Appendix A-2 Special Districts Contact Materials

School Survey on Crime and Safety (SSOCS) 2018

OMB #1850-0761 v.11

Appendix A.2 – Special Contact District Materials

National Center for Education Statistics

Institute of Education Sciences

U.S. Department of Education

February 21, 2017

Contents

Special Contact District Operations 2

District Research Application Cover Letter (Districts in SSOCS) 4

District Research Application Cover Letter (Districts in NTPS & SSOCS) 5

Special District Generic Research Application 6

Special Contact District Approval Form (SSOCS) 11

Special Contact District Affidavit of Nondisclosure 12

Special Contact District Recruitment Operations Overview

Special contact districts require that a research application be submitted to and reviewed by the district before they will allow schools under their jurisdiction to participate in a study. Districts are identified as “special contact districts” prior to data collection because they were flagged as such during previous cycles of SASS, NTPS, or SSOCS, or by other NCES studies. Special contact districts are also identified during data collection when districts indicate that they will not complete the survey until a research application is submitted, reviewed, and approved.

Once a district is identified as a special contact district, basic information about the district is obtained from the NCES Common Core of Data (CCD). The basic information includes the NCES LEA ID number, district name, city, and state. The next step is to search the district’s website for a point of contact and any information available about the district’s requirements for conducting external research. Some districts identified as being a special contact district from the previous cycle may be incorrect and staff will verify whether a given district has requirements for conducting external research before proceeding.

The following are examples of the type of information that will be gathered from each district’s website in order to prepare a research application for submission to this district:

• Name and contact information for the district office or department that reviews applications to conduct external research, and the name and contact information of the person in charge of that office.

• Information about review schedules and submission deadlines.

• Whether application fees are required, and if so, how much.

• Whether a district sponsor is required.

• Whether an online application is required, and if so, the link to the application if possible.

• Information about research topics and/or agenda on which the district is focusing.

• The web link to the main research department or office website.

• Research guidelines, instructions, application forms, District Action Plans, Strategic Plan or Goals, if any.

Recruitment staff will contact districts by phone and email to obtain key information not listed on the district’s website, (e.g., requirements for the research application, research application submission deadlines, etc.).

SSOCS/NTPS staff developed a generic research application that covers the information typically requested in district research applications. Staff will customize the generic research application to each district’s specific requirements that need to be addressed or included in the research application (e.g., how the study addresses key district goals, or inclusion of a district study sponsor), or submit the generic application with minimal changes to districts that do not have specific application requirements.

Using the information obtained from the district website or phone or email exchanges, a district research request packet will be prepared. Each research application will include the following documents, where applicable:

• District research application cover letter;

• Research application (district-specific or generic, as required by the district);

• Study summary;

• FAQ document;

• Special contact district approval form;

• Participant informed consent form (if required by the district);

• SSOCS/NTPS Project Director’s resume;

• Copy of questionnaires; and

• Application fee (if required by the district).

Other information about the study may be required by the district and will be included with the application or provided upon request.

Approximately one week after the application is submitted to the district (either electronically or in hard copy, as required by the district), SSOCS/NTPS district recruitment staff will contact the district’s research office to confirm receipt of the package and to ask when the district expects to review the research application and when a decision will be made. If additional information is requested by the district (e.g., the list of sampled schools), recruitment staff will follow up on such requests and will be available to answer any questions the district may have throughout the data collection period.

To reduce burden for the special contact districts and improve operational efficiency, NCES is planning to seek research approval simultaneously for NTPS 2017-18 and SSOCS 2018. Although NCES plans to minimize overlap in the schools sampled for NTPS and SSOCS, most of the largest districts will have schools selected for both surveys. All special contact districts with schools in both surveys will receive both research applications concurrently and will be given the option to participate in NTPS only, SSOCS only, or both NTPS and SSOCS. The research request packets for the districts in both studies will contain an additional letter introducing the studies and emphasizing that SSOCS and NTPS are working together to minimize the number of schools asked to participate in both studies.

Some districts charge a fee (~$50-200) to process research application requests, which will be paid as necessary.

District Research Application Cover Letter (Districts in SSOCS)

[Name] [date]

[Position, Department]

[School District]

[Street Address]

[City, State, Zip]

Dear [District Contact Name]

The National Center for Education Statistics (NCES) of the U.S. Department of Education is requesting approval to conduct the School Survey on Crime and Safety (SSOCS) 2018 in some of your district’s schools during the 2017-18 school year.

