Form SLJASTL-15b Census of State and Local Law Enforcement Agencies Servi

Survey of State and Local Law Enforcement Agencies Serving Tribal Lands (SSLLEASTL)

PartA_Attachment 3_Pt B Attachment 06_CSLLEASTL_03-28-16

Census of State and Local Law Enforcement Agencies Serving Tribal Lands (CSLLEASTL)

OMB: 1121-0356

Document [pdf]
Download: pdf | pdf
OMB No. XXX-XXXX

U.S. Department of Justice
Bureau of Justice Statistics

Form SLJASTL-15b
NORC
RETURN 55thE Monroe
19 Floor
TO
Chicago, IL 60603

Approval Expires XX/XX/20XX

(NORC acting as data collection agent)

Census of State and Local Law
Enforcement Agencies Serving Tribal Lands

Please record the eight digit PIN assigned to your agency, the agency name and address for your agency below.
If you are unable to locate the PIN assigned to your agency, please contact [email protected].

PIN
AGENCY NAME
STREET ADDRESS

CITY

STATE

ZIP

INFORMATION SUPPLIED BY
NAME
TELEPHONE

TITLE
Area Code

Number

Extension

FAX

Area Code

Number

EMAIL ADDRESS

The Census of State and Local Law Enforcement Agencies Serving Tribal Lands (CSLLEASTL) is a census of all law
enforcement agencies that have jurisdiction over and/or provided services on tribal lands in 2015. Information collected
on this form will provide needed information to law enforcement agencies, federal agencies, and stakeholders working
on tribal lands. Your assistance is greatly appreciated.

INSTRUCTIONS
1.	 Please answer all questions with reference to the law enforcement agency specified above.
2.	 For all questions, the phrase “in 2015” refers to January 1, 2015 through December 31, 2015, unless
otherwise specified.
3.	 Some questions ask for exact counts of staff persons or of types of offenses handled by your agency. If you are
unable to provide an exact count in response to any such question, please provide your best estimate. If your
agency does not track certain information, please mark the “do not track” checkbox.
4.	 For any series of yes or no response questions, please check either "yes" or "no" for each option.
5.	 Please submit your completed form by mailing it to NORC in the enclosed postage-paid envelope, or by faxing each
page toll-free to NORC at 1-866-315-7129.
6.	 If you have questions or if you need assistance in completing the survey, please contact NORC via e-mail at
[email protected] or call 1-877-253-2087.

BURDEN STATEMENT
Federal agencies may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information,
unless it displays a currently valid OMB Control Number. Public reporting burden for this collection of information is estimated to average 60
minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate, or any other aspects of this collection of
information, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC
20531. The Omnibus Crime Control and Safe Streets Act of 1968, as amended (42 USC 3732), authorizes this information collection. Although
this survey is voluntary, we need your participation to make the results comprehensive, accurate, and timely.

Screener Questions

Section A. Adminstration

Your agency has been selected for this survey based on an
affirmative response on the 2014 Census of State and Local Law
Enforcement Agencies to an item that asked if your agency
provided law enforcement services on tribal lands or based on
your agency’s proximity to tribal lands.

Agreements/Contracts/Types of Functions
Performed/Information sharing
A1.	 In 2015, which of the following agreements provided your
agency with authority to operate on tribal lands?

Please answer the following questions:

Yes

S1.	 In 2015, did your agency provide law enforcement services
(e.g., make arrests, investigate crimes, provide detention, or
provide other court-related services) involving tribal or
non‑tribal persons on tribal lands? The term “tribal lands”
includes areas labeled Indian Country, federal or state
recognized reservations, trust lands, Alaska Native villages, and/
or tribal communities.
2	

Yes
	
No
	

3	

	Unknown

1	

a. Federal and/or state legislation authorizes
(e.g., Public Law 83-280) . . . . . . . . . . . . .
b. Memoranda of Understanding (MOUs),
Mutual Aid Agreements (MAA), or other
written agreements for service between
tribal government and the state or
jurisdictional neighbors.. . . . . . . . . . . . . . .
c. Informal or unwritten agreements
between jurisdictional neighbors (law
enforcement/local or county government
and the tribe/tribal law enforcement).. . . .

