Form 3 NAMRS Case Component

OMB Control Number 0970-XXXX

Expiration Date: XX/XX/XXXX

ATTACHMENT C

CASE COMPONENT DATA

Updated June 9, 2016

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)

Public reporting burden for this collection of information is estimated to average 150 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

Case: The Case Component data is submitted by uploading a data file to the NAMRS website annually. Specific instructions will be provided to states on the data file formatting. The reporting period is the federal fiscal year (October–September).  

Table 1–Investigation Entity

Each reporting period submission may have multiple investigations.

Element No.	Element Name	Element Description	Required	Cardinality	Type/Format	Code Values
Inv1	Investigation ID	The unique identifier used by the state for each investigation. The identifier is assigned to a specific investigation and is only used once. The Investigation ID is encrypted by the state for purposes of data submission.	Yes	Single	Encoded ID	Not applicable
Inv2	Report date	The month, day, and year the agency was notified of the suspected adult maltreatment.	No	Single	Date yyyy-mm-dd	Not applicable
Inv3	Report source	The role or profession of the person who made the report of the suspected adult maltreatment. Multiple report source code values can be submitted for the client.	No	Multiple	Enumeration (code)	1 = substitute decision maker 2 = in-home caregiver 3 = nursing home staff 4 = residential care community staff 5 = education professional 6 = financial professional 7 = law enforcement, judicial, or legal professional 8 = medical or health professional 9 = mental and behavioral health professional 10 = social services professional 11 = other professional 12 = relative 13 = neighbor, friend, other nonrelative, other nonprofessional 14 = self 15 = no role identified
Inv4	State/county FIPS code of investigative agency	The Federal Information Processing Series for state (2 digits) and county code (3 digits) of the APS agency. (Primary agency responsible for the determination of the investigation)	No	Single	FIPS (#####)	Code is the unique identification number assigned to each state and county under the Federal Information Processing Standards (FIPS) guidelines. See http://www.census.gov/geo/www/fips/fips.html
Inv5	Investigation start date	The date the investigation is assigned to an investigation worker. If the agency uses another date to indicate the start of an investigation, that date is used.	No	Single	Date yyyy-mm-dd	Not applicable
Inv6	Investigation disposition date	The date that the agency completed dispositions on the allegations of maltreatment associated with the investigation.	No	Single	Date yyyy-mm-dd	Not applicable
Inv7	Case closure date	The date that the agency completed all activities related to the investigation of the case.	Yes	Single	Date yyyy-mm-dd	Not applicable

Table 2–Client Entity

Each investigation may have multiple clients. Each client can be associated with more than one investigation but a separate client entity is required for each investigation.

