NCVS-2 Crime Incident Report

National Crime Victimization Survey

NCVS-2_Items_Booklet_2015_with_screen_names

National Crime Victimization Survey 2015-2018

OMB: 1121-0111

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1121-0111 can be found here:

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OMB No. 1121-0111: Approval Expires 8/31/2015

NOTICE - We are conducting this survey under the authority of Title 13, United States Code, Section 8. 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, United
States Code, authorizes the Bureau of Justice Statistics, Department of Justice, to collect 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.
FORM

NCVS-2

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

IImplementation Date: (07-01-2008)

Control number
Segment/Suffix

PSU

Sample
designation/Suffix

Serial/
Suffix

HH No.

ACTING AS COLLECTING AGENT FOR THE
BUREAU OF JUSTICE STATISTICS

U.S. DEPARTMENT OF JUSTICE

NATIONAL CRIME VICTIMIZATION SURVEY
LINE NUMBER OF RESPONDENT

1b.

SCREEN QUESTION NUMBER

1c.

INCIDENT NUMBER

2a.

CHECK

ITEM A

601

Line number (ex., 01)

602

Screen question number (ex., 39)

603

Incident number (ex., 01)

Has the respondent lived at this address
for more than 6 months? (If not sure,
refer to 33a on the NCVS-1 or ASK.)

2b. INCIDNETADDRESS
You said that during the last 6 months -

Yes (more than 6 months) - SKIP to 3
No (6 months or less) - ASK 2

605

(description of the crime reported in the screen question.)

1
2

While living at this address
Before moving to this address

Did (this/the first) incident happen while you
were living here or before you moved to this
address?

3. INCIDENTDATE

606

In what month did (this/the first) incident
happen?

Month

Year

Encourage respondent to give exact month.

4. INCIDENTNUMBEROFTIMES

607

____________ Number of incidents

If unsure, ask -

Altogether, how many times did this type of
incident happen during the last 6 months?
5a.

CHECK

5b.

CHECK

ITEM B

ITEM C

How many incidents?
(Refer to 4.)

INCIDENTSSIMILAR

608

1
2

1-5 incidents (not a "series") - SKIP to 6
6 or more incidents - ASK 5b

609

1
2

Similar - ASK 5c
Different (not a "series") - SKIP to 6

610

1
2

Yes (not a "series")
No (is a "series")

If unsure, ask:

Are these incidents similar to each other in
detail or are they for different types of crimes?
5c.

CHECK

ITEM D

RECALLEDTAILS

If unsure, ask:

Can you recall enough details of each incident to
distinguish them from each other?
6. INCIDENTTIME
(If box 2 is marked in 5c, read: The following questions

refer only to the most recent incident.)

About what time did (this/the most recent)
incident happen?

612
1
2
3
4
5
6
7
8
9

USCENSUSBUREAU

C
V
S

Notes

CRIME INCIDENT REPORT

1a.

Spinoff
Indicator

During day
After 6 a.m. - 12 noon
After 12 noon - 3 p.m.
After 3 p.m. - 6 p.m.
Don't know what time of day
At night
After 6 p.m. - 9 p.m.
After 9 p.m. - 12 midnight
After 12 midnight - 6 a.m.
Don't know what time of night
OR
Don't know whether day or night

2
I
N
C
I
D
E
N
T
R
E
P
O
R
T

7a. INCIDENT PLACE

613

In what city, town, or village did this
incident occur?

1
2
3

Outside U.S. - SKIP to 10a
Not inside a city/town/village - ASK 8a
SAME city/town/village as present residence - SKIP to 9

DIFFERENT city/town/village from
present residence
Don't know - ASK 8a

7b. INCIDENTPLACESPEC

ASK 7b

Specify

Please specify the city, town, or village, in which the
incident occurred.
8a. INCIDENTSTATE

614

In what state did it occur?

State ________________

8b. INCIDENTCOUNTY
In what county did it occur?
8c. COUNTYSTATE

County ________________
615

1
2

Yes
No

633

Yes

In your home or lodging? - SKIP to 10b
Near your home? - SKIP to 10c
At, in or near a friend's/relative's/neighbor's
home? - SKIP to 10d

Ask or verify:
Is this the same county and state as your
present residence?
9. INCIDENTAIR
Did this incident occur on an American Indian
Reservation or on American Indian Lands?
10a. LOCATION_GENERAL
Did this incident happen ...
Read each category until respondent says "yes", then
enter appropriate precode.

2
3
4
5

At school? - SKIP to 10g
In open areas, on the street, or
on public transportation? - SKIP to - 10h

Some where else? - SKIP to 10i

Notes

Page 2

At a commercial place? - SKIP to 10e
In a parking lot or garage? - SKIP to 10f

10b. LOCATION_IN_HOME

616

In own dwelling, own attached garage,
or enclosed porch (Include illegal entry
or attempted illegal entry of same)

In detached building on own property,
such as detached garage, storage shed,
etc. (Include illegal entry of same)

Ask if necessary:
Where in your home or lodging did this
incident happen?

10c. LOCATION_NEAR_HOME

In vacation home/second home
(Include illegal entry or attempted
illegal entry of same)

In hotel or motel room respondent
was staying in (Include illegal entry or
attempted illegal entry of same)

Ask if necessary:
6

Where near your home or lodging did this
incident happen?
7

10d. LOCATION_OTHER_HOME
Ask if necessary:
Where at, in, or near a friend's/relative's/
neighbor's home did this incident happen?

At or in home or other building on their
property

Yard, sidewalk, driveway, carport (does
not include apartment yards)
Apartment hall, storage area, laundry
room (does not include apartment
parking lot/garage)
On street immediately adjacent to their
home

10e. LOCATION_COMMERCE

12
24

Ask if necessary:

At what type of a commercial place did this
incident happen?

10f. LOCATION_PARKING
Ask if necessary:

Inside restaurant, bar, nightclub
Inside bank
Inside gas station

Inside other commercial building, such
as a store
Inside office

Inside factory or warehouse

Commercial parking lot/garage

Noncommercial parking lot/garage

Apartment/townhouse parking lot/
garage

Inside school building
On school property (school parking
area, play area, school bus, etc.)

In what type of a parking lot or garage did this
incident happen?
10g. LOCATION_SCHOOL

Own yard, sidewalk, driveway, carport,
unenclosed porch (does not include
apartment yards)
Apartment hall, storage area, laundry
room (does not include apartment
parking lot/garage)
On street immediately adjacent to own
home or lodging

Ask if necessary:

SKIP
to 11

SKIP
to 18

SKIP
to 17c

SKIP to 17a
SKIP to 17c

Where at school did this incident happen?
10h. LOCATION_OPEN_AREA
Ask if necessary:
Where in an open area, on the street, or on
public transportation did this incident
happen?
10i. LOCATION_SPEC

20
21

In apartment yard, park, field,
playground (other than school)
On the street (other than immediately
adjacent to own/friend's/relative's/
neighbor's home)
On public transportation or in station
(bus, train, plane, airport, depot, etc.)
Other - Specify

SKIP
to 18

SKIP to 17c

Please specify the other location where this
incident occurred.

Page 3

11. OFFENDERLIVE

617

Did the offender live (here/there) or have a
right to be (here/there), for instance, as a guest
or a repairperson?
12. OFFENDERINSIDE

2
3

618

Did the offender actually get INSIDE your
(house/apartment/room/garage/ shed/
enclosed porch)?
13. OFFENERTRY

619

Did the offender TRY to get in your (house/
apartment/room/garage/shed/porch)?
14. FORCEDENTRY

620

Yes - SKIP to 14
No

Don't know

Yes - ASK 14
No - SKIP to 19

Don't know - ASK 14

Yes - ASK 15a
No - SKIP to 16a

Window

15a. EVIDENCE
625

What was the evidence?

ASK 13

Was there any evidence, such as a broken lock
or broken window, that the offender(s) (got in
by force/TRIED to get in by force)?

Yes - SKIP to 19
No
ASK 12
Don't know

Damage to window (include frame,
glass broken/removed/cracked)

Screen damaged/removed

Lock on window damaged/tampered
with in some way

Other - Specify

Probe: Anything else?
Enter all that apply.

SKIP
to 19
SKIP to 15b

Door

626

Damage to door (include frame, glass
panes or door removed)

Screen damaged/removed

Lock or door handle damaged/tampered
with in some way

Other - Specify

SKIP
to 19

SKIP to 15c

Other
9

15b. EVIDENCE_SPEC14

Other than window or door - Specify

Specify

- SKIP to 19

Specify

- SKIP to 19

Specify

- SKIP to 19

Please specify what was the other evidence related
to a window.
15c. EVIDENCE_SPEC18
Please specify what was the other evidence related
to a door.
15d. EVIDENCE_SPEC19
Please specify what was the evidence other than to a
window or door.
Notes

Page 4

SKIP to 15d

16a. OFFENDERGETIN

627

How did the offender (get in/TRY to get in)?

Let in

Offender pushed his/her way in after
door opened

Through OPEN DOOR or other opening

Through UNLOCKED door or window
Through LOCKED door or window - Had
key
Through LOCKED door or window Picked lock, used credit card, etc., other
than key
Through LOCKED door or window Don't know how

5
6

Don't know

Other - Specify

Specify

16b. OFFENDERGETIN_SPEC

SKIP
to 19

SKIP to 16b

- SKIP to 19

Please specify - how the offender got in/TRIED to get
in.
17a. RESPONDENTSSCHOOL

628

Was it your school?
17b. PARTSCHOOLBLDG

629

In what part of the school building did it
happen?

Yes

No - SKIP to 17c

1
2
3
4

17c. RESTRICTEDAREA

630

Ask or verify -

1
2

Did the incident happen in an area restricted to
certain people or was it open to the public at
the time?

3
4

17d. RESTRICTEDAREA_SPEC

Classroom
Hallway/Stairwell
Bathroom/Locker room
Other (library, gym, auditorium, cafeteria)
Open to the public
Restricted to certain people (or nobody
had a right to be there)
Don't know
Other - Specify - ASK 17d

SKIP
to 18

Specify

Please specify.
18. INSIDEOROUT

631

Ask or verify -

Indoors (inside a building or enclosed space)

Outdoors
Both

Did it happen outdoors, indoors, or both?
19. FARFROMHOME

At, in, or near the building containing
the respondent's home/next door
A mile or less
Five miles or less
Fifty miles or less
More than 50 miles
Don't know how far

634

1
2

Yes - ASK 20b
No - SKIP to 56

635

632

Ask or verify-

1
2

How far away from home did this happen?

