2021 Identity Theft Supplement

Identity Theft Supplement to the National Crime Victimization Survey

Attachment 1_2021 Identity Theft Supplement Questionnaire

OMB: 1121-0317

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2021 Identity Theft Supplement
SECTION A: SCREENER QUESTIONS
INTRO 1: Now, we are conducting a special supplement on identity theft and I would like to ask you
questions. Identity theft means someone else using your personal information without your
permission to buy something, get cash or services, pay bills, or avoid the law. We will not ask you for
any specific account information. We estimate these questions will take from 5 to 15 minutes
depending on your circumstances. The U.S. Census Bureau is required by law to keep your
information confidential.
First, I’d like to ask you some questions about the possible misuse of EXISTING ACCOUNTS, which
includes existing checking, savings, credit card, social media, and other types of accounts.
1. Have you ever had a checking or savings account in your name through a bank or financial
institution?
YES
NO (Skip to Q5)
2. Has anyone EVER used your checking or savings account to make a purchase or withdraw money
without your permission?
•
•
•

Include times when someone used your debit or ATM cards to make a purchase or
withdraw money without your permission.
ONLY include times when money was actually deducted from your checking or savings
account, regardless of whether you were reimbursed later or not.
DO NOT include times when someone used your credit card or online pay accounts.

YES
NO (Skip to Q5)
3. Has this happened during the past 12 months, that is from [AUTOFILL DATE 1st OF MONTH 1 YEAR
PRIOR] until today?
YES
NO (Skip to Q5)

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4a. Did this most recently happen in 2021 or 2020?
1. 2021
2. 2020
4b. And in what month? ____________________________ Month (01-12)
If you don’t know, please provide your best estimate.
Next, I have some questions about the possible misuse of EXISTING CREDIT CARD ACCOUNTS.
5. Have you ever had a credit card account in your name? Include major credit cards such as a
MasterCard or Visa, and credit cards through retailers, such as Kohl’s, Walmart, or Amazon. Please
do not include debit cards or gift cards.
YES
NO (Skip to Q9)
6. Has anyone EVER used one or more of your credit card accounts without your permission? ONLY
include times when charges actually posted to your account, regardless of whether you were
reimbursed later.
YES
NO (Skip to Q9)
7. Has this happened during the past 12 months, that is from [AUTOFILL DATE 1st OF MONTH 1 YEAR
PRIOR] until today?
YES
NO (Skip to Q9)
8a. Did this most recently happen in 2021 or 2020?
1. 2021
2. 2020
8b. And in what month? ____________________________ Month (01-12)
If you don’t know, please provide your best estimate.

3

These next questions focus on the possible misuse of your existing EMAIL OR SOCIAL MEDIA
ACCOUNTS.
9a. Have you ever had at least one email account, such as Gmail or Outlook, or social media account
such as Facebook or Instagram?
YES
NO (Skip to Q11)
9b. Has anyone EVER used your email or social media account without your permission to pretend
to be you?
YES
NO (Skip to Q11)
10a. Has this happened during the past 12 months, that is from [AUTOFILL DATE 1st OF MONTH 1
YEAR PRIOR] until today?
YES
NO (Skip to Q11)
Which account was used without your permission…
10b. Email account, such as Gmail or Outlook? YES NO
10c. Social media account, such as Facebook or Instagram? YES NO
HARD EDIT CHECK: If Q10a is marked “yes” and BOTH Q10b and Q10c are marked “no”
You reported either your email or social media account was misused in Q10a, but didn't identify any
of these accounts in Q10b or Q10c. Either Q10a should be changed to reflect that no email or social
media accounts were misused in the past 12 months, or either email or social media account should
be identified by selecting '1' (yes) to one of the following questions in Q10b or Q10c.
10d. Please think about the most recent time someone misused [this/one of these] account(s).
Did this most recently happen in 2021 or 2020?
1. 2021
2. 2020
10e. And in what month? ____________________________ Month (01-12)
If you don’t know, please provide your best estimate.

4

These next questions ask about the possible misuse of any of your other EXISTING ACCOUNTS aside
from your bank, credit card, email or social media accounts.
11. Has anyone EVER used any of your other existing accounts, without your permission, such as…
•
•
•
•
•
•

telephone or internet accounts;
utilities accounts, such as cable, gas, or electric;
medical insurance accounts, such as Medicare or a health spending account;
entertainment accounts for music, movies, or games;
online payment accounts like PayPal or Venmo; or
some other accounts?