Element No.	Element Name	Element Description	Required	Cardinality	Type/Format	Code Values
Clt1	Client ID	The unique identifier used by the state for each client. The identifier is assigned to a specific client and is used identify the same client across investigations and reporting periods. The client ID is encrypted by state for purposes of data submission. Data on multiple clients can be submitted for the investigation.	Yes	Single	Encoded ID	Not applicable
Clt2	Maltreatment setting	The location where the alleged maltreatment occurred.	No	Single	Enumeration (code)	10 = own residence or private residence of relative or caregiver 20 = residential care community (non-specific) 21 = licensed residential care community 22 = unlicensed residential care community 30 = nursing home (non-specific) 31 = licensed nursing home 32 = unlicensed nursing home 40 = adult day services center (non-specific) 41 = licensed adult day services center 42 = unlicensed adult day services center 50 = place of business or other services 60 = other
Clt3	State/county FIPS code of client	The Federal Information Processing Series for state (2 digits) and county code (3 digits) of the client’s residence at the start of the investigation.	No	Single	FIPS (#####)	Code is the unique identification number assigned to each state and county under the Federal Information Processing Standards (FIPS) guidelines. See http://www.census.gov/geo/www/fips/fips.html
Clt4	Case closure reason	The primary reason why the case was closed.	No	Single	Enumeration (code)	10 = investigation completed 20 = investigation completed and protective services case completed 30 = investigation unable to be completed (non-specific) 31 = investigation unable to be completed due to death of client during investigation 32 = investigation unable to be completed due to refusal of client 40 = protective services case opened but not completed (non-specific) 41 = protective services case closed due to death of client 42 = protective services case closed due to client decision to not continue 50 = other
Clt5	Age	The age of the client in years (at investigation start date).	No	Single	Enumeration (code)	18,19…74 = actual age 75 = 75 through 84 85 = 85 and older
Clt6	Gender identity	The actual or perceived gender-related characteristics of the client.	No	Single	Enumeration (code)	1 = male 2 = female 3 = transgender
Clt7	Sexual orientation	The client’s enduring pattern of or disposition to experience sexual or romantic desires for, and relationships with, people of one’s same sex, the other sex, or both sexes.	No	Single	Enumeration (code)	1 = straight 2 = gay/lesbian 3 = bisexual 4 = questioning 5 = other
Clt8	Race	The population(s) or group(s) that the client identifies as being a member. A client may have more than one race (multi-racial). For example, if a client is Asian and White, the client should be reported with both race values. If specific races cannot be identified for a multiracial client, the client is reported as “Other”.	No	Multiple	Enumeration (code)	10 = American Indian or Alaska Native 20 = Asian (non-specific) 21 = Asian Indian 22 = Chinese 23 = Filipino 24 = Japanese 25 = Korean 26 = Vietnamese 27 = Other Asian 30 = Black or African American 40 = Native Hawaiian or Other Pacific Islander (non-specific) 41 = Native Hawaiian 42 = Guamanian or Chamorro 43 = Samoan 44 = other Pacific Islander 50 = White 60 = Other
Clt9	Ethnicity	The affiliation of the client as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicity code values can be submitted for the client.	No	Multiple	Enumeration (code)	10 = yes, Hispanic or Latino/a, or Spanish origin (non-specific) 11 = Mexican, Mexican American, Chicano/a 12 = Puerto Rican 13 = Cuban 14 = other Hispanic, Latino/a, or Spanish origin 20 = no, not Hispanic or Latino/a, or Spanish origin
Clt10	Primary language	The primary language or method that the client uses for written and verbal communication.	No	Single	Enumeration (code)	1 = Arabic 2 = Chinese 3 = English 4 = French 5 = German 6 = Korean 7 = Russian 8 = Spanish or Spanish Creole 9 = Tagalog 10 = Vietnamese 11 = sign language 12 = assistive technology 13 = other
Clt11	Marital status	The client’s status based on state residency laws.	No	Single	Enumeration (code)	1 = never married 2 = married 3 = domestic partner, including civil union 4 = divorced 5 = separated 6 = widowed 7 = other
Clt12	Schooling level	The highest educational degree attained by the client.	No	Single	Enumeration (code)	1 = less than high school 2 = high school diploma or equivalent 3 = associate’s degree or bachelor’s degree 4 = advanced degree
Clt13	Employment status	The involvement of the client in the labor force.	No	Single	Enumeration (code)	1 = employed 2 = unemployed 3 = not in labor force 4 = other
Clt14	Income level	The level of annual income of the client including all sources of income.	No	Single	Enumeration (code)	1 = less than $25,000 2 = $25,000-$49,999 3 = $50,000-$74,999 4 = $75,000-$99,999 5 = $100,000 or more
Clt15	Benefits	The federal and state benefits received by the client during the investigation. Multiple benefit code values can be submitted for the client.	No	Multiple	Enumeration (code)	1 = Medicaid 2 = Medicare 3 = publicly-subsidized housing 4 = Social Security Disability Insurance (SSDI) 5 = Social Security retirement benefits 6 = Supplemental Security Income (SSI) 7 = Temporary Assistance for Needy Families (TANF) 8 = veterans’ disabled benefits 9 = other
Clt16	Veteran status	The client’s status related to the US Armed Forces.	No	Single	Enumeration (code)	1 = veteran 2 = non-veteran
Clt17	Disabilities	The client’s physical, emotional, and mental health issues that result in limitation in activities and restrictions to fully participate at school, work, or in the community. Multiple disability code values can be submitted for the client.	No	Multiple	Enumeration (code)	1 = ambulatory difficulty 2 = cognitive difficulty 3 = communication difficulty 4 = hearing difficulty 5 = independent living difficulty 6 = self-care difficulty 7 = vision difficulty 8 = other 9 = none
Clt18	ADL score	The client’s score on the Katz Index of Independence in Activities of Daily Living (ADL).	No	Single	Numeric (6 integers)	Permissible values are 0-6
