CMEC2018 OMB Package Part b

SUPPORTING STATEMENT – Part B
2018 Census of Medical Examiner and Coroner Offices (CMEC)
1. Universe and Respondent Selection
The universe for the 2018 Census of Medical Examiner and Coroner Offices (CMEC) will be
based on the frame that was successfully developed and employed in the 2004 CMEC combined
with updated information from the Drug Enforcement Agency’s (DEA) 2017 National Forensic
Laboratory Information System (NFLIS) Medical Examiner and Coroner Office (OMB # 11170037) survey and a contact information verification effort to be conducted starting January 2019
(see below for discussion).
The universe is defined to include any office that conducts medicolegal death investigations
(MDI) for the jurisdiction it serves. To be eligible for completion of the Census for Medical
Examiner and Coroner Offices, the following must be positive for a medical examiner or coroner
office: 1) it investigates to determine a final cause and manner of death; 2) it signs death
certificates; and 3) it determines when autopsies should be performed, even if the autopsy is
performed outside of the office in an external autopsy facility. Based on these criteria and in
keeping with the definitions of the 2004 CMEC, Justice of the Peace offices, some of which do
sign death certificates but do not conduct further medicolegal death investigation, will be
excluded from the 2018 CMEC.
The initial frame for the 2004 CMEC was provided to BJS by the Centers for Disease Control
and Prevention and updated by RTI through internet and professional association searches. In
2004, 2,062 medical examiner or coroner offices (MECs) were enumerated; the final frame
excluded 64 offices in Louisiana due to Hurricane Katrina for a total of 1,998 offices. For the
2017 NFLIS data collection effort, 2,156 MECs were enumerated via internet searches, lists from
the National Association of Medical Examiners (NAME), the International Association of
Coroners and Medical Examiners (IAC&ME), and state MEC association directories. After the
survey findings were reviewed, and using the same eligibility criteria as CMEC, 2,128 MECs
were determined to be eligible for the NFLIS-MEC program after duplicate entries, independent
autopsy facilities, and county coroners who were actually combined with another MEC office
were eliminated from the frame. Based on these experiences, BJS estimates 2,200 offices may be
contacted.
Based on an OMB generic clearance approval (1121-0339), RTI is in the process of conducting a
frame verification effort. That effort includes telephone outreach to confirm or collect contact
information of the 268 offices that were absolute nonresponders to the NFLIS survey and efforts
to locate any offices that may have been missed in prior efforts. Those searches utilize
professional lists such as those from NAME and IAC&ME and additional internet searches. It is
anticipated that up to 50 new offices may be added to the frame based on the NFLIS project
team’s experience in post-data collection cleaning of the MEC universe. BJS estimates that as
part of this verification effort, up to 325 MEC offices will be contacted.
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The information gleaned from this effort will be combined to produce a current universe list of
MECs. Any duplicates will be identified and removed by examining the file for identical or
nearly identical addresses, phone numbers, or names of the coroner or chief medical examiner.
From this verification effort and the 2,128 offices contacted for the NFLIS project, BJS is
estimating up to 2,200 offices may be contacted for the CMEC.
The 2018 CMEC will be a census rather than a sample survey. The reasons for this decision
include:
•

The eligible population is approximately 2,200 agencies. Moving to a sample survey with
a universe of this size will not result in significant cost savings given the stratification
dimensions needed to capture critical aspects of the universe, such as size and
jurisdictional characteristics. The MDI is such a well-known constellation of disparate
agencies that it has been called a “patchwork” in the forensic professional, scientific, and
popular literatures. The differences in MDI systems between, and in some cases within,
states complicates efforts to create representative sampling strata. The form of the MDI
system is determined at the state level, so any stratification would need to be done within
states. In 2004, most states had county coroners responsible for medicolegal death
investigation, but many states used either medical examiners or organized medicolegal
death investigation at some other (municipal, regional, or state) level. Table 5 shows the
number of these offices by type of medicolegal death investigator.
Table 5. Distribution of Medical Examiner and Coroner Office Type, 2004

City
County
District or Region
State
Total

Coroner
0
1,590
29
0
1,619

Medical Examiner
3
316
35
24
378

Total
3
1,906
64
24
1,997

Any sample-based strategy would likely use the complete population in all these cells
except for county coroner. By undertaking a census BJS retains the ability to make
estimates across regions and across population served within any of the cells.
•

A census provides BJS with the opportunity to show how MECs vary across and within
states. Being able to compare MECs is particularly important considering the variability
that exists among these organizations in terms of administration, caseload, policies,
procedures, resources, staffing, and infrastructure. These differences were critical
findings in the 2004 CMEC (Hickman, Hughes, Strom, & Ropero-Miller, 2007;
https://www.bjs.gov/content/pub/pdf/meco04.pdf).

