Form NCVS-1 Basic Screener

OMB No. 1121-0111: Approval Expires 08/31/2015
NOTICE - We are conducting this survey under the authority of Title 13, United States Code, Section 8. FORM NCVS-1
Section 9 of this law requires us to keep all information about you and your household strictly
confidential. We may use this information only for statistical purposes. Also, Title 42, Section 3732,
Implementation
United States Code, authorizes the Bureau of Justice Statistics, Department of Justice, to collect
Date: (07-01-2008)
information using this survey. Title 42, Sections 3789g and 3735, United States Code, also requires us to
keep all information about you and your household strictly confidential. According to the Paperwork
Reduction Act of 1995, no persons are required to respond to a collection of information unless such
collection displays a valid OMB number.

U.S. DEPARTMENT OF COMMERCE

Economics and Statistics Administration

U.S. CENSUS BUREAU

ACTING AS COLLECTING AGENT FOR THE
BUREAU OF JUSTICE STATISTICS

PSU

Sample
Serial/
designation/Suffix Suffix

Segment/Suffix

NATIONAL CRIME
VICTIMIZATION SURVEY

201

2.

202

203

1

1
3
4

206

7.
207

8.
208

9.
209

220

1

12e.
221

2

Owned or
being bought

Rented
for cash

3

No cash
rent

1

X

2

Urban

Rural

1

Item blank

2

$1,000 or more

Less than $1,000

Type of living quarters (TYPEOFHOUSINGUNIT)
Housing unit
1
House, apartment, flat

7

8
9
10
11
12

HU in nontransient hotel, motel, etc.
HU permanent in transient hotel, motel, etc
HU in rooming house
Mobile home or trailer with no permanent room added
Mobile home or trailer with one or more permanent rooms
added
HU not specified above - Describe
OTHER unit
Quarters not HU in rooming or boarding house
Unit not permanent in transient hotel, motel, etc.
Unoccupied site for mobile home, trailer, or tent
Student quarters in college dormitory
OTHER unit not specified above - Describe

Use of telephone (TELEPHONELOCATION)
Location of phone - Mark first box that applies.

17,500 - 19,999

40,000 - 49,999

7,500 - 9,999

8

20,000 - 24,999

13

50,000 - 74,999

4

10,000 - 12,499

9

25,000 - 29,999

14

75,000 and over

5

12,500 - 14,999

10

30,000 - 34,999

1

Public Housing (PUBLICHOUSING)
X
1
Yes (public
Item blank
housing)

No (not public
housing)

2

Manager Verification of Public Housing
(PUBLICHOUSINGMGRVERIFY)
Unable to verify
Telephone
4
Other - Specify
3

American Indian Reservation or American Indian Lands
(INDIANRESERVATIONHU)
1

2

Yes

No

2

Phone in common area (hallway, etc.) ....
Phone in another unit (neighbor, friend, etc.)
Work/office phone ................
No phone - SKIP to 11a

5

Yes

2

No

3

4

4

2

5

5-9

3

3

6

10+

303

304

305

306

307

308

309

310

311

312

Codes for item 13c
1-12-13 years old and parent refused permission for self interview
2- Physically/mentally unable to answer
3- TA and won't return before closeout

(TYPEZ)

obtained for
Line No.

(Enter code)

313

314

315

316

317

318

319

320

7

Mobile home/trailer SKIP to 11c

8

Only OTHER units

Direct outside (DIRECTENTRANCETOUNIT)

1-Never available
2-Refused ....
3-Physically/
mentally
unable to
answer-no
proxy available
4-TA and no proxy
available ....
5-Other ......
6-Office use only

3
Yes 2
No
DK X
Item blank
Restricted access (GATEDWALLEDCOMMUNITY)
(RESTRICTEDACCESS)

____________ Total number

____________ Total number

222

Gated or walled community

1

Yes

2

No

X

Item blank

223

Building with restricted access 1

Yes

2

No

X

Item blank

0

None

0

None

0

None

15c. Number of Type Z noninterview household members
12 years of age and OVER

____________ Total number

15d. Crime Incident Reports filled
323

____________ Total number of NCVS-2s filled

16. Changes in Household Composition (MEMBERCHANGES)
a. Line No.
b. Reason (Enter code)
324

325

326

327

328

329

330

331

1

USCENSUSBUREAU

Codes for item 14b

15b. Household members UNDER 12 years of age

332

Refused to give number

1 - SKIP to 11c
2

(Enter code)

302

322

11a. Number of housing units in structure (NUMBEROFUNITS)
1

(PROXYREASON)

301

321
Fill 10b

10b. Is phone interview acceptable? (TELEPHONEACCEPTABLE)
1

c. Reason

(PICKPROXYRESP)
Name
Line No.

