Appendices for IC

Appendix C Attachments A-M.pdf

Annual Survey of Jails, Survey of Jails in Indian Country, Death in Custody Reporting Program (Jails)

Appendices for IC

OMB: 1121-0094

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Appendix C. Attachment Table of Contents
Attachment A.

2000 Death in Custody Reporting Act (P.L. 106-297)

p. 2-3

Attachment B.

42 USC 3989g

p. 4-6

Attachment C.

Survey form CJ9A-5

p. 7-12

Attachment D.

Survey form CJ10A-5

p. 13-18

Attachment E.

Survey form CJ9A

p. 19-21

Attachment F.

Survey form CJ10A

p. 22-24

Attachment G.

Survey form CJ9

p. 25-29

Attachment H.

Survey form CJ10

p. 30-34

Attachment I.

Historical ASJ forms

p. 35-54

Attachment J.

Survey CJ5B

p. 55-59

Attachment K.

42 USC 3735

p. 60-61

Attachment L.

Mailing packet

p. 62-72

Attachment M.

Data quality follow-up scripts

p. 73-94

Attachment A. 2000 Deaths in Custody Reporting Act
(P.L. 106-297)

PUBLIC LAW 106–297—OCT. 13, 2000

114 STAT. 1045

Public Law 106–297
106th Congress
An Act
To amend the Violent Crime Control and Law Enforcement Act of 1994 to ensure
that certain information regarding prisoners is reported to the Attorney General.

Oct. 13, 2000
[H.R. 1800]

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.

This Act may be cited as the ‘‘Death in Custody Reporting
Act of 2000’’.

Death in Custody
Reporting Act of
2000.
42 USC 13701
note.

SEC. 2. REPORTING OF INFORMATION.

Section 20104(a) of the Violent Crime Control and Law Enforcement Act of 1994 (42 U.S.C. 13704(a)) is amended—
(1) in paragraph (1)—
(A) by inserting ‘‘(A)’’ after ‘‘(1)’’; and
(B) by redesignating subparagraphs (A) and (B) as
clauses (i) and (ii), respectively;
(2) in paragraph (2), by striking ‘‘(2)’’ and inserting ‘‘(B)’’;
(3) in paragraph (3)—
(A) by striking ‘‘(3)’’ and inserting ‘‘(C)’’;
(B) by redesignating subparagraphs (A) and (B) as
clauses (i) and (ii), respectively; and
(C) by striking the period and inserting ‘‘; and’’; and
(4) by adding at the end the following new paragraph:
‘‘(2) such State has provided assurances that it will follow
guidelines established by the Attorney General in reporting,
on a quarterly basis, information regarding the death of any
person who is in the process of arrest, is en route to be incarcerated, or is incarcerated at a municipal or county jail, State
prison, or other local or State correctional facility (including
any juvenile facility) that, at a minimum, includes—
‘‘(A) the name, gender, race, ethnicity, and age of the
deceased;
‘‘(B) the date, time, and location of death; and
‘‘(C) a brief description of the circumstances surrounding the death.’’.
Approved October 13, 2000.
LEGISLATIVE HISTORY—H.R. 1800:
CONGRESSIONAL RECORD, Vol. 146 (2000):
July 24, considered and passed House.
Oct. 3, considered and passed Senate.

Æ

VerDate 11-MAY-2000

01:24 Oct 20, 2000

Jkt 069139

PO 00000

Frm 00001

Fmt 6580

Sfmt 6580

E:\PUBLAW\PUBL297.106

APPS27

PsN: PUBL297

Attachment B. 42 USC 3989g

Attachment C. Survey form CJ9A-5

OMB No. 1121-0094 Approval Expires ##/##/201#

DEATHS IN CUSTODY—2015
ANNUAL SUMMARY ON INMATES
UNDER JAIL JURISDICTION

Form CJ-9A/5

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY—
Name

Title

Official
Address

Telephone

City

FAX

State

Email

Zip

Instructions for completion and submission
FOR EACH ITEM—
 If the answer to a question is “none” or “zero,” write “0” in the space provided.
 When exact numeric answers are not available, provide estimates and mark ( X ) in the checkbox beside each number that is
estimated. For example 1,234 
Please submit your completed form(s) within 30 days of receipt. You may submit information in one of these ways:
ONLINE: Complete this form online at: https://bjsdcrp.rti.org
EMAIL: [email protected]
FAX (TOLL-FREE): 1-866-800-9179

MAIL: RTI International, Attn: Data Capture
Project Number: 0215015.001.100.102.100
5265 Capital Boulevard
Raleigh, NC 27690-1652

If you need assistance, contact Matt Bensen of RTI International toll-free at 1-800-344-1387 or [email protected].

What to include and exclude in this data collection
INCLUDE—
 Confinement facilities usually administered by a local law enforcement agency, intended for adults but sometimes holding juveniles
 All jails and city/county correctional centers that hold inmates beyond arraignment. Report data on all inmates, including those held in
separate holding or lockup areas within your facilities.
 Special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms).
 Temporary holding or lockup facilities if they are part of your combined function.
 Inmates held for other jurisdictions, including federal authorities, state prison authorities, and other local jail jurisdictions.
EXCLUDE—
X Facilities that are exclusively used as temporary holding or lockup facilities, where inmates are generally held for less than 72 hours
and not held beyond arraignment.
X Privately operated jails and facilities operated by two or more jurisdictions (i.e., multi-jurisdictional facilities). These jails will be
contacted directly for this data collection.

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 1 hour and 15 minutes per response, including reviewing instructions, searching existing data sources, gathering necessary data,
and completing and reviewing this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to
the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed form to this address.

«AGENCY ID»

Section I — INMATE DEATHS
1.

3.

Between January 1, 2015, and December 31, 2015, how
many persons died while under the supervision of your
jail facilities?

On December 31, 2015, how many persons under the
supervision of your jail jurisdiction were—
a. CONFINED in your jail facilities?
INCLUDE—
 Persons on transfer to treatment facilities but who
remain under your jurisdiction
 Persons held for other jurisdictions
 Persons in community-based programs (e.g., work
release, day release, or drug/alcohol treatment) who
return to jail at night
 Persons out to court while under your jurisdiction.

INCLUDE deaths of ALL persons—
 CONFINED in your jail facilities
 UNDER THE SUPERVISION of your jail facilities, but
out to court or in a special facility (e.g., hospital,
hospice, or nursing home; treatment facility; residential
community center; residential work release or house
arrest program; or release center)
 WHILE IN TRANSIT to or from your jail facilities while
under your supervision.

EXCLUDE—
X Persons under your jurisdiction who are boarded
elsewhere
X Inmates who are AWOL, escaped, or on long-term
transfer to other jurisdictions
X Persons in community-based programs run by your
jails (e.g., electronic monitoring, house arrest,
community service, day reporting, or work
programs) who do NOT return to jail at night.

EXCLUDE—
X Deaths of persons in the process of arrest by your
agency if they have not yet been booked into your jail
facilities. Arrest-related deaths should be reported using
a CJ-11A form.
Number of inmate deaths
a. Males ...............................................................
b. Females ..........................................................

b.

REMINDER: IF YOUR FACILITIES HAD ONE OR MORE
DEATHS IN CALENDAR YEAR 2015, please ensure that
you have completed a 2015 CJ-9/CJ-10 (individual death
report) form for each death reported. If you need additional
CJ-9/CJ-10 forms, please go to the DCRP website
(https://bjsdcrp.rti.org), call 1-800-344-1387, or send an
email to [email protected].

INCLUDE—
 Persons in community-based programs run by your
jail jurisdiction (e.g., electronic monitoring, house
arrest, community service, day reporting, or work
programs) who do NOT return to jail at night.
EXCLUDE—
X Persons on pretrial release who are not in a
community-based program run by your jail
jurisdiction
X Persons under the supervision of probation, parole,
or other agencies
X Inmates on weekend programs that allow offenders
to serve their sentences of confinement only on
weekends (e.g., Friday–Sunday)
X Inmates participating in community-based programs
(e.g., work release, day release, or drug/alcohol
treatment) who return to jail at night.

Section II — SUPERVISED POPULATION
2.

On June 30, 2015, how many persons under the
supervision of your jail jurisdiction were CONFINED in
your jail facilities?
INCLUDE—
 Persons on transfer to treatment facilities but who
remain under your jurisdiction
 Persons held for other jurisdictions
 Persons in community-based programs (e.g., work
release, day release, or drug/alcohol treatment) who
return to jail at night
 Persons out to court while under your jurisdiction.
EXCLUDE—
X Persons under your jurisdiction who are boarded
elsewhere
X Inmates who are AWOL, escaped, or on long-term
transfer to other jurisdictions
X Persons in community-based programs run by your
jails (e.g., electronic monitoring, house arrest,
community service, day reporting, or work
programs) who do NOT return to jail at night.

Under jail supervision, but NOT CONFINED?

c.
4.

TOTAL (Sum of items 3a and 3b) ..............

On the weekend prior to December 31, 2015, did your jail
facilities have a weekend program?
Weekend programs allow offenders to serve their sentences
of confinement only on weekends (e.g., Friday–Sunday).

5.

When exact numeric answers are not available, provide
estimates and mark ( X ) in the checkbox beside each number
that is estimated. For example 1,234 

1

Yes – How many inmates
participated? .........................

2

No

Of all the persons CONFINED in your jail facilities on
December 31, 2015 (as reported in item 3a), how many
were not U.S. citizens?
Non-U.S. citizens

Page 2

Section III — INMATE COUNTS AND MOVEMENTS OF
THE CONFINED POPULATION
6.

10. On December 31, 2015, how many persons CONFINED in
your jail facilities were—

On December 31, 2015, how many persons CONFINED in
your jail facilities were—
11
a. Adult males (age 18 or older) .....................

a. White, not of Hispanic origin ........................
b. Black or African American,
not of Hispanic origin ....................................
c. Hispanic or Latino ......................................
d. American Indian or Alaska Native,
not of Hispanic origin ....................................

b. Adult females (age 18 or older) ..................
c. Males age 17 or younger ...........................
d. Females age 17 or younger.......................

e. Asian, not of Hispanic origin ........................
f. Native Hawaiian or other Pacific
Islander, not of Hispanic origin ...................

e. TOTAL (Sum of items 6a through
6d should equal item 3a) .............................
7.

g. Two or more races, not of Hispanic origin ..
h. Additional categories in your
information system – Specify

Of all the persons age 17 or younger CONFINED in your
jail facilities on December 31, 2015 (sum of 6c and 6d),
how many were tried or awaiting trial in adult court?
Number of persons age 17
or younger held as adults ......................

8.

i. Not known ...................................................
j. TOTAL (Sum of items 10a to 10i
should equal item 3a) ..................................

Of all persons CONFINED in your jail facilities on
December 31, 2015, how many were—



11. On December 31, 2015, how many persons CONFINED in
your jail facilities were held for—

For persons with more than one status, report the status
associated with the most serious offense.
For convicted inmates, include probation and parole
violators with no new sentence.

Count persons with multiple holds only once with priority
being federal, state, tribal, and local.


INCLUDE contractual, temporary, courtesy, or ad hoc
holds for other agencies.
a. Federal authorities

a. Convicted ..................................................

9.

b. Unconvicted ...............................................

1. U.S. Marshals Service ....................

c. TOTAL (Sum of items 8a and 8b
should equal item 3a) .................................

2. Federal Bureau of Prisons ............
3. U.S. Immigration and Customs
Enforcement (ICE)..........................

On December 31, 2015, how many persons CONFINED in
your jail facilities, regardless of conviction status, had an
offense type of—

4. Bureau of Indian Affairs (BIA) .......
X

EXCLUDE inmates being housed for tribal
governments in item 11c below.
5. Other – Specify

For persons with more than one offense, report the most
serious type of offense.
a. Felony ........................................................

b. State prison authorities
b. Misdemeanor .............................................

1. For your state .................................

c. Other – Specify

2. For other states ..............................
c. American Indian or Alaska Native tribal governments
X

d. TOTAL (Sum of items 9a to 9c
should equal item 3a) .................................

EXCLUDE inmates being housed for the BIA in
item 11a4.

d. Other local jail jurisdictions
X
X

EXCLUDE inmates being housed for your own
jurisdiction (i.e., your own county/city inmates).
EXCLUDE inmates being housed for tribal
governments in item 11c.
1. Within your state ............................

When exact numeric answers are not available, provide
estimates and mark ( X ) in the checkbox beside each number
that is estimated. For example 1,234 

2. Outside your state .........................
e. TOTAL (Sum of items 11a to 11d) ...............
Page 3

12. a. During the 31-day period from December 1 to
December 31, 2015, on what day did your jail facilities
hold the greatest number of inmates?

15. How many persons under the supervision of your jail
jurisdiction were—
a. ADMITTED to your jail facilities during 2015?

Peak population should be equal to or greater than the
confined inmate population reported in item 3a.
December

, 2015

b. How many persons were CONFINED on that day?
Number that day
13. Between January 1, 2015, and December 31, 2015, what
was the average daily population of your jail facilities?








INCLUDE inmates who participated in weekend
programs that allow offenders to serve their sentences
of confinement only on weekends (e.g., Friday–Sunday).
To calculate the average daily population, add the
number of persons for each day during the period
January 1, 2015, through December 31, 2015, and
divide the result by 365.
If daily counts are not available, estimate the average
daily population by adding the number of persons held
on the same day of each month and divide the result by
12.
If average daily population cannot be calculated as
directed above, then estimate the typical number of
persons held in your jail facilities each day.
Average daily population
a. Males....................................................

c. TOTAL (Sum of items 13a and 13b) ....

New admissions
1. Males ....................................................
2. Females ................................................
3. TOTAL (Sum of items 15a1 and 15a2)
b. DISCHARGED from your facilities during 2015?
INCLUDE—
 Persons released after a period of confinement
(e.g., sentence completion, bail/bond releases, other
pretrial releases, transfers to other jurisdictions, or
deaths)
 Persons completing their weekend sentence leaving
the facility for the last time.

Final discharges

14. On December 31, 2015, what was the total rated capacity
of your jail facilities, excluding separate temporary
holding areas?



EXCLUDE—
X Returns from escape, work release, medical
appointments/treatment facilities, furloughs,
bail/bond releases, and court appearances.

EXCLUDE—
X Temporary discharges (e.g., work releases, medical
appointments/treatment, out to courts, furloughs,
day reporters, or transfers to other facilities within
your jurisdiction).

b. Females ...............................................



INCLUDE—
 Persons officially booked into and housed in your jail
facilities by formal legal document and by the
authority of the courts or some other official agency
 Repeat offenders booked on new charges
 Persons serving a weekend sentence coming into
the facility for the first time.

1. Males ....................................................
2. Females ................................................

Rated capacity is the maximum number of beds or
inmates assigned by a rating official to a facility.
If rated capacity is not available, estimate by using the
design capacity and mark the checkbox.

3. TOTAL (Sum of items 15b1 and 15b2)

Rated capacity

When exact numeric answers are not available, provide
estimates and mark ( X ) in the checkbox beside each number
that is estimated. For example 1,234 
Page 4

Section IV — POPULATION SUPERVISED IN THE
COMMUNITY
If item 3b equals 0 (zero), SKIP to item 17.
16. On December 31, 2015, how many persons under the
supervision of your jail jurisdiction who were NOT
CONFINED participated in—
X

Section V —STAFFING
17. On December 31, 2015, how many staff employed in your
facilities were—
Count each employee only once. Classify employees with
multiple functions by the function performed most frequently.
 INCLUDE payroll staff, nonpayroll staff on the payroll of
other government agencies (e.g., health department,
school district, or court), and unpaid interns.
X EXCLUDE staff paid through contractual agreements
and community volunteers.

EXCLUDE inmates on weekend programs.

a. Electronic monitoring ................................
b. Home detention without
electronic monitoring ................................

a. Correctional officers
(Deputies, monitors, and other custody
staff who spend more than 50% of their
time with the incarcerated population.)

c. Community service ....................................
d. Day reporting .............................................

1. Males .................................................

e. Other pretrial supervision .........................

2. Females ..............................................

f. Other alternative work programs .............
X EXCLUDE inmates participating in
work release programs who return to
jail at night.

b. All other staff
(Administrators, clerical and maintenance
staff, educational staff, professional and
technical staff, and other staff – unspecified
who spend more than 50% of their time in
the facility.)

g. Alcohol/drug treatment programs ............
X EXCLUDE inmates participating in
alcohol/drug treatment programs
who are confined in jail.

1. Males ..................................................

h. Other programs outside of
jail facilities – Specify

2. Females ..............................................
i. TOTAL (Sum of items 16a to 16h
should equal item 3b) ..................................

c. TOTAL (Sum of items 17a and 17b) ............

When exact numeric answers are not available, provide
estimates and mark ( X ) in the checkbox beside each number
that is estimated. For example 1,234 
Page 5

Attachment D. Survey form CJ10A-5

OMB No. 1121-0094 Approval Expires ##/##/201#

DEATHS IN CUSTODY—2015
ANNUAL SUMMARY ON INMATES IN
PRIVATE AND MULTIJURISDICTIONAL JAILS

Form CJ-10A/5

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY—
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

Email

Instructions for completion and submission
FOR EACH ITEM—
 If the answer to a question is “none” or “zero,” write “0” in the space provided.
 When exact numeric answers are not available, provide estimates and mark ( X ) in the checkbox beside each number that is
estimated. For example 1,234 
Please submit your completed form(s) within 30 days of receipt. You may submit information in one of these ways:
ONLINE: Complete this form online at: https://bjsdcrp.rti.org
EMAIL: [email protected]
FAX (TOLL-FREE): 1-866-800-9179

MAIL: RTI International, Attn: Data Capture
Project Number: 0215015.001.100.102.100
5265 Capital Boulevard
Raleigh, NC 27690-1652

If you need assistance, contact Matt Bensen of RTI International toll-free at 1-800-344-1387 or [email protected].

What to include and exclude in this data collection
INCLUDE—
 Confinement facilities—including detention centers, jails, and other correctional facilities—intended for adults but sometimes holding
juveniles, that are either privately owned and operated or administered by two or more governments (or a board composed of
representatives from two or more governments).
 All jails and city/county correctional centers that hold inmates beyond arraignment. Report data on all inmates, including those held in
separate holding or lockup areas within your facilities.
 Special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms).
 Temporary holding or lockup facilities if they are part of your combined function.
 Inmates held for other jurisdictions, including federal authorities, state prison authorities, and other local jail jurisdictions.
EXCLUDE—
X Facilities that are exclusively used as temporary holding or lockup facilities, where inmates are generally held for less than 72 hours
and not held beyond arraignment.

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 1 hour and 15 minutes per response, including reviewing instructions, searching existing data sources, gathering necessary data,
and completing and reviewing this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to
the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed form to this address.

«AGENCY ID»

Section I — INMATE DEATHS
1.

3.

Between January 1, 2015, and December 31, 2015, how
many persons died while under the supervision of this
facility?

On December 31, 2015, how many persons under the
supervision of your jail were—
a. CONFINED in this facility?
INCLUDE—
 Persons on transfer to treatment facilities but who
remain under your jurisdiction
 Persons held for other jurisdictions
 Persons in community-based programs (e.g., work
release, day release, or drug/alcohol treatment) who
return to jail at night
 Persons out to court while under your jurisdiction.