Only include times when someone successfully posted charges to, took money from, or otherwise
misused your account.
YES
NO (Skip to Q15)
12. Has this happened during the past 12 months, that is from [AUTOFILL DATE 1st OF MONTH 1
YEAR PRIOR] until today?
YES
NO (Skip to Q15)
13. Which of the following types of your EXISTING accounts, other than credit card, bank, email, or
social media accounts, did someone post charges to, take money from, or otherwise misuse? Did
they misuse one or more of your…
13a. Telephone or internet accounts? YES NO
13b. Utilities accounts, such as cable, gas, or electric accounts? YES NO
13c. Medical insurance accounts, such as Medicare or a health spending account? YES NO
13d. Entertainment accounts, such as for movies, music, or games? YES NO
13e. Online payment accounts, such as PayPal or Venmo? YES NO
13f. Some other type of account? YES NO
[If yes] What other types of accounts were misused? __________
(If any 13a-13f = yes, ask Q14a; else skip to Q15)
HARD EDIT CHECK: If Q12 is marked “yes” and ALL of Q13a through Q13f are marked “no”
You reported one or more of your existing accounts were misused in Q12, but didn't identify any of
these existing accounts in Q13a, Q13b, Q13c, Q13d, Q13e, or Q13f. Either Q12 should be changed to
reflect that no existing accounts were misused in the past 12 months or the type of existing account
should be identified by selecting '1' (yes) to one or more of the following questions in Q13a, Q13b,
Q13c, Q13d, Q13e, or Q13f.

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14a. Please think about the most recent time someone misused [this/one of these] existing
accounts.
Did this most recently happen in 2021 or 2020?
1. 2021
2. 2020
14b. In what month? __________________________ Month (01-12)
If you don’t know, please provide your best estimate.
Next, I have some questions about any NEW ACCOUNTS someone might have opened using your
personal information.
15. Has anyone EVER, without your permission, used your personal information to successfully open
any NEW accounts, such as…
•
•
•
•
•
•
•
•
•
•
•

checking or savings account;
credit card accounts;
email accounts, such as Gmail or Outlook;
social media accounts, such as Facebook or Instagram;
telephone or internet accounts;
utilities accounts, such as cable, gas, or electric;
entertainment accounts, such as for music, movies or games;
loans or mortgages;
insurance policies;
online payment accounts, such as PayPal or Venmo; or
some other type of new account?

Please include times when someone successfully opened a new account, even if you did not lose
any money or were reimbursed later.
YES
NO (Skip to Q19)
16. Has this happened during the past 12 months, that is from [AUTOFILL DATE 1st OF MONTH 1
YEAR PRIOR] until today?
YES
NO (Skip to Q19)

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17. With this next question, I’m going to read a list of 11 NEW accounts someone may have
successfully opened using your personal information without your permission during the past 12
months. You can say yes to more than one account.
Did someone open…
17a. New checking or savings accounts? YES NO
17b. New credit card accounts? YES NO
17c. New email accounts such as Gmail or Outlook? YES NO
17d. New social media accounts, such as Facebook or Instagram? YES NO
17e. New telephone or internet accounts? YES NO
17f. New utilities accounts, such as cable, gas, or electric? YES NO
17g. New entertainment accounts, such as for music, movies, or games? YES NO
17h. New loans or mortgages? YES NO
17i. New insurance policies? YES NO
17j. New online payment accounts, such as PayPal or Venmo? YES NO
17k. Some other type of new account? YES NO
[If yes] What other type of new account was opened? __________
(If any 17a-17k = yes, ask Q18a; else skip to Q19)
HARD EDIT CHECK - If Q16 is marked “yes” and ALL of Q17a through Q17k are marked “no”
Responses to questions Q17a, Q17b, Q17c, Q17d, Q17e, Q17f, Q17g, Q17h, Q17i, Q17j, and Q17k are
inconsistent with answer to Q16 = Yes. Either the response to Q16 is incorrect or one or more of the
following questions Q17a, Q17b, Q17c, Q17d, Q17e, Q17f, Q17g, Q17h, Q17i, Q17j, or Q17k should be
marked '1' (Yes).
18a. Please think about the most recent time someone successfully opened [this/one of these] new
accounts.
Did this most recently happen in 2021 or 2020?
1. 2021
2. 2020
18b. And in what month? ___________________________ Month (01-12)
If you don’t know, please provide your best estimate.

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The next set of questions are about any other misuses of your personal information.
19. Has anyone EVER used your personal information for some other fraudulent purpose such as…
•
•
•
•
•
•
•

filing a fraudulent tax return;
getting medical treatment;
applying for a job;
providing your information to the police to conceal their identity;
providing your information to some other government authority such as the Department of
Motor Vehicles;
applying for government benefits; or
something else?