14. Type Z noninterview
b. Reason
a. Interview not

Fill BOUNDING INFORMATION

S
1

College/University (STUDENTHOUSING)
2
No
Yes

15a. Household members 12 years of age and OVER

Phone in unit ...................

4

11c.

$5,000 - 7,499

3

Complete 17-28 for each Line No. in 14a

1
3

213

35,000 - 39,999

12

obtained for
Line No.

Farm Sales (FARMSALES)

6

11b.

11

13. Proxy information - Fill for all proxy interviews
a. Proxy interview b. Proxy respondent

Land (LANDUSE)

5

212

15,000 - 17,499

7

Tenure (TENURE)

4

211

6

Able to verify
1
Public housing
2
Not public housing

____________

3

210

219

12d.

Noninterview the previous enumeration
Other - Specify

Group Quarters [GQ] type code

2

10a.

12c.

____________ Go to page 2

205

6.

Same household interviewed the previous enumeration
Replacement household since the previous enumeration

Less than $5,000

2

12b.
218

Line number of household respondent

204

5.

Unit in sample the previous enumeration period - Fill 3
Unit in sample first time this period - SKIP to 4

Household status - Mark first box that applies.
2

4.

1

Unit status
2

3.

Household Income (HOUSEHOLDINCOME)

214

Field representative identification
Code
Name

V

NCVS-1 BASIC SCREEN QUESTIONNAIRE

HH No. Spinoff
Indicator

12a.
1.

C

U.S. DEPARTMENT OF JUSTICE

Control number

N

Only enter
changes discovered
during the current
enumeration

RESPONDENT'S PERSONAL CHARACTERISTICS
18.

17. Name of respondent (NAME)

Last

19.

Type of interview

Line
No.

401
1

First

Per. - Self-respondent
Tel. - Self-respondent
Per. - Proxy
Fill 13 on cover page
Tel. - Proxy

2
3
4

20.

21.

(RELATIONSHIP)
Relationship
reference
person

22a.
(MARITAL)
Marital status

Age last
Birthday

403

22b.

THIS survey
period

404

(From previous
enumeration)
Marital
status LAST
survey period

405

23.

26.

(ARMED
(EDUCATION
FORCES) ATTAIN)
Armed
Educational
Forces
attainment
Member

407

406

25.

24.

(SEX)
Sex

402

408

________
Line No.

27.

28.

(RACE)

(ATTENDING (SP_
ORIGIN)
SCHOOL)
Attending
School

Hispanic
Origin

411

409

413

Race
Mark all that
apply.
412

*
1

1
Husband
2
Wife
Son
________ 3
Age
4
Daughter
5
Father
Mother
Brother
Sister
Other relative
Nonrelative
Ref. person

2
3
4
5
6
7
8
9
10
11

29.

Married
Widowed
Divorced
Separated
Never
married

1
2
3
4
5
6

Married
Widowed
Divorced
Separated
Never
married
Not interviewed
last
survey
period

1
2

M
F

1
2

1

Yes
No

____________ 2
Highest level
completed
3
4

5

Regular 1
school
2
College/
University
Trade
school
Vocational
school
None of
the
above
schools

Yes 1
No 2
3

4
5

6

White
Black/African
American
American
Indian/Alaska
Native
Asian
Native
Hawaiian/Other
Pacific Islander
Other - Specify

501

Date of interview

Month

Day

Year

MOBILITY QUESTIONS
33a. TIMEATADDRESS

506

____________ Years (Round to nearest whole year)

Before we get to the crime questions, I have some questions that are
helpful in studying where and why crimes occur.

