting the different types of services you needed?
M. Any other help or services? ____________________________
Yes
Yes
No
No
Yes
Yes
Yes
Yes
No
No
No
No
Yes
Yes
Yes
No
No
No
IF YES TO ANY IN VS2A-M, CONTINUE TO VS3
OTHERWISE GO TO VS4
VS3. How satisfied were you with (IF MORE THAN ONE YES RESPONSE IN VS2: each of the types
of services you received/IF ONLY ONE RESPONSE IN VS2: FILL CATEGORY FROM VS2)? Mark one
answer in each row. [NEW]
1.
2.
3.
4.
5.
Very satisfied
Somewhat satisfied
Neither satisfied or dissatisfied
Somewhat dissatisfied
Very dissatisfied
A. (IF VS2A=YES) Hotline, helpline, or crisis line intervention
B. (IF VS2B=YES) Counseling, therapy, support groups, or help from a mental health
provider
C. (IF VS2C=YES) Help or advocacy with medical care or medical exams (victims of violence
only)
D. (IF VS2D=YES) Sexual assault exam by a doctor, nurse or other medical professional (RSA
victims only)
E. (IF VS2E=YES) Free or low cost legal services from an attorney
F. (IF VS2F=YES) Help with the legal process, such as with police interviews, preparing for
court, or going to court
G. (IF VS2H=YES) Help getting a restraining, protection, or no-contact order
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H.
I.
J.
K.
L.
M.
(IF VS2G=YES) Help applying for victim compensation
(IF VS2I=YES) Short term or emergency financial assistance
(IF VS2J=YES) Free or reduced cost childcare for victims
(IF VS2K=YES) Housing, shelter or safehouse services
(IF VS2L=YES) Help getting the different types of services you needed
(IF VS2M=YES) Any other help or services you received
IF NO OR BLANK TO ANY IN VS2A-L, CONTINUE. OTHERWISE SKIP TO NEXT MODULE.
VS4. Were there any types of services that you TRIED to get BUT WERE UNABLE TO GET? [NEW]
1. Yes – GO TO VS5
2. No – GO TO VS7
VS5. Which of the following services did you TRY to get BUT WERE UNABLE TO GET? Mark all
that apply. [NEW]
1. (IF VS2A=NO OR BLANK) Hotline, helpline, or crisis line intervention
2. (IF VS2B=NO OR BLANK) Counseling, therapy, support groups, or help from a mental
health provider
3. (IF VS2C=NO OR BLANK) Help or advocacy with medical care or medical exams (Attack,
RSA, injury victims only)
4. (IF VS2D=NO OR BLANK) Sexual assault exam by a doctor, nurse or other medical
professional (RSA victims only)
5. (IF VS2E=NO OR BLANK) Free or low cost legal services from an attorney
6. (IF VS2F=NO OR BLANK) Help with the legal process, such as with police interviews,
preparing for court, or going to court
7. (IF VS2G=NO OR BLANK) Help getting a restraining, protection, or no-contact order
8. (IF VS2H=NO OR BLANK) Help applying for victim compensation
9. (IF VS2I=NO OR BLANK) Short term or emergency financial assistance
10. (IF VS2J=NO OR BLANK) Free or reduced cost childcare for victims (victims w/children
only)
11. (IF VS2K=NO OR BLANK) Housing, shelter or safehouse services
12. (IF VS2L=NO OR BLANK) Help getting the different types of services you needed
13. Other (specify)_________________________________________
IF YES TO ANY IN VS5A-L, CONTINUE. OTHERWISE SKIP TO NEXT MODULE.
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VS6.
Were any of the following reasons why you didn’t actually get the services you needed
after the incident? Mark one answer in each row. [NEW]
A. The services you needed were not available in your area?
B. You did not think you were eligible for services, or you were told
you were not eligible?
C. You did not have transportation?
D. (IF CHILDREN IN HH) You did not have childcare?
E. The service provider did not have enough resources to help you?
F. You could not take time off work or school?
G. The services were not available in your language?
H. It was taking too much time or effort?
I. You didn’t want to get the offender in trouble or face harsh
consequences?
J. You were afraid of what the offender might do?
K. Some other reason? (Specify) ___________________________
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
Yes
Yes
No
No
ALL IN VS6, SKIP TO NEXT MODULE. IF NO TO ALL IN VS2A-M AND NO TO VS4, CONTINUE.
OTHERWISE SKIP TO NEXT MODULE.
VS7. You said you didn’t try to get any services. Did you want any services? [NEW]
1
2
Yes
No
IF YES TO VS7, GO TO VS8. OTHERWISE, SKIP TO NEXT MODULE.
VS8. Please indicate whether or not each of the following were reasons why you did not try
to get any services. Mark one answer in each row. [NEW]
A.
B.
C.
D.
E.
You did not know what help or services were available
You did not have transportation
(IF CHILDREN IN HH) You did not have childcare
You could not take time off work or school
You didn’t want to get the offender in trouble or
face harsh consequences
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Yes
Yes
Yes
Yes
No
No
No
No
Yes
No
112
F. You were afraid of what the offender might do
G. Some other reason (Specify) ___________________________
Narrative
Yes
Yes
No
No
Thank you for providing this information about the incident (in MONTH). On the next screen,
you will be asked to describe the incident in your own words. Remember that you can skip any
question, including this one, if you don’t recall particular details, or don’t want to answer.
N1. To check that the survey questions have captured what happened in this incident, please
describe the incident in your own words. Depending on your situation, this might include who
did it, where it occurred, what was taken, whether you were injured or any other details you
feel are important to understand what happened. [CIR174, modified]
_____________________________________________________________
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Person Characteristics II
The next questions ask about you.
PNP8 Ask if P5=2.
P8.
Earlier you said you did not have a job or business last week. During the past 4 WEEKS,
have you been ACTIVELY looking for work? [new, from ACS 36]
Yes ......................................................................................... 1
No .......................................................................................... 2
PNP9 Ask if P6=1 (no job last week but job in past 6 months), else go to PNP11:
P9.
Earlier you said you had a job or worked at a business at some time in the past 6
months. Did that (job/work) last 2 consecutive weeks or more? [75c]
Yes ......................................................................................... 1 (P10)
No .......................................................................................... 2 (P19)
P10.