Please stop here and mail/fax survey to the location
provided on the previous page.

d. Agreements to provide services to tribes
without recognized lands or to tribal
communities recognized at the state, but
not federal level. . . . . . . . . . . . . . . . . . . . .

S2.	 Does your agency function under Public Law 83-280
(PL‑280)?
1	
2	
3	

e. Services in Optional Public Law 83-280
states with exceptional programs. . . . . . .

Skip to S4
	Yes
No
	
	Do not know/unfamiliar with PL-280

2	

	Yes
	No

3	

	Unknown

Unknown

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

f. Other agreement (specify):
_________________________________

S3.	 In 2015, did your agency have some other agreement, formal
or informal, to service tribal lands according to legislation
other than Public Law 83-280 or consensual agreements
among tribal, state, and local governments?
1	

No

A2.	 Please provide the names of all the tribal lands or villages
for which your agency provided services in 2015. If your
office provided services to more than 5 tribes, please check the
box below and include a hardcopy list with this survey.
1.��������������������������������������������������
��������������������������������������������������

S4.	 For crimes occurring on tribal lands, whom did your agency
have the authority to arrest in 2015? Your agency may have
varying authority across different tribal lands on which your
agency works. When answering this question, please respond
‘yes’ if it applies to at least one of the tribes or villages with which
your agency had an agreement.
Authority to arrest crimes involving

Yes

2.��������������������������������������������������
��������������������������������������������������
3.��������������������������������������������������

No

a. Indian offenders with Indian victims . . . . . . . . . . 

1

2

b. Indian offenders with non-Indian victims. . . . . . . 

1

2

c. Non-Indian offenders with Indian victims . . . . . . 

1

2

d. Non-Indian offenders with non-Indian victims. . . 

1

2

1

2

��������������������������������������������������
4.��������������������������������������������������

e. Other (specify):
_______________________________________

��������������������������������������������������
5.��������������������������������������������������
��������������������������������������������������
A printed list of tribes is included

2

Types of functions covered under agreements
with Indian tribes on tribal lands.

A4.	 In 2015, did your agency perform these traffic, vehiclerelated, and special public safety functions on tribal lands?

Your agency may have formal or informal agreements with one or
more tribes. When answering the following questions, please
respond ‘yes’ if it applies to at least one of the tribes or villages
with which your agency has an agreement. As a reminder, the term
‘tribal lands’ includes areas labeled Indian Country, federal or state
recognized reservations, trust lands, Alaska Native villages, and/or
tribal communities.

Type of function

a. First response to criminal
incidents ��������������������������������

Yes,

Yes,

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

f. Animal control������������������������

1

2

3

4

g. School crossing services��������

1

2

3

4

h. Fire services ��������������������������

1

2

3

4

i. Emergency medical services

1

2

3

4

j. Emergency management ������

1

2

3

4

k. Search and rescue ����������������

1

2

3

4

1

2

3

4

1

2

3

4

c. Crash/Collision/Accident
investigation���������������������������
d. Parking enforcement and
control������������������������������������
e. Commercial vehicle
enforcement���������������������������

No,

referred to
primary secondary
not
another
responder responder
provided
agency
1

2

3

4

1

2

3

4

1

2

3

4

d. Arrests of criminal suspects ��

1

2

3

4

e. Special events crowd control

1

2

3

4

f. Dispatching calls for service��

1

2

3

4

g. Homicide investigations����������

1

2

3

4

1

2

3

4

i. Arson investigations ��������������

1

2

3

4

j. Cybercrime investigations������

1

2

3

4

a. Provide jail services���������������

1

2

3

4

b. Booking and release of
inmates and arrestees������������

1

2

3

4

1

2

3

4

b. Patrol service��������������������������
c. Responding to citizen
requests for service����������������

h. Domestic violence response/
investigations��������������������������

k. Forensic crime scene
investigations��������������������������
l. Financial crimes and
investigations��������������������������
m. Other criminal investigation����

No,

referred to
primary secondary
not
another
responder responder
provided
agency

b. Traffic direction and control����

A3.	 In 2015, did your agency perform these patrol, response, and
criminal investigation functions on tribal lands?
No,

Yes,

a. Traffic law enforcement����������

For questions A3 through A5, please respond ‘yes’ if these
services were provided only on tribal lands or if they were
provided to the entire resident population, of which tribal lands
are included. If services were not provided on tribal lands or at all
by your agency, select ‘No, not provided’

