1121-0218 CJRP - Attachment E (Revised)

Census of Juveniles in Residential Placement (CJRP)

Census of Juveniles in Residential Placement - Attachment E (Revised)

Census of Juveniles in Residential Placement (CJRP)

OMB: 1121-0218

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U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU
ACTING AS A COLLECTING AGENT FOR

2021 Census of Juveniles
in Residential Placement

U.S. DEPARTMENT OF JUSTICE
OFFICE OF JUVENILE JUSTICE AND
DELINQUENCY PREVENTION

Password:

User ID:

(Please correct any error in name, mailing address, and ZIP Code above)

This questionnaire asks about persons who had assigned
beds in this facility on Wednesday, October 27, 2021.

PLEASE COMPLETE ONLINE AT:
https://respond.census.gov/cjrp
(see enclosed flyer for details)

RETURN THE
COMPLETED
FORM TO

COMPLETE AND MAIL THIS FORM
IN THE ENCLOSED ENVELOPE BY
NOVEMBER 24, 2021.

US Census Bureau
PO Box 5000
Jeffersonville, IN 47199-5000
GOVS/CJRP
Fax: 1–888–262–3974
EMAIL: [email protected]
If you have any questions, call Megan Minnich
U.S. Census Bureau, 1–800–352–7229.
PERSON COMPLETING THIS QUESTIONNAIRE

Name

E-mail address

Title
Business address – Number and street/or P.O. Box/Route number

Telephone
Area code

Number

Area code

Number

Extension

Fax Number
City
FORM

State

CJ-14 (7-29-2021)

ZIP Code

OMB No. 1121-0218: Approval Expires 05/31/2022

Section I – GENERAL INFORMATION

IMPORTANT INSTRUCTIONS
Complete this questionnaire for just the one
facility listed on the cover. If additional
questionnaires are needed for other
facilities for which you report, call
1–800–352–7229 to request more forms.

NOTE
B

Questions 4 and 5 ask who
OPERATES this facility.

4a. Is this facility OPERATED by one or more
of the following –
Mark (X) all that apply.
01
02
03

a private non-profit agency
a for profit agency
a government agency ➔ Go to Question 5

1a. Is this facility part of a larger agency?
01
02

Yes
No ➔

4b. What is the name of the private non-proﬁt
or for-proﬁt agency that OPERATES this
facility?

Go to Note A

1b. What is the name of this agency?

➔

5.
NOTE
A

Questions 2 and 3 ask who OWNS this
facility. Later you will be asked who
OPERATES this facility.

2a. Is this facility OWNED by one or more of
the following –
Mark (X) all that apply.
01
02
03

What is the level of the government agency
that OPERATES this facility (either directly
or under a contract with)?
Mark (X) all that apply.
01
02
03
04

a private non-profit agency
a for profit agency
a government agency ➔ Go to Question 3

Go to
Question
6

05
06

A Native American Tribal Government
Federal
State
County
Municipal (includes Washington, DC)
Other – Specify

2b. What is the name of the private non-proﬁt
or for-proﬁt agency that OWNS this facility?

➔
3.

Go to
NOTE B

What is the level of the government agency
that OWNS this facility?
Mark (X) all that apply.
01
02
03
04
05
06

Page 2

A Native American Tribal Government
Federal
State
County
Municipal (includes Washington, DC)
Other – Specify

FORM CJ-14 (7-29-2021)

Section I – GENERAL INFORMATION
6.

What type of residential facility is the one
listed on the front cover? Mark (X) those
that apply.
Detention center: A short-term facility that
01
provides temporary care in a physically restricting
environment for juveniles in custody pending court
disposition and, often, for juveniles who are
adjudicated delinquent and awaiting disposition or
placement elsewhere, or are awaiting transfer to
another jurisdiction. In some jurisdictions, detention
centers may also hold juveniles committed for short
periods of time as part of their disposition (e.g.,
weekend detention).
Training school/Long-term secure facility:
02
A specialized type of facility that provides strict
confinement and long-term treatment generally for
post-adjudication committed juvenile offenders.
Includes training schools, juvenile correctional
facilities, youth development centers.
03

IMPORTANT INSTRUCTIONS
The following items ask you to use your
records to provide counts of persons who had
assigned beds in this facility at the end of the
day on Wednesday, October 27, 2021. This
date has been chosen carefully to give a
standardized count of persons in facilities like
yours across the country. You will be asked to
classify your facility population into two age
groups:
1. those persons under age 21; and
2. those persons age 21 and older.
You will then be asked to classify each person
UNDER THE AGE OF 21 into one of the two
following categories:

Reception or diagnostic center: A short-term
facility that screens juvenile offenders committed by
the courts and assigns them to appropriate
correctional facilities.