SSOCS is administered on a recurring basis by the U.S. Census Bureau on behalf of NCES. Its data are crucial in helping legislators and education leaders make informed decisions to provide a safe school environment. By participating in this survey, you will ensure that information about your district’s schools is included in those decisions.

[For districts where sample has been drawn, insert: “From your district, XX schools were sampled for SSOCS.”] No student, faculty, or classroom time is involved in this survey.

Thank you for your consideration of the research application for SSOCS 2018. The enclosed application and materials describe the purposes, survey topics, sample size, and respondent burden for SSOCS. The SSOCS 2016 questionnaire is also included for your reference. Only minor changes are proposed for the 2018 questionnaire. In addition, a District Approval Form is enclosed for you to indicate whether your district has approved participation in SSOCS. Please return the form as soon as possible to the contact listed on the form.

If you have any questions about SSOCS or the research application, please contact the study’s district research application team, by e-mail at [email]@westat.com or by telephone at 1-800-[phone]. You can find additional information about SSOCS and results from prior SSOCS administrations at http://nces.ed.gov/surveys/ssocs.

Sincerely,

Rachel Hansen

Project Director

School Survey on Crime and Safety

National Center for Education Statistics

PCP, 550 12th St., SW, 4th floor, Room 4012

Washington, DC 20202

Enclosures

D istrict Research Application Cover Letter (Districts in NTPS & SSOCS)

[Name] January 22, 2021

[Position, Department]

[School District]

[Street Address]

[City, State, Zip]

Dear [District Contact Name]

The National Center for Education Statistics (NCES) of the U.S. Department of Education is requesting approval to conduct the National Teacher and Principal Survey (NTPS) 2017-18 and the School Survey on Crime and Safety (SSOCS) 2018 in some of your district’s schools during the 2017-18 school year.

NTPS and SSOCS are administered by the U.S. Census Bureau on behalf of NCES on a recurring basis. The collected data are crucial in helping legislators and education leaders make informed decisions to improve education. By participating in these surveys, you will ensure that information about your district’s schools, principals, and teachers is included in those decisions. No student or classroom time is involved in either survey.

[For districts where sample has been drawn, insert: “From your district, XX of schools were sampled for NTPS and XX of schools were sampled for SSOCS.”] NCES recognizes the increased burden on schools asked to respond to multiple surveys. NTPS and SSOCS are working together to minimize as much as possible the number of schools asked to participate in both surveys.

We appreciate your consideration of the research applications for these important surveys. The enclosed applications and materials describe the purposes, survey topics, sample sizes, and respondent burden for NTPS and SSOCS. The applications and materials for each survey are provided separately. If you have any questions about the research applications, please contact the studies’ district research application team, by e-mail at [email]@westat.com or by telephone at 1-800-[phone].

Sincerely,

Amy Ho

Project Director

National Teacher and Principal Survey

National Center for Education Statistics

PCP, 550 12th St., SW, 4th floor, Room 4014

Washington, DC 20202

Rachel Hansen

Project Director

School Survey on Crime and Safety

National Center for Education Statistics

PCP, 550 12th St., SW, 4th floor, Room 4012

Washington, DC 20202

Enclosures

2017–18 SSOCS Generic Research Application

Contact

Applicant: Rachel Hansen

Title: Project Director

Affiliation: National Center for Education Statistics (NCES)

Institute of Education Sciences (IES)

United States Department of Education

Address: PCP, 550 12^th Street, SW, 4^th floor, Room 4012

Washington, DC 20202

Phone: (202) 245-7082

E-mail: [email protected]

SSOCS Research Application Contact:

District Research Application Team

1-800-[phone]

[email]@westat.com

Title of Study: 2017–18 School Survey on Crime and Safety (SSOCS:2018)

Anticipated Start Date: February 2018

Anticipated End Date: June 2018

Purpose of Study:

The School Survey on Crime and Safety (SSOCS) is conducted by the National Center for Education Statistics (NCES), part of the Institute of Education Sciences (IES), within the United States Department of Education, in order to collect extensive data on issues of crime and safety in U.S. public primary, middle, high, and combined-grade schools. The survey asks school principals about topics such as incidents of crime and violence; disciplinary actions; discipline problems; use of security measures; school policies and practices related to school crime and violence; violence prevention programs and activities; the presence and role of school security staff; parent and community involvement; staff training; availability of mental health services; and other school characteristics. NCES is authorized to conduct SSOCS by the Education Sciences Reform Act of 2002 (ESRA; 20 U.S.C. §9543).