If = 0 ASK to 33b
If = DK or RF SKIP to 33c
Else SKIP to 33d

Ask or verify How long have you lived at this address?
(Enter 0 if less than 1 year.)

33b. MONTHSATADDRESS

505

____________ Months (1-11) - SKIP to 33e

How many months?

33c. TIMEATADDRESSPROBE
Have you lived here...
Read categories 1-4:

33d.

CHECK

33e.

TIMEMOVEDIN5YEARS

ITEM A

1

More than 5 years - If HHLD Respondent ASK 34, else SKIP to 36a.

2

Less than 5 years, but more than 1 year

3

Less than 1 year, but more than 6 months

4

6 months or less
Don't Know

5

5 years or more - If HHLD Respondent SKIP to 34, else SKIP to 36a
Less than 5 years - ASK 33e

How many years are entered in 33a?

508

__________ Number of times -

Altogether, how many times have you moved in the last
5 years, that is, since _________________, 20 ___?

If HHLD Respondent ASK 34,
Else SKIP to 36a

Enter number of times.

BUSINESS OPERATED FROM SAMPLE ADDRESS (Ask of Household Respondent Only)
34.

BUSINESS (Asked of Household Respondent Only)

530

Does anyone in this household operate a business from this
address?

35. BUSINESSSIGN (Asked of Household Respondent Only)
If this is a PERSONAL visit - Fill by observation.
If this is a TELEPHONE contact - Ask.
Is there a sign on the premises or some other indication to the
general public that a business is operated from this address?

Page 2

SKIP
to 33e

531

1

Yes - ASK 35

2

No - SKIP to 36a

1

Yes (Recognizable business)

2

No (Unrecognizable business)

RESPONDENT'S SCREEN QUESTIONS
36a. SQTHEFT
I'm going to read some examples that will give you an idea of the
kinds of crimes this study covers.
As I go through them, tell me if any of these happened to you in the
last 6 months, that is since __________ ______, 20 ____.
Was something belonging to YOU stolen, such as Read each category.
(a) Things that you carry, like luggage, a wallet, purse, briefcase
book (b) Clothing, jewelry, or cellphone (c) Bicycle or sports equipment (d) Things in your home - like a TV, stereo, or tools (e) Things outside your home such as a garden hose or lawn
furniture - (Asked of Household Respondent only)
(f) Things belonging to children in the household (Asked of Household Respondent only)
(g) Things from a vehicle, such as a package, groceries, camera, or
CDs OR
(h) Did anyone ATTEMPT to steal anything belonging to you?
Ask only if necessary

532

1

Yes - ASK 36b

2

No - If Household Respondent SKIP to 37a;
Else SKIP to 40a

Did any incidents of this type happen to you?

36b. SQTHEFTTIMES

533

How many times?

Number of times (36b)

36c. SQTHEFTSPEC

Briefly describe incident(s)

What happened?

If Household Respondent ASK 37a; else SKIP to 40a

37a.

SQBREAKIN (Asked of Household Respondent Only)

(Other than any incidents already mentioned,) has anyone Read each category.
(a) Broken in or ATTEMPTED to break into your home by forcing a
door or window, pushing past someone, jimmying a lock, cutting
a screen, or entering through an open door or window?
(b) Has anyone illegally gotten in or tried to get into a garage, shed,
or storage room?
OR
(c) Illegally gotten in or tried to get into a hotel or motel room or
vacation home where you were staying?
Ask only if necessary

534

Did any incidents of this type happen to you?

37b. SQBREAKINTIMES (Asked of Household Respondent Only)
How many times?

37c. SQBREAKINSPEC (Asked of Household Respondent Only)

1

Yes - ASK 37b

2

No - SKIP to 38

535
Number of times (37b)

Briefly describe incident(s)

What happened?

Notes

Page 3

RESPONDENT'S SCREEN QUESTIONS
38.

SQTOTALVEHICLES (Asked of Household Respondent Only)

536

4

None - SKIP to 40a
1
2
3
4 or more

1

Yes - ASK 39b

2

No - SKIP to 40a

0
1

What was the TOTAL number of cars, vans, trucks, motorcycles, or
other motor vehicles owned by you or any other member of this
household during the last 6 months? Include those you no longer
own.