Clt19	IADL score	The client’s score on the Lawton Instrumental Activities of Daily Living (IADL).	No	Single	Numeric (6 integers)	Permissible values are 0-8
Clt20	Behavioral health screenings or diagnoses	The results of assessments on the client, conducted by the APS agency. Multiple behavioral health code values can be submitted for the client.	No	Multiple	Enumeration (code)	1 = alcohol use disorder 2 = anxiety 3 = bipolar disorder 4 = dementia 5 = depression 6 = schizophrenia and other psychotic disorders 7 = substance use disorder 8 = traumatic brain injury 9 = other 10 = none
Clt21	Living setting at start	The primary residential environment of the client at the start of investigation.	No	Single	Enumeration (code)	10 = own residence or residence of relative or caregiver 20 = residential care community (non-specific) 21 = licensed residential care community 22 = non-licensed residential care community 30 = nursing home (non-specific) 31 = licensed nursing home 32 = non-licensed nursing home 40 = other
Clt22	Living setting at close	The primary residential environment of the client at the time of case closure.	No	Single	Enumeration (code)	10 = own residence or residence of relative or caregiver 20 = residential care community (non-specific) 21 = licensed residential care community 22 = non-licensed residential care community 30 = nursing home (non-specific) 31 = licensed nursing home 32 = non-licensed nursing home 40 = other
Clt23	Substitute decision makers at start	The authorizations that are in effect related to health, personal, or financial decision making for the client at the start of the investigation. Multiple substitute decision maker code values can be submitted for the client.	No	Multiple	Enumeration (code)	10 = health care proxy in effect 20 = financial proxy in effect 30 = guardianship or conservatorship (non-specific) 31 = guardianship or conservatorship of person 32 = guardianship or conservatorship of property 40 = representative payee 50 = none
Clt24	Substitute decision makers at close	The authorizations that are in effect related to health, personal, or financial decision making for the client at time of case closure. Multiple substitute decision maker code values can be submitted for the client.	No	Multiple	Enumeration (code)	10 = health care proxy in effect 20 = financial proxy in effect 30 = guardianship or conservatorship (non-specific) 31 = guardianship or conservatorship of person 32 = guardianship or conservatorship of property 40 = representative payee 50 = none
Clt25	Services at start	The services known to the agency that the client was already receiving at the start of the investigation. Multiple service code values can be submitted for the client.	No	Multiple	Enumeration (code)	1 = care/case management services 2 = caregiver support services 3 = community day services 4 = education, employment, and training services 5 = emergency assistance and material aid services 6 = financial planning services 7 = housing and relocation services 8 = in-home assistance services 9 = legal services 10 = medical and dental services 11 = medical rehabilitation services 12 = mental health services 13 = nutrition 14 = public assistance benefits 15 = substance use services 16 =transportation 17 = victim services 18 = other services 19 = none
Clt26	Services APS	The services that the agency provided on behalf of the client during the investigation or while the agency kept an open case. Multiple service code values can be submitted for the client.	No	Multiple	Enumeration (code)	1 = care/case management services 2 = caregiver support services 3 = community day services 4 = education, employment, and training services 5 = emergency assistance and material aid services 6 = financial planning services 7 = housing and relocation services 8 = in-home assistance services 9 = legal services 10 = medical and dental services 11 = medical rehabilitation services 12 = mental health services 13 = nutrition 14 = public assistance benefits 15 = substance use services 16 =transportation 17 = victim services 18 = other services 19 = none
Clt27	Services referred	The services for which the agency referred the client. Multiple services code values can be submitted for the client.	No	Multiple	Enumeration (code)	1 = care/case management services 2 = caregiver support services 3 = community day services 4 = education, employment, and training services 5 = emergency assistance and material aid services 6 = financial planning services 7 = housing and relocation services 8 = in-home assistance services 9 = legal services 10 = medical and dental services 11 = medical rehabilitation services 12 = mental health services 13 = nutrition 14 = public assistance benefits 15 = substance use services 16 =transportation 17 = victim services 18 = other services 19 = none
Clt28	Services at close	The services known to the agency that the client was receiving at the time of case closure. Multiple services code values can be submitted for the client.	No	Multiple	Enumeration (code)	1 = care/case management services 2 = caregiver support services 3 = community day services 4 = education, employment, and training services 5 = emergency assistance and material aid services 6 = financial planning services 7 = housing and relocation services 8 = in-home assistance services 9 = legal services 10 = medical and dental services 11 = medical rehabilitation services 12 = mental health services 13 = nutrition 14 = public assistance benefits 15 = substance use services 16 =transportation 17 = victim services 18 = other services 19 = none
Clt29	Interagency coordination	The agencies to which the client was referred. Multiple interagency coordination code values can be submitted for the client.	No	Multiple	Enumeration (code)	1 = law enforcement or prosecutorial offices 2 = Protection and Advocacy or Client Advocacy Program (CAP) 3 = state licensing agency 4 = State Medicaid Fraud Control Unit (MFCU) 5 = Long Term Care Ombudsman Program 6 = other 7 = none
Clt30	Previous report	The indication that the agency has information that the client was the subject of a previous report.	No	Single	Enumeration (code)	1 = yes 2 = no