INCLUDE deaths of ALL persons—
 CONFINED in this facility
 UNDER THE SUPERVISION of this facility, but out to
court or in a special facility (e.g., hospital, hospice, or
nursing home; treatment facility; residential community
center; residential work release or house arrest
program; or release center)
 WHILE IN TRANSIT to or from this facility while under
your supervision.

EXCLUDE—
X Persons under your jurisdiction who are boarded
elsewhere
X Inmates who are AWOL, escaped, or on long-term
transfer to other jurisdictions
X Persons in community-based programs run by this
facility (e.g., electronic monitoring, house arrest,
community service, day reporting, or work
programs) who do NOT return to jail at night.

EXCLUDE—
X Deaths of persons in the process of arrest by your
agency if they have not yet been booked into this
facility. Arrest-related deaths should be reported using a
CJ-11A form.
Number of inmate deaths
a. Males ...............................................................
b.

b. Females ..........................................................

INCLUDE—
 Persons in community-based programs run by this
facility (e.g., electronic monitoring, house arrest,
community service, day reporting, or work
programs) who do NOT return to jail at night.

REMINDER: IF THIS FACILITY HAD ONE OR MORE
DEATHS IN CALENDAR YEAR 2015, please ensure that
you have completed a 2015 CJ-9/CJ-10 (individual death
report) form for each death reported. If you need additional
CJ-9/CJ-10 forms, please go to the DCRP website
(https://bjsdcrp.rti.org), call 1-800-344-1387, or send an
email to [email protected].

EXCLUDE—
X Persons on pretrial release who are not in a
community-based program run by this facility
X Persons under the supervision of probation, parole,
or other agencies
X Inmates on weekend programs that allow offenders
to serve their sentences of confinement only on
weekends (e.g., Friday–Sunday)
X Inmates participating in community-based programs
(e.g., work release, day release, or drug/alcohol
treatment) who return to jail at night.

Section II — SUPERVISED POPULATION
2.

On June 30, 2015, how many persons under the
supervision of your jail were CONFINED in this facility?
INCLUDE—
 Persons on transfer to treatment facilities but who
remain under your jurisdiction
 Persons held for other jurisdictions
 Persons in community-based programs (e.g., work
release, day release, or drug/alcohol treatment) who
return to jail at night
 Persons out to court while under your jurisdiction.
EXCLUDE—
X Persons under your jurisdiction who are boarded
elsewhere
X Inmates who are AWOL, escaped, or on long-term
transfer to other jurisdictions
X Persons in community-based programs run by this
facility (e.g., electronic monitoring, house arrest,
community service, day reporting, or work
programs) who do NOT return to jail at night.

Under jail supervision, but NOT CONFINED?

c.
4.

TOTAL (Sum of items 3a and 3b) ..............

On the weekend prior to December 31, 2015, did this
facility have a weekend program?
Weekend programs allow offenders to serve their sentences
of confinement only on weekends (e.g., Friday–Sunday).

5.

1

Yes – How many inmates
participated? .........................

2

No

Of all the persons CONFINED in this facility on December
31, 2015 (as reported in item 3a), how many were not U.S.
citizens?
Non-U.S. citizens

When exact numeric answers are not available, provide
estimates and mark ( X ) in the checkbox beside each number
that is estimated. For example 1,234 
Page 2

Section III — INMATE COUNTS AND MOVEMENTS OF
THE CONFINED POPULATION
6.

10. On December 31, 2015, how many persons CONFINED in
this facility were—

On December 31, 2015, how many persons CONFINED in
this facility were—
11
a. Adult males (age 18 or older) .....................

a. White, not of Hispanic origin ........................
b. Black or African American,
not of Hispanic origin ....................................

b. Adult females (age 18 or older) ..................

c. Hispanic or Latino ......................................
d. American Indian or Alaska Native,
not of Hispanic origin ....................................

c. Males age 17 or younger ...........................
d. Females age 17 or younger.......................

e. Asian, not of Hispanic origin ........................
f. Native Hawaiian or other Pacific
Islander, not of Hispanic origin ...................

e. TOTAL (Sum of items 6a through
6d should equal item 3a) .............................
7.

g. Two or more races, not of Hispanic origin ..
h. Additional categories in your
information system – Specify

Of all the persons age 17 or younger CONFINED in this
facility on December 31, 2015 (sum of 6c and 6d), how
many were tried or awaiting trial in adult court?
Number of persons age 17
or younger held as adults ......................

8.

i. Not known ...................................................
j. TOTAL (Sum of items 10a to 10i
should equal item 3a) ..................................

Of all persons CONFINED in this facility on
December 31, 2015, how many were—



For persons with more than one status, report the status
associated with the most serious offense.
For convicted inmates, include probation and parole
violators with no new sentence.

11. On December 31, 2015, how many persons CONFINED in
this facility were held for—
Count persons with multiple holds only once with priority
being federal, state, tribal, and local.


INCLUDE contractual, temporary, courtesy, or ad hoc
holds for other agencies.
a. Federal authorities

a. Convicted ..................................................
b. Unconvicted ...............................................

1. U.S. Marshals Service ....................
c. TOTAL (Sum of items 8a and 8b
should equal item 3a) .................................
9.

2. Federal Bureau of Prisons ............
3. U.S. Immigration and Customs
Enforcement (ICE)..........................

On December 31, 2015, how many persons CONFINED in
this facility, regardless of conviction status, had an
offense type of—

4. Bureau of Indian Affairs (BIA) .......
X

EXCLUDE inmates being housed for tribal
governments in item 11c below.
5. Other – Specify

For persons with more than one offense, report the most
serious type of offense.
a. Felony ........................................................

b. State prison authorities

b. Misdemeanor .............................................

1. For your state .................................
c. Other – Specify

2. For other states ..............................
c. American Indian or Alaska Native tribal governments
X

d. TOTAL (Sum of items 9a to 9c
should equal item 3a) .................................

EXCLUDE inmates being housed for the BIA in
item 11a4.

d. Other local jail jurisdictions
X
X

EXCLUDE inmates being housed for your own
jurisdiction (i.e., your own county/city inmates).
EXCLUDE inmates being housed for tribal
governments in item 11c.
1. Within your state ............................

When exact numeric answers are not available, provide
estimates and mark ( X ) in the checkbox beside each number
that is estimated. For example 1,234 

2. Outside your state .........................
e. TOTAL (Sum of items 11a to 11d) ...............
Page 3

12. a. During the 31-day period from December 1 to
December 31, 2015, on what day did this facility hold
the greatest number of inmates?

15. How many persons under the supervision of your jail
were—
a. ADMITTED to this facility during 2015?

Peak population should be equal to or greater than the
confined inmate population reported in item 3a.
December

, 2015

b. How many persons were CONFINED on that day?
Number that day

EXCLUDE—
X Returns from escape, work release, medical
appointments/treatment facilities, furloughs,
bail/bond releases, and court appearances.

13. Between January 1, 2015, and December 31, 2015, what
was the average daily population of this facility?








INCLUDE—
 Persons officially booked into and housed in this
facility by formal legal document and by the authority
of the courts or some other official agency
 Repeat offenders booked on new charges
 Persons serving a weekend sentence coming into
the facility for the first time.

INCLUDE inmates who participated in weekend
programs that allow offenders to serve their sentences
of confinement only on weekends (e.g., Friday–Sunday).
To calculate the average daily population, add the
number of persons for each day during the period
January 1, 2015, through December 31, 2015, and
divide the result by 365.
If daily counts are not available, estimate the average
daily population by adding the number of persons held
on the same day of each month and divide the result by
12.
If average daily population cannot be calculated as
directed above, then estimate the typical number of
persons held in this facility each day.
Average daily population
a. Males....................................................

New admissions
1. Males ....................................................
2. Females ................................................
3. TOTAL (Sum of items 15a1 and 15a2)
b. DISCHARGED from this facility during 2015?
INCLUDE—
 Persons released after a period of confinement
(e.g., sentence completion, bail/bond releases, other
pretrial releases, transfers to other jurisdictions, or
deaths)
 Persons completing their weekend sentence leaving
the facility for the last time.
EXCLUDE—
X Temporary discharges (e.g., work releases, medical
appointments/treatment, out to courts, furloughs,
day reporters, or transfers to other facilities within
your jurisdiction).

b. Females ...............................................
c. TOTAL (Sum of items 13a and 13b) ....

Final discharges
14. On December 31, 2015, what was the total rated capacity
of this facility, excluding separate temporary holding
areas?



1. Males ....................................................
2. Females ................................................

Rated capacity is the maximum number of beds or
inmates assigned by a rating official to a facility.
If rated capacity is not available, estimate by using the
design capacity and mark the checkbox.

3. TOTAL (Sum of items 15b1 and 15b2)

Rated capacity

When exact numeric answers are not available, provide
estimates and mark ( X ) in the checkbox beside each number
that is estimated. For example 1,234 
Page 4

Section IV — POPULATION SUPERVISED IN THE
COMMUNITY
If item 3b equals 0 (zero), SKIP to item 17.

Section V —STAFFING
17. On December 31, 2015, how many staff employed in this
facility were—

16. On December 31, 2015, how many persons under the
supervision of this facility who were NOT CONFINED
participated in—
X

Count each employee only once. Classify employees with
multiple functions by the function performed most frequently.
 INCLUDE payroll staff, nonpayroll staff on the payroll of
other government agencies (e.g., health department,
school district, or court), and unpaid interns.
X EXCLUDE staff paid through contractual agreements
and community volunteers.

EXCLUDE inmates on weekend programs.

a. Electronic monitoring ................................
b. Home detention without
electronic monitoring ................................

a. Correctional officers
(Deputies, monitors, and other custody
staff who spend more than 50% of their
time with the incarcerated population.)

c. Community service ....................................
d. Day reporting .............................................

1. Males .................................................

e. Other pretrial supervision .........................

2. Females ..............................................

f. Other alternative work programs .............
X EXCLUDE inmates participating in
work release programs who return to
jail at night.

b. All other staff
(Administrators, clerical and maintenance
staff, educational staff, professional and
technical staff, and other staff – unspecified
who spend more than 50% of their time in
the facility.)

g. Alcohol/drug treatment programs ............
X EXCLUDE inmates participating in
alcohol/drug treatment programs
who are confined in jail.

1. Males ..................................................

h. Other programs outside of
jail facilities – Specify

2. Females ..............................................
i. TOTAL (Sum of items 16a to 16h
should equal item 3b) ..................................

c. TOTAL (Sum of items 17a and 17b) ............

When exact numeric answers are not available, provide
estimates and mark ( X ) in the checkbox beside each number
that is estimated. For example 1,234 
Page 5

Attachment E. Survey form CJ9A

OMB No. 1121-0094 Approval Expires ##/##/201#
U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:

DEATHS IN CUSTODY—2015
ANNUAL SUMMARY ON INMATES
UNDER JAIL JURISDICTION

Form CJ-9A

RTI INTERNATIONAL

FORM COMPLETED BY—
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

Email

Instructions for completion and submission
FOR EACH ITEM—
 If the answer to a question is “none” or “zero,” write “0” in the space provided.
 When exact numeric answers are not available, provide estimates and mark ( X ) in the checkbox beside each number that is
estimated. For example 1,234 
Please submit your completed form(s) within 30 days of receipt. You may submit your annual summary in one of these ways:
ONLINE: Complete this form online at: https://bjsdcrp.rti.org
EMAIL: [email protected]
FAX (TOLL-FREE): (866) 800-9179

MAIL: RTI International, Attn: Data Capture
Project Number: 0215015.001.100.102.100
5265 Capital Boulevard
Raleigh, NC 27690-1652

If you need assistance, contact Matt Bensen of RTI International toll-free at 1-800-344-1387 or [email protected].

What to include and exclude in this data collection
INCLUDE—
 Confinement facilities usually administered by a local law enforcement agency, intended for adults but sometimes holding juveniles.
 All jails and city/county correctional centers that hold inmates beyond arraignment. Report data on all inmates, including those held in
separate holding or lockup areas within your facilities.
 Special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms).
 Temporary holding or lockup facilities if they are part of your combined function.
 Inmates held for other jurisdictions, including federal authorities, state prison authorities, and other local jail jurisdictions.
EXCLUDE—
X Facilities that are exclusively used as temporary holding or lockup facilities, where inmates are generally held for less than 72 hours
and not held beyond arraignment.
X Privately operated jails and facilities operated by two or more jurisdictions (i.e., multi-jurisdictional facilities). These jails will be
contacted directly for this data collection.

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of this
collection is estimated to average 15 minutes per response, including reviewing instructions, searching existing data sources, gathering necessary data, and completing
and reviewing this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau
of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed form to this address.

«AGENCY ID»

INMATE COUNTS AND DEATHS

1. On December 31, 2015, how many persons under the
supervision of your jail jurisdiction were CONFINED in
your jail facilities?
INCLUDE—





X
X

Persons under your jurisdiction who are boarded
elsewhere
Inmates who are AWOL, escaped, or on long-term
transfer to other jurisdictions
Persons in community-based programs run by your
jails (e.g., electronic monitoring, house arrest,
community service, day reporting, or work programs)
who do NOT return to jail at night.

Inmates on
December 31,
2015

Males:

Estimate

Females:

Estimate

2. How many persons under the supervision of your jail
jurisdiction were ADMITTED to your jail facilities during
2015?
INCLUDE—




Persons officially booked into and housed in your jail
facilities by formal legal document and by the
authority of the courts or some other official agency
Repeat offenders booked on new charges
Persons serving a weekend sentence coming into the
facility for the first time.

Returns from escape, work release, medical
appointments/treatment facilities, furloughs, bail/bond
releases, and court appearances.

New ANNUAL
admissions
during 2015

INCLUDE contractual, temporary, courtesy, or ad hoc
holds for other agencies.
Count persons with multiple holds only once with priority
being federal, state, tribal, and local.

a. U.S. Immigration and
Customs Enforcement:

Estimate

b. U.S. Marshals Service:

Estimate

c. All other holds (state and
federal prison, Bureau of
Indian Affairs, or any holds
for other jail jurisdictions):

Estimate

4. Between January 1, 2015, and December 31, 2015, what
was the average daily population of your jail facilities?


INCLUDE inmates who participated in weekend
programs that allow offenders to serve their sentences
of confinement only on weekends (e.g., Friday–Sunday).
To calculate the average daily population, add the
number of persons for each day between January 1,
2015, and December 31, 2015, and divide the result by
365.
If daily counts are not available, estimate the average
daily population by adding the number of persons held
on the same day of each month and divide the result by
12.
If average daily population cannot be calculated as
directed above, then estimate the typical number of
persons held in your jail confinement facilities each day.







Average daily
population
during 2015

Males:

Estimate

Females:

Estimate

5. Between January 1, 2015, and December 31, 2015, how
many persons died while under the supervision of your
jail facilities?
INCLUDE deaths of ALL persons—

EXCLUDE—
X




Persons on transfer to treatment facilities but who
remain under your jurisdiction
Persons held for other jurisdictions
Persons in community-based programs (e.g., work
release, day release, or drug/alcohol treatment) who
return to jail at night
Persons out to court while under your jurisdiction.

EXCLUDE—
X

3. On December 31, 2015, how many persons CONFINED in
your jail facilities were held for—

Males:

Estimate

Females:

Estimate






CONFINED in your jail facilities
UNDER THE SUPERVISION of your jail facilities, but
out to court or in special facilities (e.g., hospital,
hospice, or nursing home; treatment facility;
residential community center; residential work release
or house arrest program; or release center)
WHILE IN TRANSIT to or from your jail facilities while
under your supervision.

EXCLUDE—
X

Number of
inmate
deaths
during 2015

Deaths of persons in the process of arrest by your
agency if they have not yet been booked into your jail
facilities. Arrest-related deaths should be reported
using a CJ-11A form.

Males:
Females:

«AGENCY ID»

Attachment F. Survey form CJ10A

OMB No. 1121-0094 Approval Expires ##/##/201#
U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:

DEATHS IN CUSTODY—2015
ANNUAL SUMMARY ON INMATES IN
PRIVATE AND MULTIJURISDICTIONAL JAILS

Form CJ-10A

RTI INTERNATIONAL

FORM COMPLETED BY—
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

Email

Instructions for completion and submission
FOR EACH ITEM—
 If the answer to a question is “none” or “zero,” write “0” in the space provided.
 When exact numeric answers are not available, provide estimates and mark ( X ) in the checkbox beside each number that is
estimated. For example 1,234 
Please submit your completed form(s) within 30 days of receipt. You may submit your annual summary in one of these ways:
ONLINE: Complete this form online at: https://bjsdcrp.rti.org
EMAIL: [email protected]
FAX (TOLL-FREE): (866) 800-9179

MAIL: RTI International, Attn: Data Capture
Project Number: 0215015.001.100.102.100
5265 Capital Boulevard
Raleigh, NC 27690-1652

If you need assistance, contact Matt Bensen of RTI International toll-free at 1-800-344-1387 or [email protected].

What to include and exclude in this data collection
INCLUDE—
 Confinement facilities—including detention centers, jails, and other correctional facilities—intended for adults but sometimes holding
juveniles, that are either privately owned and operated or administered by two or more governments (or a board composed of
representatives from two or more governments).
 All jails and city/county correctional centers that hold inmates beyond arraignment. Report data on all inmates, including those held in
separate holding or lockup areas within your facilities.
 Special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms).
 Temporary holding or lockup facilities if they are part of your combined function.
 Inmates held for other jurisdictions, including federal authorities, state prison authorities, and other local jail jurisdictions.
EXCLUDE—
X Facilities that are exclusively used as temporary holding or lockup facilities, where inmates are generally held for less than 72 hours
and not held beyond arraignment.

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of this
collection is estimated to average 15 minutes per response, including reviewing instructions, searching existing data sources, gathering necessary data, and completing
and reviewing this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau
of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed form to this address.

«AGENCY ID»

INMATE COUNTS AND DEATHS

1. On December 31, 2015, how many persons under the
supervision of your jail were CONFINED in this facility?



INCLUDE—





Persons on transfer to treatment facilities but who
remain under your jurisdiction
Persons held for other jurisdictions
Persons in community-based programs (e.g., work
release, day release, or drug/alcohol treatment) who
return to jail at night
Persons out to court while under your jurisdiction.

EXCLUDE—
X
X
X

Persons under your jurisdiction who are boarded
elsewhere
Inmates who are AWOL, escaped, or on long-term
transfer to other jurisdictions
Persons in community-based programs run by this
facility (e.g., electronic monitoring, house arrest,
community service, day reporting, or work programs)
who do NOT return to jail at night.

Inmates on
December 31,
2015

3. On December 31, 2015, how many persons CONFINED in
this facility were held for—

Males:

Estimate

Females:

Estimate

INCLUDE contractual, temporary, courtesy, or ad hoc
holds for other agencies.
Count persons with multiple holds only once with priority
being federal, state, tribal, and local.



a. U.S. Immigration and
Customs Enforcement:

Estimate

b. U.S. Marshals Service:

Estimate

c. All other holds (state and
federal prison, Bureau of
Indian Affairs, or any holds
for other jail jurisdictions):

Estimate

4. Between January 1, 2015, and December 31, 2015, what
was the average daily population of this facility?


INCLUDE inmates who participated in weekend
programs that allow offenders to serve their sentences
of confinement only on weekends (e.g., Friday–Sunday).
To calculate the average daily population, add the
number of persons for each day between January 1,
2015, and December 31, 2015, and divide the result by
365.
If daily counts are not available, estimate the average
daily population by adding the number of persons held
on the same day of each month and divide the result by
12.
If average daily population cannot be calculated as
directed above, then estimate the typical number of
persons held in this facility each day.