SSOCS is one of the nation’s few sources of national information on school crime and safety, as reported by principals in U.S. public schools. SSOCS was first conducted during the 1999–2000 school year and was conducted again during the 2003–04, 2005–06, 2007–08, 2009–10, and 2015–16 school years. Many topics in the prior administrations are repeated in the 2017–18 questionnaire to enable comparisons between the seven survey periods. Because data are collected on a recurring basis, it is possible to assess whether our nation’s schools are becoming safer for students and educators. By participating, information from schools in your district allows for comparisons among different types of schools across the nation that are valuable to governing agencies, policy makers, educators and the general public.

Significance of the Study and Benefits of Participation:

SSOCS is the only recurring federal survey that collects detailed information on the incidence, frequency, seriousness, and nature of violence affecting students and school personnel, as well as other indices of school safety from the schools’ perspective. As such, it fills an important gap in data collected by NCES and other agencies. With the help of survey participants, NCES is able to produce national estimates of school crime and discipline, and of school policies and programs concerning crime and safety. These data are crucial in helping legislators and education leaders make informed decisions to provide a safe school environment. The ability of NCES to provide this important information is contingent upon the voluntary participation of sampled schools; participation of these schools is dependent upon their districts’ approval. Because your district and its schools represent themselves and many others like them, their participation is vital for producing high quality information. By participating in this survey, you will ensure that information about your districts’ schools is included in those important decisions.

Hypotheses and Measurement:

The SSOCS questionnaire is divided into 10 broad research objectives, each with a series of measurement items addressing a specific research question. Each research objective is briefly stated below in terms of the crime and safety issues in need of measurement, as well as the research questions we are seeking to answer. These measurement items and corresponding research questions are:

1. Frequency of Crime and Violence at School: frequency and nature of crime at public schools

   1. What is the number of incidents, by type of crime?

   2. What are the characteristics of those incidents?

      1. How many incidents were reported to police?

   3. What is the number of hate-crime incidents?

      1. What biases motivated these incidents?

   4. How many arrests were made at school?

   5. How many schools report violent deaths?

   6. How many schools report school shootings?

   7. How many schools report disruptions for violent threats?

2. Number of Incidents: frequency and nature of discipline problems and disorder at public schools

   1. What types of discipline problems and disorder occur at public schools?

   2. How serious are the problems?

3. Disciplinary Problems and Actions: disciplinary actions used by public schools

   1. What types of disciplinary actions were available to principals?

   2. How many disciplinary actions were taken, by type of action and offense?

4. School Practices and Policies: practices to prevent/reduce crime and violence at public schools

   1. How do schools monitor student behavior?

   2. How do schools control student behavior?

   3. How do schools monitor and secure the physical grounds?

   4. How do schools limit access to the school?

   5. How do schools plan and practice procedures for emergencies?

5. School Security Staff: involvement of law enforcement at public schools

   1. Do schools have sworn law enforcement officers present on a regular basis?

      1. How often are they available and at what times?

      2. What activities do they participate in?

      3. How many are present at the school?

      4. How are sworn law enforcement officers armed?

   2. Is there written documentation outlining the roles and responsibilities of law enforcement in schools?

   3. Do schools have security guards or personnel other than law enforcement?

6. School Mental Health Services: availability and access to student mental health services at public schools

   1. Are mental health services, such as diagnostic assessment and treatment, available to students?

      1. Where are those services available?

   2. What factors limit a school’s efforts to provide mental health services to students?

7. School Programs: formal programs designed to prevent/reduce crime and violence at public schools

   1. Which programs target students, teachers, parents, and other community members?

   2. What are the characteristics of the programs?

   3. Do schools have threat assessment teams?

      1. How often do they formally meet?

   4. What student groups promote acceptance of student diversity?

   5. What training is provided to staff?

8. Parent and Community Involvement at School: efforts used by public schools to prevent/reduce crime and violence involving various stakeholders (e.g., law enforcement, parents, juvenile justice agencies, mental health agencies, social services, and the business community)

   1. In what activities are stakeholders involved?

   2. How much are stakeholders involved?

9. Limitations on Crime Prevention: the problems principals encounter in preventing/reducing crime and violence in public schools

10. School Characteristics which are related to the research questions above

    1. What are the demographic characteristics of schools?

    2. What are the characteristics of the student population?

    3. What is the average student/teacher ratio?

    4. What are the general measures of school climate, such as truancy or student mobility?

Questionnaire:

A copy of the 2016 SSOCS questionnaire is enclosed for your reference. Only minor changes are proposed for the 2018 questionnaire. The sections in the 2018 questionnaire, outlined below, are the same as those in the 2016 questionnaire. Additional information about SSOCS and results from prior SSOCS administrations is available at http://nces.ed.goc/surveys/ssocs.