When did that job end? [new]
___ ___ / ___ ___ / ___ ___ ___ ___
MM/DD/YYYY
IF THERE IS ANY DATA IN WV3-WV9 THEN GO TO P11a. Otherwise go to instruction after
P11a:
P11a. Earlier you said that an incident happened while you were at work. Have you changed
your job since then? [NEW]
Yes (go to P11)
No (go to P20)
PNP11 Ask if P5=1 (job last week) or P9=1 (2+ weeks of work), else go to P20:
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P11.
(Earlier you said you had a job or worked at a business last week.) The next questions
are about your (current main/most recent) job. (Are/Were) you employed by . . . [NCVS2, 138a]
DISPLAY: If P5=1, display “Earlier . . .,” “current main,” and “Are.” If P9=1, display “most
recent” and “Were.”
A private company, business, or individual for wages, ............................................ 1
(P12)
Federal government, ................................................................................................. 2
(P13)
A sState, county, or local government, ..................................................................... 3
(P13)
Yourself (self-employed) in your own business, professional practice, or farm, or . 4
(P12)
A private not-for-profit, tax-exempt, or charitable organization? ........................... 5
(P13)
P12.
(Is/Was) this business incorporated? [NCVS-2, 138b]
DISPLAY: If P9=1 and P11=4, display “Was”; else display “Is.”
Yes ......................................................................................... 1
No .......................................................................................... 2
P13.
What is the name of the (company/government agency/business/non-profit
organization) for which you work(ed)? [NCVS-2, 138c]
P14.
What kind of business or industry is this? [NCVS-2, 138d]
P15.
Is this mainly . . . [modified NCVS-2, 138e]
Agriculture ............................................................................. 1
Forestry .................................................................................. 2
Construction........................................................................... 3
Healthcare and Social Assistance........................................... 4
Manufacturing ....................................................................... 5
Mining .................................................................................... 6
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Oil and Gas Extraction ............................................................ 7
Public Safety ........................................................................... 8
Services .................................................................................. 9
Transportation .......................................................................10
Warehousing ..........................................................................11
Utilities ...................................................................................12
Retail trade ............................................................................ 13
Wholesale trade ..................................................................... 14
Something else ...................................................................... 15
P16.
What kind of work (do/did) you do, that is, what (is/was) your occupation? [NCVS-2,
138f]
P17.
What (are/were) your usual activities or duties at this job? [NCVS-2, 138g]
The next questions ask about any health conditions, impairments, or disabilities you may have.
(NCVS-2, 168; Near Term Change to NCVS, 2016)
P20.
Are you deaf or do you have serious difficulty hearing? [NCVS-2, 169a]
Yes ......................................................................................... 1
No .......................................................................................... 2
P21.
Are you blind or do you have serious difficulty seeing even when wearing glasses?
[NCVS-2, 169b; Near Term Change to NCVS, 2016]
Yes ......................................................................................... 1
No .......................................................................................... 2
Because of a physical, mental, or emotional condition, do you have serious difficulty:
P22.
. . . concentrating, remembering or making decisions? [NCVS-2, 170a(1; Near Term
Change to NCVS, 2016)]
Yes ......................................................................................... 1
No .......................................................................................... 2
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P23.
. . . walking or climbing stairs? [NCVS-2, 170a(2); Near Term Change to NCVS, 2016]
Yes ......................................................................................... 1
No .......................................................................................... 2
P24.
. . . dressing or bathing? [NCVS-2, 170a(3); Near Term Change to NCVS, 2016]
Yes ......................................................................................... 1
No .......................................................................................... 2
P25.
(IF AGE 15+) Because of a physical, mental, or emotional condition, do you have
difficulty doing errands alone such as visiting a doctor's office or shopping? [NCVS-2,
170b; Near Term Change to NCVS, 2016]
Yes ......................................................................................... 1
No .......................................................................................... 2
P26
Are you Hispanic or Latino (if female, Latina)? [23]
Yes ......................................................................................... 1
No .......................................................................................... 2
P27.
Which one or more of the following would you say is your race? Select one or more. [24]
White ..................................................................................... 1
Black or African American ..................................................... 2
American Indian or Alaska Native ......................................... 3
Asian ...................................................................................... 4
Native Hawaiian or other Pacific Islander ............................. 5
______________________________________________________
PNP28 IF {H9}1, FILL AS “MARRIED.” (P28 asked of adults only)
P28. Are you now . . . [18]
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Married, ................................................................................ 1
Widowed, .............................................................................. 2
Divorced, ............................................................................... 3
Separated, or ......................................................................... 4
Never married? ..................................................................... 5
PN: IF {P28}1, AND {H9} NE 1, ASK:
P30.
Is your spouse living with you? [NEW] (P30 asked of adults only)
Yes ......................................................................................... 1 (P29)
No .......................................................................................... 2 (P31a)
PNP32 If AGE GE 18, P28 NE 1, H9 NE 2, and another adult in HH, ask:
P32. Do you live with a boyfriend, girlfriend, or partner? [New, from CPS] (P32 asked of adults
only)
Yes ......................................................................................... 1
No .......................................................................................... 2
Programming note: The questions about sexual orientation and gender identity will be asked of
respondents age 18 and older.
PNP35 If Male, ask:
P35. Which of the following BEST represents how you think of yourself? [New, from NHIS;
Near Term Change to NCVS, 2016 ]
Gay ........................................................................................ 1 [skip to P37]
Straight, that is, not gay ........................................................ 2 [skip to P37]
Bisexual ................................................................................. 3 [skip to P37]
Something else ....................................................................... 4 [skip to P37]
PNP36 If Female or Other, ask: :
P36. Which of the following BEST represents how you think of yourself? [New, from NHIS;
Near Term Change to NCVS, 2016 ]
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Lesbian or gay ........................................................................1
Straight, that is, not lesbian or gay .......................................2
Bisexual .................................................................................3
Something else .......................................................................4
P37.
What sex was recorded on your original birth certificate? [NCVS, 2016)
Male ...................................................................................... 1
Female ................................................................................... 2
Refused
Don’t know
P39.
Do you currently describe yourself as male, female, or transgender? [NCVS, 2016]
Male ...................................................................................... 1 (P42)
Female ................................................................................... 2 (P42)
Transgender ........................................................................... 3 (P42)
None of these (SPECIFY) ……………………………………………………………………………. 4 [P41]
PNP42 Ask if responses in P39 and P40 do not match:
P42. Just to confirm, your sex was recorded as {INSERT RESPONSE FROM P37} at birth and
you now describe yourself as {P39}. Is that correct? [NCVS, 2016)
Yes .......................................................................................... 1
No ........................................................................................... 2 (Go back to P37 or P39 to
correct)
Refused
Don’t know
Citizenship
P43.