•

A census provides an opportunity to build a foundation for conducting future surveys of
MECs by other federal agencies. Completing the census, for example, will provide the
information necessary to produce samples based on a more comprehensive and fuller
understanding of how each MEC operates given the variability that exists within and
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across states. Generating samples of MECs without this crucial information would be
more time intensive and costly. A complete frame may be used for future research in
studying only one type of office (either medical examiners or coroners) or drawing
samples to support public health surveillance programs (such as the re-established Drug
Abuse Warning Network (DAWN) from the Substance Abuse and Mental Health
Services Administration).
•

The small increase in effort to conduct a census over a sample will allow BJS to report
subnational and state-level estimates on MECs in all 50 states and Washington DC.

2. Procedures for Collecting Information
CMEC will utilize a multi-mode data collection approach with web as the primary mode (see
Attachment 3 for example screenshots) and hard copy data collection as an alternative. CMEC
will utilize mail, email, and telephone follow-up as needed. The data collection period is planned
for approximately seven months and will involve initial invitations, several reminders, and an
end-of-study letter. There will be data quality follow-up and non-response follow-up. To
promote an efficient and cost effective data collection, the web-based submission method will be
promoted over submitting printed copies of the questionnaire and initial mailing will not include
a copy of the paper instrument, but rather instructions to complete the questionnaire online.
Table 6 shows the 2018 CMEC contact schedule.
Table 6. 2018 CMEC Contact Schedule
Week
0
2
3
6

Contact description
Mailed pre-notification
Mailed survey invitation and endorsement letters
Email survey invitation and endorsement letters
Reminder 1 - mail and email
Start telephone/email data quality follow-up; start telephone prompting
8
for incomplete responders
11
Reminder 2 - postcard reminder
14
Reminder 3 – email or letter
17
Reminder 4 – letter with questionnaire and business reply envelope
19
Start telephone and email non-response follow up
20
Reminder 5 – postcard reminder
22
End-of-study email/letter reminder
Variable Thank you letter

Attachment(s)
6
7, 22, 23
8, 22, 23
9, 10
16, 17
11
12, 13
14, 2
18
15
19, 20
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Pre-notification letter. The data collection period will open with a pre-notification letter (see
Attachment 6), on BJS letterhead and signed by the BJS director, being sent to all MECs. The
pre-notification letter highlights the importance of the 2018 CMEC and encourages participation.
It also provides contact information that can be used to obtain additional information.