2. How many persons under the supervision of your jail were
ADMITTED to this facility during 2015?



INCLUDE—




Persons officially booked into and housed in this
facility by formal legal document and by the authority
of the courts or some other official agency
Repeat offenders booked on new charges
Persons serving a weekend sentence coming into the
facility for the first time.

EXCLUDE—
X

Returns from escape, work release, medical
appointments/treatment facilities, furloughs, bail/bond
releases, and court appearances.

New ANNUAL
admissions
during 2015

Males:

Estimate

Females:

Estimate

Average daily
population
during 2015

Males:

Estimate

Females:

Estimate

5. Between January 1, 2015, and December 31, 2015, how
many persons died while under the supervision of this
facility?
INCLUDE deaths of ALL persons—





CONFINED in this facility
UNDER THE SUPERVISION of this facility, but out to
court or in special facilities (e.g., hospital, hospice, or
nursing home; treatment facility; residential
community center; residential work release or house
arrest program; or release center)
WHILE IN TRANSIT to or from this facility while
under your supervision.

EXCLUDE—
X

Number of
inmate
deaths
during 2015

Deaths of persons in the process of arrest by your
agency if they have not yet been booked into this
facility. Arrest-related deaths should be reported
using a CJ-11A form.

Males:
Females:

«AGENCY ID»

Attachment G. Survey form CJ9

OMB No. 1121-0094 Approval Expires XX/XX/201X

DEATHS IN CUSTODY—2016
DEATH REPORT ON INMATES
UNDER JAIL JURISDICTION

Form CJ-9

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Instructions for Completion
If no deaths occurred in 2016:

You do not need to report anything at this time.

At the beginning of 2016, you will be asked to complete a summary form whether or not you had a death occurrence in 2015.
If you had more than one death in 2016:

Make copies of this form for each additional death.

Complete the entire form for each inmate death.

Once your death records are complete, there are several ways to submit a death report:
ONLINE: Complete the report online at: https://bjsdcrp.rti.org
E-MAIL: [email protected]
FAX (TOLL-FREE): (866) 800-9179

MAIL: RTI International, Attn: Data Capture
Project Number: 0215015.001.100.102.100
5265 Capital Boulevard
Raleigh, NC 27690-1652

If you need assistance, contact Matt Bensen of RTI International toll-free at (800) 344-1387 or [email protected]

What deaths should be reported?
INCLUDE deaths of ALL persons…

EXCLUDE deaths of ALL persons…



Confined in your jail facilities, whether housed under
your own or another jurisdiction



Confined in facilities operated by two or more
jurisdictions or those held in privately operated jails



Under your jurisdiction but housed in special jail
facilities (e.g., medical/treatment/release centers,
halfway houses, or work farms); or on transfer to
treatment facilities



Under your jurisdiction but in nonresidential communitybased programs run by your jails (e.g., electronic
monitoring, house arrest, community service, day
reporting, work programs)



Under your jurisdiction but out to court





Under your jurisdiction but AWOL, escaped, or on longterm transfer to another jurisdiction

In transit to or from your facilities while under your
jurisdiction



In the process of arrest by your agency, but not yet
booked into your jail facility

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 30 minutes per each reported death, including reviewing instructions, searching existing data sources, gathering necessary data,
and completing and reviewing this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to
the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed form to this address.

.

«AGENCY ID»

LOCAL JAIL INMATE DEATH REPORT

1. What was the inmate’s name?
LAST

8. On what date was the inmate admitted to a facility
under your jurisdiction?

FIRST

MI
MONTH

DAY

YEAR

2. On what date did the inmate die?
2
MONTH

DAY

0

1

9. Was the inmate being confined in your jail facility
on behalf of any of the following?

6

YEAR

PLEASE PROVIDE A RESPONSE FOR EACH ITEM (a–c)

3. What was the name and location of the correctional
facility involved?
Facility Name:

Facility City:

Facility State:

DON’T
YES NO KNOW
a. U.S. Immigration and
Customs Enforcement................................ ...........
b. U.S. Marshals Service ................................ ...........
c. State or federal prison,
Bureau of Indian Affairs,
or any other jail jurisdiction......................... ...........

10. For what offense(s) was the inmate being held?
4. What was the inmate’s date of birth?

a.
b.

MONTH

DAY

YEAR

c.
5. What was the inmate’s sex?
Male
Female

6. Was the inmate of Hispanic, Latino, or Spanish
origin?
Yes
No
7. In addition, what was the inmate’s race? Please
select one or more of the following racial
categories:
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Some other race
Please Specify:

d.
e.

11. What was the inmate’s legal status at time of
death? (For inmates with more than one status, report
the status associated with the most serious offense.)
Convicted—new court commitment
Convicted—returned probation/parole violator
Unconvicted
Other
Please Specify:

12. Since admission, did the inmate ever stay
overnight in a mental health observation unit or an
outside mental health facility?
Yes
No
Don’t Know

«AGENCY ID»

13. Where did the inmate die?
In a general housing unit within the jail facility or in a general housing unit on jail grounds
In a segregation unit
In a special medical unit/infirmary within the jail facility
In a special mental health services unit within the jail facility
In a medical center outside the jail facility
In a mental health center outside the jail facility
While in transit
Elsewhere
Please Specify:

14. Are the results of a medical examiner’s or coroner’s evaluation (such as an autopsy, postmortem exam, or
review of medical records) available to establish an official cause of death?
YES
CONTINUE TO Q15
Evaluation complete—results are pending
SKIP REMAINING QUESTIONS AND SUBMIT THIS FORM—YOU WILL BE CONTACTED AT A LATER
TIME FOR THE CAUSE OF DEATH
No evaluation is planned
15. What was the cause of death?

CONTINUE TO Q15
*** Please SPECIFY cause of death—it is critical information ***

Illness—Exclude AIDS-related deaths [Specify]
Acquired Immune Deficiency Syndrome (AIDS)
Accidental alcohol/drug intoxication [Describe]
Accidental injury to self [Describe]
Accidental injury by other (e.g., vehicular
accidents during transport) [Describe]
Suicide (e.g., hanging, knife/cutting instrument,
intentional drug overdose) [Describe]
Homicide [Describe]
Other cause(s) [Specify]

16. Where did the incident (e.g., accident, suicide, or homicide) causing the death take place?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
In the jail facility or on the jail grounds
In the inmate’s cell/room
In a temporary holding area/lockup
In a common area within the facility (e.g., yard, library, cafeteria)
[PLEASE
In a segregation unit
SPECIFY]
In a special medical unit/infirmary
In a special mental health services unit
Elsewhere within the jail facility
Please Specify:

Outside the jail facility (e.g., while on work release or on work detail)
Elsewhere
Please Specify:
«AGENCY ID»

17. When did the incident (e.g., accident, suicide, or homicide) causing the death occur?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
Morning (6 am to Noon)
Afternoon (Noon to 6 pm)
Evening (6 pm to Midnight)
Overnight (Midnight to 6 am)
18. Excluding emergency care provided at the time of death, did the inmate receive any of the following medical
services for the medical condition that caused his/her death after admission to your correctional facilities?
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide

a.
b.
c.
d.
e.
f.

YES
NO
DON’T KNOW
Evaluation by physician/medical staff ......................................................
PLEASE PROVIDE A
Diagnostic tests (e.g., X-rays, MRI) .........................................................
RESPONSE FOR
Medications ...............................................................................................
EACH ITEM (a–f)
Treatment/care other than medications ....................................................
Surgery ......................................................................................................
Confinement in special medical unit. ........................................................

19. Was the cause of death the result of a pre-existing medical condition or did the inmate develop the condition
after admission? (If multiple conditions caused the death and any of the conditions were pre-existing, mark
“Pre-existing medical condition.”)
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
Pre-existing medical condition
Deceased developed condition after admission
Could not be determined
Please add any additional notes regarding this death here:

«AGENCY ID»

Attachment H. Survey form CJ10

OMB No. 1121-0094 Approval Expires XX/XX/201X

DEATHS IN CUSTODY—2016
DEATH REPORT ON INMATES IN
PRIVATE AND MULTI-JURISDICTIONAL JAILS

Form CJ-10

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

FORM COMPLETED BY:
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

Instructions for Completion
If no deaths occurred in 2016:

You do not need to report anything at this time.

At the beginning of 2016, you will be asked to complete a summary form whether or not you had a death occurrence in 2015.
If you had more than one death in 2016:

Make copies of this form for each additional death.

Complete the entire form for each inmate death.

Once your death records are complete, there are several ways to submit a death report:
ONLINE: Complete the report online at: https://bjsdcrp.rti.org
E-MAIL: [email protected]
FAX (TOLL-FREE): (866) 800-9179

MAIL: RTI International, Attn: Data Capture
Project Number: 0215015.001.100.102.100
5265 Capital Boulevard
Raleigh, NC 27690-1652

If you need assistance, contact Matt Bensen of RTI International toll-free at (800) 344-1387 or [email protected]

What deaths should be reported?
INCLUDE deaths of ALL persons…


Confined in your jail facilities, even if housed for
another jurisdiction



Under your jurisdiction but housed in special jail
facilities (e.g., medical/treatment/release centers,
halfway houses, or work farms); or on transfer to
treatment facilities



Under your jurisdiction but out to court



In transit to or from your facilities while under your
supervision

EXCLUDE deaths of ALL persons…


Under your jurisdiction but in nonresidential communitybased programs run by your jails (e.g., electronic
monitoring, house arrest, community service, day
reporting, work programs)



Under your jurisdiction but AWOL, escaped, or on longterm transfer to another jurisdiction



In the process of arrest by your agency, but not yet
booked into your jail facility

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control number. The burden of
this collection is estimated to average 30 minutes per each reported death, including reviewing instructions, searching existing data sources, gathering necessary data,
and completing and reviewing this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to
the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed form to this address.

.
«AGENCY ID»

JAIL INMATE DEATH REPORT
1. What was the inmate’s name?
LAST

8. On what date was the inmate admitted to your jail
facility?

FIRST

MI
MONTH

DAY

YEAR

2. On what date did the inmate die?
2

2
MONTH

DAY

0

0

1

1

3

9. Was the inmate being confined in your jail facility
on behalf of any of the following?

6

YEAR

PLEASE PROVIDE A RESPONSE FOR EACH ITEM (a–c)

3. What was the name and location of the correctional
facility involved?
FacilityName:
Name:
Facility
Facility Location:
Facility City:

Facility State:

DON’T
YES NO KNOW
a. U.S. Immigration and
Customs Enforcement ................................ ..........
b. U.S. Marshals Service ................................ ..........
c. State or federal prison,
Bureau of Indian Affairs,
or any other jail jurisdiction ......................... ..........

10. For what offense(s) was the inmate being held?
4. What was the inmate’s date of birth?
MONTH

DAY

YEAR

a.
b.
c.

5. What was the inmate’s sex?
Male
Female

d.
e.

6. Was the inmate of Hispanic, Latino, or Spanish
origin?
Yes
No

7. In addition, what was the inmate’s race? Please
select one or more of the following racial
categories:
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Some other race
Please Specify:

11. What was the inmate’s legal status at time of
death? (For inmates with more than one status, report
the status associated with the most serious offense.)
Convicted—new court commitment
Convicted—returned probation/parole violator
Unconvicted
Other
Please Specify:

12. Since admission, did the inmate ever stay
overnight in a mental health observation unit or an
outside mental health facility?
Yes
No
Don’t Know

«AGENCY ID»

13. Where did the inmate die?
In a general housing unit within the jail facility or in a general housing unit on jail grounds
In a segregation unit
In a special medical unit/infirmary within the jail facility
In a special mental health services unit within the jail facility
In a medical center outside the jail facility
In a mental health center outside the jail facility
While in transit
Elsewhere
Please Specify:

14. Are the results of a medical examiner’s or coroner’s evaluation (such as an autopsy, postmortem exam, or
review of medical records) available to establish an official cause of death?
YES
CONTINUE TO Q15
Evaluation complete—results are pending
SKIP REMAINING QUESTIONS AND SUBMIT THIS FORM - YOU WILL BE CONTACTED AT A LATER
TIME FOR THE CAUSE OF DEATH
No evaluation is planned
CONTINUE TO Q15

15. What was the cause of death?

*** Please SPECIFY cause of death—it is critical information ***

Illness—Exclude AIDS-related deaths [Specify]
Acquired Immune Deficiency Syndrome (AIDS)
Accidental alcohol/drug intoxication [Describe]
Accidental injury to self [Describe]
Accidental injury by other (e.g., vehicular
accidents during transport) [Describe]
Suicide (e.g., hanging, knife/cutting instrument,
intentional drug overdose) [Describe]
Homicide [Describe]
Other cause(s) [Specify]
16. Where did the incident (e.g., accident, suicide, or homicide) causing the death take place?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
In the jail facility or on the jail grounds
In the inmate’s cell/room
In a temporary holding area/lockup
In a common area within the facility (e.g., yard, library, cafeteria)
[PLEASE
In a segregation unit
SPECIFY]
In a special medical unit/infirmary
In a special mental health services unit
Elsewhere within the jail facility
Please Specify:

Outside the jail facility (e.g., while on work release or on work detail)
Elsewhere
Please Specify:

«AGENCY ID»

17. When did the incident (e.g., accident, suicide, or homicide) causing the death occur?
NOT APPLICABLE—Cause of death was illness, intoxication, or AIDS-related
Morning (6 am to Noon)
Afternoon (Noon to 6 pm)
Evening (6 pm to Midnight)
Overnight (Midnight to 6 am)
18. Excluding emergency care provided at the time of death, did the inmate receive any of the following medical
services for the medical condition that caused his/her death after admission to your correctional facilities?
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide

a.
b.
c.
d.
e.
f.

YES
NO
DON’T KNOW
Evaluation by physician/medical staff ......................................................
PLEASE PROVIDE A
Diagnostic tests (e.g., X-rays, MRI) .........................................................
RESPONSE FOR EACH
Medications ...............................................................................................
ITEM (a–f)
Treatment/care other than medications ....................................................
Surgery ......................................................................................................
Confinement in special medical unit. ........................................................

19. Was the cause of death the result of a pre-existing medical condition or did the inmate develop the condition
after admission? (If multiple conditions caused the death and any of the conditions were pre-existing, mark
“Pre-existing medical condition.”)
NOT APPLICABLE—Cause of death was accidental injury, intoxication, suicide, or homicide
Pre-existing medical condition
Deceased developed condition after admission
Could not be determined
Please add any additional notes regarding this death here:

«AGENCY ID»

Attachment I. Historical ASJ forms – CJ5DA, CJ5D,
CJ5A, CJ5

CJ-5

OMB No. 1121-0094: Approval Expires 5/31/2016

CJ-5

RETURN
TO

U.S. Census Bureau
Governments Division
Washington, DC 20233-6800

FORM
(3-7-2014)

U.S. DEPARTMENT OF JUSTICE

2014 ANNUAL
SURVEY OF JAILS

BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT

U.S. DEPARTMENT OF COMMERCE
ECONOMICS AND STATISTICS ADMINISTRATION
U.S. CENSUS BUREAU

DATA SUPPLIED BY
Name
OFFICIAL
ADDRESS
TELEPHONE

Title
Number and street or P.O. box/Route number
Area code

Number

Extension

City
FAX
NUMBER

State ZIP Code
Area Code

Number

E-MAIL
ADDRESS

(Please correct any error in name, mailing address, and ZIP Code)

GENERAL INFORMATION
• If you have any questions, call the U.S. Census Bureau at 1–800–253–2078, or e-mail [email protected].
• Please complete the questionnaire before July 31, 2014 using the web-reporting option (see the web flyer for details), by
mailing the completed form to the U.S. Census Bureau in the enclosed envelope, or by FAXing all pages to
1–888–262–3974.
• Please retain a copy of the completed form for your records.

What types of facilities are included in this survey?
Confinement facilities usually administered by a local law enforcement agency, intended for adults but sometimes
holding juveniles.
• INCLUDE jails and city/county correctional centers.
• INCLUDE special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms).
• INCLUDE temporary holding or lockup facilities if they are part of your combined function.
• EXCLUDE temporary holding or lockup facilities that are not part of your combined function from which inmates are
usually transferred within 72 hours and not held beyond arraignment. If your only function is a temporary holding or
lockup facility, DO NOT complete this form – contact Leslie Miller at 1–800–253–2078.
• EXCLUDE facilities reporting to form CJ-5D, which collects data from jail jurisdictions that are selected with certainty to
participate in the Annual Survey of Jails.

Burden statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a
currently valid OMB control number. The burden of this collection is estimated to average 1 1/4 hours per response,
including reviewing instructions, searching existing data sources, gathering necessary data, and completing and reviewing
this form. Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing
this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your
completed form to this address.

FORM CJ-5 (3-7-2014)

REPORTING INSTRUCTIONS
• If the answer to a question is "not available" or "unknown," write "DK" in the space provided.
• If the answer to a question is "not applicable," write "NA" in the space provided.
• If the answer to a question is "none" or "zero," write "0" in the space provided.
• When exact numeric answers are not available, provide estimates and mark (X) in the
box beside each figure that is estimated. For example 1,234 X

Section I — SUPERVISED POPULATION

I.2. Of all persons under your jail supervision
reported in item I.1c, how many were not U.S.
citizens?

I.1. On June 30, 2014, how many persons under the
supervision of your jail jurisdiction were —

Non-US citizens

a. CONFINED in your jail facilities?
I.3. On the weekend prior to June 30, 2014, did your
jail jurisdiction have a weekend program?

• INCLUDE persons on transfer to treatment
facilities but who remain under your
jurisdiction.

• Weekend programs allow offenders to serve their

• INCLUDE persons held for other jurisdictions.

sentences of confinement only on weekends (e.g.,
Friday–Sunday).

• INCLUDE persons in community-based programs
(e.g., work release, day release, drug/alcohol
treatment) who return to jail at night.

1

Yes – How many inmates
participated?

2

No

• EXCLUDE any persons housed in facilities
operated by two or more jurisdictions or those
housed in privately operated jails.

Section II — INMATE COUNTS AND MOVEMENTS
OF THE CONFINED POPULATION

• EXCLUDE inmates on AWOL, escape, or
long-term transfer to other jurisdictions.
• EXCLUDE inmates being boarded out to another
county or held in another facility not operated by
your jail jurisdiction.

II.1. On June 30, 2014, how many persons CONFINED
in your jail facilities were —
a. Adult males (age 18 or
older) . . . . . . . . . . . . . . . . . . .
b. Adult females (age 18 or
older) . . . . . . . . . . . . . . . . . . .

b. Under jail supervision but NOT CONFINED?
• INCLUDE all persons in community-based programs
run by your jails (e.g., electronic monitoring, house
arrest, community service, day reporting, and work
programs).

c. Males under age 18 . . . . . . .
d. Females under age 18 . . . . .

• EXCLUDE persons on pretrial release who are not in
a community based program run by your jails.
• EXCLUDE persons under supervision of probation,
parole or other agencies.
• EXCLUDE inmates on weekend programs.
Weekend programs allow offenders to serve
their sentences of confinement only on weekends
(e.g., Friday–Sunday).

e. TOTAL (Sum of items II.1a to
II.1d should equal item I.1a) . . . .
II.2. Of all persons under the age of 18 CONFINED in
your jail facilities on June 30, 2014 (items II.1c
and II.1d), how many were tried, or awaiting
trial, in adult court?
Number of persons under
age 18 held as adults. . . . . . . . . .