Are you a citizen of the United States? That is, were you born in the United States, born
in a U.S. territory, born of U.S. citizen parents, or did you become a citizen of the U.S.
through naturalization? [new, from ACS; Near Term changes NCVS, 2016]
Yes, born in the United States .............................................. 1 (P46)
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Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands,
or Northern Marianas ......................................................... 2 (P45)
Yes, born abroad of U.S. citizen parent or parents ............... 3 (P45)
Yes, U.S. citizen by naturalization ......................................... 4 (P44)
No, not a U.S. citizen ............................................................. 5 (P45)
Military Service
P46.
Have you ever served on active duty in the U. S. Armed Forces, Reserves, or National
Guard? [new, from CPS; Near term changes to NCVS 2016]
Never served in the military ..................................................0 (Next Section)
Only on active duty for training in the Reserves
or National Guard ...............................................................1 (Next Section)
Now on active duty ...............................................................2
On active duty in the past, but not now ...............................3
P47.
When did you serve on active duty in the U.S. Armed Forces? Mark all that apply, even if
just for part of the time period. [new, from CPS; Near term changes to NCVS 2016]
September 2001 or later ....................................................... 1
August 1990 to August 2001 (including Persian Gulf War) ... 2
May 1975 to July 1990 .......................................................... 3
Vietnam Era (August 1964 to April 1975) ............................. 4
February 1955 to July 1964 ................................................... 5
Korean War (July 1950 to January 1955) .............................. 6
January 1947 to June 1950 ................................................... 7
World War II (December 1941 to December 1946) .............. 8
November 1941 or earlier ..................................................... 9
HOUSEHOLD CHARACTERISTICS II [ASK OF HH RESPONDENT ONLY]
H26a. Thinking about all of the people who lived in your household in the past 12 months,
which category represents the TOTAL combined income ? This includes money from
jobs, net income from business, farm or rent, pensions, dividends, interest, Social
Security payments, and any other money income received by the people in this
household who are 14 years of age or older. [Near Term Change to NCVS, 2016]
NCVS Redesign
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120
1
2
Less than $30,000
$30,000 or more
H26b. Was it…
(IF LESS THAN $30,000 IN H26a)
Less than $5,000 ................................................................... 1
$5,000 to $7,499 ................................................................... 2
$7,500 to $9,999 ................................................................... 3
$10,000 to $12,499 ............................................................... 4
$12,500 to $14,999 ............................................................... 5
$15,000 to $17,499 ............................................................... 6
$17,500 to $19,999 ................................................................ 7
$20,000 to $24,999 ............................................................... 8
$25,000 to $29,999 ............................................................... 9
(IF $30,000 OR MORE IN H26a)
$30,000 to $34,999 ............................................................... 10
$35,000 to $39,999 ............................................................... 11
$40,000 to $49,999 ............................................................... 12
$50,000 to $74,999 ............................................................... 13
$75,000 to $99,999 ............................................................... 14
$100,000 to $149,999 ........................................................... 15
$150,000 to $199,999 ........................................................... 16
$200,000 or more ................................................................. 17
H27.
At any time during the past 12 months, did anyone who lives there receive any kind of
welfare or public assistance from a state or local welfare office – any food or housing
benefits, welfare-to-work assistance, emergency help, or anything like that? (new:
modified from Survey of Income and Program Participation)
Yes .......................................................................................... 1
No .......................................................................................... 2
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121
H28.
How often do you worry that your total income (for everyone who lives there) will not
be enough to meet your expenses and bills? (new National Survey of Families and
Households)
Almost all the time ................................................................. 1
Often ..................................................................................... 2
Once in a while ...................................................................... 3
Hardly ever ............................................................................. 4
Never ..................................................................................... 5
Please click on the “submit” button below to submit your responses. Thank you for your
participation.
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Attachment 2
NCVS Redesign
Usability Testing Protocol
INTRODUCTION
Thank you for taking the time to help us today. The session will take approximately an hour and a half.
I’ll give you a little background on what we’ll be doing today.
Westat is working with the Bureau of Justice Statistics, which is part of the U.S. Department of Justice.
We are interested in how people think about different experiences that may happen to them to help us
test questions that may be used on the National Crime Victimization Survey. The NCVS is administered
every year nationwide and collects information on people’s experiences with crime and victimization.
(YOUTH: Anyone age 12 or older is eligible to be selected for this national survey.) The goal of this
interview is to get your feedback on the online survey to make sure it is easy to understand and navigate
and that the questions make sense to you.
Today, I am going to ask you to go through the whole questionnaire as a survey respondent. (REMOTE
INTERVIEWS: In a moment, I’m going to pass control over to you.) I am going to watch you as you do this
and will take some notes as you go through the survey. Every now and then, I will stop you and we’ll talk
about what you are seeing on the screen or how you decided on your answer to the question. If
anything is confusing for you, or if you’re not sure how to answer a question or are unsure what to do
next, just tell me.
This is a research project and your participation is voluntary. You can skip any question and you can stop
at any point. We would very much appreciate your permission to (IN PERSON: audio record/REMOTE:
audio and video record) this conversation. The recording will be used for note-taking purposes only and
may be (listened to/watched) only by members of the project or the BJS staff. It will be destroyed when
the project is over. When we are finished, we will give you (ADULTS: 60/YOUTH: 40) dollars to offset the
cost of your participation.
INFORMED CONSENT
ADULTS: HAND THE CONSENT FORM TO PARTICIPANT, ANSWER ANY QUESTIONS, AND OBTAIN
CONSENT BEFORE CONTINUING. This form contains more information about the research and your
rights in this interview. Please read it over and let me know if you have any questions. (ANSWER
QUESTIONS) If you are willing to take part in the study, please sign both copies. One copy is for you, and
I will hold onto the other.
YOUTH: HAND THE ASSENT FORM TO PARTICIPANT, ANSWER ANY QUESTIONS, AND OBTAIN VERBAL
ASSENT BEFORE CONTINUING. This form has more information about the research and your rights in
this interview. Let me know if you have any questions. (ANSWER QUESTIONS) If you are willing to take
NCVS Redesign – Usability Testing Protocol Wave 1
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Attachment 2
part in the study, please check off the box at the bottom of the form and I will sign at the bottom. One
copy is for you, and I will hold onto the other.
[START RECORDER AND GET ORAL PERMISSION TO RECORD.] It is [DATE AND TIME], do I have your
permission to (audio/video) record this conversation? ~~~~Thank you.