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Invitation package and email message. Two weeks after the pre-notification letter is sent, RTI
will mail an invitation package including a cover letter (Attachment 7) to the director or designee
of all eligible MEC offices. This letter, signed by the BJS program manager, will include the survey
web address, agency specific log-in credentials, and instructions to complete the web survey. The letter
will stress the purpose and importance of CMEC and the need for participation. It will notify the
recipient of the survey due date and provide RTI contacts for any questions or comments. This
invitation package will include letters of support from both the National Association of Medical
Examiners (NAME) (Attachment 22) and the International Association of Medical Examiners &
Coroners (IAC&ME) (Attachment 23). Because this population has not been well-surveyed, it is not
known what percentage of MECs will respond to the invitation package.
Within a week after the mailed invitation letter is sent, an email invitation (see Attachment 8) will be
sent to those directors/designees for whom an email address is available. This invitation is closely
aligned with the mailed invitation letter but contains a hyperlink to the web survey.
Mail and email reminders. Starting three weeks after the invitation package is sent, the project
team will begin to send reminders to respondents alternating between mail and email to keep
survey reminders fresh according to the following schedule—
•Week 6: Three weeks after the invitation package is sent, the project team will send the
first reminder via letter to nonrespondents for whom it has no email address (Attachment
9). Respondents for whom the project teams has an email will also receive a reminder via
email (Attachment 10).
•Week 11: Five weeks after the first reminder, the project team will mail a second
reminder via postcard (Attachment 11).
•Week 14: Three weeks after the second reminder, the project team will send a third
reminder via email (Attachment 12) or via letter (Attachment 13) for those offices for
which it does not have an email address.
•Week 17: Three weeks after the third reminder, the project team will send the fourth
reminder via letter (Attachment 14) including the questionnaire (Attachment 2) and a
business reply envelope with which to return the completed form.
•Week 20: Three weeks after the fourth reminder, the project team will send the fifth
reminder via postcard (Attachment 15).
Telephone and email data quality follow-up. Approximately 8 weeks after data collection
begins, RTI will begin reviewing the data received. As data discrepancies or missing data values
are discovered, RTI staff will follow up with respondents via telephone or email to clarify
responses or obtain missing information (Attachment 16).
Telephone prompting for incomplete responses. Approximately 8 weeks into data collection,
RTI will be begin telephone prompting for incomplete responders. As responders have the ability
to break off from a survey and pause, this effort will be geared toward prompting respondents
who have begun but did not complete their surveys (Attachment 17). These communications
will also allow the project staff to assess whether respondents have any issues accessing and
completing the survey. Responses will be considered incomplete if a form is partially completed,
and remains incomplete for three weeks.
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Telephone and nonresponse follow-up. Nineteen weeks into the data collection (two
weeks after the fourth reminder), telephone follow-up with nonrespondents will begin
(Attachment 18). Respondents will be reminded of the purpose and importance of the survey and
informed of the goal of receiving a completed survey from each office. They will be asked to
submit the survey online but will be sent another hard copy version of the survey if requested.
Up to 10 calls will be made by RTI until surveys are received (or an office refuses to participate)
and will reference the most recent communication (e.g., reminder letters, reminder emails, etc.).
This effort will also be used to capture survey items deemed critical from non-responders.
Mail and email the end-of-study notification. In week 22 of the data collection (two weeks
after the fifth reminder), RTI will send an end-of-study notification both via mail and email to
notify nonrespondents that the study is coming to an end and that their response is needed within
two weeks (Attachments 19, 20). Data collection will continue for approximately three more
weeks to allow for receipt of any remaining questionnaires.
Thank-you letters. Beginning two weeks after the invitation package is sent out, RTI will mail
thank you letters to those respondents who have completed the survey (Attachment 21). These
letters will thank them for the time and effort necessary to complete the survey and once again
emphasize the importance of CMEC data. Mailings of thank you letters will continue until the
survey ends and all responders have been mailed a letter.
Data Editing. As part of the data quality follow-up, RTI will attempt to reconcile missing or
erroneous data through automated and manual edits of questionnaires within two weeks of
completion. In collaboration with BJS, RTI will develop a set of edits that will use other data
provided by the respondent on the survey instrument to confirm acceptable responses or identify
possible errors due to missing or inconsistent data elements. For example, if a screening question
was left blank, but the follow-up questions were completed, a manual edit would be made to
indicate the intended positive response to the screening question. Through this process, RTI can
quickly identify which hard copy questionnaires require follow-up and indicate the items that
need clarification or retrieval from the respondent.
Data Retrieval. When errors due to missing or inconsistent data elements are found during data
review and editing, attempts to verify or collect the correct information with the respondent will
occur. When it is determined that data retrieval is needed, a project staff member will contact the
respondent for clarification. Throughout the data retrieval process, RTI will document the
questions needing retrieval (e.g. missing or inconsistent data elements) then request clarification
on the provided information, obtain values for missing data elements, and discuss any other
issues related to the respondent’s submission.
Data Entry. Respondents completing the survey via the web instrument will enter their
responses directly into the online instrument. The instrument will have quality control checks
programmed in to enforce skip patterns and check for out-of-range values. For those respondents
returning the survey via hardcopy (mail or fax), the survey responses will be hand keyed by
trained and certified data entry personnel at RTI’s Raleigh Operations Center (ROC). Twenty