No,

Yes,

Type of function

l. Natural resources
enforcement���������������������������
m. Other (specify):
________________________

A5.	 In 2015, did your agency perform these detention related and
court-related functions for offenses that occurred on tribal
lands?
Yes,

No,

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

h. Executing arrest warrants������

1

2

3

4

i. Apprehension of fugitives ������

1

2

3

4

j. Serving eviction notices���������

1

2

3

4

k. Enforcing protection orders����

1

2

3

4

l. Enforcing child support orders

1

2

3

4

referred to
primary secondary
not
another
responder responder
provided
agency

c. Inmate transport ��������������������
d. Operating OVERNIGHT
lockup or temporary
holding facility SEPARATE
from a jail ������������������������������
e. Operating a temporary
holding facility
(NOT FOR OVERNIGHT
DETENTION)��������������������������
f. Court security ������������������������
g. Service of process (i.e., legal
notification) ����������������������������

3

No,

Yes,

Type of function

Information sharing

A12.	 In 2015, did your agency hold meetings or other events with
tribal officials (e.g., tribal council, Chief of Tribal Police,
or tribal elders)?

A6.	 In 2015, did your agency have any formal or informal
agreements with tribal law enforcement agencies, other
tribal justice agencies, or both regarding access to restricted
criminal justice system databases?
1	

	Yes

2	

	No

3	

	Unknown

Skip to A8

1	

	Yes

2	

	No

3	

	Unknown

Skip to A14
Skip to A14

A13.	 In 2015, how often did your agency have contact with tribal
officials (e.g., tribal council, Chief of Tribal Police, or
tribal elders)?

Skip to A8

A7.	 In 2015, what types of restricted criminal justice information
did your agency share with tribal law enforcement agencies
or other tribal justice agencies?
Yes

No

Unknown

a. FBI/NCIC information . . . . . . . . . . . . . . . .

1

2

3

b. State records. . . . . . . . . . . . . . . . . . . . . . .

1

2

3

c. Regional/Local records. . . . . . . . . . . . . . .

1

2

3

1

2

3

1	

	 At least once a week

2	

	 Once a month

3	

	 A few times a year

4	

	 Once during the previous year

5	

	Other (specify):

����������������������������������������������������

d. Other (specify):
_________________________________

A14.	 In 2015, was there an identified point of contact
within your office for tribal affairs?

A8.	 In 2015, did your agency have an agreement with tribal law
enforcement or other tribal justice agencies regarding
information sharing between agencies?
1	

	Yes

2	

	No

3	

	Unknown

1	

	Yes

2	

	No

3	

	Unknown

A15.	 In 2015, did your agency have an identified point of contact
at a federal law enforcement agency (e.g., U.S. Marshals,
FBI, BIA) responsible for policing crimes occurring on tribal
lands? Please respond ‘yes’ if your agency had an identified
point of contact for one or more of these agencies.

A9.	 In 2015, did your agency’s information systems have the
capability to report statistics related to crimes occurring on
tribal lands separately from crimes occurring in other parts
of your jurisdiction?
1	

	Yes

1	

	Yes

2	

	 No, however this system is currently in development

2	

	No

3	

	 No, not planned in the foreseeable future

3	

	Unknown

4	

	Unknown

A16.	 In 2015, how often did your agency have contact with at
least one of the federal agencies responsible for policing
tribal lands regarding tribal lands?

A10.	 In 2015, could your agency’s reported arrest counts be
reported separately for crimes occurring on and off
tribal lands?
1	

	Yes

Skip to A12

1	

	 At least once a week

2	

	 Once a month
	 A few times a year

2	

	No

3	

3	

	Unknown

4	

	Once

5	

	Other (specify):�������������������������������������

6	

	Unknown

A11.	 What would be required to report crime and arrest counts
separately for crimes occurring on tribal lands?
Yes

a. Implementation of a new record
management system. . . . . . . . . . . . . . . . .

No

Unknown

1

2

3

1

2

3

c. Training. . . . . . . . . . . . . . . . . . . . . . . . . . .

1

2

3

d. Increased staff. . . . . . . . . . . . . . . . . . . . . .

