SSV-4 SSV Other Correctional Facilities Summary Form

OMB No. 1121-0292: Approval Expires XXXXXX
U.S. DEPARTMENT OF JUSTICE

SSV-4

FORM
(3-4-2014)

BUREAU OF JUSTICE STATISTICS

SURVEY OF SEXUAL VICTIMIZATION, 2013
Other Correctional Facilities
Summary Form

AND ACTING AS COLLECTION AGENT

U.S. DEPT. OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

DATA SUPPLIED BY

TELEPHONE
E-MAIL
ADDRESS

City

Number and street or P.O. Box/Route Number
Area code

Number

FAX
NUMBER

State

▼

OFFICIAL
ADDRESS

Title

▼▼▼

Name

Area Code

ZIP Code
Number

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

What facilities are included in this data collection?
• MULTI-JURISDICTIONAL FACILITIES: Facilities
including detention centers, jails, community-based
facilities, and other correctional facilities administered by
two or more governments (or a board composed of
representatives from two or more governments) that are
intended for adults but sometimes hold juveniles.
• PRIVATELY OPERATED FACILITIES: All privately
owned or operated confinement facilities including prisons,
jails, detention centers, community-based facilities, and
other correctional facilities that are intended for adults but
sometimes hold juveniles.
• FACILITIES OPERATED BY OR FOR:
• THE UNITED STATES MILITARY
• THE BUREAU OF IMMIGRATION AND
CUSTOMS ENFORCEMENT
• TRIBAL AUTHORITIES
• THE BUREAU OF INDIAN AFFAIRS
What inmates and incidents are included in this data
collection?
Inmates under your custody between January 1, 2013, and
December 31, 2013.
• INCLUDE incidents involving inmates under the authority,
custody, or care of your confinement or community-based
facilities or staff.
• EXCLUDE inmates held in other jurisdictions.

Reporting instructions:
• Please complete the entire SSV-4 Form.
• If the answer to a question is "not available" or "unknown,"
write "DK" (do not know) 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," mark the
box ( X ) provided.
• When exact numeric answers are not available, provide
estimates and mark ( X ) the box beside each figure.
Substantiated incidents of sexual violence:
• Please complete an Incident Form (Adult, SSV-IA)
for each substantiated incident of sexual victimization.
Returning forms:
• If you need assistance, please call Greta Clark at the
U.S. Census Bureau toll–free at 1–888–369–3613,
option 2, or e-mail [email protected]
• Please return your completed questionnaire and
substantiated incident forms by
September 1, 2014.
• You may complete these forms online (see
enclosed instructions). Or if you prefer, you may
return these forms by mail or fax.
• MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000
• FAX (TOLL FREE) TO: 1–812–218–3085

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 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.

Section II – INMATE-ON-INMATE SEXUAL
VICTIMIZATION

Section I – GENERAL INFORMATION
1. How many persons under the supervision of your
facility were –

DEFINITIONS

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

The survey utilizes the definition of “sexual abuse” as
provided by 28 C.F.R. §115.6 in the National Standards to
Prevent, Detect, and Respond to Prison Rape (under the
Prison Rape Elimination Act of 2003). For purposes of SSV,
sexual abuse is disaggregated into three categories of
inmate-on-inmate sexual victimization. These categories are:

• INCLUDE persons out to court while under your
jurisdiction.

NONCONSENSUAL SEXUAL ACTS

• INCLUDE persons held for other jurisdictions.

Sexual contact of any person without his or her consent,
or of a person who is unable to consent or refuse;

a. CONFINED on December 31, 2013?

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

AND
• Contact between the penis and the vulva or the penis
and the anus including penetration, however slight;

• EXCLUDE all persons in non-residential
community-based programs run by your facility
(e.g., electronic monitoring, house arrest,
community service, day reporting, work
programs).
Male

OR
• Contact between the mouth and the penis, vulva, or
anus;

Female

OR

Inmates on
December 31, 2013 . .

• Penetration of the anal or genital opening of another
person however slight, by a hand, finger, object, or other
instrument.

b. ADMITTED to your facility during 2013?
• INCLUDE new admissions only, i.e., persons
officially booked into and housed in your facilities by
formal legal document and by the authority of the
courts or some other official agency.

