Crime Survey-V1

Generic Clearance for Cognitive, Pilot and Field Studies for Bureau of Justice Statistics Data Collection Activities

Appendix 3. Online survey instruments_final_clean

Testing of Proposed Revisions to the National Crime Victimization Survey hate crime questions

OMB: 1121-0339

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Crime Survey – v1

INTRO: This survey asks questions about possible experiences with crime during the past three years, that is since <month> of 2018. We estimate these questions will take approximately 3 minutes to complete.

  1. In the last 3 years, did anyone break into your home, garage, storage unit or shed or get in without permission? Exclude break‐ins of vehicles or trespassing in a yard.

    1. Yes

    2. No

  2. In the last 3 years, since <month> 2018, was a car, truck, or other motor vehicle belonging to anyone in your household ...

    1. Stolen?

      1. Yes

      2. No

    2. Vandalized or broken into?

      1. Yes

      2. No

  3. Was anything else stolen from you in the last 3 years (For example: cash, a wallet, purse, watch, jewelry, cell phone, tablet, or anything else that might have been stolen.)?

    1. Yes

    2. No

  4. Vandalism is when someone deliberately damages or destroys something belonging to you. Examples are breaking windows, slashing tires, or painting graffiti on walls. In the past 3 years, has anyone vandalized your home, car, or something else that belongs to you?

    1. Yes

    2. No

  5. In the last 3 years, has anyone physically attacked you?

    1. Yes

    2. No

  6. In the last 3 years, has anyone threatened you with physical violence?

    1. Yes

    2. No

  7. In the last 3 years, did you experience any type of unwanted sexual contact?

    1. Yes

    2. No

  8. In the last 3 years, did anyone attempt any type of forced unwanted sexual contact? Include times when someone threatened or tried to force you but did not succeed.

    1. Yes

    2. No

If all responses 1-8=no, skip to question 16

  1. A hate crime is a crime of prejudice or bigotry that occurs when an offender targets someone because of one or more of their characteristics or religious beliefs, such as:

- Race

- Religion

- Ethnic background or national origin

- A disability

- Sex

- Sexual orientation or gender identity



This could happen even if the offender falsely thinks you have certain characteristics or religious beliefs. Thinking about the crimes that happened to you in the past 3 years, do you think any of these were a hate crime targeted at you?

  1. Yes GO TO 10

  2. No GO TO 11



  1. How many times in the past 3 years did you experience a hate crime?

    1. Once (skip to 11)

    2. More than once (show instruction)

For the remaining questions, please think about the most recent time you experienced a hate crime.

  1. Do you think prejudice or bigotry towards any of the following was a reason you were targeted, even if the offender falsely thought something about you?

    1. Because of your race?

      1. Yes

      2. No

    2. Because of your religion?

      1. Yes

      2. No

    3. Because of your ethnic background or national origin?

      1. Yes

      2. No

    4. Because of any disability you may have?

      1. Yes

      2. No

    5. Because of your sex?

      1. Yes

      2. No

    6. Because of your sexual orientation or gender identity - by this we mean gay, lesbian, bisexual, straight, transgender, or gender non-conforming?

      1. Yes

      2. No

If yes to any, move to 12

  1. Do you think this was a hate crime targeted at any of the people you spend time with?

    1. Yes (ask 14)

    2. No (skip to question 16)



  1. Did the offender(s) say something, write something, or leave something behind at the crime scene that made you think it was a hate crime?

    1. Yes (ask 14)

    2. No (skip to question 16)



  1. Did any of the following things happen?

    1. The offender(s) used language that indicated you were targeted for a hate crime because of your sex, religion, race or ethnicity, sexual orientation or gender identity, or a disability

      1. Yes

      2. No

    2. There was something at the scene, such as a swastika or a burning cross, that made you think this was a hate crime

      1. Yes

      2. No

    3. The police told you that this was a hate crime

      1. Yes

      2. No

    4. From what you know, the offender(s) had committed similar hate crimes in the past

      1. Yes

      2. No

    5. The incident happened around a holiday, event, or place commonly associated with a specific group

      1. Yes

      2. No

    6. Other hate crimes had occurred in your local area or neighborhood

      1. Yes

      2. No

    7. Something else happened that would suggest it was a hate crime.

      1. Yes Specify: _____________

      2. No

  2. In your own words, please describe <the/the most recent> hate crime you experienced. What happened? Where did it happen? Did you know the offender? What made you think this was because of your [protected characteristic(s) indicated in survey, if applicable]. Please do not use proper names in describing the location or offender.