2
3

39a. SQMVTHEFT (Asked of Household Respondent Only)
During the last 6 months, (other than any incidents already
mentioned,) (was the vehicle/were any of the vehicles) Read each category.
(a) Stolen or used without permission?
(b) Did anyone steal any parts such as a tire, car stereo, hubcap, or
battery?
(c) Did anyone steal any gas from (it/them)?
OR
(d) Did anyone ATTEMPT to steal any vehicle or parts attached to
(it/them)?
Ask only if necessary

537

Did any incidents of this type happen to you?

39b. SQMVTHEFTTIMES (Asked of Household Respondent Only)

538

How many times?

39c.

Number of times (39b)
Briefly describe incident(s)

SQMVTHEFTSPEC (Asked of Household Respondent Only)

What happened?

40a. SQATTACKWHERE
(Other than any incidents already mentioned,) since __________
______, 20 ____, were you attacked or threatened OR did you have
something stolen from you Read each category.
(a) At home including the porch or yard (b) At or near a friend's, relative's, or neighbor's home (c) At work or school d) In places such as a storage shed or laundry room, a shopping
mall, restaurant, bank, or airport (e) While riding in any vehicle (f) On the street or in a parking lot (g) At such places as a party, theater, gym, picnic area, bowling
lanes, or while fishing or hunting OR
(h) Did anyone ATTEMPT to attack or ATTEMPT to steal
anything belonging to you from any of these places?
Ask only if necessary

539

Did any incidents of this type happen to you?

40b.

SQATTACKWHERETIMES

How many times?

40c.

SQATTACKWHERESPEC

What happened?

Page 4

1

Yes - ASK 40b

2

No - SKIP to 41a

540
Number of times (40b)
Briefly describe incident(s)

RESPONDENT'S SCREEN QUESTIONS
41a.

SQATTACKHOW

(Other than any incidents already mentioned,) has anyone attacked
or threatened you in any of these ways (Exclude telephone threats) Read each category.
(a) With any weapon, for instance, a gun or knife (b) With anything like a baseball bat, frying pan, scissors, or stick (c) By something thrown, such as a rock or bottle (d) Include any grabbing, punching, or choking,
(e) Any rape, attempted rape or other type of sexual attack (f) Any face to face threats OR
(g) Any attack or threat or use of force by anyone at all? Please
mention it even if you are not certain it was a crime.
Ask only if necessary

541

Did any incidents of this type happen to you?

41b.

SQATTACKHOWTIMES

1

Yes - ASK 41b

2

No - SKIP to 42a

542

How many times?

41c.

Number of times (41b)

Briefly describe incident(s)

SQATTACKHOWSPEC

What happened?

42a.

SQTHEFTATTACKKNOWNOFF

People often don't think of incidents committed by someone they
know. (Other than any incidents already mentioned,) did you have
something stolen from you OR were you attacked or threatened by (Exclude telephone threats)
Read each category.
(a) Someone at work or school (b) A neighbor or friend (c) A relative or family member (d) Any other person you've met or known?
Ask only if necessary

543

Did any incidents of this type happen to you?

42b.

SQTHEFTATTACKKNOWNOFFTIMES

How many times?

42c.

SQTHEFTATTACKKNOWNOFFFSPEC

1

Yes - ASK 42b

2

No - SKIP to 43a

544
Number of times (42b)
Briefly describe incident(s)

What happened?

Notes

Page 5

RESPONDENT'S SCREEN QUESTIONS
43a.

SQSEXUAL

Incidents involving forced or unwanted sexual acts are often
difficult to talk about. (Other than any incidents already
mentioned,) have you been forced or coerced to engage in
unwanted sexual activity by Read each category.
(a) Someone you didn't know (b) A casual acquaintance OR
(c) Someone you know well?
Ask only if necessary

545

Did any incidents of this type happen to you?

43a.

1

Yes - ASK 43b

2

No - SKIP to 44a

546

SQSEXUALTIMES

How many times?

43c.

Number of times (43b)
Briefly describe incident(s)

SQSEXUALSPEC

What happened?

44a.