The SSOCS:2018 questionnaire consists of the following sections:

• School practices and programs;

• Parent and community involvement at school;

• School security staff;

• School mental health services;

• Staff training;

• Limitations on crime prevention;

• Frequency of crime and violence at school;

• Number of incidents;

• Disciplinary problems and actions; and

• School characteristics: 2017–18 school year.

Methodology and Sampling:

The U.S. Census Bureau collects the SSOCS data on behalf of NCES. SSOCS is a self-administered survey that is offered to respondents primarily through a mail questionnaire. As part of an effort to increase survey response rates, subject to approval, a random sample of respondents will be offered an online version of the survey in 2018 and a random sample of schools will receive a prepaid gift card in the initial survey package. Principals, or the school staff most knowledgeable about school crime and policies for a safe environment, complete the survey and return it directly to the U.S. Census Bureau. School districts and state educational agencies are not involved in the data collection in any way. Depending on the school’s data collection system, some principals may seek input from other school staff, such as school resource officers or guidance counselors. The survey does not require the participation of either students or faculty. No classroom time is involved in the completion of this survey.

SSOCS provides aggregate estimates for public schools across the nation. A stratified sample design is used to select approximately 4,500 U.S. public schools for SSOCS:2018. The sample is designed to provide national estimates of primary, middle, high, and combined-grade schools taking into account the level of instruction, type of locale (urbanicity), and size of the student enrollment.

The sampling frame for SSOCS is derived from the Common Core of Data (CCD), the universe of public schools supplied annually by state educational agencies to NCES. Only public schools in the 50 states and the District of Columbia are included in the SSOCS sampling frame. Certain types of schools are excluded, including special education schools, vocational schools, alternative schools (e.g., adult continuing education schools and remedial schools), newly closed schools, home schools, virtual schools, ungraded schools, schools with high grades of kindergarten or lower, and schools run by the Bureau of Indian Education. Regular public schools, charter schools, and schools that have partial or total magnet programs are included in the frame. For sample allocation purposes, strata are defined by instructional level, type of locale (urbanicity), and enrollment size. Both percent minority enrollment and region are used as sorting variables in the sample selection process to induce implicit stratification.

Data Collection:

The 2017–18 SSOCS data collection will begin in February of 2018. The U.S. Census Bureau, acting as a contractor for NCES, will handle the data collection. Sampled schools will receive a letter notifying them of the survey in February 2018. Within a week of receiving the advance letter notifying them of the survey, the principals of the sampled schools will be sent the SSOCS questionnaire, and will be asked to return the questionnaire within two weeks. If the surveys are not returned or items are left incomplete, the school may receive follow-up telephone calls and emails. All follow-up data collection activities will end in June 2018. School districts and state education agencies are not involved in the data collection in any way, nor does the survey require the participation of students or faculty. Completed questionnaires are sent directly back to the U.S. Census Bureau.

SSOCS:2018 timetable
Questionnaires mailed to principals	February 2018
Questionnaires due from principals	March 2018
Phone and email follow-up with non-responders begins	March 2018
All data collection efforts end	June 2018

Response Burden:

SSOCS relies on the voluntary participation of schools. The quality of national estimates is dependent on the level of respondent participation. The data provided by individual schools are combined with the information provided by other schools in statistical reports to present estimates of school crime and discipline, and of school policies and programs concerning crime and safety in schools nationwide. Every effort is made to create questionnaires that collect in-depth data without putting an undue burden on the respondent. The response burden for the survey is estimated to be 52 minutes per school.

SSOCS does not require the participation of either students or faculty. The recruitment materials and questionnaire clearly state that SSOCS:2018 is a voluntary survey. The materials also state that the data will only be reported in statistical summaries that preclude the identification of any individual principal or school participating in the survey.

Analysis and release of information:

The information collected in the 2017–18 SSOCS will be released in several ways. Many of the estimates will be included in statistical analysis reports published by NCES. In addition, the major findings will be included on the NCES website.