Table 3–Maltreatment Allegation Entity

Each client may have multiple maltreatment allegation entities within a specific investigation but only one of a particular maltreatment type. Each maltreatment allegation entity is associated with only one client. Each maltreatment allegation entity must be composed of a maltreatment type and maltreatment disposition.

Element No.	Element Name	Element Description	Required	Cardinality	Type/Format	Code Values
Mal1	Maltreatment type	The alleged maltreatments that are investigated.	Yes	Single (per entity)	Enumeration (code)	10 = abandonment 20 = emotional abuse 30 = exploitation (non-specific) 31= financial exploitation 32= other exploitation 40 = neglect 50 = physical abuse 60 = sexual abuse 70 = suspicious death 80 = self-neglect 90 = other
Mal2	Maltreatment disposition	The disposition of each alleged maltreatment.	Yes	Single (per entity)	Enumeration (code)	1 = substantiated 2 = inconclusive 3 = unsubstantiated 4 = other

Table 4–Perpetrator Entity

Each investigation may have zero, one, or more than one perpetrator. A perpetrator must be associated with at least one substantiated maltreatment investigation that is associated with a specific client within the investigation. A perpetrator may be associated with more than one investigation but a separate perpetrator entity is required for each of the associated investigations.

Element No.	Element Name	Element Description	Required	Cardinality	Type/Format	Code Values
Per1	Perpetrator ID	The unique identifier used by the state for the person who is found to be responsible for substantiated maltreatment(s). The identifier is assigned to a specific perpetrator and is used to identify the same perpetrator across investigations and reporting periods. The Perpetrator ID is encrypted by the state for purposes of data submission.	Yes	Single	Encoded ID	Not applicable
Per2	Age	The age of the perpetrator in years (at investigation start date).	No	Single	Enumeration (code)	17 = 17 and younger 18,19…74 = actual age 75 = 75 through 84 85 = 85 and older
Per3	Gender identity	The actual or perceived gender-related characteristics of the perpetrator.	No	Single	Enumeration (code)	1 = male 2 = female 3 = transgender
Per4	Race	The population(s) or group(s) that the perpetrator identifies as being a member. A perpetrator may have more than one race (multi-racial). For example, if a perpetrator is Asian and White, the perpetrator should be reported with both race values. If specific races cannot be identified for a multiracial perpetrator, the perpetrator is reported as “Other”.	No	Multiple	Enumeration (code)	10 = American Indian or Alaska Native 20 = Asian (non-specific) 21 = Asian Indian 22 = Chinese 23 = Filipino 24 = Japanese 25 = Korean 26 = Vietnamese 27 = Other Asian 30 = Black or African American 40 = Native Hawaiian or Other Pacific Islander (non-specific) 41 = Native Hawaiian 42 = Guamanian or Chamorro 43 = Samoan 44 = other Pacific Islander 50 = White 60 = Other
Per5	Ethnicity	The affiliation of the perpetrator as Hispanic or Latino/a or non-Hispanic or Latino/a. Multiple ethnicity code values can be submitted for the perpetrator.	No	Multiple	Enumeration (code)	10 = yes, Hispanic or Latino/a, or Spanish origin (non-specific) 11 = Mexican, Mexican American, Chicano/a 12 = Puerto Rican 13 = Cuban 14 = other Hispanic, Latino/a, or Spanish origin 20 = no, not Hispanic or Latino/a, or Spanish origin
Per6	Disabilities	The perpetrator's physical, emotional, and mental health issues that result in limitation in activities and restrictions to fully participate at school, work, or in the community. Multiple disability code values can be submitted for the perpetrator.	No	Multiple	Enumeration (code)	1 = ambulatory difficulty 2 = cognitive difficulty 3 = communication difficulty 4 = hearing difficulty 5 = independent living difficulty 6 = self-care difficulty 7 = vision difficulty 8 = other 9 = none
Per7	Behavioral health screenings or diagnoses	The results of assessments on the perpetrator, conducted by the APS agency. Multiple behavioral health code values can be submitted for the perpetrator.	No	Multiple	Enumeration (code)	1 = alcohol use disorder 2 = anxiety 3 = bipolar disorder 4 = dementia 5 = depression 6 = schizophrenia and other psychotic disorders 7 = substance use disorder 8 = traumatic brain injury 9 = other 10 = none