SQCALLPOLICECRIME

547

1

Yes - ASK 44b

2

No - SKIP to 45a

During the last 6 months, (other than any incidents already
mentioned,) did you call the police to report something that
happened to YOU which you thought was a crime?

44b.

SQCALLPOLICESPEC

Briefly describe incident(s)

What happened?

CHECK

44c.

ITEM B

SQCALLPOLICEATTACKTHREAT

549

1

Yes - ASK 44d

2

No - SKIP to 45a

If not sure ask:
Were you attacked or threatened, or was something stolen or an
attempt made to steal something that belonged to you or another
household member?

44d.

SQCALLPOLICEATTACKTHREATTIMES

How many times?

Notes

Page 6

550
Number of times (44d)

RESPONDENT'S SCREEN QUESTIONS
45a.

551

SQNOCALLPOLICECRIME

1

Yes - ASK 45b

2

No - If HHLD Respondent ASK 46, Else SKIP to 71

During the last 6 months, (other than any incidents already
mentioned,) did anything which you thought was a crime happen to
YOU, but you did NOT report to the police?

45b.

Briefly describe incident(s)

SQNOCALLPOLICESPEC

What happened?

45c.

CHECK

ITEM C

553
SQNOCALLPOLICEATTACKTHREAT

1

Yes - ASK 45d

2

No - If HHLD Respondent ASK 46, Else SKIP to 71

If not sure ask:
Were you attacked or threatened, or was something stolen or an
attempt made to steal something that belonged to you or another
household member?

45d.

554

SQNOCALLPOLICEATTACKTHREATTIMES

How many times?

Number of times (45d)

- If HHLD Respondent ASK 46, Else SKIP to 71

RESPONDENT'S CHECK ITEMS D, E, AND G
71.

CHECK
ITEM D

PRESENTFORSQS

555

1

Personal interview - Mark all that apply.

*
2

Who besides the respondent was present when the screen questions
were asked? (If telephone interview, mark box 1 only.)

3
4

CHECK
ITEM E

PROXYHELP

556

No one besides respondent present
Respondent's spouse

5

HHLD member(s) 12+, not spouse
HHLD member(s) under 12

6

Nonhousehold member(s)

7

Someone was present - Can't say who
Don't know if someone else present

8

72.

Telephone interview - SKIP to 73.

1

Yes

2

No

3

Person for whom interview taken not present

If a Proxy interview,
ASK 72,
else SKIP to 73.

Did the person for whom this interview was taken help the proxy
respondent answer any screen questions?

73.

CHECK
ITEM G

Is one or more crimes reported in
36b, 37b, 39b, 40b, 41b, 42b, 43b, 44d, or 45d?

Yes - SKIP to Crime Incident Report (Item 1a on the NCVS-2)
No - SKIP to 74 (on the NCVS-1)

Notes

Page 7

RESPONDENT'S EMPLOYMENT QUESTIONS
All incident reports must be completed before asking this series of questions.

CHECK

74.

75a.

ITEM H1

Is the respondent 16 years or older?

JOBLASTWEEK

576

1

Yes - ASK 75a

2

No - SKIP to 80

1

Yes - SKIP to 76a

2

No - ASK 75b

1

Yes - ASK 75c

2

No - SKIP to 80

1

Yes - ASK 76a

2

No - SKIP to 80

Did you have a job or work at a business LAST WEEK? (Do not include
volunteer work or work around the house.)
(If farm or business operator in household, ask about unpaid work.)

75b. JOBDURINGREFPERIOD

577

Ask or verify Did you have a job or work at a business DURING THE LAST 6
MONTHS?

75c.

JOBLAST2WEEKS

578

Did that (job/work) last 2 consecutive weeks or more?

76a.

JOBDESCRIPTION

1

Medical Profession? - SKIP 76c

2

Ask or verify -

Mental Health Services Field? - SKIP to 76e

3

Teaching Profession? - SKIPto 76g

Which of the following best describes your job?

4

Law Enforcement or Security Field? - SKIP to 76i

5

Retail Sales? - SKIPto 76k

Were you employed in the ...
Read each category until respondent says "yes", then enter appropriate
precode.

76b.