NCES allows researchers to access the data through restricted-use licensing for additional analyses. Only users who have official clearance from NCES may have access to the restricted-use data files. The data will be made available to the public as soon as possible after data collection. A public use dataset will be made available to the public on the Department of Education web site. In compliance with NCES confidentiality procedures, the public use dataset will not contain any information that can be used to identify an individual school or the state or district in which the school is located.

Benefit to your school district:

The U.S. Department of Education recognizes that safe schools are essential for learning: without a safe and secure environment, teachers cannot teach and students cannot learn. Effective data collection that encourages a high level of participation, and clear and timely analysis and presentation of the data, provide educators with a powerful set of tools for achieving the goal of school safety by providing accurate, up-to-date information about school crime and safety. This information is crucial in helping legislators and education leaders make informed decisions to provide a safe school environment. The ability of NCES to provide this important information is contingent upon the voluntary participation of sampled schools, and participation of these schools is dependent upon their districts’ approval. Because your district and its schools represent themselves and many others like them, their participation is vital for producing high quality information. By participating in this survey, you will ensure that information about your districts’ schools is included in those important decisions.

Confidentiality:

Data security and confidentiality protection procedures have been put in place for SSOCS:2018 to ensure that all NCES contractors and agents working on SSOCS:2018 comply with all privacy requirements, including, as applicable: the Inter-agency agreement with NCES for this study; Privacy Act of 1974 (5 U.S.C. §552a); Privacy Act Regulations (34 CFR Part 5b); Computer Security Act of 1987; U.S.A. Patriot Act of 2001 (P.L. 107-56); Education Sciences Reform Act of 2002 (ESRA, 20 U.S.C. §9573); Confidential Information Protect and Statistical efficiency Act of 2002; E-Government Act of 2002, Title V, Subtitle A; Cybersecurity Enhancement Act of 2015 (6 U.S.C. §151); the U.S. Department of Education General Handbook for Information Technology Security General Support Systems and Major Applications Inventory Procedures (March 2005); the U.S. Department of Education Incident Handling Procedures (February 2009); the U.S. Department of Education, ACS Directive OM: 5-101, Contractor Employee Personnel Security Screenings; NCES Statistical Standards; and all new legislation that impacts the data collected through the inter-agency agreement for this study.

The U.S. Census Bureau will collect data under an interagency agreement with NCES, and maintain the individually identifiable questionnaires per the security plan, including:

1. Provisions for data collection in the field;

2. Provisions to protect the data-coding phase required before machine processing;

3. Provisions to safeguard completed survey documents;

4. Authorization procedures to access or obtain files containing identifying information; and

5. Provisions to remove printouts and other outputs that contain identification information from normal operation. Such materials will be maintained in secured storage areas and will be securely destroyed as soon as practical.

U.S. Census Bureau will comply with the Department of Education’s IT security policy requirements as set forth in the Handbook for Information Assurance Security Policy and related procedures and guidance, as well as IT security requirements in the Federal Information Security Management Act (FISMA), Federal Information Processing Standards (FIPS) publications, Office of Management and Budget (OMB) Circulars, and the National Institute of Standards and Technology (NIST) standards and guidance. All data products and publications will also adhere to: the revised NCES Statistical Standards, as described at the website: http://nces.ed.gov/statprog/2012/.

By law (20 U.S.C. §9573), a violation of the confidentiality restrictions is a felony, punishable by imprisonment of up to 5 years and/or a fine of up to $250,000. All government or contracted staff working on the SSOCS study and having access to the data are required to sign an NCES Affidavit of Nondisclosure and have received public-trust security clearance.

From the initial contact with the participants in this survey through all of the follow-up efforts, potential survey respondents will be informed that (a) the U.S. Census Bureau administers SSOCS on behalf of NCES; (b) NCES is authorized to conduct SSOCS by the Education Sciences Reform Act of 2002 (ESRA; 20 U.S.C. §9543); (c) all of the information they provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151); and that their participation is voluntary.

The following language will be included in respondent contact materials and on data collection instruments:

All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151).

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary information collection is 1850-0761. The time required to complete this information collection is estimated to average 52 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate, suggestions for improving this collection, or comments or concerns about the contents or the status of your individual submission of this questionnaire, please e-mail: [email protected], or write directly to: School Survey on Crime and Safety (SSOCS), National Center for Education Statistics, PCP, 550 12^th Street SW, #4012, Washington, DC 20202.