3
4

PROBE: Was it within a mile, 5 miles, 50 miles or
more?

Enter the code for the first answer category that the
respondent is sure of.
20a. HHMEMBERPRESENT
Ask or verify Were you or any other member of this
household present when this incident
occurred?
You may need to probe to obtain more details to
determine if respondent was present.
20b. WHICHMEMBER
Ask or verify -

Which household members were present?

Respondent only
Respondent and other household
member(s)

Ask 21

Only other household member(s), not
respondent - SKIP to 59a
Page 5

21. SEEOFFENDER

636

1
2

Yes
No

637

1
2
3

Yes - ASK 23a
No
Don't know

Ask or verify Did you personally see an offender?
22. WEAPONPRESENT
Did the offender have a weapon such as a gun
or knife, or something to use as a weapon, such
as a bottle or wrench?
23a. WEAPON
What was the weapon?

638

Probe: Anything else?

1
2
3
4
5
6

Enter all that apply.
23b. WEAPON_SPEC

SKIP to 24

Hand gun (pistol, revolver, etc.)
Other gun (rifle, shotgun, etc.)
Knife
Other sharp object (scissors, ice pick, axe,
etc.)
Blunt object (rock, club, blackjack, etc.)
Other - Specify - ASK 23b

SKIP
to 24

Specify

Please specify the other weapon.
24. ATTACK

639

1
2

Yes - SKIP to 29a
No - ASK 25

640

1
2

Yes - SKIP to 28a
No - ASK 26

641

1
2

Yes - SKIP to 28c
No - ASK 27a

642

1
2

Did the offender hit you, knock you down or
actually attack you in any way?
25. TRYATTACK
Did the offender TRY to attack you?
26. THREATEN
Did the offender THREATEN you with harm in
any way?
27a. WHATHAPPEN
What actually happened?
Probe: Anything else?
Enter all that apply.

3
4
5
6
7
8
9
10

27b. WHATHAPPEN_SPEC

Something taken without permission
SKIP
Attempted or threatened to take
to 35c
something
Harassed, argument, abusive language
Unwanted sexual contact with force
SKIP to 27c
(grabbing, fondling, etc.)
Unwanted sexual contact without force
(grabbing, fondling, etc.)
Forcible entry or attempted forcible
entry of house/apartment
SKIP
Forcible entry or attempted forcible entry
to 35c
of car
Damaged or destroyed property
Attempted or threatened to damage or
destroy property
Other - Specify - ASK 27b

Specify - SKIP to 35c

Please specify what actually happened.
27c. SEXCONFORCEPROBE_1
You mentioned some type of unwanted sexual
contact with force. Do you mean forced or
coerced sexual intercourse including attempts?
Notes

Page 6

1
2

Yes - SKIP to 29a
No - SKIP to 35c

28a. HOWTRYATTACK
How did the offender TRY to attack you?

643

Probe: Any other way?

1
2
3
4
5

Enter all that apply.

6
644

7
8
9
10

645

11
12
13
14

Verbal threat of rape
Verbal threat to kill
SKIP
Verbal threat of attack other than to kill or rape
to 35c
Verbal threat of sexual assault other than rape
Unwanted sexual contact with force
SKIP to 28e
(grabbing, fondling, etc.)
Unwanted sexual contact without force
(grabbing, fondling, etc.)
Weapon present or threatened with weapon
Shot at (but missed)
Attempted attack with knife/sharp weapon
Attempted attack with weapon other
SKIP
than gun/knife/sharp weapon
to 35c
Object thrown at person
Followed or surrounded
Tried to hit, slap, knock down, grab, hold,
trip, jump, push, etc.
Other - Specify - ASK 28b

Specify - SKIP to 35c

28b. HOWTRYATTACK_SPEC
Please specify how the offender TRIED to attack you.

28c. HOWTHREATEN
How were you threatened?

643

Probe: Any other way?

1
2
3
4
5

Enter all that apply.

6
644

7
8
9
10

645

11
12
13
14

Specify - SKIP to 35c

28d. HOWTHREATEN_SPEC
Please specify how you were threatened.
28e. SEXCONFORCEPROBE_2

1
2

You mentioned some type of unwanted sexual
contact with force. Do you mean forced or
coerced sexual intercourse including
attempts?
29a. HOWATTACK
How were you attacked?

646

1
2
3

Probe: Any other way?
4

Enter all that apply.
647

*
648

29b. HOWATTACK_SPEC

5
6
7
8
9
10
11
12
13
14

Yes - ASK 29a
No - SKIP to 35c

- ASK 29c
Raped
- ASK 29d
Tried to rape
Sexual assault other than rape or
attempted rape
Shot
Shot at (but missed)
Hit with gun held in hand
Stabbed/cut with knife/sharp weapon
Attempted attack with knife/sharp weapon
SKIP
Hit by object (other than gun) held in hand
to 30a
Hit by thrown object
Attempted attack with weapon other
than gun/knife/sharp weapon
Hit, slapped, knocked down
Grabbed, held, tripped, jumped, pushed, etc.
Other - Specify - ASK 29b

Specify - SKIP to 30a

Please specify how you were attacked.

Page 7

29c. RAPE_CK1

Yes - SKIP to 30a
No - go back to 29a

You mentioned rape. Do you mean forced or
coerced sexual intercourse?
If "no", then ask: What do you mean?
29d. ATTRAPE_CK1

Yes - SKIP to 30a
No - go back to 29a

You mentioned attempted rape. Do you mean
attempted forced or coerced sexual
intercourse?
If "no", then ask: What do you mean?
30a. PRETHREATEN

649

Did the offender THREATEN to hurt you before
you were actually attacked?
30b. PRETHREATEN_SPEC

1
2
3

Yes
SKIP to 31a
No
Other - Specify - ASK 30b

Specify

Please specify.
31a. iNJURY
What were the injuries you suffered, if any?

655

Probe: Anything else?
Enter all that apply.
656

1
2
3
4
5
6
7
8
9
10
11

None
Raped
Attempted rape
Sexual assault other than rape or
attempted rape
Knife or stab wounds
Gun shot, bullet wounds
Broken bones or teeth knocked out
Internal injuries
Knocked unconscious
Bruises, black eye, cuts, scratches,
swelling, chipped teeth

SKIP to 35c
SKIP to 31c
SKIP to 31d

Other - Specify - ASK 31b
Specify - SKIP to 32

31b. INJURY_SPEC
Please specify the injuries you suffered.
31c. RAPE_CK2

Yes - SKIP to 32
No - go back to 31a

You mentioned rape. Do you mean forced or
coerced sexual intercourse?
If "no", then ask: What do you mean?
31d. ATTRAPE_CK2

Yes - SKIP to 32a
No - go back to 31a

You mentioned attempted rape. Do you mean
attempted forced or coerced sexual
intercourse?
If "no", then ask: What do you mean?
32a. INJURYNOTGUN

657

1
2

Yes - ASK 32b
No - SKIP to 33a

658

2
3
4

Raped
Attempted rape
Sexual assault other than rape or attempted rape

Ask or verifyWere any of the injuries caused by a weapon
other than a gun or knife?
32b. FIRSTINJURY
Which injuries were caused by a weapon
OTHER than a gun or knife?

Broken bones or teeth knocked out
Internal injuries
Knocked unconscious
Bruises, black eye, cuts, scratches,
swelling, chipped teeth
Other - Specify

1
2

Yes - ASK 33b
No - SKIP to 35c

7
8
9

Enter all that apply.

33a. MEDICALCARE
Were you injured to the extent that you
received any medical care, including self
treatment?
Page 8

659

SKIP
to
32

33b. RECEIVECAREWHERE
Where did you receive this care?

660

Probe: Anywhere else?

1
2
3
4
5
6
7

Enter all that apply.

At the scene
At home/neighbor's/friend's
Health unit at work/school, first aid
station at a stadium/park, etc.
Doctor's office/health clinic
Emergency room at hospital/emergency clinic
Hospital (other than emergency room)
Other - Specify - ASK 33c

SKIP
to
33d

Specify

33c. RECEIVECAREWHERE_SPEC
Please specify where you received this care.
33d.

CHECK

ITEM E1

1
2

Yes - ASK 34a
No - SKIP to 35a

662

1
2

Yes - ASK 34b
No - SKIP to 35a

663

____________ Number of days

664

Is (box 6) "Hospital" marked in
35a?

34a. CAREOVERNIGHT
Did you stay overnight in the hospital?
34b. CAREDAYHOSPIT
How many days did you stay in the hospital?
35a. MEDICALINSURANCE
At the time of the incident, were you covered
by any medical insurance, or were you eligible
for benefits from any other type of health
benefits program, such as medicaid, Veterans
Administration, or Public Welfare?
35b. MEDICALEXPENSES
What was the total amount of your medical
expenses resulting from this incident
(INCLUDING anything paid by insurance)?
Include hospital and doctor bills, medicine,
therapy, braces, and any other injury related
expenses.

2
3

665

Yes
No
Don't know

$ ____________ .
0

No cost

1
2

Yes - ASK 36a
No - SKIP to 39

1
2

Yes
No

1
2

Yes
No

Total amount

Obtain an estimate, if necessary.
35c.

CHECK

ITEM E2

Is (box 1) "Yes" marked in 24, 25 or
26 or are (box 4 or 5) "Unwanted
sexual contact with or without
force" marked in 27?

36a. IMPACT_JOB

969

Being a victim of crime affects people in
different ways. Next I would like to ask you
some questions about how being a crime
victim may have affected you.
Did being a victim of this crime lead you to
have significant problems with your job or
schoolwork, or trouble with your boss,
coworkers, or peers?
36b. IMPACT_FAMILY

970

Did being a victim of this crime lead you to
have significant problems with family
members or friends, including getting into
more arguments or fights than you did before,
not feeling you could trust them as much, or
not feeling as close to them as you did before?
36c. HOW_DISTRESSING
How distressing was being a victim of this
crime to you? Was it not at all distressing,
mildly distressing, moderately distressing, or
severely distressing?

971
1
2
3
4

Not at all distressing
Mildly distressing
Moderately distressing
Severely distressing

Page 9

36d.

37.

CHECK

ITEM E3

Is (box 1) "Yes" marked in 36a or
36b or are (box 3 or 4)
"Moderately or severely
distressing" marked in 36c?

1
2

Yes - ASK 37
No - SKIP to 39

Still thinking about your distress
associated with being a victim of this crime
did you feel any of the following ways for A
MONTH OR MORE? Did you feel ...