Do you have any questions before we get started? I am going to hand over control of the computer to
you and will watch as you answer the questions. Every now and then we will stop to talk about the
questions and the web site.
PART A. ISSUE LOG
Any time the respondent has issues with navigation or questions, record the question number and a few
words about the problem on the Issue Log. Use the Code Key to determine what probes to ask about the
issue.
PART B: QUESTION-SPECIFIC PROBES
Person Characteristics I
P1
What did you think about the way this screen looks?
How did you decide whether to answer in months,
years, or both?
Police Ask-All/Community Measures
Probe to get R’s reaction to the grid format.
What did you think about the way this screen looks?
How easy or hard was it to answer the questions on
this screen? What made it easy/difficult?
Screener
6 month calendar
When R first encounters calendar:
Did you notice the calendar?
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Attachment 2
What did you think about this calendar?
How did the calendar help you, if at all, to figure out
if the incident happened in the past 6 months?
When would you use it?
What would you change, if anything?
Periodically throughout as the calendar pops up, note how respondent is using the calendar. Probe
why/why not using.
Did you use the calendar to help you remember if
this incident happened in the past 6 months? (Probe
to understand why/why not)
Was it helpful to show the 6-month calendar again
on this screen? (Explain)
Incident counting probes (How many times did ____ happen in the past 6 months?)
When R first encounters the incident counting probe:
Do you have any feedback on this screen before we
move on?
De-duping probes (Is this incident part of any other incident you have already mentioned?)
When R first encounters the de-duping probe:
In your own words, tell me what this question is
asking.
How did you decide how to answer to this question?
Interleaving
Ask when R first encounters interleaving questions:
What did you think about being asked some followup questions after you reported an incident?
IF ANSWERED YES TO ANY: Just to confirm, did this
happen as a part of the incident you just mentioned
[POINT TO TEXT AT TOP OF PAGE]?
Did you read the text at the top of the page? In your
own words, what are these follow-up questions
asking you to do?
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Attachment 2
Transition from screener to CIR – CIR 1
What do you think about this page?
IF MORE THAN ONE INCIDENT: Does this page tell
you what you need to know about the incident you
are going to be asked about?
IF MORE THAN ONE BULLET POINT APPEARS ON
SCREEN: Thinking about what happened to you in
this incident, what do you think of the way we’ve
ordered this list?
IF NEEDED: Is there a better order that would make
more sense to you? (EXPLAIN)
Do you have any other feedback on this page before
we move on?
Display text for offender definition:
YOUTH: Have you heard of the word “offender”
before?
How do you feel about using the word “offender” to
describe the person or persons who did this to you?
IF NEEDED: What word would you use to describe
the person or persons who did this to you?
CRIME INCIDENT REPORT – CIR
If R answered about more than one incident in screener, note in issue log if he/she switches to another
incident during the CIR or answers about multiple incidents at the same time.
SV1
What did you think about the look of this page with
the yes/no questions?
How easy or hard was it to answer the questions in
the grid? What made it easy/hard?
Module A - Attacks
Ask after respondent finishes module:
What did you think of this series of questions?
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Attachment 2
What did you think about the order of the
questions?
How well did these questions describe what
happened to you?
Were there any questions that were hard or
frustrating to answer?
Module CI – Injuries
CI1
What do you think this question is asking?
What kinds of injuries do you think it means to
include? Exclude?
How did you decide whether to answer yes or no?
CI2/CI2a
How did you decide what answers to mark?
How easy or hard was it to find categories that fit
the types of injuries you had?
CI6
What do you think this question is asking?
What kinds of medical or dental professionals were
you thinking about?
CI7
What do you think this question is asking?
How did you decide on your answer?
CI10
What do you think this question is asking?
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How did you decide on your answer?
CI11
How easy or hard was it to answer this question?
How sure are you of your answer?
Module T – After T2a/T2b
How well did these options describe what was
stolen from you?
Were there any responses missing that you were
looking for?
Location Series
Ask after respondent finishes Location Series:
How well do these questions describe where the
incident happened?
Is there anything else about the location of the
incident that was not covered?
Were there any questions that were difficult or
frustrating to answer?
Victim Offender Relationship: VO19
What did you think about the look of this screen?
How easy or hard was it to answer the questions on
this screen? What made it easy/hard?
Self Protection: SP2
How easy or hard was it to answer this question?
What do you think about this list of options?
Is there anything missing from the list?
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Attachment 2
Hate Crimes: HC1
Can you tell me what this definition of hate crimes
means in your own words?
(IF YES) How did you decide on your answer to this
question?
Police Involvement PI2a
How easy or hard was it to answer this question?
What do you think about this list of options?
Is there anything missing from the list?
Consequences – Socio Emotional Series
CS1
What do you think is meant by “serious problems”?
(IF YES) What made you decide that your problems
were serious?
CS2
(IF YES) How did you decide on your answer to this
question?
CS4
(IF YES TO ANY) How easy or hard was it to decide on
your answers to these questions?
Were any of the categories confusing or unfamiliar
to you?
CS8
How easy or hard was it to answer this question?
How sure are you of your answer?
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Attachment 2
Consequences – Economic Series
CE1/CE4/CE5/CE7/CE13/CE18
How easy or hard was it to answer this question?
How sure are you of your answer?
CE16
How did you decide how to answer this question?
How sure are you of your answer?
Victim Services: VS2
How easy or hard was it to answer this question?
What do you think about this list of options?
Is there anything missing from the list?
Is anything on this list confusing?
Narrative
How easy or hard was it to answer this question?
What did you think about having to type in your
story?
Do you think what you typed in is the whole story or
are there pieces you left out? (If so, why did you
decide to leave out those pieces?)
DEBRIEFING
General
Now that you’ve worked through the questionnaire,
what are your overall thoughts on it?
What did you like about the survey?
What didn’t you like about the survey?
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Attachment 2
Were there any features or things about the web
survey design that you particularly liked?
Were there any features or things about the web
survey design that you didn’t like?
What did you think about the way the
questions looked on the screens, in terms of the font,
the font size, and being able to find the buttons to
click for your answers?
How about the background color?
What did you think about the screens that were
arranged in grids, with rows of questions for you to
answer?
Were there any web design features that you felt
were missing that would have helped you in
completing the questionnaire?
Did you have any problems with going from screen to
screen?
Do you have any feedback for me on the amount of
scrolling up and down that you had to do on screens?