Please consider only times when your information was actually used, even if the situation was later
resolved.
YES
NO (Skip to Check Item A)
20. Has this happened during the past 12 months, that is from [AUTOFILL DATE 1st OF MONTH 1
YEAR PRIOR] until today?
YES
NO (Skip to Check Item A)
21. In which of the following ways has someone used your personal information during the past 12
months? Was your personal information used…
21a. To file a fraudulent tax return? YES NO
21b. To get medical treatment? YES NO
21c. To apply for a job? YES NO
21d. To provide false information to the police to conceal their identity? YES NO
21e. To provide false information to some other government authority such as the Department of
Motor Vehicles? YES NO
21f. To apply for government benefits? YES NO
21g. In some other way not already mentioned? YES NO
[If yes] How else was your personal information misused? __________
(If any 21a-21g = yes, ask Q22a; else skip to Check Item A)
HARD EDIT CHECK: If Q20 is marked “yes” and ALL of Q21a through Q21g are marked “no”
Response to Q20 is inconsistent with responses to Q21a, Q21b, Q21c, Q21d, Q21e, Q21f, and Q21g.
Either the response to Q20 is incorrect or one or more of the questions Q21a, Q21b, Q21c, Q21d,
Q21e, Q21f, and Q21g should be answered '1' (Yes).

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22a. Please think about the most recent time your personal information was misused in [this
way/one of these ways].
Did this most recently happen in 2021 or 2020?
1. 2021
2. 2020
22b. And in what month? ____________________________ Month (01-12)
If you don’t know, please provide your best estimate.
CHECK ITEM A
Is “no,” “don’t know,” “refused,” or “blank” marked for Q2, Q6, Q9b, AND “no,” “don’t know,” or
“refused,” marked for Q11, Q15, and Q19?
YES – Skip to Section H
NO – Skip to Check Item B
CHECK ITEM B
Is “no,” “don’t know,” “refused,” or “out of universe” marked for Q3, Q7, Q10a, Q12, Q16, AND Q20?
YES – Skip to Section G
NO – Skip to Check Item C
CHECK ITEM C
Is only one response marked “yes” from questions Q3, Q7, Q10a, Q12, Q16, AND Q20?
YES – Skip to Q23
NO – Skip to Check Item D
CHECK ITEM D
Is the most recent Month/Year provided more than once in Q4a/b, Q8a/b, Q10d/e, Q14a/b, Q18a/b,
and Q22a/b (e.g. if respondent answered 2021, May in both Q4a/b and Q8a/b, select “yes.”)?
YES – Skip to Q24
NO – Ask Q23

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23. You said that in  someone . Was this the result of one related incident or was your personal information misused
multiple times in separate unrelated incidents? An incident of identity theft occurs when your
information is stolen. A stolen credit card or debit card may be used multiple times but this should
be considered a single incident.
1. Multiple Incidents (Skip to Section B, Intro 1)
2. One related incident (Skip to Section B, Intro 2)
If the respondent states, “I don’t know,” instruct the respondent to select what they believe to be
the best response.
24. You said that in  someone . Were these the result of one related incident or was your personal information misused
multiple times in separate unrelated incidents? An incident of identity theft occurs when your
information is stolen. A stolen credit card or debit card may be used multiple times but this should
be considered a single incident.
1. Multiple Incidents (Ask Q25)
2. One related incident (Skip to Section B, Intro 2)
If the respondent states, “I don’t know,” instruct the respondent to select what they believe to be
the best response.
25. Which of these misuses of your personal information happened during the most recent
incident?
(Mark all that apply, and only read response items that match autofill “yes” responses from Q2, Q6,
Q9b, Q11, Q15, and Q19)
1.
2.
3.
4.
5.
6.

Misuse of an existing checking and/or savings account
Misuse of an existing credit card account
Misuse of an existing email or social media account
Misuse of other types of existing accounts
Misuse of personal information to open a NEW account
Misuse of personal information for other fraudulent purpose.

(Skip to Section B, Intro 1)

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SECTION B. HOW/WHEN IDENTITY THEFT DISCOVERED
INTRO 1: For those with more than one incident: I will now ask you to consider only the most recent
incident of identity theft that you experienced during the past 12 months.
For the next series of questions, please think about the [autofill most recent type of ID theft from
Q25 or (“yes” response from Q2, Q6, Q9b, Q11, Q15, OR Q19)] you experienced in [autofill most
recent month/year from Q4a/b, Q8a/b, Q10d/e, Q14a/b, Q18a/b, or Q22a/b].
INTRO 2: For those with a single incident For the next series of questions, please think about the
[autofill “yes” responses from (Q2, Q6, Q9b, Q11, Q15, or Q19] you experienced in [autofill
month/year from Q4a/b, Q8a/b, Q10d/e, Q14a/b, Q18a/b, or Q22a/b].