(a) FEEL_WORRIED

972

Worried or anxious?
(b) FEEL_ANGRY

Yes

973

Angry?
(c) FEEL_SAD

974

Sad or depressed?
(d) FEEL_VULNERABLE

975

Vulernable?
(e) FEEL_VIOLATED

976

Violated?
(f) FELL_MISTRUST

977

Like you couldn't trust people?
(g) FEEL_UNSAFE

978

Unsafe?
(h) FEE_OTHER_WAY

979

Some other way?
Specify

37i. FEEL_OTH_WAY_SP
What other way did being a victim of this
crime make you feel?
37j.

CHECK

ITEM E4

Is (box 1) "Yes" marked in any of
37a through 37h?

37k. SEEK_PRO_HELP

Did you seek any kind of professional help for
the feelings you experienced as a result of
being a victim of this crime?
Enter all that apply.
37m. HELP_SOUGHT_SP
What other kind of professional help did you seek?
Notes

Page 10

Yes - ASK 37k
No - SKIP to 38

1
2

Yes - ASK 37l
No - SKIP to 38

980

Did you seek any kind of professional help for
the feelings you experienced as a result of
being a victim of this crime?
37l. PRO_HELP_SOUGHT

1
2

981
1
2
3
4
5

Counseling/therapy
Medication
Visited a doctor or nurse
Visted ER/hospital/clinic
Other - Specify - ASK 37m

Specify

SKIP
to 38

38.

Did you experience any of the following
physical problems associated with being a
victim of this crime for A MONTH OR MORE?
Did you experience ...

(a) HAVE_HEADACHES

982

Headaches?
(b) TRBL_SLEEPING

Yes

983

Trouble sleeping?
(c) EATING_PROBS

984

Changes in your eating or drinking habits?
(d) UPSET_STOMACH

985

Upset stomach?
(e) FATIGUE

986

Fatigue?
(f) HIGH_BLOOD_PRESS

987

High blood pressure?
(g) MUSCLE_TENSION

988

Muscle tension or back pain?
(h) OTHER_PHYSICAL

989

Some other physical problem?
Specify

38i. OTH_PHY_SP
What other physical problem did you
experience for A MONTH OR MORE?
38j.

CHECK

ITEM E5

Is (box 1) "Yes" marked in any of
38a through 38h?

38k. SEEK_HELP_PHYPROBS

Yes - ASK 38k
No - SKIP to 39

1
2

Yes - ASK 38l
No - SKIP to 39

990

Other than any medical care you received for
the injury(ies) you suffered) did you seek any
professional or medical help for the physical
problems you experienced as a result of being
a victim of this crime?
38l. KIND_HELP_PHYPROBS

1
2

991

What type of professional or medical help did
you seek?

1
2

Enter all that apply.

3
4
5

Counseling/therapy
Medication
Visited a doctor or nurse
Visted ER/hospital/clinic
Other - Specify - ASK 38m

SKIP
to 39

Specify

38m. KIND_HELP_PHYOTH_SP
What other kind of professional help did you seek?
39.

CHECK

ITEM F1

Is respondent female and
between the ages of 18-49?

40. PREGATTIMEOFINC
Research shows that pregnant women may be
at a higher risk of being the victim of a violent
crime.

960

1
2

Yes - ASK 40
No - SKIP to 41a

Yes

Were you pregnant at the time of this incident?
Notes

Page 11

41a. PROTECTSELF

666

Did you do anything with the idea of
protecting YOURSELF or your PROPERTY while
the incident was going on?
41b. DURINGINCIDENT
Was there anything you did or tried to do about the
incident while it was going on?

667

1
2

42a. ACTIONDURINGINC
What did you do?

668

Probe: Anything else?

Enter all that apply.

669

670

1
2
3
4
5
6

7
8

Yes - SKIP to 42a
No/took no action/kept still - ASK 41b

Yes - SKIP to 42a
No/took no action/kept still - ASK 47

USED PHYSICAL FORCE TOWARD OFFENDER
Attacked offender with gun; fired gun
Attacked with other weapon
Attacked without weapon (hit, kicked, etc.)
Threatened offender with gun
Threatened offender with other weapon
Threatened to injure, no weapon
RESISTED OR CAPTURED OFFENDER
Defended self or property (struggled,
ducked, blocked blows, held onto property)
Chased, tried to catch or hold offender

SCARED OR WARNED OFF OFFENDER
Yelled at offender, turned on lights,
threatened to call police, etc.

10
11

PERSUADED OR APPEASED OFFENDER
Cooperated, or pretended to (stalled, did
what they asked)
Argued, reasoned, pleaded, bargained, etc.

ESCAPED OR GOT AWAY
Ran or drove away, or tried; hid, locked door

GOT HELP OR GAVE ALARM
671

13
14

*
15

Called police or guard
Tried to attract attention or help, warn others
(cried out for help, called children inside)
REACTED TO PAIN OR EMOTION
Screamed from pain or fear
OTHER

Other - Specify - ASK 42b

Specify

42b. ACTIONDURINGINC_SPEC
Please specify what you did.
42c.

CHECK

ITEM F2

Was the respondent injured in
this incident? (Are any of the
boxes 2-11 marked in 31a?)

43a. INJACITON
Did you take these actions before, after, or at
the same time that you were injured?

1
2

672

1
2
3

Yes - ASK 43a
No - SKIP to 43b

Actions taken before injury
Actions taken after injury
Actions taken at same time as injury

Enter all that apply.
43b. INACTIONHELP
Did (any of) your action(s) help the situation in
any way?
Probe: Did your action(s) help you avoid injury,
protect your property, escape from the
offender - or were they helpful in some other
way?
Notes

Page 12

673

1
2
3

Yes - ASK 44a
No
Don't know SKIP to 45

SKIP
to 42c

44a. HELP
How were they helpful?

674

Probe: Any other way?

1
2
3
4
5

Enter all that apply.

44b. HELP_SPEC

Helped avoid injury or greater injury to
respondent
Scared or chased offender off
Helped respondent get away from offender
Protected property
Protected other people
Other - Specify - ASK 44b

SKIP
to 45

Specify

Please specify how were they helpful.
45. ACTIONWORSE

675

1
2

Did (any of) your action(s) make the situation
worse in any way?

Yes - ASK 46a
No
Don't know SKIP to 47

Probe: Did your action(s) lead to injury, greater
injury, loss of property, make the offender
angrier, or make the situation worse in some
other way?
46a. WORSE
How did they make the situation worse?

676

Probe: Any other way?

1
2
3
4

Enter all that apply.

5
6

Led to injury or greater injury to
respondent
Caused greater loss of property or
damage to property
Other people got hurt (worse)
Offender got away
Made offender angrier, more
aggressive, etc.
Other - Specify - ASK 46b

SKIP
to 47

Specify

46b. WORSE_SPEC
Please specify how the respondent's actions made
the situation worse.
47. ANYONEPRESENT

677

Was anyone present during the incident
besides you and the offender? (Other than
children under age 12.)
48. OTHERSACTIONS

678

Did the actions of (this person/any of these
people) help the situation in any way?
49a. HOWOTHERSHELP
How did they help the situation?

1
2
3

679

Probe: Any other way?

1
2
3
4
5

Enter all that apply.

Yes - ASK 48
No
Don't know

SKIP to 54c

Yes - ASK 49a
No
Don't know SKIP to 50
Helped avoid injury or greater injury to
respondent
Scared or chased offender off
Helped respondent get away from offender
Protected property
Protected other people
Other - Specify - ASK 49b

SKIP
to 50

Specify

49b. HOWOTHERSHELP_SPEC
Please specify how they helped the situation.
50. OTHERSACTIONSWORSE
Did the actions of (this person/any of these
people) make the situation worse in any way?

680

1
2
3

Yes - ASK 51a
No
Don't know SKIP to 52

Notes

Page 13

51a. OTHWORSE
How did they make the situation worse?

681

Probe: Any other way?

3
4

Enter all that apply.

5
6

Specify

51b. OTHWORSE_SPEC
Please specify how they made the situation worse.
52. PERSONSHARMED

682

1
2

Not counting yourself, were any of the persons
present during the incident harmed (Pause),
threatened with harm (Pause), or robbed by
force or threat of harm? (Do not include
yourself, the offender, or children under 12
years of age.)

Yes - ASK 53
No
Don't know

SKIP to 54c

53. PERSONSHARMEDNUM
How many? (Do not include yourself, the
offender or children under 12 years of age.)

683

____________ Number of persons

54a. HHMEMHARMED

684

____________ Number of persons

How many of these persons are members of
your household now? (Do not include yourself,
the offender or children under 12 years of age.)

54b. HHMEMHARMED_NAMES

None - SKIP to 54c

Line number(s)

If not sure ask:
Who are these household members? (Do not
include yourself, the offender, or children
under 12 years of age)
Enter the line number(s) of other household
members.
54c.

CHECK

ITEM G

Did the respondent use or
threaten to use physical force
against the offender? (Are any of
the boxes 1-6 marked in 42a?)

55. FIRSTTOUSE FORCE

685

1
2

Yes - ASK 55
No - SKIP to 60

686

1
2
3

Respondent
Offender(s)
Someone else

Who was the first to use or threaten to use
physical force - you, the offender, or someone
else?
56. KNOWLEARNOFFENDERS
Do you know or have you learned anything
about the offender(s) - for instance, whether
there was one or more than one offender
involved, whether it was someone young or
old, or male or female?

687

1
2

Yes - ASK 57
No - SKIP to 88

57. SUREOFINFO
How sure are you of this information? Do you
have a suspicion, are you fairly sure or are you
certain?

688

1
2
3

Suspicion
Fairly sure
Certain

Notes

Page 14

SKIP to 60

SKIP
to 52

58a. LEARNOFFENDERS
How did you learn about the offender(s)?

689

2
3

Probe: Any other way?

Enter all that apply.
690

5
6
7
8
9
10

Respondent saw or heard offender
From other member of household who
was eyewitness
From eyewitness(es) other than
household member(s)
From police
Other person (not eyewitness)
Offender(s) admitted it
Offender(s) had threatened to do it
Stolen property found on offender's
property or in offender's possession
Figured it out by who had motive,
opportunity, or had done it before
Other - Specify - ASK 58b

SKIP
to 88

Specify - SKIP to 88

58b. LEARNOFFENDERS_SPEC
Please specify how you learned about the offender(s).

59a.HAPPEN
What actually happened?

691

Probe: Anything else?

1
2
3
4
5
6

Enter all that apply.