1. those here because they have been
charged with or court-adjudicated for an
offense. An offense is any behavior that is
illegal in your state for underage persons
alone or for both underage persons and
adults.

Group home/Halfway house: A long-term
facility that is generally non-secure and intended for
post-adjudication commitments in which young
persons are allowed extensive contact with the
community, such as attending school or holding a
job.
Residential treatment center: A facility that
focuses on providing some type of individually
planned treatment program for youth (substance
abuse, sex offender, mental health, etc.) in
conjunction with residential care. Such facilities
generally require specific licensing by the state that
may require that treatment provided is
Medicaid-reimbursable.
Boot camp: A secure facility that operates like
military basic training. It is designed to combine
elements of basic military training programs,
correctional components and treatment programs.
The emphasis is on strict discipline, drills, and
work.
Ranch, forestry camp, wilderness or
marine program or farm: These are long-term
generally non-secure residential facilities often
located in a relatively remote area. The juveniles
participate in a structured program that emphasizes
outdoor work, including conservation and related
activities.
Runaway and homeless shelter: A short-term
facility that provides temporary care in a physically
unrestricted environment. It can also provide
longer-term care under a juvenile court disposition
order.
Other type of shelter: This includes emergency
non-secure shelters where juveniles are housed
short-term until another placement can be found.
Other: This includes independent living programs and
anything that cannot be classified above. Specify

2. those here for reasons other than offenses.
Please classify each person under age 21
into just one of these categories. Detailed
descriptions of the above categories are
provided in the questions themselves and on
the Offense Codes on Pages 19 and 20 of
the CJRP form.
Please use your records to answer the
following questions.

7a.

According to your records, at the end of
the day on October 27, 2021, did ANY
persons have assigned beds in this
facility? Include persons who were temporarily
away, but had assigned beds on October 27, 2021.
Do NOT include staff.
01

Yes

➔ STOP HERE and mail this form ONLY
if there were NO PERSONS IN
YOUR FACILITY OR THE
FACILITY WAS CLOSED
(permanently or temporarily) on this
date. Indicate the reason in the
COMMENTS Section on Page 18.

7b. According to your records, at the end of
the day on October 27, 2021, how many
persons had assigned beds in this facility?
Persons

FORM CJ-14 (7-29-2021)

Page 3

Section I – GENERAL INFORMATION – Continued
8.

How many of the persons who had
assigned beds at the end of the day on
Wednesday, October 27, 2021, were AGE
21 or older? Include persons who were
temporarily away, but had assigned beds on
October 27, 2021.
Do NOT include staff. Please write "0" if there are
NO persons age 21 or older.
Persons 21 or older

9a.

At the end of the day on Wednesday,
October 27, 2021, did ANY persons
UNDER AGE 21 have assigned beds in
this facility? INCLUDE juveniles being tried as
adults in criminal court. Do NOT include staff.
01
Yes
02

➔ STOP HERE and mail this form ONLY
if there were NO persons under 21 in
your facility on this date. Indicate the
reason in the COMMENTS Section on
Page 18.

9b.

According to your records at the end of
the day on Wednesday, October 27, 2021,
how many persons UNDER AGE 21 had
assigned beds in this facility? Include
persons who were temporarily away but had
assigned beds on October 27, 2021. Do NOT
include staff.
Persons under the age of 21

As a check, the sum of question 8 (persons 21 and
NOTE older) and 9b (persons under age 21) should equal
the sum reported in question 7b (number of persons
C
assigned beds in the facility).

10a. At the end of the day on Wednesday,
October 27, 2021, did ANY of the
persons UNDER AGE 21 have assigned
beds in this facility SPECIFICALLY
BECAUSE they were CHARGED WITH OR
COURT-ADJUDICATED FOR AN OFFENSE?
An offense is any behavior that is illegal in your
state for underage persons alone or for both
underage persons and adults. See the Offense
Codes on Page 19 and 20.
INCLUDE in your count persons UNDER
AGE 21 here BECAUSE THEY WERE
CHARGED WITH OR ADJUDICATED FOR:
● ANY offense that is illegal for both adults and
underage persons.