26. How did you FIRST find out about the most recent incident of misuse of your personal
information?
(SELECT A SINGLE RESPONSE)
DISCOVERED BY RESPONDENT
1. I contacted the credit card company or bank to report a theft and was told that fraudulent
charges had already been made.
2. I noticed money missing from my account.
3. I noticed fraudulent charges on my account.
4. I received merchandise or a card that I did not order.
5. I had problems using my card or account because it was declined, closed, or had insufficient
funds.
6. I applied for credit, a bank account or loan, utilities such as cable service, employment, or
government benefits, etc. and had problems.
7. I checked my credit report.
8. I received a bill that I did not owe.
9. I had a problem filing my income taxes.
NOTIFIED BY FINANCIAL INSTITUTION
10. Credit card company or bank contacted me about suspicious activity on my account.
11. My credit monitoring service contacted me.
12. A collection agency, credit card company, credit bureau, or other financial institution
contacted me about late or unpaid bills.
NOTIFIED BY OTHER PARTY
13. A law enforcement agency notified me.
14. A company or agency notified me.
OTHER
15. Discovered in another way - (specify)

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27. In what year and month did you first discover that someone had misused your personal
information?
Enter year: __________
1. 2021
2. 2020
3. 2019 or prior
Enter month: __________ Month (01-12)
SOFT EDIT CHECK: Respondent gave month/year in Q27 that is prior to the most recent month/year
of Q4a/b, Q8a/b, Q10d/e, Q14a/b, Q18a/b, or Q22a/b.
Respondent reported that they discovered the most recent incident identity theft prior to the
month/year that it occurred. Return to Q27 (WHEN_DISCOVERED_YEAR) to correct the date or accept
the inconsistency.
28. How long had your personal information been misused before you discovered it?
1.
2.
3.
4.
5.
6.
7.
8.

One day or less (1-24 hours)
More than a day, but less than a week (more than 24 hours-6 days)
At least a week, but less than one month (7-30 days)
One month to less than three months
Three months to less than six months
Six months to less than one year
One year or more
Don’t know

29. Do you have any idea HOW your personal information was obtained, even if you are not
completely certain?
YES
NO (Skip to Q31)

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30. How do you think your personal information was obtained?
(SELECT A SINGLE RESPONSE)
1. I lost an item that included my personal information.
2. My wallet, checkbook, or purse was stolen.
3. My personal information recorded on paper documents was stolen from a place where it was
stored or placed such as my office or trash.
4. It was accessed electronically from my work or home computer, cell phone, tablet, or other
electronic device.
5. It was stolen during an online purchase/transaction.
6. Someone stole it during an in-person purchase/transaction, including using a skimmer or card
reader.
7. I responded to a scam email/phone call.
8. My personal information was stolen from my personnel or human resources files at my place
of employment.
9. It was stolen from an office/company such as a financial institution, retailer, service provider,
or restaurant.
10. Obtained in another way (specify)____________
SECTION C. VICTIM RESPONSE
31. Were you in contact with anyone at a credit card company, bank, credit union, or other financial
institution about  misuse of your personal information?
YES
NO (Skip to Q35)
32. Did you contact a credit bureau about the misuse of your personal information?
YES
NO (Skip to Q35)

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33. At any credit bureau that you contacted, did you...
a. Request your credit report? YES NO
b. Request corrections to your credit report? YES NO
c. Place a fraud alert on your credit report? YES NO DON’T KNOW
Did you...
d. Place a freeze on your credit report, which prevents the credit bureaus from sending your credit
report to anyone without your permission? YES NO
e. Take some other action with the credit bureau? YES NO
[If yes] What else did you do when you contacted the credit bureau? __________

34. After you told a credit bureau that your personal information had been misused, how satisfied
were you with the credit bureau’s response? Were you very satisfied, somewhat satisfied,
somewhat dissatisfied, or very dissatisfied?
1.
2.
3.
4.
5.

Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
Don’t know

35. Did you contact any law enforcement agencies, such as the local police, a sheriff’s office or a
federal law enforcement agency, to report  misuse of your personal
information?
YES (Ask Q36)
NO (Skip to Q40)
36. Did the law enforcement agency take a police report from you about the misuse of your
personal information?
YES (Ask Q37)
NO (Skip to Q38)
37. Did you receive a copy of that police report?
YES (Skip to Check Item E)
NO (Skip to Q38)

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CHECK ITEM E
Does Q32 = “Yes”?
YES – Ask Q37a
NO – Skip to Q38
37a. Did you send a copy of that police report to the credit bureau that you contacted?
YES

NO

38. How satisfied were you with the law enforcement agency’s response when you reported the
misuse of your personal information? Were you very satisfied, somewhat satisfied, somewhat
dissatisfied, or very dissatisfied? (ENTER A SINGLE RESPONSE)
1.
2.
3.
4.
5.