Shape1











The last set of questions ask about your personal characteristics.

  1. What is the highest level of education you have completed?


1 High School Graduate

2 Some College

3 College Graduate

4 Post-Graduate degree


  1. What is your gender?


1 Male

2 Female

3 Transgender

4 None of these


  1. Are you Spanish, Hispanic, or Latino?


1 Yes

  1. No



  1. Please choose one or more races that you consider yourself to be.


1 White

2 Black or African American

3 American Indian or Alaskan Native

4 Asian

5 Native Hawaiian or Other Pacific Islander

6 Other (specify ____________________ )



  1. Which of the following age groups includes your age?


1 Under 18

2 18-25

3 26-34

4 35-49

5 50 or Older



Thank you for completing the survey. Please enter your email address to receive your $5 Amazon.com gift card ____________________________________.

We are interested in meeting with people who can help us review and improve a survey instrument that is designed to measure hate crimes or crimes of prejudice or bigotry targeted against a person’s characteristics or religious beliefs. We are looking for people who are willing to participate in private, one-on-one interviews using videoconferencing technology to test some new questions we have developed for this survey. Our goal is to learn whether the questions are understood and can be answered by most people. This information will be used to finalize survey questions for a national study.

Would you be interested in participating in a 60-minute interview with a researcher? People who complete the interview will be given a $40 Amazon.com gift card to compensate for the costs associated with data and internet usage.

    1. Yes, I would be interested in participating.

      1. Email address_________________________________

    2. No, I do not want to participate in this study



Crime Survey – v2

INTRO: This survey asks questions about possible experiences with crime during the past three years, that is since <month> of 2018. We estimate these questions will take approximately 3 minutes to complete.

  1. In the last 3 years, did anyone break into your home, garage, storage unit or shed or get in without permission? Exclude break‐ins of vehicles or trespassing in a yard.

    1. Yes

    2. No

  2. In the last 3 years, since <month> 2018, was a car, truck, or other motor vehicle belonging to anyone in your household ...

    1. Stolen?

      1. Yes

      2. No

    2. Vandalized or broken into?

      1. Yes

      2. No

  3. Was anything else stolen from you in the last 3 years (For example: cash, a wallet, purse, watch, jewelry, cell phone, tablet, or anything else that might have been stolen.)?

    1. Yes

    2. No

  4. Vandalism is when someone deliberately damages or destroys something belonging to you. Examples are breaking windows, slashing tires, or painting graffiti on walls. In the past 3 years, has anyone vandalized your home, car, or something else that belongs to you?

    1. Yes

    2. No

  5. In the last 3 years, has anyone physically attacked you?

    1. Yes

    2. No

  6. In the last 3 years, has anyone threatened you with physical violence?

    1. Yes

    2. No

  7. In the last 3 years, did you experience any type of unwanted sexual contact?

    1. Yes

    2. No

  8. In the last 3 years, did anyone attempt any type of forced unwanted sexual contact? Include times when someone threatened or tried to force you but did not succeed.

    1. Yes

    2. No

If all responses 1-8=no, skip to question 14

  1. This next set of questions focuses on whether the offender may have been targeting you because of prejudice or bigotry toward those with your characteristics or religious beliefs, even if they thought you had certain characteristics or religious beliefs that you don’t actually have. It is different from the offender committing the act for other reasons, such as being angry or wanting to get something from you.