Do you have any feedback for me on the amount of
clicking you had to do on the screens?
If respondent had more than one incident that happened to them:
In the 2nd half of the survey, you answered
questions about ONE of the incidents that
happened to you in the past 6 months. Was it clear
that you were ONLY supposed to be answering
about that incident?
(IF UNCLEAR, PROBE TO FIND OUT WHAT
CONFUSED THEM)
Burn line
While you were answering about the specific
incident that happened to you, did you happen to
notice the reminder at the top of the screens to
make sure you know which incident you were being
asked about?
How did it help you, if at all?
Do you have any other thoughts for me on your
experiences completing the survey?
Thank you! (END RECORDING, SEND RESPONDENT BACK TO HOST OR PROVIDE INCENTIVE)
NCVS Redesign – Usability Testing Protocol Wave 1
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DK/Ref: Tell me what
you’re thinking and
what you would do on
this screen.
Navigation
Switches/blends
incidents: Which
incident are you
thinking about here?
Changes response:
What caused you to
change your answer?
R skips Q: Say more
about why you want to
skip this question
R
Verbalizations
Backtracks to earlier
Q/page: Help me
understand why you
are trying to go back.
Says Q is repetitive:
Tell me more about
what makes it repetitive
R Behaviors
Asks Question: Help
me understand more…
Hesitation: Tell me
more about what you
are thinking?
Question
Number
Confusion: What do
you think this (question
or screen) is asking?
Attachment 3
General Probes: Tell me more about…
What are you thinking here…
What do you expect to happen when you…
Respondent ID ____________
Response
NOTES
Attachment 4
NCVS-R
Usability Testing Recruiting Screener
Rockville/LA
Hello, this is [NAME] from [Facility Name].
INCOMING: Thanks for calling us about participating in one of our studies. I just need to
get a little bit of background information to start.
OUTGOING: I’m calling about a study we’re helping the U.S. Bureau of Justice Statistics
with. Let me first tell you a little about it. The Bureau of Justice Statistics is testing an
online survey that will be given to households all over the country, and wants to be sure
the survey works well for different types of people. So we are trying to find both adults
and youth who are interested in helping us by answering the questions and giving their
reactions to them. If you are interested and eligible, we will invite you to an in-person
interview, which will take about 90 minutes. At the end of the in-person interview you will
receive $60 cash to help pay for your expenses in getting here. And if you have a youth
ages 12 to 17 in your household, we are also interested in interviewing youth in a
separate interview. Youth will receive $40 cash at the end of the interview. To see if you
or a youth are eligible for the study, I need to ask you a few questions. This will only take
about 5 minutes. Is this a good time? IF NO, ASK FOR A BETTER TIME TO CALL BACK.
1. How old are you? (RECRUIT A MIX)
________
REF
DK
IF UNDER 18, REF OR DK, INELIGIBLE. THANK AND END
2. When was the last time you participated in a research focus group or interview?
LESS THAN 6 MONTHS AGO
6 MONTHS AGO OR MORE
NEVER
REF
DK
IF LESS THAN 6 MONTHS AGO, REF OR DK, INELIGIBLE. THANK AND END.
1
Attachment 4
IF INELIGIBLE: Thank you for taking the time to answer these questions. You’re not
eligible to participate in the study at this time.
3. RECORD GENDER. (RECRUIT A MIX)
IF NECESSARY, ASK: What is your gender?
FEMALE
MALE
OTHER
DK
REF
4. During the last 12 months, did any of the following happen to you, personally, whether
or not you contacted the police about it? …
FOLLOW-UP: Did the person just TRY to do this, or did it actually happen?
YES,
YES, THIS
NO, THIS
SOMEONE
ACTUALLY
DID NOT
TRIED TO
HAPPENED
HAPPEN
1
2
3
1
2
3
c. Did someone attack you or try to attack you?
1
2
3
d. Did someone break into your home or try to
1
2
3
1
2
3
DO THIS
a. Did someone steal or try to steal your vehicle
or parts from your vehicle?
b. Did someone steal something else or try to
steal something from you?
break into your home?
e. Did someone vandalize your property?
IF CODE 3 TO ALL IN #4, SKIP TO #8.
IF CODE 1 OR 2 IN #4C, SKIP TO #5.
OTHERWISE, CONTINUE
2
Attachment 4
4f. Did you have any contact with the offender as the incident was happening?
YES
NO
DK
REF
RECRUIT NO MORE THAN 2 WHO ARE A CODE 1 IN ANY OF 4A-E.
RECRUIT AT LEAST 3 WHO EITHER ARE CODE 1 OR 2 IN 4C OR ARE “YES” IN 4F.
ALSO RECRUIT ONE EACH FROM 4A, 4B, 4D, 4E (EITHER CODE 1 OR 2, BUT
PREFERABLY CODE 2).
5. What is the highest grade or level of education you have completed? (RECRUIT A MIX)
LESS THAN HIGH SCHOOL
HIGH SCHOOL DIPLOMA/GED
SOME COLLEGE (INCLUDES ASSOCIATE’S)
COLLEGE GRADUATE (BA, BS)
GRADUATE/PROFESSIONAL DEGREE (MA, MS, MD, JD, PhD, etc.)
REF
DK
6. Are you of Hispanic, Latino, or Spanish origin? (RECRUIT AT LEAST 2 WHO SAY YES)
YES
NO
REF
DK
7.
What is your race? Please select one or more. (RECRUIT A MIX)
White
Black or African American
Asian
Native Hawaiian or other Pacific Islander
American Indian or Alaska Native
3
Attachment 4
7a.
Do you regularly use any of the following devices at home?
A cell phone that is a smartphone (IF YES, What brand is it? _____________________)
A cell phone that is not a smartphone
A tablet device (IF YES, What brand is it? _____________________________)
8.
Are you the parent or guardian of a youth ages 12 to 17?
YES
NO
REF
DK
IF CODE 3 TO ALL IN #4A-E AND NO TO #8, THANK AND TERMINATE.
IF YES IN #8, CONTINUE. ELSE GO TO CONTACT INFORMATION SHEET.
9. During the last 12 months, did any of the following happen to any of your children
between the ages of 12 and 17?
FOLLOW-UP: Did the person just TRY to do this, or did it actually happen?