Institutional Review Board (IRB) or Human Subjects Review:

Under the federal policy for the protection of human subjects, SSOCS is exempt from IRB review because it utilizes survey procedures and is conducted in established or commonly accepted educational settings, involving normal educational practices. There is no potential for harm to human subjects.

The Department of Education has adopted a common set of regulations known as the Federal Policy for the Protection of Human Subjects or "Common Rule." The design of these regulations is based on established, internationally recognized ethical principles. The specific regulation is Title 34, Code of Federal Regulations, Part 97, Protection of Human Subjects, which includes Subpart A, Basic Policy, and Subpart D, Additional Protections for Children. These regulations classify as exempt certain categories of research. Research that is nonexempt is covered by the regulations. Research activities in which the only involvement of human subjects will be in one or more of the following categories are exempt [34 CFR 97.101(b)(2)]:

(2) Research involving the use of educational tests (cognitive, diagnostic, aptitude, achievement), survey procedures, interview procedures or observation of public behavior, unless the information identifies the subjects and disclosure could reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects' financial standing, employability, or reputation. Subpart D amends this exemption, in part: If the subjects are children, research involving interview or survey procedures and research involving observations of public behavior in which the researcher(s) participate in the activities being observed are not exempt. However, research involving the use of educational tests and research involving observations of public behavior in which the researcher(s) do not participate in the activities being observed are exempt.

For more information, please see http://www2.ed.gov/policy/fund/guid/humansub/overview.html.

Informed Consent:

The nature of this self-administered, cross-sectional survey is not considered intrusive and has been ruled to be exempt under the protection of human subjects’ provisions in federal research.

There are no individual student data (such as test scores or Social Security numbers) associated with any of the data acquired in this data collection. Since no data are collected about individual students, it is not necessary to obtain active, informed consent from students’ parents/guardians.

Participation in SSOCS is completely voluntary, and individual survey items can be left blank, at the discretion of each respondent. A statement on the questionnaire indicates that participation is voluntary. A respondent gives implied consent to participate by completing the SSOCS questionnaire.

Special Contact District Approval Form (SSOCS)

School Survey on Crime and Safety (SSOCS) 2018

District Approval Form

Please mark one of the boxes below to let us know your district’s decision to allow sampled school(s) to participate in the School Survey on Crime and Safety (SSOCS).

□ The U.S. Department of Education has permission to administer the School Survey on Crime and Safety (SSOCS) 2018 to one or more schools in the [District Name].

□ The U.S. Department of Education does not have permission to administer the School Survey on Crime and Safety (SSOCS) 2018 to any school in the [District Name].

Printed

Name: ___________________________ Date: ________________________

Signature: ___________________________ Title: ________________________

Address: ___________________________ Phone: _______________________

___________________________

Email: ___________________________

Please return this form to [contact info] by email to [email], or by mail to:

[address]

Special Contact District Affidavit of Nondisclosure

Affidavit of Nondisclosure for Districts that Require the List of Schools in the Study Sample

2018 School Survey on Crime and Safety (SSOCS)

____________________________________ __________________________________

(Job Title) (Organization Name)

2018 SSOCS List of Sampled Schools

____________________________________ __________________________________

(Name of NCES File with (Organization Address)

Individually Identifiable Information)

I, __________________________________________________________________________ ,

(Printed Full Name)

do solemnly swear (or affirm) that when given access to the subject NCES file, I will not

(i) use or reveal any individually identifiable information furnished, acquired, retrieved or assembled by me or others, under the provisions of the Education Sciences Reform Act of 2002 (20 U.S.C. § 9573) and Title V, subtitle A of the E-Government Act of 2002 (P.L. 107-347) for any purpose other than statistical purposes specified in the NCES survey, project or agreement;

(ii) make any disclosure or publication whereby a sample unit or survey respondent (including principals, teachers, and schools) could be identified or the data furnished by or related to any particular person or school under these sections could be identified; or

(iii) permit anyone other than the individuals authorized by the Commissioner of the National Center for Education Statistics (NCES) who have signed an affidavit of nondisclosure to examine the list of participating districts, schools, and/or staff.

[The penalty for unlawful disclosure is a fine of not more than $250,000 (under 18 U.S.C. 3571) or imprisonment for not more than five years (under 18 U.S.C. 3559), or both. The word "swear" should be stricken out when a person elects to affirm the affidavit rather than to swear to it.]

___________________________________ _________________________

(Signature) (Date)