ABUSIVE SEXUAL CONTACT
Sexual contact of any person without his or her consent,
or of a person who is unable to consent or refuse;

• INCLUDE repeat offenders booked on new charges.

AND

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

Female

• Exclude incidents in which the contact was incidental to
a physical altercation.

New admissions
during 2013 . . . . . . .

SEXUAL HARASSMENT
Repeated and unwelcome sexual advances, requests for
sexual favors, or verbal comments, gestures, or actions
of a derogatory or offensive sexual nature by one inmate
directed toward another.

2. Between January 1, 2013, and
December 31, 2013, what was the average
daily population of your confinement facility?
• To calculate the average daily population, add the
number of persons for each day during the period
January 1, 2013, through December 31, 2013, and
divide the result by 365.
Male

Female

Average daily
population . . . . . . . . . . .

FORM SSV-4 (3-4-2014)

• Intentional touching, either directly or through the
clothing, of the genitalia, anus, groin, breast, inner thigh,
or buttocks of any person.

Page 2

3. Does your facility record allegations of
inmate-on-inmate NONCONSENSUAL SEXUAL
ACTS?
Yes

01

6. Does your facility record allegations of
inmate-on-inmate ABUSIVE SEXUAL
CONTACT? (See definitions on page 2.)

➔ a. Do you record all reported occurrences,

01

01

All

02

Substantiated only

b. Do you record attempted
NONCONSENSUAL SEXUAL ACTS
or only completed ones?

02

No

Yes

or only substantiated ones?

01

Both attempted and completed

02

Completed only

02

No

➔ Can these be counted separately from
allegations of NONCONSENSUAL
SEXUAL ACTS?
01

Yes

02

No

➔ Skip to Item 9.

➔ Please provide an explanation in the space
below and then skip to Item 9.

➔ Please provide the definition used by your facility
for inmate-on-inmate NONCONSENSUAL
SEXUAL ACTS in the space below. Use that
definition to complete Items 4 and 5.

7. Between January 1, 2013, and
December 31, 2013, how many allegations
of inmate-on-inmate ABUSIVE SEXUAL
CONTACT were reported?

4. Between January 1, 2013, and
December 31, 2013, how many allegations
of inmate-on-inmate NONCONSENSUAL
SEXUAL ACTS were reported?

Number reported . . . . .
None
• If an allegation involved multiple victimizations, count
only once.
• Exclude any allegations that were reported as consensual.

Number reported . . . . . .
None
• If an allegation involved multiple victimizations, count
only once.
• Exclude any allegations that were reported as consensual.

8. Of the allegations reported in Item 7, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

5. Of the allegations reported in Item 4, how many
were — (Please contact the agency or office responsible
for investigating allegations of sexual victimization in order
to fully complete this form.)

a. Substantiated . . . . . . .

None

a. Substantiated

• The event was investigated and determined to have
occurred, based on the preponderance of evidence
(28 C.F.R. §115.72).

......

b. Unsubstantiated
b. Unsubstantiated . . . . .

....

None

None

None

• The investigation concluded that evidence was insufficient
to determine whether or not the event occurred.
c. Unfounded

.........

c. Unfounded . . . . . . . . . .

None

d. Investigation ongoing .

None

e. TOTAL (Sum of Items 8a
through 8d) . . . . . . . . . .

None

None

• The investigation determined that the event did NOT occur.
d. Investigation ongoing

None

• Evidence is still being gathered, processed or evaluated,
and a final determination has not yet been made.
e. TOTAL (Sum of Items
5a through 5d) . . . . . . . . .

None

• The total should equal the number reported in Item 7.

• The total should equal the number reported in Item 4.
FORM SSV-4 (3-4-2014)

Page 3

Section III – STAFF-ON-INMATE SEXUAL ABUSE

9. Does your facility record allegations of
inmate-on-inmate SEXUAL HARASSMENT? (See
definitions on page 2.)
01

02

Yes

No

DEFINITIONS

➔ Do you record all reported

The survey utilizes the definition of “sexual abuse” by a staff
member, contractor or volunteer as provided by 28 C.F.R.
§115.6 in the National Standards to Prevent, Detect, and
Respond to Prison Rape (under the Prison Rape Elimination
Act of 2003). For purposes of SSV, sexual abuse is
disaggregated into two categories of staff-on-inmate sexual
abuse. These categories are:

allegations or only substantiated
ones?
01

All

02

Substantiated only

➔ Please provide an explanation in the space
below and then skip to item 12.