YES,
YES, THIS
NO, THIS
SOMEONE
ACTUALLY
DID NOT
TRIED TO
HAPPENED
HAPPEN
1
2
3
1
2
3
1
2
3
DO THIS
a. Someone stole something or tried to steal
something from your child
b. Someone attacked or tried to attack your
child
c. Did any other type of crime happen to this
child over the past 12 months, even if it
was not reported to the police? (If yes,
specify)
_____________________________________
4
Attachment 4
RECRUIT AT LEAST 1 WHO IS CODE 1 OR 2 IN 9A.
RECRUIT AT LEAST 1 WHO IS CODE 1 OR 2 IN 9B.
RECRUIT 2 WHO ARE CODE 1 OR 2 IN 9C OR CODE 3 TO ALL IN #9.
(IF CODE 1 OR 2 TO 9A OR 9B, COLLECT AGE AND GENDER OF THAT CHILD.
OTHERWISE, COLLECT AGE AND GENDER OF ANY CHILD AGES 12 TO 17 IN HH)
10.
(IF CODE 1 OR 2 IN 9A or 9B) What is the age of the child that you were thinking
about when you answered yes to (this/these) question(s)?
(OTHERWISE) What is the age of one of your children who is between the ages of 12 and
17?
RECRUIT AT LEAST TWO WHO ARE 12-14.
RECRUIT AT LEAST TWO WHO ARE 15-17.
UNDER 12 - INELIGIBLE
12
13
14
15
16
17
18 OR OVER - INELIGIBLE
11.
What is this child’s gender? RECRUIT A MIX OF GENDER.
MALE
FEMALE
DK
REF
12. Is this child of Hispanic, Latino, or Spanish origin?
YES
NO
REF
DK
5
Attachment 4
13.
What is this child’s race? Please select one or more.
White
Black or African American
Asian
Native Hawaiian or other Pacific Islander
American Indian or Alaska Native
RECORD RESPONDENT NAME AND CONTACT INFORMATION ON CONTACT
INFORMATION SHEET.
IF INELIGIBLE: Thank you for taking the time to answer these questions. You’re not
eligible to participate in the study at this time.
6
Attachment 4
Contact Information – KEEP THIS DATA SEPARATE
FROM THE SCREENER AND STORE IN A LOCKED CABINET
IF ANY IN #4=CODE 1 OR 2 AND #8=NO: You are eligible for our study. We’d like to schedule
an interview to take place at {LOCATION}.
This will take at most 90 minutes and we will pay you $60 cash. May I please have your full
name and address? (We need your address so that we can send you directions. It will include a
map that shows you exactly where the room is).
IF ANY IN #4=CODE 1 OR 2 AND #8=YES: You and your child are both eligible for our study. If
you are willing to be interviewed, and to allow us to also interview your youth, we’d like to
schedule separate interviews with each of you to take place at {LOCATION}.
Let me read you the days and times I have available, and you can tell me what would be best
for both of you. This will take at most 90 minutes for each of you, but we can schedule the
interviews at the same time. We will pay you $60 cash, and your child $40 in cash. May I please
have your full name, your {son/daughter}’s first name, and your address? (We need your
address so that we can send you directions. It will include a map that shows you exactly where
the room is).
IF ALL IN #4=CODE 3 AND #8=YES: Your child is eligible for our study. If you are willing to
allow your child to be interviewed, and if she/he is willing to participate, we’d like to schedule an
interview with him/her to take place at {LOCATION}.
Let me read you the days and times I have available, and you can tell me what would be best
for him/her. This will take at most 90 minutes and we will pay your child $40 in cash. May I
please have your full name, your {son/daughter}’s first name, and your address? (We need your
address so that we can send you directions. It will include a map that shows you exactly where
the room is).
Adult Name
________________________________________________________________
Youth First Name
__________________________________________________________
Address ____________________________________________________________________
Adult Phone Number __________________________________________________________
Youth Phone Number __________________________________________________________
Adult Email Address____________________________________________________________
7
Attachment 4
We’d like to audio record the interview(s). This allows us to carefully review the
discussion and draw the proper conclusions. Will that be alright with you?
Yes
No
Date: __________________________
Time: __________________________
I will send the directions out to you shortly. If you have to cancel the interview(s), please call
back so that we can schedule someone in your place, OK? You can reach me at: [Recruiter’s
Phone Number].
IF #8=YES: We will also need you to sign a permission form to interview your child. I will send
you the form via email. After you have reviewed and signed the form, you can return it to us via
email, fax, or you can have your child bring it to the interview. Thank you! Please look for an
email later today.
PERMISSION FORM EMAIL TEXT
TO PARENT OR GUARDIAN OF ____________
Thank you for your interest in the research project we are doing for the US Bureau of Justice
Statistics. Attached you will find the parental permission form for the study. Please review this
form thoroughly. If you agree to let your child participate, sign and date the form. Your child will
also be asked if (he/she) agrees to participate in the interview. You can return the form to us by
email at [INSERT EMAIL ADDRESS] or by fax at [INSERT FAX NUMBER], or your child may
bring the permission form to the scheduled interview. We will only conduct the interview if we
have received your signed form and if your child agrees to participate.
Please let me know if you have any questions by emailing me at [EMAIL ADDRESS] or calling
[TOLL-FREE NUMBER].
Thank you,
8
Attachment 5
Research participants needed (Adults receive $60, Youth
receive $40)
Westat is seeking youth (age 12-17) and adults (18 years and older) to help test some survey
questions to be used in a national household crime survey. We are looking for individuals who
have been a victim of a crime or an attempted crime within the past 12 months. The in-person
interview will take about 90 minutes and will be held at Westat in Rockville, MD. Participants in
the study will be paid cash to help offset the costs of participation.
-
Adults will receive $60.
Youth (ages 12-17) will receive $40.
In the interview, participants will be asked to answer and give their reactions to an online survey.
The information you provide will be shared only with those working on the survey and you will
not be put on any marketing or mailing list.
If you are interested in participating and have been the victim of a crime or an attempted crime,
please call 1-855-414-9253, say you are calling about the national household crime survey, and
provide your name, phone number, and a good time to reach you.
Someone from Westat will contact you and ask some questions to determine if you are eligible.
Please understand that we may not be able to interview everyone who contacts us.
WESTAT
EOE
Attachment 6
Consent to Participate in an Interview
Purpose: We are inviting you to participate in a research activity. The research involves answering an online
survey about crimes you may or may not have experienced. You will then be asked for feedback on your
experiences filling out the questionnaire and how you understood the questions. The feedback will help us
improve the survey.
Sponsorship: Westat is conducting this project on behalf of the Bureau of Justice Statistics (BJS).