percent of these manually coded surveys will be entered a second time and have results
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compared as a form of quality control. Additionally, supervisors will conduct random spot
checks of all manually entered surveys. Any anomalies, inconsistencies, or unexpected values
will be investigated and resolved. Throughout the remainder of the data collection period, RTI
and BJS staff will conduct regular data frequency reviews to evaluate the quality and
completeness of data captured in both the web and hard copy modes. Data files will be made
available to BJS via an SFTP site when response rates reach 50%, 75%, and 90%.
3. Methods to Maximize Response Rates
The 2004 CMEC achieved an 86% response rate. BJS and RTI will undertake various activities
to ensure that high response rates are again achieved for the 2018 CMEC. CMEC will use a webbased instrument supported by various online help functions to maximize response rates. A tollfree number will also be provided for both substantive and technical assistance. RTI staff will
respond to these requests for assistance.
The survey instrument was reviewed to ensure the collection of the most pertinent information,
removing any unnecessary questions to reduce burden. An item-level review of the 2004 CMEC
was done to look for patterns of non-response (Attachment 24). When an item response rate was
below 75%, or there was a 5% or greater percentage point difference between medical examiners
and coroners, the item was flagged and discussed with the expert panel. Nineteen items from the
2004 CMEC met this criteria. Any items that were not dropped at the recommendation of the
expert panel were revised and tested in cognitive interviews. The questionnaire was also
reviewed for ease of use, flow, and additional survey methodology best practices to ensure ease
in administration by expert panel reviewers and by BJS and RTI. BJS and RTI worked with a
group of subject matter experts from MEC offices that varied in characteristics (type of office,
size of office, and geographical location) to further clarify questions that could create confusion,
eliminate questions that were not relevant to the field, and to revise questions that were out of
date. Because MEC offices use differing vocabulary to describe similar procedures, additional
directions and definitions have been added to those questions to provide a direct example of the
information BJS is looking for.
BJS will encourage respondents to submit their information via the web survey. Close attention
has been paid to the formatting of the web survey instrument. The survey is formatted in a userfriendly manner and in such a way that respondents can complete it on a computer or tablet,
through various browsers (e.g. Internet Explorer, Firefox, and Google Chrome), and at various
resolutions or screen sizes. The web survey saves respondents’ answers automatically and gives
them the option to save their progress, leave the survey and resume at a later time. Data will be
checked as it is collected for completeness and logical consistency of responses. The online
survey is programmed with data consistency checks and prompts to ensure logical consistency
like enforcement of skip patterns and out-of-range responses. This will help reduce the need for
data quality follow up calls following respondents’ submission of the questionnaire. However,
where information does appear to be incomplete or inconsistent RTI project staff will follow up
with respondents via telephone (Attachment 16).
To encourage participation and obtain higher response rates, project staff will conduct outreach
and follow-up procedures at various points during the data collection. This includes reminders to
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take the survey (Attachments 9–15), data quality follow up (Attachment 16), survey
completion prompting (Attachment 17), and nonresponse follow up calls (Attachment 18).
Throughout the data collection, resources will be available to help respondents complete the
survey. For technical help this includes telephone and email Help Desk support, and for overall
questions or concerns with the survey, this includes providing respondents with BJS contacts.
The non-response follow up script also includes prompts for nonresponders to provide items
deemed critical for the CMEC to capture. These items are highlighted on the survey form
(Attachment 2).
The 2004 CMEC enjoyed widespread support by the National Association of Medical Examiners
and the International Association of Coroners and Medical Examiners, which were enlisted to
help with the development of the questionnaire and to encourage individual offices to respond to
the survey. This continues to be case for 2018 project, and these letters of support will be
included in the survey invitation package (Attachments 22, 23).
To promote 100% item completion by respondents, RTI will monitor item response rates as
surveys are submitted. RTI has a survey management system linked to the web-based application
that will flag missing items and invalid responses. RTI will also flag missing items on hard copy
submissions on a flow basis. The data collection manager will oversee phone and email outreach
to respondents to clarify missing or invalid responses and to take corrective action (Attachment
16). Changes to survey responses obtained through this follow-up effort will be tracked and
entered in the data collection database.
As the 2018 CMEC is planned to be a complete census of coroners and medical examiners,
sampling weights are not necessary. However, in the event unit response rates are lower than
anticipated, some weighting of the data may be required. The extent of this step will depend on
response rates within sub-groups of the respondent pool. Response rates within jurisdiction size
grouping, public health region of the country, and office type will be reviewed to determine if a
weighting adjustment is necessary. To ensure that nonresponding agencies are not different than
those that participate, a nonresponse bias analysis will be conducted if the unit response rate falls
below 80 percent. Administrative data on the type of office, state in which the office is located,
and population served will be used in the nonresponse bias analysis.
Imputation procedures will be used to address issues of item nonresponse. Given the age of the
most recent CMEC, cold-deck imputation is not a plausible solution for item nonresponse in this
instance. If item nonresponse overlaps with the NFLIS data elements, then the responses offices
provided for NFLIS may offer a basis for imputation. As needed, BJS will consider hot-deck and
multiple imputation methods, flagging observations and values that were imputed in the archived
dataset.
4. Testing of Procedures
The proposed new questions in the 2018 CMEC data collection instrument and the revisions
made to those retained from 2004 were reviewed by BJS and RTI staff, suggested and discussed
by the Expert Panelists, and cognitively tested.