• EXCLUDE inmates participating in work release
programs who return to the jail at night.

c. Total (Sum of items
I.1a and I.1b) . . . . . . . . . . . . .
Page 2

FORM CJ-5 (3-7-2014)

II.3. Of all persons CONFINED in your jail facilities
on June 30, 2014, how many were —

II.5. On June 30, 2014, how many persons
CONFINED in your jail facilities were held for —
• For persons with a multiple hold, count them only
once with priority being Federal, State, and local.

• For persons with more than one status, report the
status with the most serious offense.
• For convicted inmates include probation and parole
violators with no new sentence.

a. Federal authorities
1. U.S. Marshals Service . .

a. Convicted. . . . . . . . . . . . . .
2. Federal Bureau of Prisons
How many were —
1. Unsentenced inmates
or awaiting sentencing. . . .

3. U.S. Immigration and
Customs Enforcement
(I.C.E.). . . . . . . . . . . . . . .

2. Sentenced inmates. . . . . .

4. Bureau of Indian Affairs .
5. Other – Specify

b. Unconvicted . . . . . . . . . . .
How many were —

b. State prison authorities

1. Awaiting trial/
arraignment. . . . . . . . . . .

1. For your state . . . . . . . . .

2. Awaiting transfer/hold
for other authorities. . . . . .

2. For other states . . . . . . .
c. Other local jail jurisdictions

3. Other . . . . . . . . . . . . . . .

• EXCLUDE inmates being housed for your own
jurisdiction (i.e., your own county/city inmates).

c. TOTAL (Sum of items II.3a
and II.3b should equal item I.1a)

1. Within your state . . . . . .
II.4. On June 30, 2014, how many persons
CONFINED in your jail facilities were —

2. Outside your state . . . . .
d. TOTAL (Sum of items II.5a
to II.5c) . . . . . . . . . . . . . . . . .

a. White, not of Hispanic
origin . . . . . . . . . . . . . . . . . .
b. Black or African American,

not of Hispanic origin. . . . . . . .

II.6. a. During the 30-DAY period from June 1 to
June 30, 2014, on what day did your facility
hold the greatest number of inmates?

c. Hispanic or Latino . . . . . . .

• Peak population should be equal to or greater than
the confined inmate population reported in item I.1a.

d. American Indian/Alaska
Native, not of Hispanic origin .

June
e. Asian, not of Hispanic origin . .

, 2014

b. How many persons were CONFINED on
that day?

f. Native Hawaiian or Other
Pacific Islander, not of
Hispanic origin . . . . . . . . . . . .

Number that day

g. Two or more races, not
of Hispanic origin . . . . . . . . . .
h. Additional categories in your
information system — Specify

i. Not known . . . . . . . . . . . . .
j. TOTAL (Sum of items II.4a
to II.4i should equal item I.1a) . .

Page 3

FORM CJ-5 (3-7-2014)

Section III — POPULATION SUPERVISED
IN THE COMMUNITY

II.7. Between July 1, 2013, and June 30, 2014,
what was the average daily population of all
jail confinement facilities operated by your
jurisdiction?

If item I.1b equals 0 (zero), STOP HERE.
III.1. On June 30, 2014, how many persons under
your jail supervision who were NOT CONFINED,
participated in —

• Include inmates who participated in weekend
programs that allow offenders to serve their
sentences of confinement only on weekends
(e.g., Friday-Sunday).

• EXCLUDE inmates on weekend programs.

• To calculate the average daily population, add the
number of persons for each day during the period
July 1, 2013, through June 30, 2014, and divide
the result by 365.

a. Electronic monitoring. . . .
b. Home detention without
electronic monitoring . . . .

Average daily population

c. Community service. . . . . .

II.8. On June 30, 2014, what was the total jail
capacity of your jail facilities?

d. Day reporting

a. Rated capacity
(The maximum number of beds
or inmates assigned by a rating
official to a facility, excluding
separate temporary holding
areas.) . . . . . . . . . . . . . . . .

.........

e. Other pretrial supervision
f. Other alternative work
programs . . . . . . . . . . . . .
• EXCLUDE inmates participating in work release
programs who return to the jail at night.

b. Operational capacity
(The number of inmates that can
be accommodated based on
staff, existing programs and
services in institutions within your
jurisdiction. Also known as
“budget” capacity.) . . . . . . . .

g. Alcohol/drug treatment
programs . . . . . . . . . . . . .
• EXCLUDE inmates participating in alcohol/drug
treatment programs who are confined in the jail.
h. Other programs outside
of jail facilities – Specify

c. Design capacity
(The number of inmate’s
planners or architects intended
for all jail facilities in your
jurisdiction.) . . . . . . . . . . . . .

i. TOTAL (Sum of items III.1a to
III.1h should equal item I.1b) .

II.9. During the WEEK of June 24 to June 30, 2014,
how many persons were —

III.2. On June 30, 2014, how many persons under
your jail supervision who were NOT
CONFINED were —

a. New admissions to your jail facilities?
• INCLUDE persons officially booked into and housed
in your facility by formal legal document and by the
authority of the courts or some other official agency.
• INCLUDE those persons serving a weekend
sentence coming into the facility for the first time.
• EXCLUDE returns from escape, work release,
medical appointments/treatment facilities, bail and
court appearances.

a. Adult males (age 18 or
older). . . . . . . . . . . . . . . . . .
b. Adult females (age 18 or
older). . . . . . . . . . . . . . . . . .
c. Males under age 18. . . . . .

New admissions

d. Females under age 18. . . .

b. Final discharges from your jail facilities?

e. TOTAL (Sum of items III.2a to
III.2d should equal item I.1b) . .

• INCLUDE all persons released after a period of
confinement (e.g., sentence completion, bail/bond
releases, other pretrial releases, transfers to other
jurisdictions, and deaths).
• INCLUDE those persons completing their weekend
sentence leaving the facility for the last time.
• EXCLUDE temporary discharges (e.g., work
releases, medical appointments/treatment, to courts,
furloughs, day reporters, and transfers to other
facilities within your jurisdiction).

III.3. Of all persons under your jail supervision who
were NOT CONFINED on June 30, 2014, how
many were —
a. Convicted

............

b. Unconvicted . . . . . . . . . . .
c. TOTAL (Sum of items III.3a and
III.3b should equal item I.1b) . .

Final discharges

Page 4

CJ-5D

OMB No. 1121-0094: Approval Expires 5/31/2016

CJ-5D

RETURN
TO

U.S. Census Bureau
Governments Division
Washington, DC 20233-6800

FORM
(3-7-2014)

U.S. DEPARTMENT OF JUSTICE

2014 ANNUAL
SURVEY OF JAILS

BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT

U.S. DEPARTMENT OF COMMERCE
ECONOMICS AND STATISTICS ADMINISTRATION
U.S. CENSUS BUREAU

DATA SUPPLIED BY
Name
OFFICIAL
ADDRESS
TELEPHONE

Title
Number and street or P.O. box/Route number
Area code

Number

Extension

City
FAX
NUMBER

State ZIP Code
Area Code

Number

E-MAIL
ADDRESS

(Please correct any error in name, mailing address, and ZIP Code)

GENERAL INFORMATION
• If you have any questions, call the U.S. Census Bureau at 1–800–253–2078, or e-mail [email protected].
• Please complete the questionnaire before July 31, 2014 using the web-reporting option (see the web flyer for details), by
mailing the completed form to the U.S. Census Bureau in the enclosed envelope, or by FAXing all pages to
1–888–262–3974.
• Please retain a copy of the completed form for your records.

What types of facilities are included in this survey?
Confinement facilities in jurisdictions included with certainty in the Annual Survey of Jails. Confinement facilities are usually
administered by a local law enforcement agency, intended for adults but sometimes holding juveniles.
Confinement facilities
• INCLUDE jails and city/county correctional centers.
• INCLUDE special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms).
• INCLUDE temporary holding or lockup facilities if they are part of your combined function.
• EXCLUDE temporary holding or lockup facilities that are not part of your combined function from which inmates are
usually transferred within 72 hours and not held beyond arraignment. If your only function is a temporary holding or
lockup facility, DO NOT complete this form – contact Leslie Miller at 1–800–253–2078.
Certainty jurisdictions
• INCLUDE facilities in jail jurisdictions that held juvenile inmates at the time of the 2005 Census of Jail Inmates and had an
average daily population of 500 or more inmates during the 12 months ending June 30, 2005.
• INCLUDE facilities in jail jurisdictions that held only adult inmates and had an average daily population of 750 or more at the
time of the 2005 Census of Jail Inmates.

Burden statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a
currently valid OMB control number. The burden of this collection is estimated to average 2 hours per response, including
reviewing instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form.
Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden,
to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed
form to this address.

FORM CJ-5D (3-7-2014)

REPORTING INSTRUCTIONS
• If the answer to a question is "not available" or "unknown," write "DK" in the space provided.
• If the answer to a question is "not applicable," write "NA" in the space provided.
• If the answer to a question is "none" or "zero," write "0" in the space provided.
• When exact numeric answers are not available, provide estimates and mark (X) in the
box beside each figure that is estimated. For example 1,234 X

Section I — SUPERVISED POPULATION

I.2. Of all persons under your jail supervision
reported in item I.1c, how many were not U.S.
citizens?

I.1. On June 30, 2014, how many persons under the
supervision of your jail jurisdiction were —

Non-US citizens

a. CONFINED in your jail facilities?
I.3. On the weekend prior to June 30, 2014, did your
jail jurisdiction have a weekend program?

• INCLUDE persons on transfer to treatment
facilities but who remain under your
jurisdiction.

• Weekend programs allow offenders to serve their

• INCLUDE persons held for other jurisdictions.

sentences of confinement only on weekends (e.g.,
Friday–Sunday).

• INCLUDE persons in community-based programs
(e.g., work release, day release, drug/alcohol
treatment) who return to jail at night.

1

Yes – How many inmates
participated?

2

No

• EXCLUDE any persons housed in facilities
operated by two or more jurisdictions or those
housed in privately operated jails.

Section II — INMATE COUNTS AND MOVEMENTS
OF THE CONFINED POPULATION

• EXCLUDE inmates on AWOL, escape, or
long-term transfer to other jurisdictions.
• EXCLUDE inmates being boarded out to another
county or held in another facility not operated by
your jail jurisdiction.

II.1. On June 30, 2014, how many persons CONFINED
in your jail facilities were —
a. Adult males (age 18 or
older) . . . . . . . . . . . . . . . . . . .
b. Adult females (age 18 or
older) . . . . . . . . . . . . . . . . . . .

b. Under jail supervision but NOT CONFINED?
• INCLUDE all persons in community-based programs
run by your jails (e.g., electronic monitoring, house
arrest, community service, day reporting, and work
programs).

c. Males under age 18 . . . . . . .
d. Females under age 18. . . . .

• EXCLUDE persons on pretrial release who are not in
a community based program run by your jails.
• EXCLUDE persons under supervision of probation,
parole or other agencies.
• EXCLUDE inmates on weekend programs.
Weekend programs allow offenders to serve
their sentences of confinement only on weekends
(e.g., Friday–Sunday).

e. TOTAL (Sum of items II.1a to
II.1d should equal item I.1a) . . . .
II.2. Of all persons under the age of 18 CONFINED in
your jail facilities on June 30, 2014 (items II.1c
and II.1d), how many were tried, or awaiting
trial, in adult court?
Number of persons under
age 18 held as adults . . . . . . . . .

• EXCLUDE inmates participating in work release
programs who return to the jail at night.

c. Total (Sum of items
I.1a and I.1b) . . . . . . . . . . . . .
Page 2

FORM CJ-5D (3-7-2014)

II.3. Of all persons CONFINED in your jail facilities
on June 30, 2014, how many were —

II.5. On June 30, 2014, how many persons
CONFINED in your jail facilities were held for —
• For persons with a multiple hold, count them only
once with priority being Federal, State, and local.

• For persons with more than one status, report the
status with the most serious offense.
• For convicted inmates include probation and parole
violators with no new sentence.

a. Federal authorities
1. U.S. Marshals Service . .

a. Convicted. . . . . . . . . . . . . .
2. Federal Bureau of Prisons
How many were —
1. Unsentenced inmates
or awaiting sentencing. . . .

3. U.S. Immigration and
Customs Enforcement
(I.C.E.) . . . . . . . . . . . . . . .

2. Sentenced inmates. . . . . .

4. Bureau of Indian Affairs .
5. Other – Specify

b. Unconvicted . . . . . . . . . . .
How many were —

b. State prison authorities

1. Awaiting trial/
arraignment. . . . . . . . . . .

1. For your state . . . . . . . . .

2. Awaiting transfer/hold
for other authorities. . . . . .

2. For other states . . . . . . .
c. Other local jail jurisdictions

3. Other . . . . . . . . . . . . . . .

• EXCLUDE inmates being housed for your own
jurisdiction (i.e., your own county/city inmates).

c. TOTAL (Sum of items II.3a
and II.3b should equal item I.1a)

1. Within your state
II.4. On June 30, 2014, how many persons
CONFINED in your jail facilities were —

2. Outside your state

not of Hispanic origin. . . . . . . .

II.6. a. During the 30-DAY period from June 1 to
June 30, 2014, on what day did your facility
hold the greatest number of inmates?

c. Hispanic or Latino . . . . . . .

• Peak population should be equal to or greater than
the confined inmate population reported in item I.1a.

d. American Indian/Alaska
Native, not of Hispanic origin .

June
e. Asian, not of Hispanic origin

....

d. TOTAL (Sum of items II.5a
to II.5c) . . . . . . . . . . . . . . . . .

a. White, not of Hispanic
origin . . . . . . . . . . . . . . . . . .
b. Black or African American,

.....

.

, 2014

b. How many persons were CONFINED on
that day?

f. Native Hawaiian or Other
Pacific Islander, not of
Hispanic origin . . . . . . . . . . . .

Number that day

g. Two or more races, not
of Hispanic origin . . . . . . . . .
h. Additional categories in your
information system — Specify

i. Not known . . . . . . . . . . . . .
j. TOTAL (Sum of items II.4a
to II.4i should equal item I.1a) . .

Page 3

FORM CJ-5D (3-7-2014)

II.7. Between July 1, 2013, and June 30, 2014,
what was the average daily population of all
jail confinement facilities operated by your
jurisdiction?

II.10. During the WEEK of June 24 to June 30, 2014,
how many persons discharged from your jail
jurisdiction were confined —
• Report time served, not sentence length, for
discharged person.

• Include inmates who participated in weekend
programs that allow offenders to serve their
sentences of confinement only on weekends
(e.g., Friday-Sunday).

Convicted Unconvicted
a. Less than 1 day

• To calculate the average daily population, add the
number of persons for each day during the period
July 1, 2013, through June 30, 2014, and divide
the result by 365.

.

b. 1 to 2 days . . . . . .
c. 3 to 7 days . . . . . .

Average daily population

d. 8 to 30 days . . . . .

II.8. On June 30, 2014, what was the total jail
capacity of your jail facilities?

e. 31 to 180 days . . .

a. Rated capacity
(The maximum number of beds
or inmates assigned by a rating
official to a facility, excluding
separate temporary holding
areas.) . . . . . . . . . . . . . . . .

f. More than 180 days
g. TOTAL (Sum of items
II.10a to II.10f should
equal item II.9b) . . .

b. Operational capacity
(The number of inmates that can
be accommodated based on
staff, existing programs and
services in institutions within your
jurisdiction. Also known as
“budget” capacity.) . . . . . . . .

Section III — POPULATION SUPERVISED
IN THE COMMUNITY
If item I.1b equals 0 (zero), SKIP to item IV.1

c. Design capacity
(The number of inmate’s
planners or architects intended
for all jail facilities in your
jurisdiction.) . . . . . . . . . . . . .

III.1. On June 30, 2014, how many persons under
your jail supervision who were NOT CONFINED,
participated in —
• EXCLUDE inmates on weekend programs.

II.9. During the WEEK of June 24 to June 30, 2014,
how many persons were —

a. Electronic monitoring . .
b. Home detention without
electronic monitoring. . .

a. New admissions to your jail facilities?
• INCLUDE persons officially booked into and housed
in your facility by formal legal document and by the
authority of the courts or some other official agency.
• INCLUDE those persons serving a weekend
sentence coming into the facility for the first time.
• EXCLUDE returns from escape, work release,
medical appointments/treatment facilities, bail and
court appearances.
New admissions

c. Community service . . . .
d. Day reporting . . . . . . . . .
e. Other pretrial supervision
f. Other alternative work
programs . . . . . . . . . . .
• EXCLUDE inmates participating in work release
programs who return to the jail at night.

b. Final discharges from your jail facilities?
• INCLUDE all persons released after a period of
confinement (e.g., sentence completion, bail/bond
releases, other pretrial releases, transfers to other
jurisdictions, and deaths).
• INCLUDE those persons completing their weekend
sentence leaving the facility for the last time.
• EXCLUDE temporary discharges (e.g., work
releases, medical appointments/treatment, to courts,
furloughs, day reporters, and transfers to other
facilities within your jurisdiction).

g. Alcohol/drug treatment
programs . . . . . . . . . . .
• EXCLUDE inmates participating in alcohol/drug
treatment programs who are confined in the jail.
h. Other programs outside
of jail facilities – Specify

i. TOTAL (Sum of items III.1a to
III.1h should equal item I.1b) .

Final discharges

Page 4

FORM CJ-5D (3-7-2014)

III.2. On June 30, 2014, how many persons under
your jail supervision who were NOT
CONFINED were —
a. Adult males (age 18 or
older) . . . . . . . . . . . . . . . .

IV.2. During the 365-DAY period from July 1, 2013 to
June 30, 2014, were there any inmate-inflicted
physical or sexual assaults on facility staff in
your jail jurisdiction?
• Report any assaults that involved a weapon or
serious injury requiring immediate medical attention
more extensive than first aid.

b. Adult females (age 18 or
older) . . . . . . . . . . . . . . . .
c. Males under age 18

1

Yes –
Number of assaults on –

....

a. Correctional Officers . . . .
d. Females under age 18

..
b. All other staff . . . . . . . . .

e. TOTAL (Sum of items III.2a to
III.2d should equal item I.1b) .
2
III.3. Of all persons under your jail supervision who
were NOT CONFINED on June 30, 2014, how
many were —

No assaults

IV.3. During the 365-DAY period from July 1, 2013 to
June 30, 2014, were there any staff deaths as a
result of assaults by inmates?

a. Convicted . . . . . . . . . . . . .
1
b. Unconvicted . . . . . . . . . . .

Yes –
Number of deaths –

c. TOTAL (Sum of items III.3a and
III.3b should equal item I.1b) . .

a. Correctional Officer deaths
inflicted by inmates . . . . .
b. All other staff deaths
inflicted by inmates . . . . .

Section IV — STAFF SAFETY AND SECURITY
IV.1. On June 30, 2014, how many staff employed
by your jail jurisdiction were —
• Count each employee only once. Classify
employees with multiple functions by the function
performed most frequently.

2

No deaths

IV.4. During the 365-DAY period from July 1, 2013 to
June 30, 2014, how many persons CONFINED in
your jail jurisdiction were written up or found
guilty of —
a. Physical assault on
another inmate . . . . . . . . .

• INCLUDE only payroll and nonpayroll staff.

b. A drug violation, such
as use, possession,
or dealing drugs . . . . . . . .