7
8

Something taken without permission
Attempted or threatened to take something
Harassed, argument, abusive language
Forcible entry or attempted forcible entry
of house/apartment
Forcible entry or attempted forcible
entry of car
Damaged or destroyed property
Attempted or threatened to damage or
destroy property
Other - Specify - ASK 59b

SKIP
to 60

Specify

59b. HAPPEN_SPEC
Please specify what actually happened.
692

1
2
3

Only one - SKIP to 62
More than one - SKIP to 74
Don't know - ASK 61

693

1
2

Yes - ASK 62
No - SKIP to 88

62. SINGOFFENDERKNEW
Was the offender someone you knew or a
stranger you had never seen before?

703

1
2
3

Knew or had seen before - SKIP to 64
Stranger
Don't know

63. SINGOFFENDERRECOG
Would you be able to recognize the offender if
you saw him/her?

704

1
2
3

Yes
Not sure (possibly or probably)
No - SKIP to 67

64. SINGOFFENDERHOWWELL

705

1
2
3

Sight only - ASK 65a
Casual acquaintance
Well known

1
2
3

Yes
SKIP to 67
No
Other - Specify - ASK 65b

60. ONEORMOREOFFENDERS
Ask or verify Was the crime committed by only one or by
more than one offender?
61. KNOWOFFENDERS
Do you know anything about one of the
offenders?

How well did you know the offender - by sight
only, casual acquaintance, or well known?
65a. SINGOFFENDERSIGHT
Would you have been able to tell the police
how they might find the offender, for instance,
where he/she lived, worked, went to school, or
spent time?
65b. SINGOFFENERSIGT_SPEC

706

SKIP to 65a

SKIP to 66a

Specify - SKIP to 67

Notes

Page 15

66a. SINGOFFENDERRELATION

707
1
2
3
4

How well did you know the offender? For
example, was the offender a friend, cousin,
etc.?

5
6

7
8
9
10
11
12
14
15
16
17
18
13

RELATIVE
Spouse at time of incident
Ex-spouse at time of incident
Parent or step-parent
Own child or step-child
Brother/sister
Other relative - Specify - ASK 66b

SKIP
to 67

NONRELATIVE
Boyfriend or girlfriend, ex-boyfriend or
ex-girlfriend
Friend or ex-friend
Roommate, boarder
Schoolmate
Neighbor
Customer/client
Patient
Supervisor (current or former)
Employee (current or former)
Co-worker (current or former)
Teacher/school staff
Other nonrelative - Specify - ASK 66c

SKIP
to 67

Specify - SKIP to 67

66b. SINGOFFENDERRELATION_SPEC_16
Please specify the other relative.

Specify

66c. SINGOFFENERRELATION_SPEC_28
Please specify the other nonrelative.

67. SINGOFFENDERGENDER

698

1
2
3

699

1
2
3

Was the offender male or female?
68. SINGOFFENDERAGE

Under 12
12-14
15-17
18-20

992

1
2
3

Yes
No
Don't know

708

1
2
3

How old would you say the offender was?

69. SINGOFFETHNICITY
Was the offender Hispanic or Latino?
70. SINGOFFENDERRACE
What race or races was the offender? You may
select more than one. Was the offender...

700

1
2
3

Yes (a member of a street gang)
No (not a member of a street gang)
Don't know (if a member of a street gang)

701

1
2
3

Yes (drinking or on drugs) - ASK 72b
No (not drinking/not on drugs)
Don't know (if drinking or on drugs)

702

1
2
3
4

Drinking
On drugs
Both (drinking and on drugs)
Drinking or on drugs - could not tell which

709

1
2
3

Yes (only time)
No (there were other times)
Don't know

Was the offender drinking or on drugs, or don't
you know?
72b. SINGOFFENDERDRNKORDRUG
Which was it? (Drinking or on drugs?)

73. SINGOFFENDERONLYTIME
Was this the only time this offender committed
a crime against you or your household or made
threats against you or your household?

74. HOWMANYOFFENDERS
How many offenders?

21-29
30 or older
Don't know

5
6

Was the offender a member of a street gang, or
don't you know?
72a. SINGOFFENDERDRINKDRUG

5
6
7

White?
Black or African American?
American Indian or Alaska Native?
Asian?
Native Hawaiian or Other Pacific Islander?
Don't know

Enter all that apply.
71. SINGOFFENERGANG

Male
Female
Don't know

710

Number of offenders
Don't know (number of offenders)

Page 16

SKIP to 73

SKIP to 88

75. MULTOFFENDERKNEW

3
4

All known
Some known
All strangers
Don't know

719

1
2
3

Yes
Not sure (possibly or probably)
No - SKIP to 80a

720

1
2
3

Sight only
Casual acquaintance
Well known

718

Were any of the offenders known to you, or
were they strangers you had never seen
before?
76. MULTOFFENDERRECOG
Would you be able to recognize any of them if
you saw them?
77a. MULTOFFENDERHOWWELL
How well did you know the offender(s) - by
sight only, casual acquaintance, or well
known?

1
2

SKIP
to 77a
ASK 76

SKIP to 78a

Probe: Anything else?
Enter all that apply.
77b.

CHECK
ITEM H

Yes - SKIP to 79a
No - ASK 78a

Is "casual acquaintance" or "well
known" marked in 77a?

78a. MULTOFFENDERSIGHT
Would you have been able to tell the police
how they might find any of them, for instance,
where they lived, worked, went to school, or
spent time?

Yes
No

1
2
3

722

SKIP to 80a

Other - Specify - ASK 78b

Specify - SKIP to 80a

78b. MULTOFFENDERSIGHT_SPEC
Please specify.
79a. MULTOFFENDERRELATION
How did you know them? For example, were
they friends, cousins, etc.?

723

Probe: Anything else?

1
2
3
4
5
6

Enter all that apply.
724

*
8

725

9
10
11
12
14
15
16
17
18
13

RELATIVE
Spouse at time of incident
Ex-spouse at time of incident
Parent or step-parent
Own child or step-child
Brother/sister
Other relative - Specify - ASK 79b

SKIP
to 80a

Specify - SKIP to 80a

79b. MULTOFFENDERRELATION_SPEC_16
Please specify the other relative.

Specify

79c. MULTOFFENDERRELATION_SPEC_28
Please specify the other nonrelative.
80a. MULTOFFENDERGENDER

711

Were they male or female?

80b. MULTOFFENDERMOSTGENDER
Were they mostly male or mostly female?

712

1
2
3
4

All male
All female
Don't know sex of any offenders
Both male and female

1
2
3
4

Mostly male
Mostly female
Evenly divided
Don't know

SKIP to 81
(If only two offenders,
SKIP to 81
otherwise ASK 80b)

Page 17

81. MULTOFFENDERYOUNG

713

1
2
3
4

714

1
2
3

How old would you say the youngest was?

82. MULTOFFENDEROLD

What race or races were the offenders? Were
they...

CHECK
ITEM I

994

1
2
3
4

Mostly Hispanic or Latino
Mostly non-Hispanic
Equal number of Hispanic and non-Hispanic
Don't know

726

1
2
3

4
5
6

SKIP to 84a

White?
Black or African American?
American Indian or Alaska Native?
Asian?
Native Hawaiian or Other Pacific Islander?
Don't know
Yes - ASK 84c
No - SKIP to 85

Is more than one box marked in
84a?

84c. MULTOFFENDERRACEMOST

21-29
30 or older
Don't know

Yes - ASK 83b
No
Don't know

Enter all that apply.
84b.

5
6
7

1
2
3

993

Were the offenders mostly Hispanic, mostly
non-Hispanic, or an equal number of Hispanic
and non-Hispanic?
84a. MULTOFFENDERRACE

21-29
30 or older
Don't know

Were any of the offenders Hispanic or Latino?
83b. MULTOFFENDERMOSTETHNICITY

5
6
7

Under 12
12-14
15-17
18-20

How old would you say the oldest was?

83a. MULTOFFETHNICITY

Under 12
12-14
15-17
18-20

727

What race were most of the offenders?

6
7

Mostly White
Mostly Black or African American
Mostly American Indian or Alaska Native
Mostly Asian
Mostly Native Hawaiian or Other Pacific Islander
Equal number of each race
Don't know

1
2
3
4
5

85. MULTOFFENDERGANG
Were any of the offenders a member of a street
gang, or don't you know?

715

1
2
3

Yes (a member of a street gang)
No (not a member of a street gang)
Don't know (if a member of a street gang)

86a. MULTOFFENDERDRINKDRUG

716

1
2
3

Yes (drinking or on drugs) - ASK 86b
No (not drinking/not on drugs)
Don't know (if drinking or on drugs)

717

1
2
3
4

Drinking
On drugs
Both (drinking and on drugs)
Drinking or on drugs - could not tell which

730

1
2
3

Yes (only time)
No (there were other times)
Don't know

731

Were any of the offenders drinking or on
drugs, or don't you know?
86b. MULTOFFENDERDRINKORDRUG
Which was it? (Drinking or on drugs?)

87. MULTOFFENDERONLYTIME
Was this the only time any of these offenders
committed a crime against you or your
household or made threats against you or your
household?
88. THEFT

Ask or verify:
Was something stolen or taken without
permission that belonged to you or others in the
household? (Include anything stolen from the
business operated from the respondent's home.)
Include anything stolen from an unrecognizable
business. Do not include anything stolen from a
recognizable business in respondent's home or
another business, such as merchandise or cash from a
register.

Page 18

Yes - SKIP to 96a
No
Don't know

SKIP to 87

89. ATTEMPTTHEFT

732

Ask or verify:

1
2
3

Yes - ASK 90a
No
Don't know

SKIP to 110

Did the offender(s) ATTEMPT to take something
that belonged to you or others in the
household? (Include anything stolen from the
operated from the respondent's home.)
Do not include anything the offender tried to steal
from a recognizable business in respondent's home or
another business, such as merchandise or cash from a
register.
90a. ATTEMPTTHEFTWHAT
What did the offender try to take?

733

Probe: Anything else?
Enter all that apply.

734

1
2
3
4
5
6
7

735

8
9
10

*
11
12
736

737

14
15
16

Cash
Purse
Wallet
Credit cards, checks, bank cards
Car
Other motor vehicle
Part of motor vehicle (tire, hubcap,
attached car stereo or satellite radio,
attached CB radio, etc.)
Gasoline or oil
Bicycle or parts
TV, DVD player, VCR, stereo, other
household appliances
Silver, china, art objects
Other household furnishings (furniture,
rugs, etc.)
Personal effects (clothing, jewelry, toys,
etc.)
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)
Other - Specify - ASK 90b
Don't know - SKIP to 91a

SKIP
to 91a

Specify

90b. ATTEMPTTHEFTWHAT_SPEC
Please specify what the offender(s) tried to take.
91a. ATTEMPTTHEFTOWNER
Did the (property/money) the offender tried to
take belong to you personally, to someone else
in the household, or to both you and other
household members?