Page 4

● ANY offense that is ILLEGAL IN YOUR STATE
for underage persons but not for adults.
Examples are running away, truancy,
incorrigibility, curfew violation, and underage
liquor violations. Count persons with these
behaviors here ONLY IF THE BEHAVIORS ARE
ILLEGAL IN YOUR STATE. This includes those
CHINS (Children in Need of Services) and PINS
(Persons in Need of Services) who are here
BECAUSE of an offense.
● ANY offense being adjudicated in juvenile or
criminal court, including a probation or parole
violation.
DO NOT INCLUDE here:
● Persons under age 21 who have committed one
or more offenses in the past, BUT HAVE
ASSIGNED BEDS ON OCTOBER 27, 2021
FOR REASONS OTHER THAN OFFENSES
such as neglect, abuse, dependency,
abandonment, or another NON-OFFENSE
reason.
● Persons under age 21 assigned beds here
because of mental health problems,
substance abuse problems, etc. UNLESS
THE OFFENSE THEY COMMITTED
REQUIRED TREATMENT AS PART OF THE
COURT ORDER.
● Persons under age 21 who have run away,
been truant or incorrigible, or violated curfew,
IF THESE BEHAVIORS ARE NOT
CONSIDERED ILLEGAL IN YOUR STATE.
These persons will be counted in questions
11a and 11b.
● Those persons who are PINS (Persons in
Need of Services) or CHINS (Children in
Need of Services) who have assigned
beds because of REASONS OTHER
THAN OFFENSES.
01
02

Yes
No ➔

Go to Question 11a

10b. According to your records at the end
of the day on Wednesday, October 27,
2021, HOW MANY PERSONS UNDER
AGE 21 had assigned beds in the
facility SPECIFICALLY BECAUSE
they were CHARGED WITH OR
COURT-ADJUDICATED FOR AN
OFFENSE, as deﬁned in question 10a?
Later you will be asked to provide information
about each of these persons. Include persons who
were temporarily away but had assigned beds on
October 27, 2021. Do NOT include staff.
Persons under age 21 here because
they were charged with or
court-adjudicated for an offense.

FORM CJ-14 (7-29-2021)

Section I – GENERAL INFORMATION – Continued
11a. At the end of the day on Wednesday,
October 27, 2021, did ANY of the persons
UNDER AGE 21 have assigned beds in this
facility FOR REASONS OTHER THAN
OFFENSES? Do NOT include staff.
INCLUDE here:
● Persons under age 21 assigned beds here for
NON-OFFENSE REASONS such as neglect,
abuse, dependency, abandonment, or another
NON-OFFENSE reason.
● Persons under age 21 assigned beds here
because of mental health problems
UNLESS THE OFFENSE THEY COMMITTED
REQUIRED TREATMENT AS PART OF THE
COURT ORDER.
● Persons under age 21 who have run away,
been truant or incorrigible, or violated curfew,
IF THESE BEHAVIORS ARE NOT
CONSIDERED ILLEGAL IN YOUR STATE.
● Persons assigned beds here due to voluntary or
non-offense related admissions.
DO NOT INCLUDE here:
● Persons assigned beds here BECAUSE
THEY WERE CHARGED WITH OR
COURT-ADJUDICATED FOR AN OFFENSE.
These persons are counted in questions 10a
and 10b.
01
02

Yes
No ➔

12b. What kind of treatment is provided INSIDE
this facility? Mark (X) those that apply.
01
02
03
04
05
06

13. Does this facility provide foster care?
01
Yes, for all young persons
02
Yes, for some but not all young persons
03
No
14. Does this facility provide independent
living arrangements for any young persons?
01
02

11b. According to your records at the end of
the day on Wednesday, October 27, 2021,
HOW MANY PERSONS UNDER AGE 21 had
assigned beds in this facility FOR
REASONS OTHER THAN OFFENSES, as
deﬁned in question 11a?
Include persons who were temporarily away but
had assigned beds on October 27, 2021. Do NOT
include staff.
Persons under age 21 here
because of non-offense reasons.

If this facility is a detention center, answer NO.
02

01
02

Yes
No ➔

FORM CJ-14 (7-29-2021)

Yes
No ➔

Go to Question 17

16b. When are young persons in this facility
locked into their sleeping rooms by
staff?
Mark (X) all that apply.
01
02

04
05
06
07

12a. Does this facility provide ON-SITE
RESIDENTIAL TREATMENT?