• EXCLUDE staff paid through contractual
agreements and community volunteers.
a. Correctional Officers
(Deputies, monitors, and other
custody staff who spend more
than 50% of their time with the
incarcerated population.) . . . .

c. An alcohol violation,
including unauthorized
possession, use, or sale .
d. Possession of a weapon . .

b. All other staff
(Administrators, clerical and
maintenance staff, educational
staff, professional and technical
staff, and other staff
unspecified.) . . . . . . . . . . . .

e. Possession of stolen
property. . . . . . . . . . . . . . .
f. Escape or attempted
escape. . . . . . . . . . . . . . . .
g. Any other major
violation, including work
slowdowns, food strikes,
setting fire, rioting, etc. .

c. Total (sum of items
IV.1a and IV.1b) . . . . . . . . .

Page 5

CJ-5DA

OMB No. 1121-0094: Approval Expires 5/31/2016

CJ-5DA

RETURN
TO

U.S. Census Bureau
Governments Division
Washington, DC 20233-6800

U.S. DEPARTMENT OF JUSTICE

FORM
(3-7-2014)

2014 ANNUAL
SURVEY OF JAILS
MULTI-JURISDICTION OR PRIVATE

BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT

U.S. DEPARTMENT OF COMMERCE
ECONOMICS AND STATISTICS ADMINISTRATION
U.S. CENSUS BUREAU
FACILITY

DATA SUPPLIED BY
Name
OFFICIAL
ADDRESS
TELEPHONE

Title
Number and street or P.O. box/Route number

City

Area Code

FAX
NUMBER

Number

Extension

State
Area Code

ZIP Code

Number

E-MAIL
ADDRESS

(Please correct any error in name, mailing address, and ZIP Code)

GENERAL INFORMATION
• If you have any questions, call the U.S. Census Bureau at 1–800–253–2078, or e-mail [email protected].
• Please complete the questionnaire before July 31, 2014 using the web-reporting option (see the web flyer for details), by
mailing the completed form to the U.S. Census Bureau in the enclosed envelope, or by FAXing all pages to
1–888–262–3974.
• Please retain a copy of the completed form for your records.

What types of facilities are included in this survey?
Multi-Jurisdiction facilities and privately operated facilities in jurisdictions included with certainty in the Annual Survey of
Jails. These facilities are intended for adults but sometimes hold juveniles.
For Multi-Jurisdiction facility
Confinement facilities including detention centers, jails, and other correctional facilities administered by two or more
governments (or a board composed of representatives from two or more governments) included with certainty in the Annual
Survey of Jails.
• INCLUDE regional jails or city/county correctional centers.
• INCLUDE special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms).
• INCLUDE inmates held for jurisdictions, other than the participating jurisdictions.
For Privately Operated facility
Privately owned or operated confinement facilities in jurisdictions included with certainty in the Annual Survey of
Jails, including detention centers, jails, and other correctional facilities.
• INCLUDE temporary holding or lockup facilities if they are part of your combined function.
• EXCLUDE temporary holding or lockup facilities that are not part of your combined function from which inmates are
usually transferred within 72 hours and not held beyond arraignment. If your only function is a temporary holding or
lockup facility, DO NOT complete this form – contact Leslie Miller at 1–800–253–2078.
Certainty facilities
• INCLUDE private facilities in jail jurisdictions that held juvenile inmates at the time of the 2005 Census of Jail Inmates and
had an average daily population of 500 or more inmates during the 12 months ending June 30, 2005.
• INCLUDE private facilities in jail jusridictions that held only adult inmates and had an average daily population of 750
or more at the time of the 2005 Census of Jail Inmates.
Burden statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a
currently valid OMB control number. The burden of this collection is estimated to average 2 hours per response, including
reviewing instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form.
Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden,
to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed
form to this address.

FORM CJ-5DA (3-7-2014)

REPORTING INSTRUCTIONS
• If the answer to a question is "not available" or "unknown," write "DK" in the space provided.
• If the answer to a question is "not applicable," write "NA" in the space provided.
• If the answer to a question is "none" or "zero," write "0" in the space provided.
• When exact numeric answers are not available, provide estimates and mark (X) in the
box beside each figure that is estimated. For example 1,234
X

Section I — SUPERVISED POPULATION
I.1. On June 30, 2014, how many persons under the
supervision of your jail were —

I.2. Of all persons under your jail supervision
reported in item I.1c, how many were not U.S.
citizens?
Non-US citizens

a. CONFINED in your jail facility?
• INCLUDE persons on transfer to treatment facilities
but who remain under your jurisdiction.
• INCLUDE persons held for jurisdictions other than
the participating jurisdictions.

I.3. On the weekend prior to June 30, 2014, did
your jail facility have a weekend program?
• Weekend programs allow offenders to serve
their sentences of confinement only on
weekends (e.g., Friday — Sunday).

• INCLUDE persons in community-based programs
(e.g., work release, day release, drug/alcohol
treatment) who return to jail at night.

1
2

Yes — How many inmates
participated?
No

• EXCLUDE inmates on AWOL, escape, or
long-term transfer to other jurisdictions.
• EXCLUDE inmates being boarded out to
another county or held in another facility not
operated by your jail jurisdiction.

Section II — INMATE COUNTS AND MOVEMENTS
OF THE CONFINED POPULATION
II.1. On June 30, 2014, how many persons
CONFINED in your jail facility were —
a. Adult males (age 18 or
older) . . . . . . . . . . . . . . . . . . .

b. Under jail supervision but NOT CONFINED?

b. Adult females (age 18 or
older). . . . . . . . . . . . . . . . . . .

• INCLUDE all persons in community-based
programs run by your jail (e.g., electronic
monitoring, house arrest, community service, day
reporting, and work programs).

c. Males under age 18. . . . . . .

• EXCLUDE persons on pretrial release who are
not in a community based program run by your
jail.
• EXCLUDE persons under supervision of
probation, parole or other agencies.
• EXCLUDE inmates on weekend programs.
Weekend programs allow offenders to serve
their sentences of confinement only on
weekends (e.g., Friday — Sunday).

d. Females under age 18. . . . .
e. TOTAL (Sum of items II.1a to
II.1d should equal item I.1a). . .
II.2. Of all persons under the age of 18
CONFINED in your jail facility on June 30,
2014 (items II.1c and II.1d), how many were
tried, or awaiting trial, in adult court?
Number of persons under
age 18 held as adults. . . . . . . . . .

• EXCLUDE inmates participating in work release
programs who return to the jail at night.

c. TOTAL (Sum of items
I.1a and I.1b). . . . . . . . . . . . . .

Page 2

FORM CJ-5DA (3-7-2014)

II.3. Of all persons CONFINED in your jail facility
on June 30, 2014, how many were —

II.5. On June 30, 2014, how many persons
CONFINED in your jail facility were held for —
• For persons with a multiple hold, count them only
once with priority being Federal, State, and local.

• For persons with more than one status, report the
status with the most serious offense.
• For convicted inmates include probation and parole
violators with no new sentence.

a. Federal authorities
1. U.S. Marshals Service . .

a. Convicted. . . . . . . . . . . . .
2. Federal Bureau of Prisons
How many were —
1. Unsentenced inmates
or awaiting sentencing. . . .

3. U.S. Immigration and
Customs Enforcement
(I.C.E.) . . . . . . . . . . . . . . .

2. Sentenced inmates . . . . . .

4. Bureau of Indian Affairs .
5. Other – Specify

b. Unconvicted. . . . . . . . . . .
How many were —

b. State prison authorities

1. Awaiting trial/
arraignment. . . . . . . . . . .

1. For your state . . . . . . . . .

2. Awaiting transfer/hold
for other authorities. . . . . .

2. For other states . . . . . . .
c. Other local jail jurisdictions

3. Other . . . . . . . . . . . . . . .

• EXCLUDE inmates being housed for your own
jurisdiction (i.e., your own county/city inmates).

c. TOTAL (Sum of items II.3a
and II.3b should equal item I.1a)

1. Within your state . . . . . .
II.4. On June 30, 2014, how many persons
CONFINED in your jail facility were —

2. Outside your state

d. TOTAL (Sum of items II.5a
to II.5c) . . . . . . . . . . . . . . . . .

a. White, not of Hispanic
origin . . . . . . . . . . . . . . . . .
b. Black or African American,

not of Hispanic origin . . . . . . .

....

II.6. a. During the 30-DAY period from June 1 to
June 30, 2014, on what day did your facility
hold the greatest number of inmates?

c. Hispanic or Latino . . . . . .

• Peak population should be equal to or greater than
the confined inmate population reported in item I.1a.

d. American Indian/Alaska
Native, not of Hispanic origin

June
e. Asian, not of Hispanic origin

, 2014

b. How many persons were CONFINED on
that day?

f. Native Hawaiian or Other
Pacific Islander, not of
Hispanic origin . . . . . . . . . . .

Number that day

g. Two or more races, not
of Hispanic origin . . . . . . . .
h. Additional categories in your
information system — Specify

i. Not known . . . . . . . . . . . .
j. TOTAL (Sum of items II.4a
to II.4i should equal item I.1a) .

Page 3

FORM CJ-5DA (3-7-2014)

II.7. Between July 1, 2013, and June 30, 2014,
what was the average daily population
confined in your facility?

II.10. During the WEEK of June 24 to June 30, 2014,
how many persons discharged from your jail
facility were confined —
• Report time served, not sentence length, for
discharged person.

• Include inmates who participated in weekend
programs that allow offenders to serve their
sentences of confinement only on weekends
(e.g., Friday-Sunday).

Convicted

• To calculate the average daily population, add the
number of persons for each day during the period
July 1, 2013, through June 30, 2014, and divide
the result by 365.

Unconvicted

a. Less than 1 day. . .
b. 1 to 2 days. . . . . . .

Average daily population

c. 3 to 7 days. . . . . . .

II.8. On June 30, 2014, what was the total jail
capacity of your jail facility?

d. 8 to 30 days. . . . . .
e. 31 to 180 days. . . .

a. Rated capacity
(The maximum number of beds
or inmates assigned by a rating
official to a facility, excluding
separate temporary holding
areas.) . . . . . . . . . . . . . . . . .

f. More than 180 days.
g.TOTAL (Sum of items
II.10a to II.10f should
equal item II.9b). . . . . .

b. Operational capacity
(The number of inmates that can
be accommodated based on
staff, existing programs and
services in institutions within your
jurisdiction. Also known as
“budget” capacity.) . . . . . . . . .

Section III — POPULATION SUPERVISED
IN THE COMMUNITY
If item I.1b equals 0 (zero), SKIP to item IV.1

c. Design capacity
(The number of inmate’s
planners or architects intended
for all jail facilities in your
jurisdiction.) . . . . . . . . . . . . .

III.1. On June 30, 2014, how many persons under
your jail supervision who were NOT CONFINED,
participated in —
• EXCLUDE inmates on weekend programs.

II.9. During the WEEK of June 24 to June 30, 2014,
how many persons were —

a. Electronic monitoring. . .
b. Home detention without
electronic monitoring. . . .

a. New admissions to your jail facility?
• INCLUDE persons officially booked into and housed
in your facility by formal legal document and by the
authority of the courts or some other official agency.
• INCLUDE those persons serving a weekend
sentence coming into the facility for the first time.
• EXCLUDE returns from escape, work release,
medical appointments/treatment facilities, bail and
court appearances.
New admissions

c. Community service. . . . .
d. Day reporting. . . . . . . . . .
e. Other pretrial supervision.
f. Other alternative work
programs. . . . . . . . . . . . .
• EXCLUDE inmates participating in work release
programs who return to the jail at night.

b. Final discharges from your jail facility?
• INCLUDE all persons released after a period of
confinement (e.g., sentence completion, bail/bond
releases, other pretrial releases, transfers to other
jurisdictions, and deaths).
• INCLUDE those persons completing their weekend
sentence leaving the facility for the last time.
• EXCLUDE temporary discharges (e.g., work
releases, medical appointments/treatment, to courts,
furloughs, day reporters, and transfers to other
facilities within your jurisdiction).

g. Alcohol/drug treatment
programs. . . . . . . . . . . . .
• EXCLUDE inmates participating in alcohol/drug
treatment programs who are confined in the jail.
h. Other programs outside
of jail facilities – Specify

i. TOTAL (Sum of items III.1a to
III.1h should equal item I.1b). .

Final discharges

Page 4

FORM CJ-5DA (3-7-2014)

III.2. On June 30, 2014, how many persons under
your jail supervision who were NOT CONFINED
were —
a. Adult males (age 18 or
older) . . . . . . . . . . . . . . . . .

IV.2. During the 365-DAY period from July 1, 2013 to
June 30, 2014, were there any inmate-inflicted
physical or sexual assaults on facility staff in
your jail?
• Report any assaults that involved a weapon or
serious injury requiring immediate medical attention
more extensive than first aid.

b. Adult females (age 18 or
older) . . . . . . . . . . . . . . . . .

1

Yes –
Number of assaults on —

c. Males under age 18. . . . . .

a. Correctional Officers. . . . .
d. Females under age 18. . . .
b. All other staff . . . . . . . . .

e. TOTAL (Sum of items III.2a to
III.2d should equal item I.1b). . .
2
III.3. Of all persons under your jail supervision who
were NOT CONFINED on June 30, 2014, how
many were —

No assaults

IV.3. During the 365-DAY period from July 1, 2013 to
June 30, 2014, were there any staff deaths as a
result of assaults by inmates?

a. Convicted. . . . . . . . . . . . .
1
b. Unconvicted. . . . . . . . . . .

Yes –
Number of deaths —

c. TOTAL (Sum of items III.3a and
III.3b should equal item I.1b) .

a. Correctional Officer deaths
inflicted by inmates . . . . .
b. All other staff deaths
inflicted by inmates . . . . .

Section IV — STAFF SAFETY AND SECURITY
IV.1. On June 30, 2014, how many staff employed
by your jail were —
• Count each employee only once. Classify
employees with multiple functions by the function
performed most frequently.

2

No deaths

IV.4. During the 365-DAY period from July 1, 2013 to
June 30, 2014, how many persons CONFINED in
your jail were written up or found guilty of —
a. Physical assault on
another inmate. . . . . . . . .

• INCLUDE only payroll and nonpayroll staff.

b. A drug violation, such
as use, possession,
or dealing drugs. . . . . . . . .

• EXCLUDE staff paid through contractual
agreements and community volunteers.
a. Correctional Officers
(Deputies, monitors, and other
custody staff who spend more
than 50% of their time with the
incarcerated population.) . . . . .

c. An alcohol violation,
including unauthorized
possession, use, or sale. .
d. Possession of a weapon. . .

b. All other staff
(Administrators, clerical and
maintenance staff, educational
staff, professional and technical
staff, and other staff
unspecified.) . . . . . . . . . . . . .

e. Possession of stolen
property. . . . . . . . . . . . . . .
f. Escape or attempted
escape. . . . . . . . . . . . . . . .
g. Any other major
violation, including work
slowdowns, food strikes,
setting fire, rioting, etc.. .

c. Total (sum of items
IV.1a and IV.1b) . . . . . . . . . . .

Page 5

CJ-5DA

OMB No. 1121-0094: Approval Expires 5/31/2016

CJ-5DA

RETURN
TO

U.S. Census Bureau
Governments Division
Washington, DC 20233-6800

U.S. DEPARTMENT OF JUSTICE

FORM
(3-7-2014)

2014 ANNUAL
SURVEY OF JAILS
MULTI-JURISDICTION OR PRIVATE

BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT

U.S. DEPARTMENT OF COMMERCE
ECONOMICS AND STATISTICS ADMINISTRATION
U.S. CENSUS BUREAU
FACILITY

DATA SUPPLIED BY
Name
OFFICIAL
ADDRESS
TELEPHONE

Title
Number and street or P.O. box/Route number

City

Area Code

FAX
NUMBER

Number

Extension

State
Area Code

ZIP Code

Number

E-MAIL
ADDRESS

(Please correct any error in name, mailing address, and ZIP Code)

GENERAL INFORMATION
• If you have any questions, call the U.S. Census Bureau at 1–800–253–2078, or e-mail [email protected].
• Please complete the questionnaire before July 31, 2014 using the web-reporting option (see the web flyer for details), by
mailing the completed form to the U.S. Census Bureau in the enclosed envelope, or by FAXing all pages to
1–888–262–3974.
• Please retain a copy of the completed form for your records.

What types of facilities are included in this survey?
Multi-Jurisdiction facilities and privately operated facilities in jurisdictions included with certainty in the Annual Survey of
Jails. These facilities are intended for adults but sometimes hold juveniles.
For Multi-Jurisdiction facility
Confinement facilities including detention centers, jails, and other correctional facilities administered by two or more
governments (or a board composed of representatives from two or more governments) included with certainty in the Annual
Survey of Jails.
• INCLUDE regional jails or city/county correctional centers.
• INCLUDE special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms).
• INCLUDE inmates held for jurisdictions, other than the participating jurisdictions.
For Privately Operated facility
Privately owned or operated confinement facilities in jurisdictions included with certainty in the Annual Survey of
Jails, including detention centers, jails, and other correctional facilities.
• INCLUDE temporary holding or lockup facilities if they are part of your combined function.
• EXCLUDE temporary holding or lockup facilities that are not part of your combined function from which inmates are
usually transferred within 72 hours and not held beyond arraignment. If your only function is a temporary holding or
lockup facility, DO NOT complete this form – contact Leslie Miller at 1–800–253–2078.
Certainty facilities
• INCLUDE private facilities in jail jurisdictions that held juvenile inmates at the time of the 2005 Census of Jail Inmates and
had an average daily population of 500 or more inmates during the 12 months ending June 30, 2005.
• INCLUDE private facilities in jail jusridictions that held only adult inmates and had an average daily population of 750
or more at the time of the 2005 Census of Jail Inmates.
Burden statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a
currently valid OMB control number. The burden of this collection is estimated to average 2 hours per response, including
reviewing instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form.
Send comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden,
to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not send your completed
form to this address.

FORM CJ-5DA (3-7-2014)

REPORTING INSTRUCTIONS
• If the answer to a question is "not available" or "unknown," write "DK" in the space provided.
• If the answer to a question is "not applicable," write "NA" in the space provided.
• If the answer to a question is "none" or "zero," write "0" in the space provided.
• When exact numeric answers are not available, provide estimates and mark (X) in the
box beside each figure that is estimated. For example 1,234
X

Section I — SUPERVISED POPULATION
I.1. On June 30, 2014, how many persons under the
supervision of your jail were —

I.2. Of all persons under your jail supervision
reported in item I.1c, how many were not U.S.
citizens?
Non-US citizens

a. CONFINED in your jail facility?
• INCLUDE persons on transfer to treatment facilities
but who remain under your jurisdiction.
• INCLUDE persons held for jurisdictions other than
the participating jurisdictions.

I.3. On the weekend prior to June 30, 2014, did
your jail facility have a weekend program?
• Weekend programs allow offenders to serve
their sentences of confinement only on
weekends (e.g., Friday — Sunday).

• INCLUDE persons in community-based programs
(e.g., work release, day release, drug/alcohol
treatment) who return to jail at night.

1
2

Yes — How many inmates
participated?
No

• EXCLUDE inmates on AWOL, escape, or
long-term transfer to other jurisdictions.
• EXCLUDE inmates being boarded out to
another county or held in another facility not
operated by your jail jurisdiction.