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BJS and RTI cognitively tested the instrument with 14 offices (7 medical examiners and 7
coroners) of 18 initially selected. Offices varied by geographic region, size, and population
served. To conduct the cognitive interviews, RTI talked with respondents via telephone for about
two hours while respondents read through the questionnaire item by item. Each item had at least
one probing question the RTI interviewer would ask the respondent to assess clarity and ease of
answering the questions. The cognitive testing provided insight into whether respondents fully
understood questions and provided expected answers, informed our phrasing and response
options, and provided an estimate of the burden (Attachment 25). The instrument was modified
to increase comprehension as a result of these interviews.
In addition, RTI and BJS will thoroughly test the web-based survey administration system
through systematic user testing, including testing skip patterns, attempting to “break” the
instrument, and back-end data checks on entered responses.
The 2018 CMEC will maintain similar respondent recruitment and support procedures as the
2004 CMEC administration, which was field tested and successfully employed. We expect that
response rates for the 2018 CMEC will at a minimum match the 86% response rate set by the
2004 administration and potentially, achieve over a 95% response rate. RTI has previously
utilized web-based survey instruments that are substantially similar to the format in design for
the 2018 CMEC in recent Law Enforcement Management and Administrative Statistics
(LEMAS) survey (OMB #1121-0240) and Census of State and Local Law Enforcement
Agencies (CSLLEA) (OMB #1121-0346) administrations. The web-based survey administration
procedures successfully employed in the LEMAS and CSLLEA survey designs have been
substantially retained but modified as necessary to accommodate the 2018 CMEC instrument and
respondents.
5. Contacts for Statistical Aspects and Data Collection
BJS Contacts
Connor Brooks
CMEC Program Manager
Bureau of Justice Statistics
202-514-8633
[email protected]
Kevin M. Scott, Ph.D.
Law Enforcement Statistics Unit Chief
Bureau of Justice Statistics
202-616-3615
[email protected]

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RTI Project Staff
Hope Smiley-McDonald, Ph.D.
RTI International
Program Director, CMEC Principal Investigator
Jeri Ropero Miller, Ph.D.
RTI International
Chief Scientist, CMEC Co-Principal Investigator
Attachments:
1. 34 U.S.C. §10131–10132
2. 2018 CMEC questionnaire: Formatted paper instrument
3. 2018 CMEC questionnaire: Example screen shots of web instruments
4. 60-day Federal Register notice
5. 30-day Federal Register notice
6. Pre-notification letter
7. Survey invitation cover letter
8. Survey invitation email
9. 1st reminder – letter
10. 1st reminder – email
11. 2nd reminder – postcard
12. 3rd reminder – email
13. 3rd reminder – letter
14. 4th reminder – letter
15. 5th reminder – postcard
16. Data quality follow-up telephone script
17. Sample call script for telephone prompting calls
18. Sample call script for nonresponse telephone calls
19. End-of-Study letter
20. End-of-Study email
21. Thank you letter
22. Letter of Support: National Association of Medical Examiners
23. Letter of Support: International Association of Coroners & Medical Examiners
24. Data quality assessment of 2004 CMEC
25. Cognitive testing report

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