1

2

3

e. State policy change. . . . . . . . . . . . . . . . . .

1

2

3

1

2

3

b. N
 ew hardware; new software; enhanced
technology to modify an existing system.

f. Other (specify):
_________________________________

4

A17.	 In 2015, did your agency provide the following services?
Yes

a. Serve county or state search warrants on
tribal lands�������������������������������������������������
b. Serve tribal search warrants on tribal
lands ���������������������������������������������������������
c. Serve county or state arrest warrants on
tribal lands�������������������������������������������������
d. Serve tribal arrest warrants on tribal
lands ���������������������������������������������������������
e. Serve county or state protective orders
on tribal lands �������������������������������������������
f. Serve tribal protective orders on tribal
lands ���������������������������������������������������������
g. Exchange information on jail detainers
with tribal governments�����������������������������
h. Extradite persons from tribal lands�����������

No

B4.	 As of June 30, 2015, how many sworn officers had
responsibility for matters (criminal or non-criminal) on tribal
lands? If all officers policed tribal lands, enter the total
number of officers in your agency. If no officers policed
tribal lands, please enter 0. If you cannot provide an exact
count, please provide your best estimate and check the
“Estimate” box.

Unknown

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

1

2

3

Number of Officers Estimate Unknown

a. Full time�����������������������������

__________________

b. Part time ���������������������������

__________________

B5.	 In 2015, what percentage of total staff time was spent
policing crime occurring on tribal lands?
______________________%

Estimate

Budgets

Section B. Staffing, Budgets, Training

B6.	 What was your agency’s total annual operating budget in
fiscal year 2015? Operating budget is defined as all recurring
fixed and variable costs associated with the management and
administration of your system. It does not include non-recurring
fixed capital costs, such as building construction and major
equipment purchase.

Staffing
In this section, please refer specifically to your fiscal year for
2015. Your agency may have one or multiple formal or informal
agreements with one or more tribes. When answering the following
questions, please respond ‘yes’ if it applies to at least one of the
tribes or villages with which your agency has an agreement.

$____________________.00

B1.	 The reference period for only this portion of the survey is
fiscal year 2015. What were the dates of your agency’s fiscal
year for 2015?

Estimate

	 Calendar year (January 1, 2015 to December 31, 2015)

1	

	Yes

2	

	Fiscal year starting on July 1, 2014 and ending on
June 30, 2015

2	

	 No, but planning to do so in the future

3	

	 No, no plans to do so

	Other budget cycle: (Please indicate the dates of your
agency’s 2015 budget cycle)

4	

	Unknown

B8.	 In fiscal year 2015, did your agency receive funding either
directly or indirectly from any tribe to support law
enforcement functions? This includes monetary and in-kind
contributions, such as office space or heating.

____ ____ ______ to ____ ____ ______
mm

dd

yyyy

	

mm

dd

yyyy

B2.	 As of June 30, 2015, how many sworn officers worked in
your agency? If you cannot provide an exact count, please
provide your best estimate and check the “Estimate” box.
Number of Officers Estimate Unknown

a. Full time�����������������������������

__________________

b. Part time ���������������������������

__________________

1	

	Yes

2	

	No

3	

	Unknown

Skip to B10
Skip to B10

B9.	 How much funding did your agency receive in fiscal year
2015 from tribes either directly or indirectly? If you cannot
provide an exact amount, please provide your best estimate and
check the “Estimate” box.

$____________________.00
B3.	 In fiscal year 2015, did your agency have sworn officers
whose primary responsibility was addressing matters
(criminal or non-criminal) on tribal lands? ‘Sworn officers’ is
defined as officers with full general arrest powers.
1	

	Yes

2	

	No

3	

	Unknown

Unknown

B7.	 In fiscal year 2015, did your agency track operating budgets
separately for crimes occurring on tribal lands?

1	

3	

Unknown

Estimate

Unknown

B10.	 In fiscal year 2015, did your agency receive any funding from
non-tribal sources directly to support law enforcement
functions on tribal lands? This funding can include grants or
funding from outside sources, such as BIA, county government,
state government, or federal government as well as other
sources, such as private funding.