Yes
No

16a. Are ANY young persons in this facility
locked into their sleeping rooms by staff
at ANY time to conﬁne them?

As a check, the sum of questions 10b (persons
NOTE under 21 with offenses) and 11b (persons under 21
with reasons other than offenses) should equal 9b
D
(the number of persons under age 21)

Yes
No

15. On Wednesday, October 27, 2021, did this
facility house any overﬁow detention
population? "Overflow detention population"
refers to those young persons who, because of the
unavailability of beds in a detention center, are
placed temporarily in a non-detention facility.

Go to Note D

Mental health treatment
Substance abuse treatment
Sex offender treatment
Treatment for arsonists
Treatment specifically for violent offenders
Other – Specify

08
09
10

When they are out of control
When they are suicidal
Rarely, no set schedule
During shift changes
Whenever they are in their sleeping rooms
At night
Part of each day
Most of each day
All of each day
Other – Specify

Go to Question 13

Page 5

Section I – GENERAL INFORMATION – Continued
17.

Does this facility have any of the
following features intended to conﬁne
young persons within speciﬁc areas?
Mark (X) all that apply.
01

19.

Doors for secure day rooms that are locked
by staff to confine young persons within
specific areas

Wing, floor, corridor, or other internal
security doors that are locked by staff to
confine young persons within specific areas

Outside doors that are locked by staff to
confine young persons within specific
buildings

External gates in fences or walls WITHOUT
razor wire that are locked by staff to confine
young persons

External gates in fences or walls WITH razor
wire that are locked to confine young
persons

Other – Specify

The facility has NONE of the above features

20.

During the YEAR between October 1, 2020
and September 30, 2021, did ANY young
persons die while assigned a bed at this
facility at a location either INSIDE or
OUTSIDE of this facility?
01

Yes

➔

Go to Section II on page 7

How many young persons died while
assigned beds at this facility during the
year between October 1, 2020 and
September 30, 2021?

Person(s)

18a. Are outside doors to any buildings with
living/sleeping units in this facility ever
locked?
01

Yes

➔

Go to Question 19

18b. Why are outside doors to buildings with
living/sleeping units in this facility
locked?
Mark (X) all that apply.
01
02

To keep intruders out
To keep young persons inside this facility

18c. WHEN are outside doors to buildings
with living/sleeping units in this facility
locked?
Mark (X) all that apply.
01
02
03
04
05
06
07

Page 6

Rarely, no set schedule
At night
Part of each day
Most of each day
All of each day
When the facility is unoccupied
Other – Specify

FORM CJ-14 (7-29-2021)

Section IA – COVID Addendum

COVID Addendum
The National Institute of Justice and Office
of Juvenile Justice and Delinquency
Prevention are interested in timely and
relevant information on events that may
impact residential facilities and the juvenile
population housed within these facilities. As
such, the following questions are related to
the Coronavirus pandemic (COVID-19).
Please answer the following questions
regarding the Coronavirus pandemic
(COVID-19) using the time frame October
29, 2020 through October 27, 2021. Note
that the term “young person” refers to
persons 21 and under.

1a. Between October 29, 2020 to October 27,
2021, how many Coronavirus (COVID-19)
TESTS were conducted on YOUNG persons
assigned beds in this facility? Coronavirus
test refers to the viral test for COVID-19.
Do not count serology tests (also known as
antibody tests).
INCLUDE –

● Tests conducted either on or off facility grounds
(e.g., at hospitals, medical centers, private labs,
patient service centers, and other health
vendors).
● Tests conducted on persons on transfer to
treatment facilities, but who remained under the
jurisdiction of your facility.
● Count the number of tests, regardless if any
single young person was tested more than once.
You will report the number of people later in this
survey

1b. Of those tests in question 1a, how many
TESTS were positive? Please, respond “0”
if there were NO positive tests.
Positive Tests
01

Don’t Know

2a. Individuals may test positive for the
Coronavirus (COVID-19) multiple times.
Between October 29, 2020 to October 27,
2021, how many PERSONS assigned beds
in this facility tested POSITIVE?
Multiple positive results for the same individual should be
counted only once.

