Roster of Community-Based Correctional Facilities

Appendix F. Sample Roster Template

Census of State and Federal Adult Correctional Facilities
Roster of Community-Based Correctional Facilities
The purpose of this collection is to obtain a comprehensive list of community-based correctional facilities operated by a state DOC or contractor whose primary use is to house inmates for state prison authorities and regularly permits 50%
or more of its inmates to leave unaccompanied by staff for work, study, or treatment.
INSTRUCTIONS FOR COMPLETING FORM:
• There is a tab at the bottom of this Instructions worksheet for the Roster of Facilities worksheet.
• Please review the Roster of Facilities worksheet and make changes to the facility name or mailing address, if necessary.
• Please indicate whether each facility is open or closed.
• If the facility has closed, the remaining questions will be shaded out and you can go to the next facility on the list
• If the facility is open or you don't know if the facility is closed, continue answering questions that are not shaded out.
• If there are any additional facilities not listed, please add them to the bottom of the list and provide the information requested. If you are uncertain of whether a facility should be included or you would like to provide this information in
some other format, please call 1-800-334-8571 (Extension XXXXX).
• If you have any questions or need help completing the form, please call 1-800-334-8571 (Extension XXXXX).
• Following completion of the Roster of Facilities worksheet, please email the file to: [email protected] You may also submit via fax <> or via mail <> , if preferred.
What types of facilities are INCLUDED in this collection?
INCLUDE facilities operated under state jurisdiction, private companies, or local governments that primarily house inmates for state prison authorities in which 50% or more of the inmates are regularly permitted to leave unaccompanied by
staff for work, study, or treatment.
INCLUDE boot camps, residential community correction centers, prison farms, pre-release centers, halfway houses, road camps, forestry and conservation camps, vocational training facilities, drug and alcohol treatment facilities.
INCLUDE state-authorized parolee return-to-custody facilities.
What types of facilities are EXCLUDED in this collection?
EXCLUDE facilities housing only persons for juvenile correctional authorities.

Burden Statement
We estimate that your reporting burden will average 45 minutes, including the time needed to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information.
The approval of this data collection expires XX/XX/20XX. We cannot ask you to respond to a collection unless it displays a currently valid OMB control number. Send comments regarding this burden or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, Washington, DC 20531 and to the Office of Management and Budget, OMB No. XXXX-XXX, Washington, DC 20503.
Select the "Roster of Facilities" Tab at the bottom of this worksheet to begin reviewing the facilities.

Appendix F. Sample Roster Template

Name of person completing this form:

Census of State and Federal Adult Correctional Facilities
Roster of Community-Based Correctional Facilities

E-mail address:
Phone number:

Below is a pre-populated list of community-based correctional facilities that we believe meet the criteria specified in the instructions tab. For the purpose of this collection, community-based correctional facilities are defined as primarily housing inmates
for state prison authorities in which 50% or more of the inmates are regularly permitted to leave unaccompanied by staff for work, study, or treatment. This list, based on our most recent records, may include facilities which have closed or exclude
facilities which have opened since we last compiled our data.

Name of Facility
Please edit name of facility,
if needed

Mailing Address of Facility
Please edit address, if needed
Street

City

State

Zip Code

Is this facility
open or
closed?

Does this
facility hold
inmates for
your state?

Does this facility
allow 50% or more
of its inmates to
Is this facility is operated by the
leave the facility
DOC, a private company or a
unaccompanied?
local authority?

FILL NAME OF FACILITY 1

FILL STREET

FILL CITY

FILL
STATE

FILL ZIP
CODE

O Open
O Closed
O Don't know

O Yes
O No

O Yes
O No
O Don't know

O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities

FILL NAME OF FACILITY 2

FILL STREET

FILL CITY

FILL
STATE

FILL ZIP
CODE

O Open
O Closed
O Don't know

O Yes
O No

O Yes
O No
O Don't know

O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities

FILL NAME OF FACILITY 3

FILL STREET

FILL CITY

FILL
STATE

FILL ZIP
CODE

O Open
O Closed
O Don't know

O Yes
O No

O Yes
O No
O Don't know

O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities

FILL NAME OF FACILITY 4

FILL STREET

FILL CITY

FILL
STATE

FILL ZIP
CODE

O Open
O Closed
O Don't know

O Yes
O No

O Yes
O No
O Don't know

O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities

FILL NAME OF FACILITY 5

FILL STREET

FILL CITY

FILL
STATE

FILL ZIP
CODE

O Open
O Closed
O Don't know

O Yes
O No

O Yes
O No
O Don't know

O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities

What is the operator
(company/authority) name and
contact information?
Name of
Email
Operator
Address
Phone

If there are any additional facilities not listed above, please add them below - completing columns A-E and I-M.
O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities
O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities
O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities
O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities
O DOC
O Private Company
O Local Authority
O Joint State and Local Authorities

Notes (if needed)