5

1	

	Yes

2	

	No

3	

	Unknown

Skip to B12
Skip to B12

B11.	 In fiscal year 2015, from what sources did your agency
receive this funding?
Yes

No

B17.	 In calendar year 2015, with which of the following did your
law enforcement agency have deputation agreements?

Unknown

Yes

No

Unknown

a. Federal funding source�����������������������������

1

2

3

a. Neighboring tribes/tribal police �����������������

1

2

3

b. State funding source���������������������������������

1

2

3

b. BIA law enforcement���������������������������������

1

2

3

c. Municipal funding source��������������������������

1

2

3

d. Private funding source������������������������������

1

2

3

c. County/city law-enforcement for
addressing matters on tribal lands �����������

1

2

3

1

2

3

1

2

3

d. Other (specify):

e. Other (specify):
_________________________________

_________________________________

Training

B18.	 Does your agency provide any training for tribal law
enforcement officers? Please include training that may not be
exclusive for tribal law enforcement officers, but is attended by
tribal law enforcement officers.

B12.	 In calendar year 2015, did officers receive formal or informal
training on tribal jurisdiction, law, or culture prior to working
on tribal lands?
1	 	 Formal training only
2	 	 Informal training only
3	 	 Both formal and informal training
4	 	 No training
Skip to B15
5	 	Unknown
Skip to B15

No

1

2

3

b. Training on traditional conflict resolution���

1

2

3

c. Cultural training�����������������������������������������

1

2

3

1

2

3

1

2

3

d. Training on sovereignty and jurisdictional
issues �������������������������������������������������������

Initial training prior to
a.
working on tribal lands �����

__________________

b. Yearly training thereafter���

__________________

Skip to B20

Estimate Unknown

No

Unknown

1

2

3

1

2

3

c. Community oriented policing���������������������

1

2

3

d. Domestic violence�������������������������������������

1

2

3

e. Firearms ���������������������������������������������������

1

2

3

f. Non-lethal weapons/defensive tactics�������

1

2

3

g. Drug recognition ���������������������������������������

1

2

3

h. Crime scene investigation�������������������������

1

2

3

i. DUI/DWI investigations�����������������������������

1

2

3

j. Report writing and court room testimony �

1

2

3

k. Search and rescue �����������������������������������

1

2

3

1

2

3

b. Basic reservation/village and tribal police
officer training �������������������������������������������

B14.	 In calendar year 2015, approximately how many hours of
training on tribal jurisdiction, law and/or culture did officers
who work on tribal lands receive in the following situations
Hours per officer

	Unknown

Skip to B20

a. POST required training�����������������������������

e. Other (specify):
_________________________________

	No

3	

Yes

Unknown

a. Training on tribal legal systems�����������������

	Yes

2	

B19.	 In calendar year 2015, what types of training did your agency
provide to tribal law enforcement?

B13.	 In calendar year 2015, what kind of training was received?
Yes

1	

l. Other (specify):
_________________________________

B20.	 In calendar year 2015, did any of the following provide
opportunities for joint training with tribal law enforcement
agencies?

B15.	 In calendar year 2015, were any tribal law enforcement
officers working under a cross-deputization agreement with
your agency? The term deputize means extending tribal law
enforcement officers the same or similar powers that officers
from your agency hold.
1	 	Yes
2	 	No
3	 	Unknown

Yes

B16.	 In calendar year 2015, were any officers from your agency
working under a cross-deputization agreement with one or
more tribal law enforcement agencies? The term deputize
means extending tribal law enforcement officers the same or
similar powers that officers from your agency hold. If your agency
has one or multiple formal or informal agreements with one or
more tribes, please respond ‘yes’ if it applies to at least one of
the tribes or villages with which your agency has an agreement.
1	 	Yes
2	 	No
3	 	Unknown

No

Unknown

a. Local law enforcement �����������������������������

1

2

3

b. State law enforcement������������������������������

1

2

3

c. Federal law enforcement���������������������������

1

2

3

d. Tribal law enforcement �����������������������������

1

2

3

e. Tribal legal services�����������������������������������

1

2

3

f. Tribal government�������������������������������������

1

2

3

g. Government contractors���������������������������

1

2

3

h. Non-profit organizations ���������������������������

1

2

3

i. POST or other state training council���������

1

2

3

1

2

3

j. Other (specify):
_________________________________

6

Section C. Incidents
Number and types of incidents
The following crime categories conform to the Federal Bureau of Investigation’s (FBI) Uniform Crime Reporting (UCR) definitions.
These definitions are included at the end of this survey for your convenience.
C1.	 For each of the following crimes, please provide the number of incidents that were known to your agency in the last calendar year
for which you have statistics. If the exact number is not known, please provide an estimate and indicate this in the appropriate
column for that offense. If a count is unknown, please indicate this in the appropriate column for that offense.
	