What is involved: We will be asking you to complete an online survey about different types of crimes you
might have experienced. We ask you some questions about how you understood the questions and if the online
survey was easy for you to fill out. Participation in this research project is voluntary, and you have the right to
stop at any time or to refuse to answer any question. The session will take approximately one and a half hours.
Confidentiality: We would like to record the interview. Sometimes it is helpful to review a portion of a
recording as we make recommendations for improving the survey. If the recording is reviewed later, it will only
be by a few Westat staff and possibly the client (BJS). If you choose not to have your interview recorded, that’s
okay, but we would like take notes to make sure that we don’t miss anything that you say.
To help keep everything private:
• Your name will not be recorded on the interview notes or reported in any reports.
• Everything that you say will be confidential – that is, no one outside the research team will know what
you told us.
• The things you say may be put in a written summary of this interview. Your name will not be linked to
any of your responses, though we may include quotes that you provide in our reports.
Benefits and risks: There are no known benefits for you to take part, but your answers will help us improve the
survey. There is a risk that some of the questions that we will ask you to talk about are about private and
sensitive things that may bother you. If thinking about the questions upsets you or makes you sad, you may
want to talk with a counselor. We will provide you with a list of resources at the end of the interview.
Questions: If you have any questions about the study, you can call Pamela Giambo, the project coordinator, at
240-453-2981. If you have questions about your rights and welfare as a research participant, please call the
Westat Human Subjects Protections office at 1-888-920-7631. Please leave a message with your full name, the
name of the research study that you are calling about (The N.C.V.S Redesign), and a phone number beginning
with the area code. Someone will return your call as soon as possible.
You will be paid $60 cash to help offset the costs of participation.
Please indicate your choice by checking one of the boxes below and signing and dating the form.
Yes, I agree to talk about questions that might be asked on a national survey and agree to be recorded.
Yes, I agree to talk about questions that might be asked on a national survey but do not agree to be
recorded.
No, I do not agree.
__________________________________
Your signature
_______________________________
Date
The Bureau of Justice Statistics (BJS) is authorized to conduct this data collection under 34 U.S.C. § 10132.
BJS will protect and maintain the confidentiality of your personally identifiable information (PII) to the fullest
extent under federal law. BJS, its employees, and its contractors (Westat staff) will only use the information you
provide for statistical or research purposes pursuant to 34 U.S.C. § 10134, and will not disclose your
information in identifiable form to anyone outside of the BJS project team without your consent. All PII
collected under BJS’s authority is protected under the confidentiality provisions of 34 U.S.C. § 10231. Any
person who violates these provisions may be punished by a fine up to $10,000, in addition to any other penalties
imposed by law. Further, per the Cybersecurity Enhancement Act of 2015 (6 U.S.C. § 151), federal information
systems are protected from malicious activities through cybersecurity screening of transmitted data. For more
information on how BJS and its contractors will use and protect your information, go
to https://www.bjs.gov/content/pub/pdf/BJS_Data_Protection_Guidelines.pdf.
Attachment 7
Parental Permission Form
The Bureau of Justice Statistics is preparing to conduct a national online survey that collects data on different types of
crimes. We are testing the questionnaire with youth (12-17) to make sure the online survey is easy to use and makes sense
to youth.
We would like your child’s help by having him/her fill out the online survey and giving feedback on filling it out. These
questions will be used to collect data on different types of crimes that may or may not have happened to your child. We are
interested in whether your child understands the questions and if the online survey is easy for him/her to complete. This will
help us figure out whether the survey is ready to be given to youth around the country. Your child’s participation in this
research project is voluntary, and your child has the right to stop at any time or to refuse to answer any question. You will
not be allowed to sit in on or observe your child’s interview.
We would like your permission to ask your child to participate in the interview. If you (and your child) agree, he/she will
spend about an hour and a half filling out the survey and talking with a Westat researcher about the questions. He/she will
receive $40 when we are finished to help offset the cost of participation.
It is entirely up to you whether we ask your child to participate, and then it is up to your child – your child does not have to
do this. If your child agrees to do the survey, he/she can stop answering questions at any point. If there is a question that
your child does not want to answer or talk about, he/she can skip it.
In order to have a complete record of all comments, we would like to audio-record the interview. Recordings allow us to
carefully review the discussion and draw the proper conclusions. If you or your child choose not to have the interview
recorded, that’s okay, but we would like take notes to make sure that we don’t miss anything.
To help keep everything private:
• Your child’s name will not be recorded on the interview notes or reported in any reports.
• Everything that he/she says will be confidential – that is, no one outside the research team will know your child’s
answers.
• The things your child says may be put in a written summary of the interview. Your child’s name will not be linked
to any responses, though we may include quotes that your child provides in our reports.
• Information collected during the interview will not be shared with anyone else outside of the research team (this
includes parents, your child’s school or the authorities).
There are no known benefits to taking part, but their answers will help us improve the survey. There is a risk that some of
the questions that we will ask your child to talk about are about private and sensitive things that may bother them. If
thinking about the questions upsets or makes your child sad, he/she may want to talk with a counselor. We have provided
a list of resources on the back of this form and will also provide those resources to your child.
If you have any questions about the study, you can call Pamela Giambo, the project coordinator, at 240-453-2981. If you
have questions about your child’s rights as a study participant, you can call Westat Human Subjects Protections office at
1-888-920-7631. Please leave a message with your full name, the name of the research study that you are calling about,
the N.C.V.S. Redesign, and a phone number beginning with the area code. Someone will return your call as soon as
possible.
Please indicate your choice by checking one of the boxes below and signing and dating the form.
Yes, I give my permission for you to ask my child to meet with a Westat researcher to talk about questions that
might be asked on a national survey and agree that the interview can be recorded.
Yes, I give my permission for you to ask my child to meet with a Westat researcher to talk about questions that
might be asked on a national survey but do not want the interview to be recorded.
No, I do not give you permission to talk with my child.
___________________________________
Your signature
_____________________________________
Date
The Bureau of Justice Statistics (BJS) is authorized to conduct this data collection under 34 U.S.C. § 10132.
BJS will protect and maintain the confidentiality of your personally identifiable information (PII) to the fullest
extent under federal law. BJS, its employees, and its contractors (Westat staff) will only use the information you
provide for statistical or research purposes pursuant to 34 U.S.C. § 10134, and will not disclose your
information in identifiable form to anyone outside of the BJS project team without your consent. All PII
collected under BJS’s authority is protected under the confidentiality provisions of 34 U.S.C. § 10231. Any
person who violates these provisions may be punished by a fine up to $10,000, in addition to any other penalties
imposed by law. Further, per the Cybersecurity Enhancement Act of 2015 (6 U.S.C. § 151), federal information
systems are protected from malicious activities through cybersecurity screening of transmitted data. For more
information on how BJS and its contractors will use and protect your information, go
to https://www.bjs.gov/content/pub/pdf/BJS_Data_Protection_Guidelines.pdf.