STAFF SEXUAL MISCONDUCT
Any behavior or act of a sexual nature directed toward an
inmate by an employee, volunteer, contractor, official visitor
or other agency representative (exclude family, friends or
other visitors.) Sexual relationships of a romantic nature
between staff and inmates are included in this definition.
Consensual or nonconsensual sexual acts including:
• Intentional touching of the genitalia, anus, groin, breast,
inner thigh, or buttocks that is unrelated to official duties
or with the intent to abuse, arouse, or gratify sexual
desire;
OR
• Completed, attempted, threatened, or requested sexual acts;
OR
• Occurrences of indecent exposure, invasion of privacy,
or staff voyeurism for reason unrelated to official duties
or for sexual gratification.

10. Between January 1, 2013, and
December 31, 2013, how many allegations of
inmate-on-inmate SEXUAL HARASSMENT
were reported?

STAFF SEXUAL HARASSMENT
Repeated verbal statements, comments or gestures of a sexual
nature to an inmate by an employee, volunteer, contractor,
official visitor, or other agency representative (exclude family,
friends, or other visitors).

Number reported . . . . . . .
None
• If an allegation involved multiple victims or multiple
inmate perpetrators, count only once.
• Exclude any allegations that were reported as consensual.
11. Of the allegations reported in Item 10, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

a. Substantiated . . . . . .

None

b. Unsubstantiated . . . .

None

c. Unfounded . . . . . . . . . .

None

d. Investigation ongoing .

None

e. TOTAL (Sum of Items 11a
through 11d) . . . . . . . . .

None

OR
• Repeated profane or obscene language or gestures.

• The total should equal the number reported in Item 10.
FORM SSV-4 (3-4-2014)

• Demeaning references to gender or derogatory
comments about body or clothing; sexually suggestive;

Page 4

12. Does your facility record allegations of STAFF
SEXUAL MISCONDUCT?
01

02

Yes

No

15. Does your facility record allegations of STAFF
SEXUAL HARASSMENT?

➔ Do you record all reported

01

occurrences, or only substantiated
ones?

Yes

➔ Can these allegations be counted
separately from allegations of
STAFF SEXUAL MISCONDUCT?

01

All

01

Yes

02

Substantiated only

02

No ➔ Skip to Item 18.

➔ Please provide an explanation in the space

02

below and then skip to Item 15.

➔ Please provide an explanation in the space
below and skip to Item 18.

13. Between January 1, 2013, and
December 31, 2013, how many allegations of
STAFF SEXUAL MISCONDUCT were reported?

Number reported . . . . . .

No

16. Between January 1, 2013, and
December 31, 2013, how many allegations of
STAFF SEXUAL HARASSMENT were reported?

None

Number reported

• If an allegation involved multiple victims or staff, count
only once.

.....

None

• If an allegation involved multiple victims or staff, count
only once.

14. Of the allegations reported in Item 13, how
many were — (Please contact the agency or office
responsible for investigation allegations of sexual
victimization in order to fully complete this form.)

17. Of the allegations reported in Item 16, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

None

a. Substantiated . . . . . . . .

None

.....

None

b. Unsubstantiated

.....

None

c. Unfounded . . . . . . . . . .

None

c. Unfounded

..........

None

d. Investigation ongoing .

None

d. Investigation ongoing

.

None

e. TOTAL (Sum of Items 14a
through 14d) . . . . . . . . . .

None

e. TOTAL (Sum of Items 17a
through 17d) . . . . . . . . . .

None

a. Substantiated

.......

b. Unsubstantiated

• The total should equal the number reported in Item 13.

FORM SSV-4 (3-4-2014)

Page 5

• The total should equal the number reported in Item 16.

Section IV – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION

NOTES

18. What is the total number of substantiated
incidents reported in Items 5a, 8a, 11a,
14a, and 17a?
Total substantiated
incidents . . . . . . . . . . . . . .

None

➔ Please complete an Incident Form

(Adult, SSV-IA) for each substantiated
incident of sexual victimization.

FORM SSV-4 (3-4-2014)

Page 6