Very satisfied (Skip to Q41)
Somewhat satisfied (Skip to Q41)
Somewhat dissatisfied (Ask Q39)
Very dissatisfied (Ask Q39)
Don’t know (Skip to Q41)

39. Why were you dissatisfied with the law enforcement agency’s response? (MARK ALL THAT APPLY)
1.
2.
3.
4.
5.
6.
7.
8.

Police didn’t or couldn’t do anything
Police only filled out a report
Police said the crime did not fall in their jurisdiction
Police gave me no information on what I should do about the crime
Police never got back in contact with me/never learned outcome
Didn’t feel my concerns/complaints were taken seriously
Police unable to catch the
Other (specify) __________

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40. We would like to learn more about why people who experience identity theft do not report it to
law enforcement. Why did you decide not to contact a law enforcement agency? (MARK ALL THAT
APPLY)
DIDN’T KNOW I COULD
1. Didn’t know that I could report it
2. Didn’t think about reporting it
3. Didn’t know what agency was responsible for identity theft crimes
NOT IMPORTANT ENOUGH
4. I didn’t lose any money
5. Not important enough to report/small loss
HANDLED IT ANOTHER WAY
6. Took care of it myself
7. Credit card company/bank/other organization took care of problem
DIDN’T THINK THE POLICE COULD HELP
8. Didn’t think police would do anything
9. Didn’t want to bother police
10. Didn’t find out about the crime until long after it happened/too late for police to help
11. Couldn’t identify the offender or provide much information that would be helpful to the police
12. Occurred in another state or outside of the U.S.
PERSONAL REASONS
13. The person responsible was a friend or family member and I didn’t want to get them in
trouble
14. Too inconvenient/didn’t want to take the time
OTHER
15. Other (specify) __________

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41. Next, I'm going to read you a list of other people and organizations that someone might contact
when their personal information is misused. Which of the following people or organizations, if any,
did you contact about  misuse of your personal information? Did you...
a. Contact the business or organization associated with the misuse? YES NO
b. Hire a lawyer? YES NO
c. Contact a State or local government consumer affairs agency, such as the State Attorney
General's office? YES NO
d. Contact the Federal Trade Commission? YES NO
e. Contact a nongovernment consumer agency, such as the Better Business Bureau or the National
Consumer League? YES NO
f. Contact a government agency that issues documents like driver's licenses or Social Security
cards? YES NO
g. Contact a nongovernment agency that issues documents, such as insurance cards? YES NO
h. Contact a credit monitoring service or identity theft insurance company? YES NO
i. Contact an office or agency – other than the police – that deals with victims of crime? YES NO
j. Contact some other group or organization not already mentioned? YES NO
[If yes] What other group or organization did you contact?__________
SECTION D. VICTIM IMPACT
42. The misuse of personal information affects people in different ways. Next, I would like to ask you
some questions about how  misuse of your personal information may have
affected you.
Did the misuse of your personal information lead you to have significant problems with your job or
schoolwork or trouble with your boss, co-workers, or peers?
YES
NO
43. Did the misuse of your personal information 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?
YES
NO

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44. How distressing was the misuse of your personal information to you? Was it not at all
distressing, mildly distressing, moderately distressing, or severely distressing?
(ENTER A SINGLE RESPONSE)
1.
2.
3.
4.

Not at all distressing (Skip to Section E)
Mildly distressing (Skip to Section E)
Moderately distressing (Skip to Check Item F)
Severely distressing (Skip to Check Item F)

CHECK ITEM F
Is “yes” marked in Q42 or Q43 or are categories ‘3' or ‘4' marked in Q44?
YES – Ask Q45
NO – Skip to Section E
45. Did you feel any of the following ways for A MONTH OR MORE because of 
misuse of your personal information?
a.
b.
c.
d.
e.
f.
g.
h.

Worried or anxious? YES NO
Angry? YES NO
Sad or depressed? YES NO
Vulnerable? YES NO
Violated? YES NO
Like you couldn’t trust people? YES NO
Unsafe? YES NO
Some other way? YES NO
[If yes] What other way did the misuse of your personal information make you feel? ______

(If any 45a-45h = yes, ask Q46a; else skip to Q47)
46a. Did you seek any kind of professional help for the feelings you experienced as a result of
 misuse of your personal information?
YES (Ask Q46b)
NO (Skip to Q47)
46b. What kind of professional help did you seek? (MARK ALL THAT APPLY)
1.
2.
3.
4.

Counseling/therapy
Visited primary care or private physician’s office
Visited ER/hospital/walk-in clinic
Other specify __________

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47. Did you experience any of the following physical problems caused by 
misuse of your personal information for A MONTH OR MORE? Did you experience...
a.
b.
c.
d.
e.
f.
g.
h.