738

1
2
3
4
5

Respondent only - SKIP to 92a
Respondent and other household
member(s)
SKIP to 91c
Other household member(s) only
Nonhousehold member(s) only - SKIP to 92a
Other - Specify - ASK 91b

Specify - SKIP to 92a

91b. ATTEMPTTHEFTOWNER_SPEC
Please specify who the (property/money) the
offender(s) tried to take belonged to.
91c.

CHECK

ITEM J

ATTEMPTHEFTLNS

Line number

739

If not sure, ask:

Line number

Besides the respondent, which household
member(s) owned the (property/money) the
offender tried to take?

Line number
OR

Enter appropriate line number(s).

92a. ATTEMPTTHEFTITEMSINMV
Ask or verify:

740

Household property

1
2

Yes
No

(Was/Were) the article(s) IN or ATTACHED to a
motor vehicle when the attempt was made to
take (it/them)?
Notes

Page 19

92b.

CHECK

ITEM K

Yes - ASK 93
No - SKIP to 94

Did the offender try to take cash,
a purse, or a wallet?
(Is box 1, 2, or 3 marked in 90a?)

93. ATTEMPTTHEFTONPERSON
Ask or verify:

742

1
2

Yes
No

745

1
2

Yes - ASK 95
No - SKIP to 110

746

4
5
6

Was the (cash/purse/wallet) on your person,
for instance, in a pocket or being held?
94. ATTEMPTTHEFTITEMONPERSON
Ask or verify:
Was there anything (else) the offender(s) tried
to take directly from you, for instance, from
your pocket or hands, or something that you
were wearing?
Exclude property not belonging to respondent or
other household member

95. ATTEMPTTHEFTITEMS
Which items did the offender(s) try to take
directly from you?
Exclude property not belonging to respondent or
other household member.

8
9
10
11
12
13
14
15
16
40

Notes

Page 20

Credit cards, checks, bank cards
Car
Other motor vehicle
Part of motor vehicle (tire, hubcap,
attached car stereo or satellite radio,
attached CB radio, etc.)
Gasoline or oil
Bicycle or parts
TV, DVD player, VCR, stereo, other
household appliances
Silver, china, art objects
Other household furnishings (furniture,
rugs, etc.)
Personal effects (clothing, jewelry, toys,
etc.)
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)
Other
Tried to take everything marked in 90a
directly from respondent

SKIP
to 110

96a. WHATWASTAKEN
What was taken that belonged to you or
others in the household?

748

Probe: Anything else?
Enter all that apply.
749

1
2
3
4

5
6
7
8
9
10

750

*
12
13

751

*
752

753

CASH/PURSE/WALLET/CREDIT CARDS
Cash
Purse
Wallet
Credit cards, check, bank cards
VEHICLE OR PARTS
Car
Other motor vehicle
Part of motor vehicle (tire, hubcap, attached car
stereo or satellite radio, attached CB radio, etc.)
Unattached motor vehicle accessories or equipment
(unattached CD player or satellite radio, etc.)
Gasoline or oil
Bicycle or parts
HOUSEHOLD FURNISHINGS
TV, DVD player, VCR, stereo, other household
appliances
Silver, china, art objects
Other household furnishings (furniture, rugs, etc.)

PERSONAL EFFECTS
Portable electronic and photographic gear
(Personal stereo, TV, cellphone, camera, etc.)
Clothing, furs, luggage, briefcase
Jewelry, watch, keys
Collection of stamps, coins, etc.
Toys, sports and recreation equipment
(not listed above)
Other personal and portable objects

20
21

FIREARMS
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)

14
15
16
17
18

MISCELLANEOUS
754

*
755

*
96b.

CHECK

ITEM L1

22
23
24
25
26
27

If Box 26 is marked in 96a - ASK 96c
If Box 2 and/or 3 is marked in 96a - SKIP to 96d
If Box 1 is marked in 96a - SKIP to 96e
If none of the conditions above are met - SKIP to 97a

Follow the skip pattern for the
first category met, based on the
entries in 96a.

Specify - If Box 2 and/or 3 is marked in 96a - ASK to 96d
If Box 1 is marked in 96a - SKIP to 96e
Otherwise SKIP to 97a

96c. WHATWASTAKEN_SPEC
Please specify what was taken.

96d. PRSWLT_CONTAINMONEY

1
2

Did the stolen (purse/wallet) contain any
money?
96e. AMOUNTCASHTAKEN

Tools, machines, office equipment
Farm or garden produce, plants, fruit, logs
Animals -pet or livestock
Food or liquor
Other - Specify
Don't know

747

Yes - ASK 96e
No
If Box 1 is marked in 96a ASK 96e
otherwise SKIP to 97a

$ ____________ .

Amount of cash taken

If not sure, ask:
How much cash was taken?
97a. WHOOWNEDSTOLENPROPERTY
Did the stolen (property/money) belong to you
personally, to someone else in the household,
or to both you and other household members?

97b. ATTEMPTTHEFTOWNER_SPEC

760

1
2
3
4
5

Respondent only - SKIP to 97d
Respondent and other household
member(s)
SKIP to 97c
Other household member(s) only
Nonhousehold member(s) only - SKIP to 97d
Other - Specify - ASK 97b

Specify - SKIP to 97d

Please specify who the stolen (property/money)
belonged to.

Page 21

97c.

CHECK

ITEM L2

OTHERSOWNEDSTOLENPROPERTY

761

Line number

If not sure, ask:

Line number

Besides the respondent, which household
member(s) owned the stolen (property/
money)?

Line number
OR

Enter appropriate line number(s).
97d.

CHECK

ITEM M1

Yes - ASK 98
No - SKIP to 100a

Was a car or other motor vehicle
stolen?
(Is box 5 or 6 marked in 96a?)

98. PERMISSIONGIVEN

1
2
3

Yes - ASK 99
No
Don't know

764

1
2

Yes
No

765

1
2

Yes
No

763

Had permission to use the (car/motor vehicle)
ever been given to the offender(s)?
99. RETURNCAR
Did the offender return the (car/motor vehicle)
this time?
100a. ARTICLEINCAR

Household property

Ask or verify:

SKIP to 100b

(Was/Were) the article(s) IN or ATTACHED to a
motor vehicle when (it was/they were) taken?
100b.

CHECK

ITEM M2

Yes - ASK 101a
No - SKIP to 101b

Did the offender(s) take a
handgun?
(Is box 20 marked in 96a?)

101a. NUMBERHANDGUNS

923

Number of handguns

How many handguns were taken?
101b.

CHECK

ITEM M3

Yes - ASK 101a
No - SKIP to 101b

Did the offender(s) take some
other type of firearm?
(Is box 21 marked in 96a?)

101c. NUMBERFIREARMS

924

Number of handguns

How many other types of firearms were taken?
101d.

CHECK

ITEM N1

Yes - ASK 102a
No - SKIP to 102b

Was cash, a purse, or a wallet
taken? (Is box 1, 2, or 3 marked
in 96a?)

102a. CASHONPERSON
Ask or verify:

767

1
2

Yes
No

768

1
2

Yes - ASK 103
No - SKIP to 104a

Was the (cash/purse/wallet) on your person,
for instance, in a pocket or being held?
102b. OTHERONPERSON
Ask or verify:
Was there anything (else) the offender(s) took
directly from you, for instance, from your
pocket or hands, or something that you were
wearing?
Exclude property not belonging to respondent or
other household member

Notes

Page 22

103. ITEMSTAKEN
Which items did the offender(s) take directly
from you?

769

5
6
7

Exclude property not belonging to respondent or
other household member.

8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
40

104a.

CHECK

ITEM N2

Yes - SKIP to 106
No - ASK 104b

Were only cash, a purse, or a
wallet taken? (Are boxes 1, 2, or
3 the only boxes marked in 96a?)

104b. PROPERTYVALUE
What was the value of the PROPERTY that was
taken? Include recovered property. (Exclude
any stolen (cash/checks/credit cards) If jointly
owned with a nonhousehold member(s),
include only the share owned by household
members.)

Credit cards, check, bank cards
Car
Other motor vehicle
Part of motor vehicle (tire, hubcap, attached car
stereo or satellite radio, attached CB radio, etc.)
Unattached motor vehicle accessories or equipment
(unattached CD player or satellite radio, etc.)
Gasoline or oil
Bicycle or parts
TV, DVD player, VCR, stereo, other household
appliances
Silver, china, art objects
Other household furnishings (furniture, rugs, etc.)
Portable electronic and photographic gear
(Personal stereo, TV, cellphone, camera, etc.)
Clothing, furs, luggage, briefcase
Jewelry, watch, keys
Collection of stamps, coins, etc.
Toys, sports and recreation equipment
(not listed above)
Other personal and portable objects
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)
Tools, machines, office equipment
Farm or garden produce, plants, fruit, logs
Animals -pet or livestock
Food or liquor
Other
Everything marked in 96a was taken
directly from respondent

770

$ ____________ .

Value of property taken

Enter total dollar value for all items taken.
105a. DECIDEDVALUE
How did you decide the value of the property
that was taken?

771

Probe: Any other way?
Enter all that apply.

1
2
3
4
5
6
7

Original cost
Replacement cost
Personal estimate of current value
Insurance report estimate
Police estimate
Don't know
Other - Specify - ASK 105b

SKIP to 106

Specify

105b. DECIDEDVALUE_SPEC
Please specify how the value of the property (that
was taken) was decided.
106. ALLPARTRECOVERED

772

Was all or part of the stolen (money/property)
recovered, not counting anything received
from insurance?
107a. WHATRECOVERED
What was recovered?
Probe: Anything else?
Enter all that apply.
107b.

CHECK

ITEM N3

Follow the skip pattern for the
first category met, based on the
entries in 107a.

776

All - SKIP to 107d
Part - ASK 107a
None - SKIP to 109

1
2
3
4
5
6

Cash recovered
Purse
Wallet
Credit cards, checks, bank cards
Car or other motor vehicle
Property other than the above

1
2

If Box 2 and/or 3 is marked in 107a - ASK 107c
If Box 1 is marked in 107a - SKIP to 107d
If none of the conditions above are met - SKIP to 107e

Page 23

107c. CONTAINMONEY

1
2

Did the recovered (purse/wallet) contain any
money?
107d. CASHRECOVERED

775

Yes - ASK 107d
No
If Box 1 is marked in 107a ASK 107d
otherwise SKIP to 107e

$ ____________ .