Section II — INMATE COUNTS AND MOVEMENTS
OF THE CONFINED POPULATION
II.1. On June 30, 2014, how many persons
CONFINED in your jail facility were —
a. Adult males (age 18 or
older) . . . . . . . . . . . . . . . . . . .

b. Under jail supervision but NOT CONFINED?

b. Adult females (age 18 or
older). . . . . . . . . . . . . . . . . . .

• INCLUDE all persons in community-based
programs run by your jail (e.g., electronic
monitoring, house arrest, community service, day
reporting, and work programs).

c. Males under age 18. . . . . . .

• EXCLUDE persons on pretrial release who are
not in a community based program run by your
jail.
• EXCLUDE persons under supervision of
probation, parole or other agencies.
• EXCLUDE inmates on weekend programs.
Weekend programs allow offenders to serve
their sentences of confinement only on
weekends (e.g., Friday — Sunday).

d. Females under age 18. . . . .
e. TOTAL (Sum of items II.1a to
II.1d should equal item I.1a). . .
II.2. Of all persons under the age of 18
CONFINED in your jail facility on June 30,
2014 (items II.1c and II.1d), how many were
tried, or awaiting trial, in adult court?
Number of persons under
age 18 held as adults. . . . . . . . . .

• EXCLUDE inmates participating in work release
programs who return to the jail at night.

c. TOTAL (Sum of items
I.1a and I.1b). . . . . . . . . . . . . .

Page 2

FORM CJ-5DA (3-7-2014)

II.3. Of all persons CONFINED in your jail facility
on June 30, 2014, how many were —

II.5. On June 30, 2014, how many persons
CONFINED in your jail facility were held for —
• For persons with a multiple hold, count them only
once with priority being Federal, State, and local.

• For persons with more than one status, report the
status with the most serious offense.
• For convicted inmates include probation and parole
violators with no new sentence.

a. Federal authorities
1. U.S. Marshals Service . .

a. Convicted. . . . . . . . . . . . .
2. Federal Bureau of Prisons
How many were —
1. Unsentenced inmates
or awaiting sentencing. . . .

3. U.S. Immigration and
Customs Enforcement
(I.C.E.) . . . . . . . . . . . . . . .

2. Sentenced inmates . . . . . .

4. Bureau of Indian Affairs .
5. Other – Specify

b. Unconvicted. . . . . . . . . . .
How many were —

b. State prison authorities

1. Awaiting trial/
arraignment. . . . . . . . . . .

1. For your state . . . . . . . . .

2. Awaiting transfer/hold
for other authorities. . . . . .

2. For other states . . . . . . .
c. Other local jail jurisdictions

3. Other . . . . . . . . . . . . . . .

• EXCLUDE inmates being housed for your own
jurisdiction (i.e., your own county/city inmates).

c. TOTAL (Sum of items II.3a
and II.3b should equal item I.1a)

1. Within your state . . . . . .
II.4. On June 30, 2014, how many persons
CONFINED in your jail facility were —

2. Outside your state

d. TOTAL (Sum of items II.5a
to II.5c) . . . . . . . . . . . . . . . . .

a. White, not of Hispanic
origin . . . . . . . . . . . . . . . . .
b. Black or African American,

not of Hispanic origin . . . . . . .

....

II.6. a. During the 30-DAY period from June 1 to
June 30, 2014, on what day did your facility
hold the greatest number of inmates?

c. Hispanic or Latino . . . . . .

• Peak population should be equal to or greater than
the confined inmate population reported in item I.1a.

d. American Indian/Alaska
Native, not of Hispanic origin

June
e. Asian, not of Hispanic origin

, 2014

b. How many persons were CONFINED on
that day?

f. Native Hawaiian or Other
Pacific Islander, not of
Hispanic origin . . . . . . . . . . .

Number that day

g. Two or more races, not
of Hispanic origin . . . . . . . .
h. Additional categories in your
information system — Specify

i. Not known . . . . . . . . . . . .
j. TOTAL (Sum of items II.4a
to II.4i should equal item I.1a) .

Page 3

FORM CJ-5DA (3-7-2014)

II.7. Between July 1, 2013, and June 30, 2014,
what was the average daily population
confined in your facility?

II.10. During the WEEK of June 24 to June 30, 2014,
how many persons discharged from your jail
facility were confined —
• Report time served, not sentence length, for
discharged person.

• Include inmates who participated in weekend
programs that allow offenders to serve their
sentences of confinement only on weekends
(e.g., Friday-Sunday).

Convicted

• To calculate the average daily population, add the
number of persons for each day during the period
July 1, 2013, through June 30, 2014, and divide
the result by 365.

Unconvicted

a. Less than 1 day. . .
b. 1 to 2 days. . . . . . .

Average daily population

c. 3 to 7 days. . . . . . .

II.8. On June 30, 2014, what was the total jail
capacity of your jail facility?

d. 8 to 30 days. . . . . .
e. 31 to 180 days. . . .

a. Rated capacity
(The maximum number of beds
or inmates assigned by a rating
official to a facility, excluding
separate temporary holding
areas.) . . . . . . . . . . . . . . . . .

f. More than 180 days.
g.TOTAL (Sum of items
II.10a to II.10f should
equal item II.9b). . . . . .

b. Operational capacity
(The number of inmates that can
be accommodated based on
staff, existing programs and
services in institutions within your
jurisdiction. Also known as
“budget” capacity.) . . . . . . . . .

Section III — POPULATION SUPERVISED
IN THE COMMUNITY
If item I.1b equals 0 (zero), SKIP to item IV.1

c. Design capacity
(The number of inmate’s
planners or architects intended
for all jail facilities in your
jurisdiction.) . . . . . . . . . . . . .

III.1. On June 30, 2014, how many persons under
your jail supervision who were NOT CONFINED,
participated in —
• EXCLUDE inmates on weekend programs.

II.9. During the WEEK of June 24 to June 30, 2014,
how many persons were —

a. Electronic monitoring. . .
b. Home detention without
electronic monitoring. . . .

a. New admissions to your jail facility?
• INCLUDE persons officially booked into and housed
in your facility by formal legal document and by the
authority of the courts or some other official agency.
• INCLUDE those persons serving a weekend
sentence coming into the facility for the first time.
• EXCLUDE returns from escape, work release,
medical appointments/treatment facilities, bail and
court appearances.
New admissions

c. Community service. . . . .
d. Day reporting. . . . . . . . . .
e. Other pretrial supervision.
f. Other alternative work
programs. . . . . . . . . . . . .
• EXCLUDE inmates participating in work release
programs who return to the jail at night.

b. Final discharges from your jail facility?
• INCLUDE all persons released after a period of
confinement (e.g., sentence completion, bail/bond
releases, other pretrial releases, transfers to other
jurisdictions, and deaths).
• INCLUDE those persons completing their weekend
sentence leaving the facility for the last time.
• EXCLUDE temporary discharges (e.g., work
releases, medical appointments/treatment, to courts,
furloughs, day reporters, and transfers to other
facilities within your jurisdiction).

g. Alcohol/drug treatment
programs. . . . . . . . . . . . .
• EXCLUDE inmates participating in alcohol/drug
treatment programs who are confined in the jail.
h. Other programs outside
of jail facilities – Specify

i. TOTAL (Sum of items III.1a to
III.1h should equal item I.1b). .

Final discharges

Page 4

FORM CJ-5DA (3-7-2014)

III.2. On June 30, 2014, how many persons under
your jail supervision who were NOT CONFINED
were —
a. Adult males (age 18 or
older) . . . . . . . . . . . . . . . . .

IV.2. During the 365-DAY period from July 1, 2013 to
June 30, 2014, were there any inmate-inflicted
physical or sexual assaults on facility staff in
your jail?
• Report any assaults that involved a weapon or
serious injury requiring immediate medical attention
more extensive than first aid.

b. Adult females (age 18 or
older) . . . . . . . . . . . . . . . . .

1

Yes –
Number of assaults on —

c. Males under age 18. . . . . .

a. Correctional Officers. . . . .
d. Females under age 18. . . .
b. All other staff . . . . . . . . .

e. TOTAL (Sum of items III.2a to
III.2d should equal item I.1b). . .
2
III.3. Of all persons under your jail supervision who
were NOT CONFINED on June 30, 2014, how
many were —

No assaults

IV.3. During the 365-DAY period from July 1, 2013 to
June 30, 2014, were there any staff deaths as a
result of assaults by inmates?

a. Convicted. . . . . . . . . . . . .
1
b. Unconvicted. . . . . . . . . . .

Yes –
Number of deaths —

c. TOTAL (Sum of items III.3a and
III.3b should equal item I.1b) .

a. Correctional Officer deaths
inflicted by inmates . . . . .
b. All other staff deaths
inflicted by inmates . . . . .

Section IV — STAFF SAFETY AND SECURITY
IV.1. On June 30, 2014, how many staff employed
by your jail were —
• Count each employee only once. Classify
employees with multiple functions by the function
performed most frequently.

2

No deaths

IV.4. During the 365-DAY period from July 1, 2013 to
June 30, 2014, how many persons CONFINED in
your jail were written up or found guilty of —
a. Physical assault on
another inmate. . . . . . . . .

• INCLUDE only payroll and nonpayroll staff.

b. A drug violation, such
as use, possession,
or dealing drugs. . . . . . . . .

• EXCLUDE staff paid through contractual
agreements and community volunteers.
a. Correctional Officers
(Deputies, monitors, and other
custody staff who spend more
than 50% of their time with the
incarcerated population.) . . . . .

c. An alcohol violation,
including unauthorized
possession, use, or sale. .
d. Possession of a weapon. . .

b. All other staff
(Administrators, clerical and
maintenance staff, educational
staff, professional and technical
staff, and other staff
unspecified.) . . . . . . . . . . . . .

e. Possession of stolen
property. . . . . . . . . . . . . . .
f. Escape or attempted
escape. . . . . . . . . . . . . . . .
g. Any other major
violation, including work
slowdowns, food strikes,
setting fire, rioting, etc.. .

c. Total (sum of items
IV.1a and IV.1b) . . . . . . . . . . .

Page 5

Attachment J. Survey form CJ5B

CJ-5B
RETURN
TO

OMB No.1121-0094: Approval Expires 6/30/2016

Melissa Wilson
Survey of Jails in Indian Country
Westat
1500 Research Boulevard
Rockville, MD 20850
TB 371

FORM

CJ-5B

(06-22-15)

U.S. DEPARTMENT OF JUSTICE

2015 aNNual
SURVEY OF JAILS
IN INDIAN COUNTRY

BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT

WESTAT

Data Supplied by
NAME

Title

ADDRESS

Number and street or P.O. box/Route

City

TELEPHONE

Area Code

FAX Number

Number

State
Area Code

Zip Code

Number

E-MAIL
ADDRESS

General information
zz

If you have any questions about completing this form, please contact Karla Eisen of Westat at 1-888-675-7330 or BJS
Statistician, Todd Minton at 202-305-9630.

zz

Please mail your completed questionnaire to Westat before August 1, 2015 or FAX (all) pages to 301-610-4950.

zz

Please retain a copy of the completed form for your records.

Who does this survey cover?
All confinement facilities, including detention centers, jails, and other correctional facilities operated by tribal authorities or
the Bureau of Indian Affairs.
zz

INCLUDE special jail facilities (e.g., medical/treatment/release centers, halfway houses, and work farms).

All persons under your jail supervision.
zz

INCLUDE all confined adults and juveniles (i.e., persons under age 18).

zz

INCLUDE persons on transfer to treatment facilities but who remain under your legal jurisdiction.

zz

INCLUDE persons held for other jurisdictions.

What data are to be excluded from this survey?
zz

EXCLUDE inmates on AWOL, escape, or long-term transfer to other jurisdictions.

zz

EXCLUDE any persons housed in a correctional facility not operated by your jurisdiction.

Burden statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently
valid OMB control number. The burden of this collection is estimated to average 1 1/4 hours per response, including reviewing
instructions, searching existing data sources, gathering necessary data, and completing and reviewing this form. Send
comments regarding this burden estimate or any aspect of this survey, including suggestions for reducing this burden, to the
Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531.

FORM CJ-5B (06-22-15)

Instructions
zz

If the answer to a question is “not available” or “unknown,” write “DK” in the space provided.

zz

If the answer to a question is “not applicable,” write “NA” in the space provided.

zz

If the answer to a question is “none” or “zero,” write “0” in the space provided.

zz

When exact numeric answers are not available, provide estimates and mark × in the box beside each
figure that is estimated. For example, 1,234 ×

SECTION I—INMATE COUNTS AND MOVEMENT
 1.	 On June 30, 2015, how many persons were
CONFINED in this facility?

 5.	 On June 30, 2015, how many persons CONFID in
this facility, regardless of conviction status, had as
their most serious offense —

zz

INCLUDE persons on transfer to treatment facilities but who
remain under your jurisdiction.

zz

INCLUDE persons held for other jurisdictions.

zz

EXCLUDE inmates on AWOL escape, or long-term transfer to
other jurisdictions.

a. Domestic violence offense . . . . . . .

Number confined	

zz

b. Assault . . . . . . . . . . . . . . . . . . . . . . .

 2.	 On June 30, 2015, how many persons CONFID in
this facility were —
a. Males age 18 or older. . . . . . . . . . . . 

zz

INCLUDE aggravated and simple assault.

zz

EXCLUDE domestic violence offenses
and rape/sexual assault.

c. Rape/sexual assault. . . . . . . . . . . . .

b. Females age 18 or older . . . . . . . . . 

zz

c. Males under age 18 . . . . . . . . . . . . . 

zz

e. TOTAL (Sum of items 2a to 2d
should equal item 1). . . . . . . . . . . . . . . . 

zz

zz

Exclude motor-vehicle theft.

g. A drug law violation. . . . . . . . . . . . .
zz

 4.	 Of all persons CONFINED in this facility on
June 30, 2015, how many were —

For convicted inmates, include probation and parole violators
with no new sentence.

Also known as breaking and entering.

f. Larceny-theft. . . . . . . . . . . . . . . . . . .

Number of juveniles
(under age 18) held as adults	

zz

EXCLUDE domestic violence offenses,
assaults, and rape/sexual assault.

e. Burglary. . . . . . . . . . . . . . . . . . . . . . .

 3.	 Of all male and female juveniles CONFINED in this
facility on June 30, 2015, how many were tried or
awaiting trial in ADULT court?

For persons with more than one status, report the status with
the most serious offense.

EXCLUDE domestic violence offenses
and assaults reported in item 5b.

d. Other violent offenses. . . . . . . . . . .

d. Females under age 18. . . . . . . . . . . 

zz

INCLUDE assault, abuse, cruelty,
or threat to a spouse, intimate, or
a dependent child.

INCLUDE offenses relating to the
unlawful possession, distribution,
sale, use, growing, or manufacturing
of narcotic drugs.

h. Driving while intoxicated or
driving under the influence
of alcohol or drugs. . . . . . . . . . . . . 
i. Public intoxication. . . . . . . . . . . . . . .

a. Convicted . . . . . . . . . . . . . . . . . . . . . .

zz

b. Unconvicted. . . . . . . . . . . . . . . . . . . .
c. TOTAL (Sum of items 4a and 4b
should equal item 1). . . . . . . . . . . . . 

Also known as “drunk and
disorderly.”

j. Other offenses. . . . . . . . . . . . . . . . . .
k. TOTAL (Sum of items 5a to 5j
should equal item 1). . . . . . . . . . . . . . 

Page 2

FORM CJ-5B (06-22-15)

 6.	 On June 30, 2015, how many persons CONFID in
this facility, regardless of conviction status, had an
offense type of —
zz

For persons with more than one offense, report the most
serious type of offense.

a. How many persons died while CONFINED in
this facility?
zz

Enter 0 if no deaths.

Number of deaths

a. Felony . . . . . . . . . . . . . . . . . . . . . . . 

b. O
 f those who died, how many committed suicide?

b. Misdemeanor . . . . . . . . . . . . . . . . . 

Number of completed suicides

c. Other—Specify

c. How many persons ATTEMPTED suicide while
CONFINED in this facility?
Number of attempted suicides

d. TOTAL (Sum of items 6a to 6c
should equal item 1). . . . . . . . . . . . . 

SECTION II—FACILITY OPERATIONS AND STAFF
For items 10 and 11, please respond based on the
inclusionary and exclusionary instructions below.

 7.	 During the 30 day period from June 1, 2015, to
June 30, 2015 —

INCLUDE

a. What was the average daily population of your
facility?
zz

 9.	 B —

To calculate the average daily population, add the number
of persons confined in your facility for each day during the
period June 1-30, 2015, and divide the results by 30.

Average daily population
b. On what day did this facility hold the
greatest number of persons?
June	

, 2015

zz

full-time and part-time staff, payroll staff that are tribal or BIA
direct-funded staff (e.g., 638 contract and self-governance).

zz

nonpayroll staff employed by other tribal/governmental
agencies (staff provided by IHS, education, or other human
service departments or courts).

zz

contract nonpayroll staff paid through private service
contracts (e.g., food service, healthcare, maintenance,
transportation).

zz

Exclude community volunteers and unpaid interns.

 10.	 Of the total number of CORRECTIONAL employees
on June 30, 2015, how many were in—

c. How many persons were CONFINED on that day?
Number that day

zz

 8.	 During the 30 day period from June 1, 2015, to June
30, 2015, how many persons were —

Count each employee only once. Classify employees with
multiple functions by the function performed most frequently.

a. Administration
zz

a. New admissions to this jail facility
zz

INCLUDE persons officially booked into and housed in
your facility by formal legal document or by the authority of
the courts or some other official agency.

zz

EXCLUDE returns from escape, work release, medical
appointments/treatment facilities, bail and court
appearances.

Include the jail administrators,
assistants and other personnel who
work in an administrative capacity
more than 50% of the time.. . . . . . . . . . 

b. Jail operations
zz

New admissions

INCLUDE correctional officers, guards, and
other staff who spend more than 50%
of their time supervising inmates.. . . . . 

c. Educational staff

b. Final discharges from this jail facility?
zz

INCLUDE all persons released after a period of
confinement (e.g., sentence completion, bail/bond, other
pretrial release, transfers to other jurisdictions, and death).

zz

EXCLUDE temporary discharges (e.g., work releases,
medical appointments/treatment facilities, to courts,
furloughs, day reporters, and transfers to other facilities
within your jurisdiction).

Final discharges

zz

INCLUDE academic and
vocational staff.. . . . . . . . . . . . . . . . . . 

d. Technical/professional staff
zz

INCLUDE counselors, psychiatrists, psychologists,
social workers, dentists, medical staff, and other
professional staff

zz

INCLUDE dispatchers with no inmate
supervision duties . . . . . . . . . . . . . . . .

e. Clerical, maintenance, and
food service . . . . . . . . . . . . . . . . . .
f. Other—Specify
g. TOTAL (Sum of items 10a
to10f) . . . . . . . . . . . . . . . . . . . . . . 
Page 3

FORM CJ-5B (06-22-15)

 11.	 Of the total number of JAIL OPERATION employees
reported in item 10b, how many had received —
a. The basic detention officer
certification?. . . . . . . . . . . . . . . . . . . 
zz

INCLUDE BIA or State certification.

b. 40 hours of in-service training?. . . 
 12.	 On June 30, 2015, what was the total rated capacity
of this facility?
zz

EXCLUDE temporary spaces such as tents, trailers, and
other temporary space.

zz

Rated capacity is the maximum number of beds or inmates
assigned by a rating official to this facility.

zz

If rated capacity is not available, estimate by using the
design capacity and mark the box.