Headaches? YES NO
Trouble sleeping? YES NO
Changes in your eating or drinking habits? YES NO
Upset stomach? YES NO
Fatigue? YES NO
High blood pressure? YES NO
Muscle tension or back pain? YES NO
Some other problem? YES NO
[If yes] What other physical problems did you experience for A MONTH OR MORE? ________

(If any 47a-47h = yes, ask Q48; else skip to Section E)
48. Did you seek any kind of professional or medical help for the physical problems you just
reported?
YES (Ask Q49)
NO (Skip to Section E)
49. What kind of professional or medical help did you seek? (MARK ALL THAT APPLY)
1.
2.
3.
4.

Counseling/therapy
Visited primary care or private physician’s office
Visited ER/hospital/walk-in clinic
Other specify __________

SECTION E. OFFENDER
50. Do you know, or have you learned, anything at all about the person or persons who  misused your personal information?
YES (Ask Q51)
NO (Skip to Section F)

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51. How well did you know this person or these people at the time of the incident? For example,
was it a family member, friend, acquaintance, salesperson, or somebody else?
RELATIVE
1. Spouse (ex-spouse)
2. Parent or step-parent
3. Brother or sister or step-brother/step-sister
4. Child or step-child
5. Other relative (specify) __________
NONRELATIVE
6. Boyfriend or girlfriend (ex-boyfriend or ex-girlfriend)
7. Friend or ex-friend
8. Housemate or roommate
9. Neighbor
10. Co-worker (current or former, supervisor or other employee)
11. Someone working in my home (babysitter, housecleaner, etc.)
12. Casual acquaintance
13. Salesperson
14. Food service attendant such as a waiter/waitress, server, or barista
15. Other non-relative (specify) __________
STRANGER
16. Do not recall ever meeting or seeing the person before
SECTION F. FINANCIAL IMPACT
52. What is the approximate total dollar value of what someone obtained when they misused your
personal information ? Include the value of goods, services,
credit, loans, cash, and anything else the person may have obtained.
(IF THE RESPONDENT PROVIDES A RANGE, ASK THE RESPONDENT TO PROVIDE THEIR BEST TOTAL
DOLLAR VALUE ESTIMATE INSTEAD OF A RANGE)

RECORD THE ESTIMATED AMOUNT. $__________.00 (IF OVER $1,000, PROBE: I just want to verify
that the total amount is (INSERT AMOUNT RESPONDENT INDICATED)
If response = $0, skip to Q54b.
53. Of this  that was obtained during 
misuse of your personal information, how much of that money did you personally lose? That is, how
much did you lose that was not covered or reimbursed by insurance, bank, or credit card company?
RECORD ESTIMATED AMOUNT. $___________.00 (IF “NONE,” PROBE: Just to confirm, you didn’t
personally lose anything?)

20

HARD EDIT CHECK - If Q53 > Q52
The respondent just reported their personal loss was greater than the total dollar amount obtained.
Return to PERSONAL_LOSS and fix the amount or reduce the amount of personal loss so that it
doesn't exceed the amount reported in TOTAL_LOSS.
CHECK ITEM G
Is answer to Q53 equal to $0 (the respondent did not lose anything or did not have to pay anything
personally)?
YES – Skip to Q54b
NO – Ask Q54a
54a. Other than the costs you already told me about, , how much, IF ANY,
additional costs did YOU incur as a result of  misuse of your personal
information? Include costs for things such as legal fees, overdraft fees, and any miscellaneous
expenses, such as postage, phone calls, or notary fees. Do not include lost wages.
OR
54b. How much, IF ANY, costs did YOU incur during  misuse of your personal
information? Include costs for things such as legal fees, overdraft fees, and any miscellaneous
expenses, such as postage, phone calls, or notary fees. Do not include lost wages.
RECORD ESTIMATED AMOUNT. $___________.00 SKIP to Q55
DO NOT INCLUDE COSTS WHICH WERE REIMBURSED.
(IF OVER $1,000, PROBE: I just want to verify that the total amount is (INSERT AMOUNT RESPONDENT
INDICATED).
55. Have you been successful in clearing up all of the financial and credit problems associated with
 misuse of your personal information?
YES (Ask Q56)
NO (Skip to Q57)
DON’T KNOW (Skip to Q57)

21

56. How long did it take you to clear up all of the financial and credit problems associated with the
misuse after you discovered it? (ENTER A SINGLE RESPONSE.)
1.
2.
3.
4.
5.
6.
7.