Please indicate the year for which your agency has provided statistics:
_________________________ Year

	

Please check this box if the information is collected by your agency, but would be too burdensome to report

Most serious
charge at incident

Incidents occurring
both off and on tribal
lands.Total number of
incidents referred to
your office in 2015.

Estimate:
(Place a check
mark if the
recorded counts
are estimates)

Unknown or Do
not Track: (Place a
check mark if
unknown or not
tracked)

Incidents occurring
both off and on tribal
lands. Total number
of incidents referred
to your office in 2015.

a. Murder������������������������������������

____________

____________

b. Rape/Sexual Assault��������������

____________

____________

c. Robbery����������������������������������

____________

____________

d. Aggravated Assault����������������

____________

____________

e. Simple assault������������������������

____________

____________

f.

Burglary����������������������������������

____________

____________

g. Larceny/Motor Vehicle Theft��

____________

____________

h. Drug Trafficking����������������������

____________

____________

i.

Drug Possession��������������������

____________

____________

j.

Weapons��������������������������������

____________

____________

k. Driving under the influence����

____________

____________

Estimate:
(Place a check
mark if the
recorded counts
are estimates)

Unknown or Do
not Track: (Place a
check mark if
unknown or not
tracked)

C2.	 In calendar year 2015, where were cases referred when they involved juvenile tribal members?
Incident occurred on tribal lands
Yes

No

Unknown

Incident occurred outside of tribal lands
Yes

No

Unknown

a. Tribal justice authorities������������������������������������������������������������

1

2

3

4

5

6

b. County justice authorities ��������������������������������������������������������

1

2

3

4

5

6

c. State justice authorities������������������������������������������������������������

1

2

3

4

5

6

d. Federal justice authorities��������������������������������������������������������

1

2

3

4

5

6

1

2

3

4

5

6

e. Other (specify):
_________________________________________________

7

FBI UCR DEFINITIONS
Murder and non-negligent manslaughter: The willful (non-negligent)
killing of one human being by another.
Rape: Penetration, no matter how slight, of the vagina or anus with
any body part or object, or oral penetration by a sex organ of another
person, without the consent of the victim.
Robbery: The taking or attempting to take anything of value from the
care, custody, or control of a person or persons by force or threat of
force or violence and/or by putting the victim in fear.
Aggravated assault: An unlawful attack by one person upon another
for the purpose of inflicting severe or aggravated bodily injury.
Other assaults (simple): Assaults and attempted assaults where no
weapon was used or no serious or aggravated injury resulted to the
victim. Stalking, intimidation, coercion, and hazing are included.
Burglary: The unlawful entry of a structure to commit a felony or a
theft, including attempted forcible entry.

Larceny-theft (except motor vehicle theft): The unlawful taking,
carrying, leading, or riding away of property from the possession or
constructive possession of another.
Motor vehicle theft: The theft or attempted theft of a motor vehicle.
Drug trafficking: The violation of laws prohibiting the production and
distribution, of certain controlled substances.
Drug possession: The unlawful cultivation, purchase, use or
possession of controlled substances.
Weapons: carrying, possessing, etc.: The violation of laws or
ordinances prohibiting the manufacture, sale, purchase, transportation,
possession, concealment, or use of firearms, cutting instruments,
explosives, incendiary devices, or other deadly weapons.
Driving under the influence: Driving or operating a motor vehicle or
common carrier while mentally or physically impaired as the result of
consuming an alcoholic beverage or using a drug or narcotic.

Please submit your completed form by mailing it
to NORC in the enclosed postage-paid envelope
or by faxing each page toll-free to NORC at 1-866-315-7129.
If you have questions or concerns, or if you need assistance in completing the
survey, please contact NORC via e-mail at
[email protected] or call 1-877-253-2087.


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