JOBDESCRIPTIONSPEC

6

Transportation Field? - SKIP to 76m

7

Something else? - Specify - ASK 76b

Specify - SKIP to 76o

Please specify the job not covered in answer categories 1-6 in 76a.

76c.

MEDICALJOB

Medical Profession

Employed in the Medical Profession:

1

Physician?

As a -

2

Nurse?

3

Technician?

4

Other medical profession? - Specify - ASK 76d

Read each category.

76d.

MEDICALJOBSPEC

SKIP to 76o

Specify - SKIP to 76o

Please specify employed in the medical profession as a -

76e. MENTALHEALTHJOB
Employed in the Mental Health Services Field:
Are YOUR duties Read each category.

76f.

MENTALHEALTHJOBSPEC

Please specify duties in the mental health services field.

Notes

Page 8

Mental Health Services Field
5
6
7

Professional (Social worker/psychiatrist)?
Custodial care?

SKIP to 76o

Some other mental health services profession? - Specify ASK
76f

Specify - SKIP to 76o

RESPONDENT'S EMPLOYMENT QUESTIONS
76g.

Teaching Profession

TEACHINGJOB

Employed in the Teaching Profession:

8

Preschool?

9

Elementary school?
Junior high or middle school?
High school?
College or university?

10

Were you employed in a -

11

Read each category.

12
14

Technical or industrial school?
Special education facility?

15

Other teaching profession? - Specify - ASK 76h

13

76h.

- SKIP to 76o

Specify - SKIP to 76o

TEACHINGJOBSPEC

Please specify employed in the teaching profession as a -

76i.

Law Enforcement or Security Field

LAWENFORCEJOB

Employed in the Law Enforcement or Security Field:
Were you employed as a -

Law enforcement officer?

17

- SKIP to 76o
Prison or jail guard?
Security guard?
Law enforcement profession? - Specify - ASK 76j

18
19

Read each category.

76j.

16

Specify - SKIP to 76o

LAWENFORCEJOBSPEC

Please specify employed in the law enforcement or security field as a -

76k.

RETAILSALESJOB

Retail Sales -

Employed in Retail Sales:
Were you employed as a-

20
21

Convenience or liquor store clerk?
Gas station attendant?

22

Bartender?
Other retail sales profession? - Specify - ASK 76l

23

- SKIP to 76o

Read each category.

76l.

Specify - SKIP to 76o

RETAILSALESJOBSPEC

Please specify employed in retail sales as a -

76m.

Transportation Field -

TRANSPORTJOB

Bus driver?

24

Employed in the Transportation Field:

- SKIP to 76o
Taxi cab driver?
Other transportation FIeld profession? - Specify - ASK 76n

25
26

Were you employed as aRead each category.

76n.

Specify

TRANSPORTJOBSPEC

Please specify employed in the transportation field as a -

76o.

CHECK
ITEM H2

579

If 76a equals 7, enter 27 here., otherwise enter the number of the
employment code entered in item 76c, 76e, 76g, 76i 76k, or 76m.

77.

EMPLOYERTYPECURRENT

580

Ask or verify -

1
2
3

Is your job with -

4

Read each category.

78.

COLLEGEEMPLOYER

581

2

Are you employed by a college or university?

79.

CURRENTJOBMSATYPE

While working at your job, do you work mostly in Read each category.

1

582

A private company, business, or
individual for wages?
The Federal government?
A State, county, or local government?
Yourself (Self-employed) in your own
business, professional practice, or farm?

If 76o = 22
SKIP to 79,
Else ASK
78.

Yes
No

1

A city?

2

Suburban area?

3

Rural area?

4

Combination of any of these?

Page 9

RESPONDENT'S CHECK ITEM I
80.

CHECK

ITEM I

Is this the last household member to be
interviewed?

Yes - If Household Respondent finish collecting income
and telephone information, then END interview.
Otherwise END interview.
No - GO TO question 33a for the next respondent. See
note below before interviewing next household member.

FIELD REPRESENTATIVE --

Notes

Page 10

(Read to the Household Respondent Only.) If there are any household members under 18, tell the Household Respondent
that you will be asking the same questions you just asked him/her.