One day or less (1-24 hours)
More than a day, but less than a week (more than 24 hours-6 days)
At least a week, but less than one month (7-30 days)
One month to less than three months
Three months to less than six months
Six months to less than one year
One year or more

57. How many hours  clearing up financial or credit problems
associated with  misuse of your personal information? If you don’t know,
please provide your best estimate.
__________ Number of hours
58. Other than anything we have already talked about, have you experienced any of the following
problems as a result of  misuse of your personal information? Have you…
a. Had credit related problems, such as having to repeatedly correct the same information on your
credit report, being turned down for credit or loans, changes in your credit score, or having to pay
higher rates? YES NO
b. Had banking problems, such as being turned down for a checking account or having checks
bounce? YES NO
c. Had debt collectors or collections departments contact you? YES NO
d. Had utilities cut off or been denied new service? YES NO
As a result of the misuse of your personal information, have you...
e.
f.
g.
h.

Been turned down for a job or lost a job? YES NO
Had a lawsuit filed against you? YES NO
Been the subject of an arrest or criminal proceedings? YES NO
Had some other type of problems? YES NO
[If yes] What other type of problem did you experience? __________

CHECK ITEM H
Did respondent experience more than one incident of identity theft during the past 12 months (Q23=1
or Q24=1)?
YES – Ask Q59
NO – Skip to Section G

22

59. For the next few questions, please think about ALL of the misuses of your personal information
during the last year, that is, since [AUTOFILL DATE 1st OF MONTH 1 YEAR PRIOR]. Including every
incident that occurred over the past 12 months, not just the most recent, what is the approximate
total dollar value of what someone obtained while misusing your personal information? Include
the value of goods, services, credit, loans, cash, and anything else the person may have obtained.
(IF THE RESPONDENT PROVIDES A RANGE, ASK THE RESPONDENT TO PROVIDE THEIR BEST TOTAL
DOLLAR VALUE ESTIMATE INSTEAD OF A RANGE. THIS INCLUDES “WHAT SOMEONE OBTAINED”
REGARDLESS OF WHETHER THE RESPONDENT WAS REIMBURSED.)
RECORD THE ESTIMATED AMOUNT. $__________.00

HARD EDIT CHECK - If Q59 < Q52
The respondent reported less than  incident of misuse of their personal
information, PROBE:
I just want to verify that the total amount is .
The respondent just reported their total dollar value of what the offender obtained from the most
recent misuse of their personal information was greater than the total dollar value of what the
offender obtained from every incident that occurred over the past 12 months. Return to
TOTAL_EVERY_INCIDENT and fix the amount or reduce the amount of TOTAL_LOSS from the most
recent misuse of their personal information, so that it doesn't exceed the amount reported in
TOTAL_EVERY_INCIDENT.
60. Not counting the  dollars that were obtained during ALL incidents of
identity theft in the past 12 months, what were the total additional costs, that YOU incurred as a
result of the misuses of your personal information? Include costs for things such as legal fees,
overdraft fees, and any miscellaneous expenses, such as postage, phone calls, or notary fees. Do
not include lost wages.
RECORD ESTIMATED AMOUNT. $___________.00 DO
NOT INCLUDE COSTS WHICH WERE REIMBURSED.
ANY RESPONSE – Skip to Section G after the following Hard Edits performed

23

HARD EDIT CHECK - If Q60 < Q54a
The respondent reported less than value of additional costs incurred from 
Incident of misuse of their personal information, PROBE:
I just want to verify that the total amount is .
The respondent just reported the additional costs incurred from the most recent misuse of their
personal information was greater than the additional costs incurred from every incident that occurred
over the past 12 months. Return to TOTAL_ADD_COSTS and fix the amount or reduce the amount of
ADD_COSTS_INCUR from the most recent misuse of their personal information, so that it doesn't
exceed the amount reported in TOTAL_ADD_COSTS.
HARD EDIT CHECK - If Q60 < Q54b
The respondent reported less than value of additional costs incurred from 
Incident of misuse of their personal information, PROBE:
I just want to verify that the total amount is .
The respondent just reported the additional cost incurred from the most recent misuse of their
personal information was greater than the additional costs incurred from every incident that occurred
over the past 12 months. Return to TOTAL_ADD_COSTS and fix the amount or reduce the amount of
NO_PERSONAL_LOSS from the most recent misuse of their personal information, so that it doesn't
exceed the amount reported in TOTAL_ADD_COSTS.
SECTION G. LONG-TERM VICTIMIZATION AND CONSEQUENCES
INTRO: Now I’m going to ask you to think about any identity theft that may have occurred more
than 12 months ago, that is, any time before [AUTOFILL DATE 1st OF MONTH 1 YEAR PRIOR]. 
Again, identity theft means someone else using your personal information without your permission
to buy something, get cash or services, pay bills, or avoid the law.