Rated capacity

Notes

Page 4

Attachment K. 42 USC 3735

Attachment L. Mailing Packet

3040 Cornwallis Road  PO Box 12194
Research Triangle Park, NC 27709-2194
ATTN: Matt Bensen 0213149.001.400.402.100

 

 

 

Bureau of Justice Statistics (Bureau) – Confidentiality Assurances 
42 USC § 3735 ‐ Use of Data 
Data collected by the Bureau shall be used only for statistical or research purposes, and shall be gathered in a manner 
that precludes their use for law enforcement or any purpose relating to a private person or public agency other than 
statistical or research purposes. 

42 USC § 3789g ‐ Confidentiality of information  
(a) Research or statistical information; immunity from process; prohibition against admission as evidence or use in 
any proceedings  
No officer or employee of the Federal Government, and no recipient of assistance under the provisions of this chapter 
shall use or reveal any research or statistical information furnished under this chapter by any person and identifiable to 
any specific private person for any purpose other than the purpose for which it was obtained in accordance with this 
chapter. Such information and copies thereof shall be immune from legal process, and shall not, without the consent of 
the person furnishing such information, be admitted as evidence or used for any purpose in any action, suit, or other 
judicial, legislative, or administrative proceedings.  
(b) Criminal history information; disposition and arrest data; procedures for collection, storage, dissemination, and 
current status; security and privacy; availability for law enforcement, criminal justice, and other lawful purposes; 
automated systems: review, challenge, and correction of information  
All criminal history information collected, stored, or disseminated through support under this chapter shall contain, to 
the maximum extent feasible, disposition as well as arrest data where arrest data is included therein. 
The collection, storage, and dissemination of such information shall take place under procedures reasonably designed to 
insure that all such information is kept current therein; the Office of Justice Programs shall assure that the security and 
privacy of all information is adequately provided for and that information shall only be used for law enforcement and 
criminal justice and other lawful purposes. In addition, an individual who believes that criminal history information 
concerning him contained in an automated system is inaccurate, incomplete, or maintained in violation of this chapter, 
shall, upon satisfactory verification of his identity, be entitled to review such information and to obtain a copy of it for 
the purpose of challenge or correction. 
(c) Criminal intelligence systems and information; prohibition against violation of privacy and constitutional rights of 
individuals  
All criminal intelligence systems operating through support under this chapter shall collect, maintain, and disseminate 
criminal intelligence information in conformance with policy standards which are prescribed by the Office of Justice 
Programs and which are written to assure that the funding and operation of these systems furthers the purpose of this 
chapter and to assure that such systems are not utilized in violation of the privacy and constitutional rights of 
individuals.  
(d) Violations; fine as additional penalty 
 Any person violating the provisions of this section, or of any rule, regulation, or order issued there under, shall be fined 
not to exceed $10,000, in addition to any other penalty imposed by law.  
 

January 12, 2015
«Salutation» «ContactFirstName» «ContactLastName»
«Agency Name»
«ContactAddress1» «ContactAddress2»
«ContactCity», «ContactState», «ContactZip»
Dear «Salutation»«ContactLastName»:
Thanks to the efforts of jail administrators nationwide, the Bureau of Justice Statistics’ (BJS) Deaths in Custody
Reporting Program (DCRP) has been a great success since its inception in 2000. We appreciate your continued
support of this important program, which typically enjoys a 97% or better response rate across all jail jurisdictions
in the country. This letter marks the beginning of the 2015 DCRP data collection cycle.
BJS will use the data collected under this Program only for research and statistical purposes, as described in Title
42, USC §3735 and 3789g (enclosed). BJS will not report any death or population data at the facility or
jurisdiction level.
Using the enclosed year-specific instructions, please complete all applicable 2014 and 2015 forms online by
logging onto the DCRP Web site (https://bjsdcrp.rti.org) and using the following login credentials:
USERNAME: «username»
PASSWORD: «password»
If you prefer to use paper, you may access 2014 and 2015 forms by visiting the DCRP Web site
(https://bjsdcrp.rti.org). Specifically, you may print and complete the Annual Summary on Inmates in Private and
Multi-Jurisdiction Jails form (CJ-10A) for 2014, a Death Report on Inmates in Private and Multi-Jurisdictional
Jails form (CJ-10) for 2014, and a Death Report on Inmates in Private and Multi-Jurisdictional Jails form (CJ10) for 2015.
We request that you submit all remaining 2014 data, including the CJ-10A, by February 28, 2015. If you have
questions about the DCRP, please contact Matt Bensen, the RTI data collection task leader, via phone or e-mail at
(800) 344-1387 or [email protected]. We thank you in advance for your participation and look forward to our
continued work together.
Sincerely,

Margaret E. Noonan, Program Manager
Deaths in Custody Reporting Program
(202) 353-2060
[email protected]

Daniela Golinelli, Chief
Corrections Unit
(202) 616-5164
[email protected]

Enclosures: DCRP Update, 2014 Reporting Instructions, 2015 Reporting Instructions, Confidentiality Assurances

January 12, 2015
«Salutation» «ContactFirstName» «ContactLastName»
«Agency Name»
«ContactAddress1» «ContactAddress2»
«ContactCity», «ContactState», «ContactZip»
Dear «Salutation»«ContactLastName»:
Thanks to the efforts of jail administrators nationwide, the Bureau of Justice Statistics’ (BJS) Deaths in Custody
Reporting Program (DCRP) has been a great success since its inception in 2000. We appreciate your continued
support of this important program, which typically enjoys a 97% or better response rate across all jail jurisdictions
in the country. This letter marks the beginning of the 2015 DCRP data collection cycle.
BJS will use the data collected under this Program only for research and statistical purposes, as described in Title
42, USC §3735 and 3789g (enclosed). BJS will not report any death or population data at the facility or
jurisdiction level.
Using the enclosed year-specific instructions, please complete all applicable 2014 and 2015 forms online by
logging onto the DCRP Web site (https://bjsdcrp.rti.org) and using the following login credentials:
USERNAME: << username>>
PASSWORD: << password>>
If you prefer to use paper, you may access 2014 and 2015 forms by visiting the DCRP Web site
(https://bjsdcrp.rti.org). Specifically, you may print and complete the Annual Summary on Inmates under Jail
Jurisdiction form (CJ-9A) for 2014, a Death Report on Inmates under Jail Jurisdiction form (CJ-9) for 2014, and
a Death Report on Inmates under Jail Jurisdiction form (CJ-9) for 2015.
We request that you submit all remaining 2014 data, including the CJ-9A, by February 28, 2015. If you have
questions about the DCRP, please contact Matt Bensen, the RTI data collection task leader, via phone or e-mail at
(800) 344-1387 or [email protected]. We thank you in advance for your participation and look forward to our
continued work together.
Sincerely,

Margaret E. Noonan, Program Manager
Deaths in Custody Reporting Program
(202) 353-2060
[email protected]

Daniela Golinelli, Chief
Corrections Unit
(202) 616-5164
[email protected]

Enclosures: DCRP Update, 2014 Reporting Instructions, 2015 Reporting Instructions, Confidentiality Assurances

ACTION REQUESTED
2014 Reporting Instructions for Private and
Multi-Jurisdictional Agencies

 All agencies should submit a 2014 CJ-10A Annual
Summary form, even if no deaths occurred in your
agency’s custody during 2014. The Annual Summary
form has five questions and takes about 15 minutes to
complete.
Please submit a 2014 CJ-10 Death Report form for each
death occurring in your agency’s custody during 2014.
Please be sure that the total number of deaths you report
on the 2014 Annual Summary form matches the number
of individual death reports you submit for 2014.
 Please submit your data online by logging onto the
Deaths in Custody Reporting Program (DCRP) Web site
(https://bjsdcrp.rti.org) using the login credentials in
your cover letter.
 To submit via paper, access the 2014 CJ-10A and the
2014 CJ-10 forms on the DCRP Web site
(https://bjsdcrp.rti.org), and print them. Please mail or
fax these according to the form instructions.

What’s New in 2014?




The content of the 2014 Annual Summary form has returned to that in
the 2012 version
Multi-facility jurisdictions only need to fill out 1 ASF for 2014
There are some formatting and guidance language differences in the
2014 Annual Summary form. These changes are designed to increase
accurate and full reporting

ACTION REQUESTED
2014 Reporting Instructions for Locally-Run, Single
Jurisdiction Agencies

 All agencies should submit a 2014 CJ-9AAnnual
Summary form, even if no deaths occurred in your
agency’s custody during 2014. The Annual Summary
form has five questions and takes about 15 minutes to
complete.
Please submit a 2014 CJ-9Death Report form for each
death occurring in your agency’s custody during 2014.
Please be sure that the total number of deaths you report
on the 2014 Annual Summary form matches the number
of individual death reports you submit for 2014.
 Please submit your data online by logging onto the
Deaths in Custody Reporting Program (DCRP) Web site
(https://bjsdcrp.rti.org) using the login credentials in
your cover letter.
 To submit via paper, access the 2014 CJ-9A and the
2014 CJ-9 forms on the DCRP Web site
(https://bjsdcrp.rti.org) and print them. Please mail or

fax these according to the form instructions.
What’s New in 2014?




The content of the 2014 Annual Summary form has returned to that in
the 2012 version
Multi-facility jurisdictions only need to fill out 1 ASF for 2014
There are some formatting and guidance language differences in the
2014 Annual Summary form. These changes are designed to increase
accurate and full reporting

FOR FUTURE REFERENCE
2015 Reporting Instructions
 If no deaths have occurred in your agency’s custody to
date in 2015, do not report anything at this time.
 Please submit a 2015 CJ-10 Death Report form for any
deaths that occur in your agency’s custody in 2015 as soon
as the autopsy or other official death investigation results
are available.
 Please provide an answer for ALL questions on the form,
including “Specify” fields, if applicable.
 Please submit your data online by logging onto the Deaths
and Custody Reporting Program (DCRP) Web site
(https://bjsdcrp.rti.org) using the login credentials in your
cover letter.
 To submit via paper, access the 2015 CJ-10 Death Report
form on the DCRP Web site (https://bjsdcrp.rti.org), and
print the appropriate number of copies. Please mail or fax
these according to the form instructions.

FOR FUTURE REFERENCE
2015 Reporting Instructions
 If no deaths have occurred in your agency’s custody to
date in 2015, do not report anything at this time.
 Please submit a 2015 CJ-9 Death Report form for any
deaths that occur in your agency’s custody in 2015 as soon
as the autopsy or other official death investigation results
are available.
 Please provide an answer for ALL questions on the form,
including “Specify” fields, if applicable.
 Please submit your data online by logging onto the Deaths
and Custody Reporting Program (DCRP) Web site
(https://bjsdcrp.rti.org) using the login credentials in your
cover letter.
 To submit via paper, access the 2015 CJ-9 Death Report
form on the DCRP Web site (https://bjsdcrp.rti.org), and print
the appropriate number of copies. Please mail or fax these according to the
form instructions.

Attachment M. Data quality follow-up scripts

Call	Scripts	&	Voicemail	Messages:		
Agencies	that	have	submitted	their	ASF	
Your calls with POCs need to be flexible and conversational, so there will be no script to read verbatim. However, each 
conversation should contain some basic elements. We have provided an example for each basic conversational element 
below. 
 
IDENTIFY YOURSELF 
 
Hello, this is __________ calling on behalf of the U.S. Department of Justice regarding the Deaths in Custody Reporting 
Program. May I speak to __________? 
 
IDENTIFY REASON FOR CALL 
 
Thank you for providing the 2014 DCRP data. We have a few questions regarding your data.  Is now a good time for me to 
speak with you? 
 
 
 IF ISSUES WITH ASF: EXPLAIN ERRORS AND ASK FOR CORRECTIONS 
o We have a few questions regarding the ASF you submitted… 
 If you have time, we can go over them on the phone now, or, I can e‐mail the list of questions 
for your review. 
o If necessary, schedule a time to discuss/reconcile the issues by phone. 
o You may determine another way to provide data after discussions with the POC. 
 IF MISSING DEATH REPORTS 
o You can log onto the DCRP Web site to complete the forms 
 OFFER TO SEND USERNAME AND PASSWORD VIA E‐MAIL 
o You can also download the forms and e‐mail, mail, or fax them to us. 
o (LEAST PREFERRED) I can mail you a copy of the form. 
 IF ISSUES WITH SUBMITTED DEATH REPORTS 
o We have a few questions regarding the Death Reports you submitted… 
 If you have time, we can go over them on the phone now, or, I can e‐mail the list of questions 
for your review. 
o If necessary, schedule a time to discuss/reconcile the issues by phone. 
o You may determine another way to provide data after discussions with the POC. 
 
 
 
 
REMIND POC OF “ALWAYS‐ON” DATA COLLECTION (UNLESS YOU FEEL THE POC IS JUST NOT READY TO HEAR IT.) 
 
If your agency has any deaths in‐custody this year (in 2015), we ask that you submit a Death Report form on each 
individual’s death. You can submit Death Report forms at any time. These can be submitted online or via fax, e‐mail, or mail.  
 
In January 2016, we will contact you regarding the 2015 Annual Summary form. We ask all agencies to complete this form 
every year, regardless of whether they experienced a death during the previous year.  
 
THANK RESPONDENT 
 
We really appreciate your participation in the Deaths in Custody Reporting Program. You can reach me via telephone toll‐
free at 1‐800‐334‐8571 extension _____ or via e‐mail at [email protected]. 

1
DQFU Call Scripts 
Updated April 2015 

Voicemail	Messages	
General Mailbox 
Good {morning/ afternoon}.  My name is __________ and I’m calling on behalf of the U.S. Department of Justice regarding 
the Deaths in Custody Reporting Program. I have a few questions regarding the 2014 Deaths in Custody data submitted by 
__________. I sent him/her an e‐mail explaining what information we need. Should you have any questions, I can be 
reached, toll‐free, at 1‐800‐334‐8571 extension _____. Again, that number is 1‐800‐334‐8571 extension _____. Thank you. 
POC Mailbox 
Good {morning/ afternoon}.  My name is __________ and I’m calling on behalf of the U.S. Department of Justice regarding 
the Deaths in Custody Reporting Program. I have a few questions regarding your 2014 Deaths in Custody data. I sent you an 
e‐mail explaining what information we need. Should you have any questions, I can be reached, toll‐free, at 1‐800‐334‐8571 
extension _____. Again, that number is 1‐800‐334‐8571 extension _____. Thank you. 

2
DQFU Call Scripts 
Updated April 2015 

Call	Script	&	Voicemail	Messages:		
Agencies	that	have	not	submitted	their	ASF(s)	
but	have	submitted	at	least	one	DR	
IDENTIFY YOURSELF 
 
Hello, this is __________ calling on behalf of the U.S. Department of Justice regarding the Deaths in Custody Reporting 
Program. May I speak to __________? 
 
IF WE HAVE RECEIVED 1 OR MORE DEATH REPORTS AND NONE HAVE ERRORS:    
 
We received the Death Report(s) you submitted for _________ . Thank you. We have not yet received your Annual 
Summary form. All agencies should complete an Annual Summary form. The form takes only a few minutes to 
complete and is critical for calculating mortality rates in all [JAILS or PRISONS] across the U.S. [SPEAK TO HOW THEY 
CAN PROVIDE DATA DRAWING ON YOUR NR EXPERIENCE.] 
 
IF ANY OF THE DEATH REPORT FORMS HAVE ERRORS: 
 
We have a few questions regarding the Death Reports you submitted… 
 If you have time, we can go over them on the phone now, or, I can e‐mail the list of questions for your 
review. 
 If necessary, schedule a time to discuss/reconcile the issues by phone. 
 You may determine another way to provide data after discussions with the POC. 
 
Also, we have not yet received your Annual Summary form. All agencies should complete an Annual Summary form. 
The form takes only a few minutes to complete and is critical for calculating mortality rates in all [JAILS or PRISONS] 
across the U.S. [SPEAK TO HOW THEY CAN PROVIDE DATA DRAWING ON YOUR NR EXPERIENCE.] 
 
ALERT POC THAT YOU MAY CALL AGAIN 
 
After you submit new data, our project staff members will review your data and may contact you if they have any questions. 
Also, if we don’t receive your data within the next couple of weeks, we’ll probably call again to see if we can assist you 
further. 
 
REMIND POC OF “ALWAYS‐ON” DATA COLLECTION (UNLESS YOU FEEL THE POC IS JUST NOT READY TO HEAR IT) 
 
If your agency has any deaths in‐custody this year (in 2015), we ask that you submit a Death Report on each individual’s 
death. You can submit Death Reports at any time. These can be submitted online or via fax, e‐mail, or mail.  
 
In January 2016, we will contact you regarding the 2015 Annual Summary form. We ask all agencies to complete this form 
every year, regardless of whether they experienced a death during the previous year.  
 
THANK RESPONDENT 
 
We really appreciate your participation in the Deaths in Custody Reporting Program. You can reach me via telephone toll‐
free at 1‐800‐334‐8571 extension _____ or via e‐mail at [email protected]. 

1
DQFU Call Scripts 
Updated April 2015 

Voicemail	Messages	(omit	reference	to	needing	to	
ask	about	submitted	DRs	if	appropriate)	
General Mailbox 
Good {morning/ afternoon}. This message is for __________.  My name is __________ and I’m calling on behalf of the U.S. 
Department of Justice regarding the Deaths in Custody Reporting Program. We have some follow‐up questions regarding 
the Death Report form data your agency submitted. Also, we have not received your 2014 [CJ‐9A, CJ‐10A or NPS‐4] Annual 
Summary form. I sent an e‐mail to __________ explaining what information we need. Should you have any questions, I can 
be reached, toll‐free, at 1‐800‐334‐8571 extension _____. Again, that number is 1‐800‐334‐8571 extension _____. Thank 
you. 
POC Mailbox 
Good {morning/ afternoon}.  My name is __________ and I’m calling on behalf of the U.S. Department of Justice regarding 
the Deaths in Custody Reporting Program. We have some follow‐up questions regarding the Death Report form data your 
agency submitted. Also, we have not received your 2014 [CJ‐9A, CJ‐10A or NPS‐4] Annual Summary form. I sent you an e‐
mail explaining what information we need. Should you have any questions, I can be reached, toll‐free, at 1‐800‐334‐8571 
extension _____. Again, that number is 1‐800‐334‐8571 extension _____. Thank you. 
 
 
 
 
 
 

2
DQFU Call Scripts 
Updated April 2015 

DQFU	E‐mails	
CJ‐9,	CJ‐10,	NPS‐4A	
Case	Status	Code	1:	Errors	to	DRs	that	need	follow	up	(ASF	fine)	
 
SUBJECT: Following up on Data Quality Issues | <> 
Dear <> <>: 
Thank you for submitting the 2014 Deaths in Custody Reporting Program (DCRP) information for your agency earlier this year. 
We recently reviewed all of the DCRP submissions and wanted to follow up on the following Death Report form(s). 
 
I’ve listed the name(s) of the inmate(s) for whom we have questions, as well as the specific information we need below: 
 
 <> 
o <> 
o <> 
o …etc. 
 <> 
o <> 
o <> 
o …etc. 
 ..etc. 
 
Any information you may have from a coroner’s or medical examiner’s report would be extremely helpful. 
 
You may review or enter the above information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the 
following log‐in information: 
 
Username: <> 
Password: <> 
 
I’d also be happy to take this information over the phone or via e‐mail. I can be reached at (800) 334‐8571 ext. <> 
or <>. 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please let me know. 
 