Amount of cash recovered

If necessary:
How much cash was recovered?
107e.

CHECK

ITEM O

Was PROPERTY other than cash,
checks, or credit cards
recovered? (Are boxes 2, 3, 5, or
6 marked in 107a?)

108. RECOVEREDCASHVALUE

Yes - ASK 108
No - SKIP to 109

777

1
2

778

$ ____________ .

779

1
2
3
4

Yes
No
Don't have insurance
Don't know

780

1
2

Yes - ASK 111
No - SKIP to 115

781

1
2
3

Yes, all
Yes, part
No, none - ASK 112

Considering any damage, what was the value
of the property after it was recovered? Do not
include recovered (cash/checks/credit cards)

Value of property recovered

If value of recovered property is the same as value of
property taken then enter the amount from 104b
above.
109. RECOVEREDINSURANCE
Was the theft reported to an insurance
company?
110. DAMAGED
(Other than any stolen property) was
anything that belonged to you or other
members of the household damaged in this
incident?
Probe: For example, was (a lock or window
broken/clothing damaged/damage done to a
car), or something else?
111. DAMAGEDREPAIRED
(Was/Were) the damaged item(s) repaired or
replaced?
112. ESTCOSTTOREPAIRREPLACE

782

How much would it cost to repair or replace the
damaged item(s)?
113. ACTCOSTREPAIRREPLACE

783

How much was the repair or replacement cost?
114a. PAIDREPAIRS
Who (paid/will pay) for the repairs or
replacement?

$ ____________ .

784

Probe: Anyone else?

1
2
3
4
5
6

Cost to repair/replace -

Cost to repair/replace - ASK 114a

No cost - SKIP to 115
Items will not be repaired or replaced
Household member
Landlord or landlord's insurance
Victim's (or household's) insurance
Offender
Other - Specify - ASK 114b

Enter all that apply.
Specify

114b. PAIDREPAIRS_SPEC
Please specify who (paid/will pay) for the repairs or
replacement.
115. POLICEINFORMED
Were the police informed or did they find out
about this incident in any way?

Page 24

800

1
2
3

SKIP
to 114a

No cost - SKIP to 115

$ ____________ .
0

SKIP to 113

Yes - ASK 116a
No - SKIP to 117a
Don't know - SKIP to 130

SKIP
to 115

116a. POLICEFINDOUT

801

How did the police find out about it?
Enter first precode that applies.

1
2
3
4
5
6
7

If proxy interview, we want the proxy
respondent to answer questions 116a - 134b for
herself/himself, not for the person for whom the
proxy interview is being taken.
116b. POLICEFINDOUT_SPEC

Respondent - SKIP to 119a
Other household member
Someone official called police (guard, apt.
manager, school official, etc.)
Someone else
Police were at scene - SKIP to 123a
Offender was a police officer - SKIP to 124
Some other way - Specify - ASK 116b

SKIP
to 121

Specify - SKIP to 124

Please specify how the police found out about it.
117a. NOTREPORTEDPOLICE
What was the reason it was not reported to the
police?

802

1
2

Probe: Can you tell me a little more? Any other
reason?
3

Enter all that apply.
4
5

STRUCTURED PROBE Was the reason because you dealt with it
another way, it wasn't important enough to
you, insurance wouldn't cover it, police
couldn't do anything, police wouldn't help, or
was there some other reason?

803

8
9

804

*
12
13

805

*
806

15
16
17

18
19

117b. NOTREPORTEDPOLICE_SPEC

DEALT WITH ANOTHER WAY
Reported to another official (guard, apt.
manager, school official, etc.)
Private or personal matter or took care of it
myself or informally; told offender's parent
NOT IMPORTANT ENOUGH TO RESPONDENT
Minor or unsuccessful crime, small or no
loss, recovered property
Child offender(s), "kid stuff"
Not clear it was a crime or that harm was
intended
INSURANCE WOULDN'T COVER
No insurance, loss less than deductible, etc.
POLICE COULDN'T DO ANYTHING
Didn't find out until too late
Could not recover or identify property
Could not find or identify offender, lack of
proof
POLICE WOULDN'T HELP
Police wouldn't think it was important
enough, wouldn't want to be bothered or
get involved
Police would be inefficient, ineffective
(they'd arrive late or not at all, wouldn't do a
good job, etc.)
Police would be biased, would harass/insult
respondent, cause respondent trouble, etc.)
Offender was police officer
OTHER REASON
Did not want to get offender in trouble with
the law
Was advised not to report to police
Afraid of reprisal by offender or others
Did not want to or could not take time - too
inconvenient
Other - Specify - ASK 117b
Respondent not present or doesn't know
why it wasn't reported - SKIP to 117c

Codes
1-17
SKIP
to 117c

Specify

Please specify the reason it was not reported to the
police.
117c.

CHECK

ITEM P

Is more than one reason marked
in 117a?

1
2

Yes - ASK 118
No - SKIP to 130

Notes

Page 25

118. NOTREPORTEDIMPORTANT
Which of these would you say was the most
important reason why the incident was not
reported to the police?

808

3
4
5
6
7
8
9
10

12
13
14
15
16
17
18
30

119a. REASONREPORT
Besides the fact that it was a crime, did YOU
have any other reason for reporting this
incident to the police?

809

1
2

Probe: Any other reason?
3
4

Enter all that apply.
STRUCTURED PROBE Did you report it to get help with this incident,
to recover your loss, to stop or punish the
offender, to let police know about it, or was
there some other reason?

6
810

7
8

9
10

119b. REASONREPORT_SPEC

811

Reported to another official (guard, apt.
manager, school official, etc.)
Private or personal matter or took care of
it myself or informally; told offender's
parent
Minor or unsuccessful crime, small or no
loss, recovered property
Child offender(s), "kid stuff"
Not clear it was a crime or that harm was
intended
No insurance, loss less than deductible,
etc.
Didn't find out until too late
Could not recover or identify property
Could not find or identify offender, lack
of proof
Police wouldn't think it was important
enough, wouldn't want to be bothered
or get involved
Police would be inefficient, ineffective
(they'd arrive late or not at all, wouldn't
do a good job, etc.)
Police would be biased, would harass/
insult respondent, cause respondent
trouble, etc.)
Offender was police officer
Did not want to get offender in trouble
with the law
Was advised not to report to police
Afraid of reprisal by offender or others
Did not want to or could not take time too inconvenient
Other
No one reason more important
TO GET HELP WITH THIS INCIDENT
Stop or prevent THIS incident from
happening
Needed help after incident due to injury,
etc.
TO RECOVER LOSS
To recover property
To collect insurance
TO GET OFFENDER
To prevent further crimes against
respondent/ respondent's household
by this offender
To stop this offender from committing
other crimes against anyone
To punish offender
Catch or find offender - other reason
or no reason given
TO LET POLICE KNOW
To improve police surveillance of
respondent's home, area, etc.
Duty to let police know about crime
OTHER
Other reason - Specify - ASK 119b
No other reason - SKIP to 121

Specify

Please specify other reason for reporting this
incident to the police.
119c.

CHECK

ITEM Q

Notes

Page 26

Is more than one reason marked
in 119a?

1
2

All
codes,
SKIP
to 130

Yes - ASK 120
No - SKIP to 121

SKIP
to 119c

120. REPORTIMPORTANT

Stop or prevent THIS incident from
happening
Needed help after incident due to injury, etc.
To recover property
To collect insurance
To prevent further crimes against
respondent/ respondent's household
by this offender
To stop this offender from committing
other crimes against anyone
To punish offender
Catch or find offender - other reason
or no reason given
To improve police surveillance of
respondent's home, area, etc.
Duty to let police know about crime
Other reason
No one reason more important
Because it was a crime was most important

814

1
2
3
4

Yes - ASK 122
No
SKIP to 124
Don't know
Respondent went to police - SKIP to 123a

815

1
2
3
4
5
6

Within 5 minutes
Within 10 minutes
Within an hour
Within a day
Longer than a day
Don't know how soon

816

817

1
2
3
4
5
6
7

813

Which of these would you say was the most
important reason why the incident was
reported to the police?

1
2
3
4
5

6
7
8
9
10
11
21

121. POLICEARRIVE
Did the police come when they found out
about the incident?
122. TIMEPOLICEARRIVE
How soon after the police found out did they
respond? Was it within 5 minutes, within 10
minutes, an hour, a day, or longer?
Enter the code for the first answer category
respondent is sure of.
123a. POLICEACTION
What did they do while they were (there/here)?

Probe: Anything else?
Enter all that apply.

Took report
Searched/looked around
Took evidence (fingerprints, inventory, etc.)
Questioned witnesses or suspects
Promised surveillance
Promised to investigate
Made arrest
Other - Specify - ASK 123b
Don't know - SKIP to 124

SKIP
to 124

Specify

123b. POLICEACTION_SPEC
Please specify what they did while they were (there/
here).
124. POLICECONTACT

818

Did you (or anyone in your household) have
any later contact with the police about the
incident?
125a. POLICEINTOUCH

819

Did the police get in touch with you or did you
get in touch with them?

1
2
3

1
2
3
4
5

Yes - ASK 125a
No
Don't know

SKIP to 128

Police contacted respondent or other
HHLD member
Respondent (or other HHLD member)
contacted police
Both
Don't know
Other - Specify - ASK 125b

SKIP
to 126

Specify

125b. POLICEINTOUCH_SPEC
Please specify did the police get in touch with you or
did you get in touch with them.
126. HOWPOLICECONTACT
Was that in person, by phone, or some other
way?

820

1
2
3
4

In person
Not in person (by phone, mail, etc.)
Both in person and not in person
Don't know

Notes

Page 27

127a. POLICEFOLLOWUP
What did the police do in following up this
incident?

821

Probe: Anything else?
822

Enter all that apply.