CHECK ITEM I
Is (“yes” marked for any of Q2, Q6, Q9b, Q11, Q15, or Q19) AND (“yes,” “don’t know,” “refused,” or
“out of universe” marked for Q3, Q7, Q10a, Q12, Q16, AND Q20)?
YES – Skip to Q61
NO – Skip to Q62

24

61. Not including the past 12 months, has anyone EVER, without your permission:
• misused one of your existing accounts,
• used your personal information to open a new account,
• or used your personal information for some other fraudulent purpose, such as
getting medical care, a job, government benefits or something else?
YES
NO (Skip to Section H)
62. At any point during the past 12 months did you experience credit or other financial problems,
legal problems, relationship problems with family or friends, problems at work or school, physical
problems, or emotional distress as a result of the identity theft that happened to you more than 12
months ago?
YES
NO (Skip to Section H)
63. During the past 12 months, have you experienced any of the following consequences as a result
of the identity theft that occurred more than 12 months ago? Have you had…
a. Significant problems with your job or schoolwork, or trouble with your boss, co-workers, or peers
during the past 12 months? YES NO
b. Significant problems during the past 12 months 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? YES NO
As a result of the identity theft that occurred more than 12 months ago, have you...
c. Experienced any of the following feelings for a month or more during the past 12 months:
worry, anger, sadness or depression, vulnerability, feeling violated like you couldn’t trust people,
or feeling that you were unsafe? YES NO
d. Had physical problems during the past 12 months resulting from the misuse of your personal
information, such as headaches, trouble sleeping, changes in your eating or drinking habits, an
upset stomach, high blood pressure or some other physical problem? YES NO
e. Had credit related problems during the past 12 months, such as having to repeatedly correct the
same information on your credit report, being turned down for credit, loans or having to pay
higher rates? YES NO
f. Had banking problems during the past 12 months, such as being turned down for a checking
account or having checks bounce? YES NO

25

As a result of the identity theft that occurred more than 12 months ago, have you...
g. Had debt collectors or collections departments contact you during the past 12 months? YES NO
h. Had utilities cut off or been denied new service during the past 12 months? YES NO
i. Been turned down for a job or lost a job during the past 12 months? YES NO
j. Had legal problems, such as having a lawsuit filed against you or being the subject of an arrest or
criminal proceedings, during the past 12 months? YES NO
k. Had some other type of problems during the past 12 months? YES NO
[If yes] What other types of problems have occurred during the past 12 months? _________

SECTION H. PREVENTATIVE BEHAVIORS
64. Now I’m going to ask you about any actions taken to prevent someone from obtaining your
personal information. In the past 12 months, that is since [AUTOFILL DATE 1st OF MONTH 1 YEAR
PRIOR], have you:
a. Checked your credit report? YES NO
b. Changed passwords on any of your financial accounts? YES NO
c. Purchased identity theft protection from a company that offers protection services? YES NO
d. Purchased credit monitoring or identity theft insurance? YES NO
e. Shredded or destroyed documents containing your personal information? YES NO
f. Checked your banking or credit card statements for unfamiliar charges? YES NO
g. Used security software program on your computer to protect against loss of credit cards/card
theft? YES NO
CHECK ITEM J
If (“yes” for Q64a, Q64b, Q64c, Q64d, Q64e, Q64f, or Q64g) AND (“yes” for Q2, Q6, Q9b, Q11, Q15, or
Q19) continue to Q65.
Else, skip to Q67.
65. You said that during the past 12 months, you . Did you take any of these actions as a result of previous misuse of your personal
information?
YES (Ask Q66)

26

NO (Skip to Q67)
66. You said that during the past 12 months you: . Which actions did you take in direct response to any previous misuse of your
personal information?
(Mark all that apply, and only read response items that match autofill responses in this question)
1.
2.
3.
4.
5.
6.
7.

Checked your credit report
Changed passwords on any of your financial accounts
Purchased identity theft protection from a company that offers protection services
Purchased credit monitoring or identity theft insurance
Shredded or destroyed documents containing your personal information
Checked your banking or credit card statements for unfamiliar charges
Used security software program on your computer to protect it against loss of credit
cards/card theft

SECTION I. DATA BREACHES
67. My final questions involve organizations that may have your personal information in their files.
During the past 12 months, did a company, government agency, or some other organization that
has your personal information:
a. Notify you or announce publicly that some or all of their files or data may have been stolen, lost,
or posted on a publicly available website?
YES (Ask Q67b)
NO (Skip to End of Survey)
b. Did they notify you directly that YOUR personal information may have been stolen, lost, or
posted on a publicly available website?
YES (Ask Q68)
NO (Skip to End of Survey)
68. Did this personal information include your Social Security number?
YES
NO
DON’T KNOW

END OF SURVEY


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