Sincerely,  
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 

DQFU: Automated E‐mail Text 
Updated March 2015 

CJ‐9A,	CJ‐10A	
Case	Status	Code	2:	Errors	to	ASF	that	need	follow	up	(DR	fine)	
 
SUBJECT: Following up on Data Quality Issues | <> 
Dear <> <>: 
 
Thank you for submitting the 2014 Deaths in Custody Reporting Program (DCRP) information for your agency earlier this year. 
We recently reviewed all of the DCRP submissions and wanted to follow up on the following item(s) from your Annual Summary 
form (ASF): 
 
 <> 
 <> 
 ..etc. 
 
You may review the above information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the following 
log‐in information: 
 
Username: <> 
Password: <> 
 
Please note that you cannot revise or edit the ASF information online at this time. Please contact me via phone or e‐mail to 
provide ASF information instead. I can be reached at (800) 334‐8571 ext. <> or <>. 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please let me know.  
 
Sincerely, 
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 

DQFU: Automated E‐mail Text 
Updated March 2015 

NPS‐4	
Case	Status	Code	2:	Errors	to	ASF	that	need	follow‐up	(DR	fine)	
 
SUBJECT: Following up on Data Quality Issues | <> 
Dear <> <>: 
 
Thank you for submitting the 2014 Deaths in Custody Reporting Program (DCRP) information for your agency earlier this year. 
We recently reviewed all of the DCRP submissions and wanted to follow up on the following item from your Annual Summary 
form: 


<> 

Please review this information and reply to this e‐mail to confirm the correct number of deaths for 2014 or to provide updated 
information. 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please contact me at (800) 334‐8571 ext. <> or <>.  
 
Sincerely, 
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 

DQFU: Automated E‐mail Text 
Updated March 2015 

 

CJ‐9,	CJ‐9A,	CJ‐10,	CJ‐10A		
Case	Status	Code	3:	Errors	to	ASF	and	DRs	that	need	follow‐up	
 
SUBJECT: Following up on Data Quality Issues | <> 
Dear <> <>: 
 
Thank you for submitting the 2014 Deaths in Custody Reporting Program (DCRP) information for your agency earlier this year. 
We recently reviewed all of the DCRP submissions and wanted to follow up on the following item(s) from your Annual Summary 
form (ASF): 
 
 <> 
 <> 
 …etc. 
 
We also wanted to follow up on the following Death Report form(s). I’ve listed the name(s) of the inmate(s) for whom we have 
questions, as well as the specific information we need below: 
 
 <> 
o << DR Error 1>> 
o <> 
o …etc. 
 <> 
o <> 
o <> 
o …etc. 
 …etc. 
 
Any information you may have from a coroner’s or medical examiner’s report would be extremely helpful. 
 
You may review the above information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the following 
log‐in information: 
 
Username: <> 
Password: <> 
 
Please note that you can only revise or edit Death Report form information online at this time. Please contact me via phone or e‐
mail to provide ASF information. I can be reached at (800) 334‐8571 ext. <> or <>. 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please let me know. 
 
Sincerely, 
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 

DQFU: Automated E‐mail Text 
Updated March 2015 

NPS‐4,	NPS‐4A		
Case	Status	Code	3:	Errors	to	ASF	and	DRs	that	need	follow‐up	
 
SUBJECT: Following up on Data Quality Issues | <> 
Dear <> <>: 
 
Thank you for submitting the 2014 Deaths in Custody Reporting Program (DCRP) information for your agency earlier this year. 
We recently reviewed all of the DCRP submissions and wanted to follow up on the following item from your Annual Summary 
form (ASF): 
 
 <> 
 
Please review this information and reply to this e‐mail to confirm the correct number of deaths for 2014. 
 
We also wanted to follow up on the following Death Report form(s). I’ve listed the name(s) of the inmate(s) for whom we have 
questions, as well as the specific information we need below: 
 
 <> 
o << DR Error 1>> 
o <> 
o …etc. 
 <> 
o <> 
o <> 
o …etc. 
 …etc. 
 
Any information you may have from a coroner’s or medical examiner’s report would be extremely helpful. 
 
You may review the above information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the following 
log‐in information: 
 
Username: <> 
Password: <> 
 
Please note that you can only revise or edit Death Report form information online at this time. Please contact me via phone or e‐
mail to provide ASF information.  I can be reached at (800) 334‐8571 ext. <> or <>. 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please let me know. 
 
Sincerely, 
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 
 

DQFU: Automated E‐mail Text 
Updated March 2015 

CJ‐9A,	CJ‐9	
Case	Status	Code	4:	No‐ASF	–	one	or	more	DRs	Submitted	where	at	least	one	DR	has	an	
error	
 
SUBJECT: Following up on Data Quality Issues | <> 
Dear <> <>: 
 
We recently reviewed all of the Deaths in Custody Reporting Program (DCRP) submissions and noticed that we are missing the 
2014 Annual Summary form (ASF) from your agency.  
I have included a copy of the ASF questions below. Please answer the questions by replying via email. Please note that we accept 
estimates for questions one through four if exact answers are unavailable. 
2014 ASF  
1.    How many males and females under the supervision of your jail jurisdiction were CONFINED in your jail facilities on 
December 31, 2014? 
 Males:   
 
 
 
 
 Females:    
 
 
 
2.    How many males and females under the supervision of your jail jurisdiction were ADMITTED to your jail facilities during 
2014? 
 Males:  
 
 
 
 
 Females:     
 
 
 
3.    On December 31, 2014, how many persons were CONFINED in your jail facilities on behalf of any of the following: 
 U.S. Immigration and Customs Enforcement: 
 
 U.S. Marshals Service: 
 
 
 
 
 All other holds (state and federal prison, Bureau of Indian Affairs, or any holds for other jail jurisdictions):   
   
 
 
4.    Between January 1, 2014, and December 31, 2014, what was the average daily population of all jail confinement 
facilities operated by your jurisdiction?  
 Males:  
 
 
 
 
 Females:   
 
 
 
5.    Between January 1, 2014, and December 31, 2014, how many persons died while under the supervision of your jail 
jurisdiction?  
 Males:  
 Females: 
 
We also wanted to follow up on the following Death Report form(s). I’ve listed the name(s) of the inmate(s) for whom we have 
questions, as well as the specific information we need below: 
 
 <> 
o << DR Error 1>> 
o <> 
o …etc. 
 <> 
o <> 
o <> 
o …etc. 
 …etc. 
 
DQFU: Automated E‐mail Text 
Updated March 2015 

Any information you may have from a coroner’s or medical examiner’s report would be extremely helpful. 
 
You may review or enter the above information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the 
following log‐in information: 
 
Username: <> 
Password: <> 
 
I’d also be happy to take this information over the phone or via e‐mail. I can be reached at (800) 334‐8571 ext. <> 
or <>. 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please let me know. 
 
Sincerely, 
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 
 

DQFU: Automated E‐mail Text 
Updated March 2015 

 

CJ‐10A,	CJ‐10		
Case	Status	Code	4:	No‐ASF	–	one	or	more	DRs	Submitted	where	at	least	one	DR	has	an	
error	
 
SUBJECT: Following up on Data Quality Issues | <> 
Dear <> <>: 
 
We recently reviewed all of the Deaths in Custody Reporting Program (DCRP) submissions and noticed that we are missing the 
2014 Annual Summary form (ASF) from your agency.  
I have included a copy of the ASF questions below. Please answer the questions by replying via email. Please note that we do 
accept estimates for questions one through four if exact answers are unavailable. 
2014 ASF  
1.    How many males and females under the supervision of your jail were CONFINED in your jail facility on December 31, 
2014? 
 Males:   
 
 
 
 
 Females:    
 
 
 
2.    How many males and females under the supervision of your jail were ADMITTED to your jail facility during 2014? 
 Males:  
 
 
 
 
 Females:     
 
 
 
3.    On December 31, 2014, how many persons were CONFINED in your jail facility on behalf of any of the following: 
 U.S. Immigration and Customs Enforcement: 
 
 
 
 
 
 U.S. Marshals Service: 
 All other holds (state and federal prison, Bureau of Indian Affairs, or any holds for other jail jurisdictions):   
   
 
 
4.    Between January 1, 2014, and December 31, 2014, what was the average daily population of all jail confinement 
facilities operated by your jail?  
 Males:  
 
 
 
 
 Females:   
 
 
 
5.    Between January 1, 2014, and December 31, 2014, how many persons died while under the supervision of your jail?  
 Males:  
 Females:  
 
We also wanted to follow up on the following Death Report form(s). I’ve listed the name(s) of the inmate(s) for whom we have 
questions, as well as the specific information we need below: 
 
 <> 
o << DR Error 1>> 
o <> 
o …etc. 
 <> 
o <> 
o <> 
o …etc. 
 …etc. 
 
Any information you may have from a coroner’s or medical examiner’s report would be extremely helpful. 
 
DQFU: Automated E‐mail Text 
Updated March 2015 

You may review or enter the above information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the 
following log‐in information: 
 
Username: <> 
Password: <> 
 
I’d also be happy to take this information over the phone or via e‐mail. I can be reached at (800) 334‐8571 ext. <> 
or <>. 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please let me know. 
 
Sincerely, 
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 
	

DQFU: Automated E‐mail Text 
Updated March 2015 

NPS‐4	
Case	Status	Code	4:	No‐ASF	–	one	or	more	DRs	Submitted	where	at	least	one	DR	has	an	
error	
 
SUBJECT: Following up on Data Quality Issues | <> 
Dear <> <>: 
 
We recently reviewed all of the Deaths in Custody Reporting Program (DCRP) submissions and noticed that we are missing the 
2014 Annual Summary form (ASF) from your agency.  
 
I have included a copy of the ASF question below. Please answer the question by replying via e‐mail.  
 
2014 ASF  
1. During 2014, how many persons died while in the custody of your state correctional facilities? 
 Number of Deaths in 2014:  
 
We also wanted to follow up on the following Death Report form(s). I’ve listed the name(s) of the inmate(s) for whom we have 
questions, as well as the specific information we need below: 
 
 <> 
o << DR Error 1>> 
o <> 
o …etc. 
 <> 
o <> 
o <> 
o …etc. 
 …etc. 
 
Any information you may have from a coroner’s or medical examiner’s report would be extremely helpful. 
 
You may review or enter the above information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the 
following log‐in information: 
 
Username: <> 
Password: <> 
 
I’d also be happy to take this information over the phone or via e‐mail. I can be reached at (800) 334‐8571 ext. <> 
or <>. 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please let me know. 
 
Sincerely, 
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 
DQFU: Automated E‐mail Text 
Updated March 2015 

CJ‐9A	Case	Status	Code	5:	True	Non‐responder	
Subject: Deaths in Custody Reporting Program: Requesting 2014 Annual Summary Form | <>  
Dear <> <>: 
We recently reviewed all of the Deaths in Custody Reporting Program (DCRP) submissions and noticed that we are missing the 
2014 Annual Summary form (ASF) from your agency.  
I have included a copy of the ASF questions below. Please answer the questions by replying via e‐mail. Please note that we 
accept estimates for questions one through four if exact answers are unavailable. 
2014 ASF Questions 
1.    How many males and females under the supervision of your jail jurisdiction were CONFINED in your jail facilities on 
December 31, 2014? 
 Males:   
 
 
 
 
 Females:    
 
 
 
2.    How many males and females under the supervision of your jail jurisdiction were ADMITTED to your jail facilities during 
2014? 
 Males:  
 
 
 
 
 Females:     
 
 
 
3.    On December 31, 2014, how many persons were CONFINED in your jail facilities on behalf of any of the following: 
 U.S. Immigration and Customs Enforcement: 
 
 U.S. Marshals Service: 
 
 
 
 
 All other holds (state and federal prison, Bureau of Indian Affairs, or any holds for other jail jurisdictions):   
 
4.    Between January 1, 2014, and December 31, 2014, what was the average daily population of all jail confinement 
facilities operated by your jurisdiction?  
 Males:  
 
 
 
 
 Females:   
 
 
 
5.    Between January 1, 2014, and December 31, 2014, how many persons died while under the supervision of your jail 
jurisdiction?  
 Males:  
 Females: 
 
If any deaths occurred in your facility in 2014, you will also need to complete a Death Report form for each death. You may enter 
this information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the following login information: 
 
 Username: <> 
 Password: <> 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please contact me at (800) 334‐8571 ext. <> or <>.  
 
Sincerely,  
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 

DQFU: Automated E‐mail Text 
Updated March 2015 

CJ‐10A	Case	Status	Code	5:	True	Non‐responder	
Subject: Deaths in Custody Reporting Program: Requesting 2014 Annual Summary Form | <>  
Dear <> <>: 
We recently reviewed all of the Deaths in Custody Reporting Program (DCRP) submissions and noticed that we are missing the 
2014 Annual Summary form (ASF) from your agency.  
I have included a copy of the ASF questions below. Please answer the questions by replying via e‐mail. Please note that we 
accept estimates for questions one through four if exact answers are unavailable. 
2014 ASF Questions 
1.    How many males and females under the supervision of your jail were CONFINED in your jail facility on December 31, 
2014? 
 Males:   
 
 
 
 
 Females:    
 
 
 
2.    How many males and females under the supervision of your jail were ADMITTED to your jail facility during 2014? 
 Males:  
 
 
 
 
 Females:     
 
 
 
3.    On December 31, 2014, how many persons were CONFINED in your jail facility on behalf of any of the following: 
 U.S. Immigration and Customs Enforcement: 
 
 U.S. Marshals Service: 
 
 
 
 
 All other holds (state and federal prison, Bureau of Indian Affairs, or any holds for other jail jurisdictions):   
 
4.    Between January 1, 2014, and December 31, 2014, what was the average daily population of all jail confinement 
facilities operated by your jail?  
 Males:  
 
 
 
 
 Females:   
 
 
 
5.    Between January 1, 2014, and December 31, 2014, how many persons died while under the supervision of your jail?  
 Males:  
 Females:  
 
If any deaths occurred in your facility in 2014, you will also need to complete a Death Report form for each death. You may enter 
this information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the following login information: 
 Username: <> 
 Password: <> 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please contact me at (800) 334‐8571 ext. <> or <>.  
 
Sincerely,  
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 

DQFU: Automated E‐mail Text 
Updated March 2015 

	

NPS‐4	Case	Status	Code	5:	True	Non‐responder	
Subject: Deaths in Custody Reporting Program: Requesting 2014 Annual Summary Form | <> 
Dear <> <>: 
We recently reviewed all of the Deaths in Custody Reporting Program (DCRP) submissions and noticed that we are missing the 
2014 Annual Summary form (ASF) from your agency.  
I have included a copy of the ASF question below. Please answer the question by replying via e‐mail.  
2014 ASF Question 
1. During 2014, how many persons died while in the custody of your state correctional facilities?  
 Number of Deaths in 2014:  
 
If any deaths occurred within your facilities in 2014, you will also need to complete a Death Report form for each death. You may 
enter this information online by visiting the DCRP Web site at https://bjsdcrp.rti.org and using the following login information: 
 
 Username: <> 
 Password: <> 
 
We appreciate your cooperation and look forward to our continued work together! If you have any questions or if there is 
anything else I can do to assist you, please contact me at (800) 334‐8571 ext. <> or <>.  
 
Sincerely,  
<> 
Agency Liaison 
RTI International 
DCRP Data Collection Agent for the Bureau of Justice Statistics 
 

DQFU: Automated E‐mail Text 
Updated March 2015 

 

RY2015 Verification Call Script (DOCs) 
Introduction 
Hello. My name is [FILL]. I am calling on behalf of the U.S. Department of Justice.  
I am trying to reach [FILL] about the Deaths in Custody Reporting Program. 
 

[OR] 
I am trying to reach the person who is responsible for reporting your agency’s data to the 
Deaths in Custody Reporting Program. (Last year, our primary contact was [FILL]). 

IF NAMED POC 
‐‐NO LONGER WORKDS THERE: 
‐‐IS UNKNOWN TO THE PERSON: 
‐‐IS UNAVAILABLE: 
ASK WHO MIGHT BE THE APPROPRIATE PERSON TO CONTACT ABOUT THE DEATHS IN CUSTODY 
REPORTING PROGRAM 
IF NAMED POC IS AVAILABLE OR ANOTHER PERSON INDICATES WILLINGNESS TO HELP, EXPLAIN 
REASON FOR CALL 
We appreciate your participation in the Deaths in Custody Reporting Program. 
In preparation for sending the annual DCRP package to you in January, we would like to make sure that 
the information we have on file for your agency is still correct. We also have a population‐based 
question. This should only take a few minutes. 
IF “NO,” FIND A GOOD TIME TO CALL BACK AND PRESS END CALL 
IF “YES,” PRESS CONTINUE 
 

 

1 
 

 

Agency Information  
First, I’d like to confirm that we have the correct name for your agency… [FILL] Is your agency name 
accurate? 
[IF “NO”] What is the correct name of your agency? 
We have the following as the physical address for your agency… [FILL] 
 

[IF ~”NOT RIGHT”] What is the correct physical address for your agency? 

Point of Contact Information 
Our files indicate that ([FILL] / YOU) should be the primary contact for providing us with death reports 
and agency‐level summary data for the Deaths in Custody Reporting Program. Is this correct? 
[If “NO,” GATHER INFORMATION FOR NEW POINT OF CONTACT, INCLUDING: Salutation/Title, 
First Name, Last Name, Mailing Address (Street, City, State, and Zip Code), Phone Number, E‐
mail Address] 
[IF “YES”] I would like to review the contact information we have on file for [FILL] / YOU.  
[REVIEW THE FOLLOWING: Salutation/Title, First Name, Last Name, Mailing Address 
(Street, City, State, and Zip Code), Phone Number, E‐mail Address] 

Agency Head Information 
We would like to collect some information about the head of your agency. Our files indicate that [FILL] is 
the head of your agency. Is this correct? 
[If “NO,” GATHER INFORMATION FOR NEW AGENCY HEAD, INCLUDING: Salutation/Title, First 
Name, Last Name, Mailing Address (Street, City, State, and Zip Code), Phone Number, E‐mail 
Address] 
[IF “YES”] I would like to review the contact information we have on file for [FILL] / YOU.  
[REVIEW THE FOLLOWING: Salutation/Title, First Name, Last Name, Mailing Address 
(Street, City, State, and Zip Code), Phone Number, E‐mail Address] 

Data Submission Status 
Thank you. Regarding 2014: 
[IF ALL PRIOR YEAR REPORTS WERE SUBMITTED] Thank you for submitting all of your reports for 
2014.  
[IF NO PRIOR YEAR REPORTS WERE SUBMITTED] Our records show that we have not received 
your agency’s 2014 Annual Summary form. All agencies should complete the Annual Summary 
form each year, even those that did not experience a death in custody.  
[IF MISSING PRIOR YEAR DEATH REPORTS, BUT ASF WAS SUBMITTED] Our records show that we 
have received your agency’s 2014 Annual Summary form. However, we are still expecting [FILL] 
2 
 

 
death report(s). ). A death report is expected for each death reported on the Annual Summary 
Form.  
[IF MISSING PRIOR YEAR ASF, BUT DEATH REPORTS WERE SUBMITTED] Our records show that 
we have received [FILL] death report(s). However, we have not received your agency’s 2014 
Annual Summary form. All agencies should complete an Annual Summary form each year.  
Also, please know that you can now submit 2015 death reports online, via mail, email or fax. Would you 
like me to provide you with your username and password so you can log in and submit your reports 
online? 
Thank you for your help today. Do you have any questions for me? 
 
 
  

3 
 


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