1
2
3
4
5
6
7
8
9

Took report
Questioned witnesses or suspects
SKIP
Did or promised surveillance/investigation
to 128
Recovered property
Made arrest
Stayed in touch with respondent/household
Other - Specify - ASK 127b
Nothing (to respondent's knowledge)
SKIP to 128
Don't know

Specify

127b. POLICEFOLLOWUP_SPEC
Please specify what the police did in following up
this incident.
128. SIGNCOMPLAINT

825

1
2

Yes
No

826

1
2
3

Yes
No
Don't know

827

1
2
3

Yes - ASK 131a
No
Don't know

1
2
3

Government
Private
Don't know

1
2

Yes - ASK 132
No - SKIP to 135a

1
2
3

Yes - ASK 133a
No
Don't know

1
2
3
4
5

Prosecutor, district attorney
Magistrate
Court
Juvenile, probation or parole officer
Other - Specify - ASK 133b

Did you (or someone in your household) sign a
complaint against the offender(s) to the police
department or the authorities?
129. ARRESTMADE
Ask or verify:
As far as you know, was anyone arrested or
were charges brought against anyone in
connection with this incident?
130. AGENCYHELP
Did you (or someone in your household)
receive any help or advice from any office or
agency - other than the police - that deals with
victims of crime?
131a. TYPEOFAGENCY

828

Was that a government or private agency?
131b.

CHECK

ITEM R

Were the police informed? (Is
"Yes" marked in 115?

132. CONTACTAUTHORITIES

829

Have you (or someone in your household) had
contact with any other authorities about this
incident (such as a prosecutor, court, or
juvenile officer)?
133a. AUTHORITIES
Which authorities?

830

Probe: Any others?

SKIP to 131b

SKIP to 134a

Enter all that apply.
Specify

133b. AUTHORITIES_SPEC
Please specify which authorities.
134a. ANYTHINGFURTHER
Do you expect the police, courts, or other
authorities will be doing anything further in
connection with this incident?
134b. ANYTHINGFURTHER_SPEC
Please specify what you expect the police, courts, or
other authorities will be doing (further) in
connection with this incident.

Page 28

831

1
2
3

Yes - Specify - ASK 134b
No
SKIP to 135a
Don't know

Specify

SKIP to 134a

135a. DOINGATINCIDENTTIME
Ask or verify:

832

What were you doing when this incident
(happened/started)?

1
2
3
4
5
6
7
8
9
10
11

Working or on duty - SKIP to 138a
On the way to or from work - SKIP to 142b
On the way to or from school
On the way to or from other place
Shopping, errands
Attending school
Leisure activity away from home
Sleeping
Other activities at home
Other - Specify - ASK 135b
Don't know - SKIP to 136

SKIP
to 136

Specify

135b. DOINGATINCIDENTTIME_SPEC
Please specify what you were doing when this
incident (happened/started).
136. JOBDURINGINCIDENT

840

1
2

Yes - SKIP to 142b
No - ASK 137a

841

1
2
3
4
5
6

Looking for work
Keeping house
Going to school
Unable to work
Retired
Other - Specify - SKIP to 137b

Ask or verify:
Did you have a job at the time of the incident?
137a. MAJORACTIVITY
What was your major activity the week of the
incident - were you looking for work, keeping
house, going to school, or doing something
else?

SKIP to 151

Specify - SKIP to 151

137b. MAJORACTIVITY_SPEC
Please specify what was your major activity the week
of the incident.
138a. EMPLOYERTYPE

843

Now I have a few questions about the job at
which you worked during the time of the
incident.

1
2
3

Were you employed by -

(Read each category - then enter appropriate code)

138b. INCORPORATED

953

Is this business incorporated?
138c. EMPLOYERNAME

A private company, business, or
individual for wages? - Ask 138b
The Federal government?
A State, county, or local
SKIP to 138c
government?
Yourself (Self-employed) in your own
business, professional practice, or farm?
SKIP
to 138c
A private, not-for-profit, tax-exempt, or
charitable organization?

1
2
3

Yes
No
Don't know

1
2
3
4

Manufacturing?
Retail trade?
Wholesale trade?
Something else?

954

What is the name of the (company/government
agency/business/non-profit organization) for
which you worked at the time of the incident?
138d. TYPEOFBUSINESS

955

What kind of business or industry is this?
Read if necessary: What do they make or do
where you worked at the time of the incident?
138e. BUSINESSSECTOR

956

Is this mainly...
(Read answer categories) 138f. OCCUPATIONDESC

957

What kind of work did you do, that is, what
was your occupation at the time of the
incident?
(For example: plumber, typist, farmer)

Page 29

139. USUALJOBDUTIES

958

What were your usual activities or duties at
this job?
140. JOBMSATYPE

844

1
2
3
4

A city?
Suburban area?
Rural area?
Combination of any of these?

845

1
2
3
4

Yes
SKIP to 141c
No
Don't know
Other - Specify - ASK 141b

While working at this job, did you work mostly
in (Read category - then enter the appropriate code).
141a. INCIDENTHAPPENATWORK
Ask or verify:
Did this incident happen at your work site?

Specify

141b. INCIDENTHAPPENATWORK_SPEC
Please specify
141c. WORKDAYNIGHT

1
2
3

Days

1
2

Yes
No

1
2

Yes (injury marked in 31a - ASK 143
No (blank or "None" marked in 31a - SKIP to 147a

870

1
2

Yes - ASK 144
No - SKIP to 147a

871

____________ Number of days - ASK 145

846

Did you usually work days or nights?
142a. ISCURRENTJOB

959

Is this your current job?
142b.

CHECK

ITEM S

Was the respondent injured in
this incident? (Is box 2-11
marked in 31a?)

143. LOSTWORKTIME
Did YOU lose time from work because of the
injuries you suffered in this incident?
144. AMOUNTTIMELOST
How much time did you lose because of
injuries?
145. LOSTPAYNOMEDINS

872

During these days, did you lose any pay that
was not covered by unemployment insurance,
sick leave, or some other source?
146. AMOUNTLOSTPAYNOMED

Less than one day - SKIP to 147a

1
2

Yes - ASK 146
No - SKIP to 147a

873

$ ____________ .

About how much pay did you lose?
147a. LOSTOTHERWORKTIME
Did YOU lose any (other) time from work
because of this incident for such things as
cooperating with a police investigation,
testifying in court, or repairing or replacing
damaged or stolen property?

874

Nights
Both days and nights/rotating shifts

1
2
3
4
5
6

Amount of pay lost

Police related activities
Court related activities
Repairing damaged property
Replacing stolen items
Other - Specify - ASK 147b
None (did not lose time from work for
any of these reasons) - SKIP to 151

Probe: Any other reason?
Enter all that apply.
Specify

147b. LOSTOTHERWORKTIME_SPEC
Please specify the (time/other time) lost from work
because of this incident.
148. DAYLOSTWORK
How much time did you lose altogether
because of (name all reasons marked in 147a)?

Page 30

875

____________ Number of days - ASK 149
0

Less than one day - SKIP to 151

ASK 148

149. LOSTPAYNOEMPINS

876

During these days, did you lose any pay that
was not covered by unemployment insurance,
paid leave, or some other source?
150. AMOUNTLOSTNOPAYEMP

1
2

877

$ ____________ .

About how much pay did you lose?
151. HHMEMLOSTWORKTIME

CHECK

ITEM T

879

____________ Number of days

Was the respondent on the way
to or from work, school, or some
other place when the incident
(happened/started)? (Is box 2, 3,
or 4 marked in 135a?)

153a. TYPETRANSPORTATION

881

Ask or verify:
You told me earlier you were on the way (to/
from) (work/school/some place) when the
incident happened.

Less than one day

1
2

Yes - ASK 153a
No - SKIP to 153c

1
2
3
4
5
6
7
8
9
10

What means of transportation were you using?

153b. TYPETRANSPORTATION_SPEC

Amount of pay lost

Yes - ASK 152a
No - SKIP to 152b

1
2

How much time did they lose altogether?
152b.

878

Were there any (other) household members 16
years or older who lost time from work
because of this incident?
152a. AMOUNTHHMEMTIMELOST

Yes - ASK 150
No - SKIP to 151

Car, truck or van
Motorcycle
Bicycle
On foot
School bus (private or public)
Bus or trolley
Subway or rapid transit
Train
Taxi
Other - Specify - Ask 153b

Skip
to 153c

Specify

Please specify what means of transportation you
were using.
153c.

CHECK

ITEM U

Is this incident part of a series of
crimes? (Is box 2 (is a "series")
marked in 5c?)

154a. SERIESNUMTIMES

1
2

883

____________ Number of incidents - SKIP to 155a

You have told me about the most recent
incident. How many times did this kind of
thing happen to you during the last 6 months?
154b. SERIESDK
Is that because there is no way of knowing, or
because it happened too many times, or is
there some other reason?
154c. SERIESDKSPEC

Yes - ASK 154a
No - SKIP to 161

Don't know - ASK 154b

884

1
2
3

No way of knowing
SKIP to 155a
Happened too many times
Some other reason - Specify - ASK 154c

Specify

Please specify the other reason the respondent
doesn't know the number of times.
Notes

Page 31

155a. SERIESWHICHMONTHQ1
In what month or months did these incidents
take place?

Number of incidents per quarter
885

Jan., Feb., or Mar.
(Qtr. 1)

886

Apr., May, or Jun.
(Qtr. 2)

887

Jul., Aug., or Sept.
(Qtr. 3)

888

Oct., Nov., or Dec.
(Qtr. 4)

Probe: How many in (name months)?
155b. SERIESWHICHMONTHQ2
In what month or months did these incidents
take place?
Probe: How many in (name months)?
155c. SERIESWHICHMONTHSQ3
In what month or months did these incidents
take place?
Probe: How many in (name months)?
155d. SERIESWHICHMONTHQ4
In what month or months did these incidents
take place?
Probe: How many in (name months)?
156. SERIESLOCATION

889

1
2
3

All in the same place
Some in the same place
None in the same place

890

1
2
3
4

All by same person
Some by same person
None by same person
Don't know - SKIP to 159a

891

1
2
3
16

RELATIVE
Spouse at time of incident
Ex-spouse at time of incident
Parent or step-parent
Own child or step-child
Brother/sister
Other relative - Specify - ASK 158b

Did all, some, or none of these incidents occur
in the same place?
157. SERIESOFFENDER
Were all, some, or none of these incidents
done by the same person(s)?
158a. SERIESOFFENDERRELATION
What (was/were) the relationship(s) of the
offender(s) to you? For example, friend,
spouse, schoolmate, etc?

17
4

Probe: Anything else?
Enter all that apply.
892

18
5
8
7
6
11
12
13
14
15
19
10

Specify - SKIP to 159a

158b. SERIESOFFENDERRELATION14SPEC
Please specify the other relative.

Specify

158c. SERIESOFFENDERRELATION26SPEC
Please specify the other nonrelative.
159a. SAMETHINGEACHTIME
Did the same thing happen each time?
159b. HOWINCIDENTSDIFFER
How did the incidents differ?