Table 5–Client Perpetrator Relationship Entity

Each client and perpetrator can have a designated relationship if data on one or more of the entity attributes is provided. A client and perpetrator have only one relationship entity within an investigation.

Element No.	Element Name	Element Description	Required	Cardinality	Type/Format	Code Values
CPR1	Cohabitation at start	The indication if the perpetrator and client are cohabitating at the start of the investigation.	No	Single	Enumeration (code)	1 = yes 2 = no
CPR2	Cohabitation at close	The indication if the perpetrator and client are cohabitating at the time of case closure.	No	Single	Enumeration (code)	1 = yes 2 = no
CPR3	Kinship relationship	The indication if the perpetrator is related to the client by affinity (blood, adoption, marriage, etc.).	No	Single	Enumeration (code)	10 = yes (non-specific) 11 = spouse 12 = domestic partner, including civil union 13 = parent 14 = child 15 = sibling 16 = grandparent 17 = grandchild 18 = other relative 20 = none
CPR4	Perpetrator association at start	The indication if the perpetrator has a caregiving relationship to the client at the start of the investigation.	No	Single	Enumeration (code)	10 = nursing home staff 20 = residential care community staff 30 = relative caregiver (non-specific) 31 = paid relative caregiver 32 = unpaid relative caregiver 40 = nonrelative caregiver (non-specific) 41 = paid nonrelative caregiver 42 = unpaid nonrelative caregiver 50 = other relationship 60 = none
CPR5	Perpetrator association at close	The indication whether the perpetrator has a caregiving relationship to the client at time of case closure.	No	Single	Enumeration (code)	10 = nursing home staff 20 = residential care community staff 30 = relative caregiver (non-specific) 31 = paid relative caregiver 32 = unpaid relative caregiver 40 = nonrelative caregiver (non-specific) 41 = paid nonrelative caregiver 42 = unpaid nonrelative caregiver 50 = other relationship 60 = none
CPR6	Perpetrator substitute decision maker at start	Authorizations that the perpetrator has in relation to the client, and that are in effect, related to health, personal or financial decision making at the start of the investigation. Multiple substitute decision maker code values can be submitted for the client perpetrator relationship.	No	Multiple	Enumeration (code)	10 = health care proxy in effect 20 = financial proxy in effect 30 = guardianship or conservatorship (non-specific) 31 = guardianship or conservatorship of person 32 = guardianship or conservatorship of property 40 = representative payee 50 = none
CPR7	Perpetrator substitute decision maker at close	Authorizations that the perpetrator has in relation to the client, and that are in effect, related to health, personal or financial decision making at the time of case closure. Multiple substitute decision maker code values can be submitted for the client perpetrator relationship.	No	Multiple	Enumeration (code)	10 = health care proxy in effect 20 = financial proxy in effect 30 = guardianship or conservatorship (non-specific) 31 = guardianship or conservatorship of person 32 = guardianship or conservatorship of property 40 = representative payee 50 = none
CPR8	Perpetrator legal remedy recommendation	The legal remedies that were recommended or sought by the APS agency regarding the status of the perpetrator. Multiple legal remedy recommendation code values can be submitted for the client perpetrator relationship.	No	Multiple	Enumeration (code)	1 = removal of guardianship rights 2 = restraining order on perpetrator regarding the client 3 = eviction of perpetrator 4 = restitution by perpetrator 5 = other legal remedy 6 = none