Resources for Youth
Counseling Hotlines
National Child Abuse Hotline:
Telephone: 1-800-422-4453
Website: https://www.childhelp.org/
Boys Town National Hotline:
Telephone: 1-800-448-3000
Website: http://www.boystown.org/hotline/Pages/default.aspx
The National Domestic Violence Hotline:
Telephone: 1-800-799-7233
Website: www.thehotline.org
The National Suicide Prevention Lifeline:
Telephone: 1-800-273-8255
https://suicidepreventionlifeline.org/
The National Sex Assault Hotline:
Telephone: 1-800-656-4673
Website: www.rainn.org
Services targeted to LGBTQ Youth
The Trevor Project:
Telephone: 1-866-488-7386
Website: http://www.thetrevorproject.org/
Victim Referral Services
Victim Connect:
Telephone: 1-855-484-2846
Website: http://victimconnect.org/
Attachment 8
Youth Permission to be in a Research Study
The Bureau of Justice Statistics is preparing to conduct a national online survey that collects data on different types of
crimes. We are testing the questionnaire with people under the age of 18 to make sure the online survey is easy to use and
makes sense to youth.
We would like your help today by showing you some of the questions that we would like to add to the survey. These
questions will be used to collect data on different types of crimes that may or may not have happened to you. We are
interested in whether you understand the questions and if the online survey is easy for you to fill out. This will help us to
improve the survey and figure out whether it is ready to be given to youth around the country.
If you agree to participate, we will spend about an hour and a half talking about the questions and you will receive $40 when
we are finished to help offset the costs of participation. Your parent already gave us permission to talk with you. But the
decision to participate is completely up to you.
You do not have to take part in this study – your participation is completely voluntary. If you agree to take part, you can
stop answering questions at any point. If there is a question that you do not want to answer or talk about, you can skip it.
There is no penalty for skipping any answers. Ask if you are not sure how to skip a question.
In order to have a complete record of all comments, we would like to audio-record the interview. Recordings allow us to
carefully review the discussion and draw the proper conclusions. If you choose not to have your interview recorded, that’s
okay, but we would like take notes to make sure that we don’t miss anything that you say.
To help keep everything private:
• Your name will not be recorded on the interview notes or reported in any reports.
• Everything that you say will be confidential – that is, no one outside the research team will know your answers.
• The things you say may be put in a written summary of this interview. Your name will not be linked to any of your
responses, though we may include quotes that you provide in our reports.
• Information collected during the interview will not be shared with anyone else outside of the research team (this
includes your parents, your school, or the authorities).
There are no known benefits for you to take part, but your answers will help us improve the survey. There is a risk that
some of the questions that we will ask you to talk about are about private and sensitive things that may bother you. If
thinking about the questions upsets you or makes you sad, you may want to talk with a counselor. We will provide you a
list of resources at the end of the interview.
If you have any questions about the study, you can call Pamela Giambo, the project coordinator, at 240-453-2981. If you
have questions about your rights as a study participant, you can call Westat Human Subjects Protections office at 1-888920-7631. Please leave a message with your full name, the name of the research study that you are calling about, the
N.C.V.S. Redesign, and a phone number beginning with the area code. Someone will return your call as soon as possible.
Please indicate your choice by checking one of the boxes below.
Yes, I agree to talk about questions that might be asked on a national survey and agree to be recorded.
Yes, I agree to talk about questions that might be asked on a national survey but do not agree to be recorded.
No, I do not agree.
___________________________________
Interviewer signature attesting to youth assent
_____________________________________
Date
The Bureau of Justice Statistics (BJS) is authorized to conduct this data collection under 34 U.S.C. § 10132.
BJS will protect and maintain the confidentiality of your personally identifiable information (PII) to the fullest
extent under federal law. BJS, its employees, and its contractors (Westat staff) will only use the information you
provide for statistical or research purposes pursuant to 34 U.S.C. § 10134, and will not disclose your
information in identifiable form to anyone outside of the BJS project team without your consent. All PII
collected under BJS’s authority is protected under the confidentiality provisions of 34 U.S.C. § 10231. Any
person who violates these provisions may be punished by a fine up to $10,000, in addition to any other penalties
imposed by law. Further, per the Cybersecurity Enhancement Act of 2015 (6 U.S.C. § 151), federal information
systems are protected from malicious activities through cybersecurity screening of transmitted data. For more
information on how BJS and its contractors will use and protect your information, go
to https://www.bjs.gov/content/pub/pdf/BJS_Data_Protection_Guidelines.pdf.
Attachment 9
Resources
Counseling Hotlines
The National Domestic Violence Hotline:
Telephone: 1-800-799-7233
Website: www.thehotline.org
The National Suicide Prevention Lifeline:
Telephone: 1-800-273-8255
Website: http://suicidepreventionlifeline.org/
The National Sex Assault Hotline:
Telephone: 1-800-656-4673
Website: www.rainn.org
Victim Referral Services
Victim Connect:
Telephone: 1-855-484-2846
Website: http://victimconnect.org/
Attachment 10
Resources for Youth
Counseling Hotlines
National Child Abuse Hotline:
Telephone: 1-800-422-4453
Website: https://www.childhelp.org/
Boys Town National Hotline:
Telephone: 1-800-448-3000
Website: http://www.boystown.org/hotline/Pages/default.aspx
The National Domestic Violence Hotline:
Telephone: 1-800-799-7233
Website: www.thehotline.org
The National Suicide Prevention Lifeline:
Telephone: 1-800-273-8255
https://suicidepreventionlifeline.org/
The National Sex Assault Hotline:
Telephone: 1-800-656-4673
Website: www.rainn.org
Services targeted to LGBTQ Youth
The Trevor Project:
Telephone: 1-866-488-7386
Website: http://www.thetrevorproject.org/
Victim Referral Services
Victim Connect:
Telephone: 1-855-484-2846
Website: http://victimconnect.org/
Sample Screenshots for Usability Testing
| File Type | application/pdf |
| Author | Darby Steiger |
| File Modified | 2018-07-17 |
| File Created | 2018-07-17 |