Page 32

893

1
2

Yes - SKIP to 160a
No - ASK 159b

Specify

SKIP
to 159a

160a. TROUBLEONGOING

894

Is the trouble still going on?
160b. WHATENDEDIT

1
2

Yes - SKIP to 160c
No - ASK 160b

Specify

What ended it?
160c. CHECK
ITEM V1
Do not read to respondent.

895
1

Enter precode that best describes this series of
crimes. If more than one category describes this
series, enter the appropriate precode with the lowest
number.

3
4

5
6

8
9

160d. SERIESCONTACTORNOT14SPEC

CONTACT CRIMES
Completed or threatened violence in the
course of the victim's job (police officer,
security guard, psychiatric social worker,
etc.)
Completed or threatened violence
between spouses, other relatives,
friends, neighbors, etc.
Completed or threatened violence at
school or on school property
Other contact crimes (other violence,
pocket picking, purse snatching, etc.) Specify - ASK 160d
NONCONTACT CRIMES
Theft or attempted theft of motor
vehicles
Theft or attempted theft of motor
vehicle parts (tire, hubcap, battery,
attached car stereo, etc.)
Theft or attempted theft of contents of
motor vehicle, including unattached
parts
Theft or attempted theft at school or on
school property
Illegal entry of, or attempt to enter,
victim's home, other building on
property, second home, hotel, motel
Theft or attempted theft from victim's
home or vicinity by person(s) KNOWN to
victim (roommate, babysitter, etc.)
Theft or attempted theft from victim's
home or vicinity by person(s)
UNKNOWN to victim
Other theft or attempted theft (at work,
while shopping, etc.) - Specify - ASK
160e

SKIP
to 161

Specify - SKIP to 161

Please specify the other contact crime.
160e. SERIESCONTACTORNOT22SPEC

Specify

Please specify the other noncontact crime.
161. INCIDENTHATECRIME
Hate crimes or crimes of prejudice or bigotry
occur when (an offender/offenders) target(s)
people because of one or more of their
characteristics or religious beliefs.

910

1
2

Yes - ASK 162
No - SKIP to 167a

Do you have any reason to suspect the
incident just discussed was a hate crime or
crime of prejudice or bigotry?
Notes

Page 33

An offender/Offenders can target people
for a variety of reasons, but we are only
going to ask you about a few today. Do
you suspect the offender(s) targeted you
because of...

162.

(a) INCHATETARGETREASONS_RACE
Your race?

896

Yes

Don't know

897

Yes

Don't know

898

Yes

Don't know

899

Yes

Don't know

900

Yes

Don't know

901

Yes

Don't know

911

Yes - Specify - ASK 163b
No
SKIP to 163c
Don't know

(b) INCHATETARGETREASONS_RELIGION
Your religion?
(c) INCHATETARGETREASONS_ETHNICITY
Your ethnic background or national origin (for
example, people of Hispanic origin)?
(d) INCHATETARGETREASONS_DISABILITY
Any disability (by this I mean physical, mental,
or developmental disabilities) you may have?
(e) INCIDENTHATETARGETREASONS_GENDER
Your gender?
(f) INCIDENTHATETARGETREASONS_SEXUAL
Your sexual orientation?
If "Yes," SAY - (by this we mean homosexual,
bisexual, or heterosexual)
Some offenders target people because
they associate with certain people or the
(offender perceives/offenders perceive)
them as having certain characteristics or
religious beliefs.

163.

Do you suspect you were targeted
because of...
(a) INCIDENTHATETARGETWHOYOUKNOW

Your association with people who have certain
characteristics or religious beliefs (for
example, a multiracial couple)?
(b) INCHATETARGETWHOYOUKNOW_SPEC

912

Specify

913

Please specify why you suspect you were targeted
because of your association with people who have
certain characteristics or religious beliefs.
(c) INCIDENTHATETARGETRELIGION

The offender(s)'s perception of your
characteristics or religious beliefs (for
example, the offender(s) thought you were
Jewish because you went into a synagogue)?
(d) INCIDENTHATETARGETRELIGION_SPEC

914

Yes - Specify - ASK 163d
No
SKIP to 163e
Don't know

Specify

Please specify why you suspect you were targeted
because of the offender(s)'s perception of your
characteristics or religious beliefs.
163e.

CHECK

ITEM V2

Are one or more boxes marked
"Yes" in 162a through 163c?

164a. INCIDENTHAVEEVIDENCEHATE
Do you have any evidence that this incident
was a hate crime or crime of prejudice or
bigotry?
164b. INCIDENTHAVEEVIDENCE_SUGGEST
Did the offender(s) say something, write
anything, or leave anything behind at the
crime scene that would suggest you were
targeted because of your characteristics or
religious beliefs?

Page 34

1
2

915

1
2
3

1
2

Yes - ASK 164a
No - SKIP to 167a
Yes - SKIP to 165
No
ASK 164b
Don't know

Yes - ASK 165
No - SKIP to 167a

The next questions ask about the
evidence you have that makes you
suspect this incident was a hate crime or
a crime of prejudice or bigotry. As I read
the following questions, please tell me if
any of the following happened:
(a) INCIDENTEVIDENCEHATE_MAKEFUN
165.

Did the offender(s) make fun of you, make
negative comments, use slang, hurtful words,
or abusive language?

916

Yes

Don't know

917

Yes

Don't know

918

Yes

Don't know

919

Yes

Don't know

920

Yes

Don't know

921

Yes

Don't know

922

Yes

Don't know

908

1
2

Yes
No

(b) INCIDENTEVIDENCEHATE_SYMBOLS
Were any hate symbols present at the crime
scene to indicate the offender(s) targeted you
for a particular reason (for example, a
swastika, graffiti on the walls of a temple, a
burning cross, or written words)?
(c) INCEVIDENCEHATE_POLICETARGET
Did a police investigation confirm the
offender(s) targeted you (for example, did the
offender(s) confess a motive, or did the police
find books, journals, or pictures that
indicated the offender(s) (was/were)
prejudiced against people with certain
characteristics or religious beliefs)?
(d) INCEVIDENCEHATE_OFFENDERDIDSAME
Do you know if the offender(s) (has/have)
committed similar hate crimes or crimes of
prejudice or bigotry in the past?
(e) INCIDENTEVIDENCEHATE_NEARHOLIDAY
Did the incident occur on or near a holiday,
event, location, gathering place, or building
commonly associated with a specific group
(for example, at the Gay Pride March or at a
synagogue, Korean church, or gay bar)?
(f) INCEVIDENCEHATE_OTHERLIKECRIMES
Have other hate crimes or crimes of prejudice
or bigotry happened to you or in your area/
neighborhood where people have been
targeted?
(g) INCEVIDENCEHATE_FELT_BELIEVED
Do your feelings, instincts, or perception lead
you to suspect this incident was a hate crime or
crime of prejudice or bigotry, but you do not
have enough evidence to know for sure?
166. TELLPOLICEHATECRIME
At any time, did you tell the police that you
believed the incident was a hate crime or crime
of prejudice or bigotry?
167a.

CHECK

Is this the first incident reported
for this respondent?

925

1
2

Yes - SKIP to 168
No - FILL 167b

167b.

CHECK

Is 171 marked "Yes" for the first
incident reported for this
respondent? (That is, has the
respondent previously indicated
that he/she has a health
condition or disability?)

926

1
2

Yes - SKIP to 172
No - SKIP to 174

ITEM V3

ITEM V4

168. DISABILITY_INTRO
Research has shown that people with disabilities may be more vulnerable to crime victimization. The next
questions ask about any health conditions, impairments, or disabilities you may have.
Notes

Page 35

169a. HEARING

967

1
2

Yes
No

968

1
2

Yes
No

963

1
2

Yes
No

962

1
2

Yes
No

964

1
2

Yes
No

1
2

Yes
No

Are you deaf or do you have serious difficulty
hearing?
169b. VISION
Are you blind or do you have serious difficulty
seeing even when wearing glasses?
Because of a physical, mental, or
emotional condition, do you have
serious difficulty:

170a.

(1) LEARN_CONCENTRATE
Concentrating, remembering or making
decisions?
(2) PHYSICAL_LIMIT
Walking or climbing stairs?
(3) DRESS_BATH
Dressing or bathing?
170b. LEAVING_HOME
Because of a physical, mental, or emotional
condition, do you have difficulty doing
errands alone such as visiting a doctor's office
or shopping?
171.

CHECK

ITEM V5

Is "Yes" marked in any of 169a 170b? (That is, has the
respondent indicated that he/
she has a health condition or
disability?)

172. VICTIMDUETODISABLE

943

944

During the incident you just told me about, do
you have reason to suspect you were
victimized because of your health
condition(s), impairment(s), or disability(ies)?
173a. WHICHDISABILITYTARGET_1

1
2

Yes - ASK 172
No - SKIP to 174

1
2
3

Yes - ASK 173a
No
Don't know

SKIP to 174

946

What health conditions, impairments, or
disabilities do you believe caused you to be
targeted for this incident?

(First Condition)

Please specify the first type of health condition,
impairment, or disability.
If multiple health conditions, impairments, or
disabilities mentioned enter only the first one
mentioned here.
173b. WHICHDISABILITYTARGETELSE_1
Any other conditions, impairments, or
disabilities?
Notes

Page 36

1
2
3

Yes - ASK 173c
No
Don't know

SKIP to 174

173c. WHICHDISABILITYTARGET_2
What other health conditions, impairments, or
disabilities do you believe caused you to be
targeted for this incident?

947

(Second Condition)

Please specify the second type of health condition,
impairment, or disability.
If multiple health conditions, impairments, or
disabilities mentioned enter only the second one
mentioned here.
173d. WHICHDISABILITYTARGETELSE_2

1
2
3

Any other conditions, impairments, or
disabilities?
173e. WHICHDISABILITYTARGET_3
What other health conditions, impairments, or
disabilities do you believe caused you to be
targeted for this incident?

Yes - ASK 173e
No
Don't know

SKIP to 174

948

(Third Condition)

Please specify the third type of health condition,
impairment, or disability.
If multiple health conditions, impairments, or
disabilities mentioned enter only the third one
mentioned here.
SUMMARY
ITEM W
Summarize this incident. Also include any details
about the incident that were not asked about in the
incident report that might help clarify the incident.

174.

CHECK

Notes

Page 37

File Type	application/pdf
File Title	untitled
File Modified	2015-06-22
File Created	2009-03-23