Thinking about the crimes that happened to you in the past 3 years, do you think any of these were done to you because the offender was targeting you due to prejudice or bigotry toward those with your…

    1. Race, ethnic background, or national origin?

      1. Yes

      2. No

    2. Religion?

      1. Yes

      2. No

    3. Disability?

      1. Yes

      2. No

    4. Sexual orientation (including being lesbian, gay, bisexual, or straight) or gender identity (including being intersex, transgender, or gender non-conforming)?

      1. Yes

      2. No

    5. Sex (i.e., against males or females)?

      1. Yes

      2. No

    6. Other characteristics, how you look or a group you are a part of?

      1. Yes

        1. Specify_________________________________

      2. No

If yes to any, skip to 11

  1. Do you think the offender did this because of the characteristics or religious beliefs of people you spend time with?

    1. Yes (ask 11)

    2. No (skip to question 14)



  1. How many times in the past 3 years did you experience a crime because the offender was targeting <people with your characteristics or religious beliefs/because of the characteristics or religious beliefs of the people you spend time with>?

    1. Once (skip to 12)

    2. More than once (show instruction)

For the remaining questions, please think about the most recent time this happened to you.

  1. Did any of the following things happen?

    1. During the incident or leading up to it, did the offender(s) use language that indicated you were targeted because of your sex, religion, race, ethnicity, or national origin, sexual orientation or gender identity, or a disability?

      1. Yes

      2. No

    2. Did the offender leave something at the scene referring to your characteristics or religion, such as graffiti with hurtful words, symbols or images, or a burning cross?

      1. Yes

      2. No

    3. Did the police find that the offender had something against people with your characteristics or religious beliefs?

      1. Yes

      2. No

    4. Did you know or learn that the offender(s) had committed similar crimes against people like you in the past?

      1. Yes

      2. No

    5. Did the incident happen around a holiday, event, or place commonly associated with a specific group?

      1. Yes

      2. No

    6. Were there other crimes against people like you in your local area or neighborhood?

      1. Yes

      2. No

    7. Did something else happen that would suggest the offender had something against people with your characteristics or religious beliefs?

      1. Yes Specify: _________________________________________

      2. No



  1. Do you believe the incident was a hate crime?

      1. Yes (ask Q14)

      2. No (skip to Q15)



  1. Did you tell the police that you believe the incident was a hate crime?

      1. Yes

      2. No



  1. Shape2 In your own words, please describe <the/the most recent> incident in which an offender targeted you because of your characteristics or religious beliefs. What happened? Where did it happen? What made you think this was because of your [protected characteristic(s) indicated in survey, if applicable]. Did you know the offender? Please do not use proper names in describing the location or offender.









The last set of questions ask about your personal characteristics.

  1. What is the highest level of education you have completed?


1 High School Graduate

2 Some College

3 College Graduate

4 Post-Graduate degree


  1. What is your gender?


1 Male

2 Female

3 Transgender

4 None of these


  1. Are you Spanish, Hispanic, or Latino?


1 Yes

  1. No



  1. Please choose one or more races that you consider yourself to be.


1 White

2 Black or African American

3 American Indian or Alaskan Native

4 Asian

5 Native Hawaiian or Other Pacific Islander

6 Other (specify ____________________ )



  1. Which of the following age groups includes your age?


1 Under 18

2 18-25

3 26-34

4 35-49

5 50 or Older



Thank you for completing the survey. Please enter your email address to receive your $5 Amazon.com gift card ____________________________________.

We are interested in meeting with people who can help us review and improve a survey instrument that is designed to measure hate crimes or crimes of prejudice or bigotry targeted against a person’s characteristics or religious beliefs. We are looking for people who are willing to participate in private, one-on-one interviews using videoconferencing technology to test some new questions we have developed for this survey. Our goal is to learn whether the questions are understood and can be answered by most people. This information will be used to finalize survey questions for a national study.

Would you be interested in participating in a 60-minute interview with a researcher? People who complete the interview will be given a $40 Amazon.com gift card to compensate for the costs associated with data and internet usage.

    1. Yes, I would be interested in participating.

      1. Email address_________________________________

    2. No, I do not want to participate in this study









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