YOUNG Persons assigned
beds – received a Coronavirus
(COVID-19) vaccine
TOTAL Persons assigned
beds – received a Coronavirus
(COVID-19) vaccine
01

Don’t Know

2b. Between October 29, 2020 to October 27,
2021, how many STAFF employed in your
facility tested POSITIVE for Coronavirus
(COVID-19)?
Multiple positive results for the same individual should be
counted only once.
INCLUDE staff tested either on or off facility grounds (e.g.,
at hospitals, medical centers, private labs, patient service
centers, and other health vendors).
EXCLUDE –

EXCLUDE –

● Antibody tests that are used to detect antibodies
produced in response to Coronavirus
(COVID-19), but do not confirm current infection.
● Suspected cases that were showing symptoms
of Coronavirus (COVID-19), but were not tested.
● Persons who tested positive for Coronavirus
(COVID-19) during the INTAKE process, and
therefore were NOT admitted into your facility.

Staff - tested positive for
Coronavirus (COVID-19)
01

Don’t Know

Number of tests conducted
01

Don’t Know

FORM CJ-14 (7-29-2021)

Page 7

Section I – COVID ADDENDUM – Continued
3a. Between October 29, 2020 to October 27,
2021, were any YOUNG persons medically
isolated or quarantined because of
Coronavirus (COVID-19)?
01

Yes

3b. Which YOUNG persons assigned beds in
this facility were medically isolated or
quarantined because of Coronavirus
(COVID-19)?
Mark (X) all that apply.
01
02
03

04
05

Residents who tested positive
Residents who presented symptoms
Residents who were contacts of confirmed or
suspected COVID-19 cases
New intakes into the facility
Residents returning to the facility following public
exposure (e.g., court hearing, hospitalization)

3c. How were YOUNG persons medically
isolated or quarantined due to COVID-19?
Mark (X) all that apply.
01
02

Solo secured room
Quarantine unit

4b. What month did your facility ﬁrst
administer a vaccine for Coronavirus
(COVID-19) to any young persons assigned
a bed in this facility?
Month
01

N/A

4c. For which YOUNG persons assigned beds
in this facility on October 27th, 2021 can
you report on their Coronavirus (COVID-19)
vaccination status?
Mark (X) all that apply.
01
02
03
04
05

All young persons
Young persons vaccinated on-site
Young persons vaccinated outside of this facility
Information not available to any young persons
Other, specify

4d. On October 27, 2021, how many PERSONS
assigned beds in this facility had received
at least one dose of the Coronavirus
(COVID-19) vaccine?
YOUNG Persons assigned
beds – received a Coronavirus
(COVID-19) vaccine

3d. What was the maximum amount of time a
YOUNG person could be isolated or
quarantined due to COVID-19?
01
02
03

Until negative test
Fewer than 10 days
10 days or longer

Year

TOTAL Persons assigned
beds – received a Coronavirus
(COVID-19) vaccine
01

Don’t Know

4a. Between October 29, 2020 to October 27,
2021, did this facility make available the
opportunity to receive the Coronavirus
(COVID-19) vaccine to any YOUNG
persons?
INCLUDE: Vaccines administered either on or off
facility ground (e.g. at hospitals, medical centers,
mass vaccinations sites, patient service centers,
and other health vendors).
01
02

Page 8

Yes
No

FORM CJ-14 (7-29-2021)

Section II – PERSON LEVEL DATA

IMPORTANT INSTRUCTIONS
FOR SECTION II
1. Record individual-level information in
Section II on the persons under age 21 you
included in Section I, question 10b.
2. You may choose one of the following ways to
record this information:
■ Manual data entry
Continue to write information directly on
this form.
■ Upload a data ﬁle
Go to our website at
https://respond.census.gov/cjrp
(Do not type "www" as a preﬁx) and
enter your Section I data. You can then
upload a data file with Section II-Person Level
data. The acceptable formats are
spreadsheet, text file, or data base file.
■ Complete all data entry on the web
Go to our website at
https://respond.census.gov/cjrp
(Do not type "www" as a preﬁx) and
enter Section I and Section II data.
3. BE SURE TO KEEP COPIES OF THE
DATA YOU SUBMIT.

FORM CJ-14 (7-29-2022)

Page 9

NOTE: IF MORE THAN 66 PERSONS MEET REQUIREMENTS A THROUGH D AS DESCRIBED BELOW

Section II – PERSON LEVEL DATA

☞

START HERE

Please COMPLETE a LINE on the table below for EACH
person who on October 27, 2021, was

List below ONLY THOSE PERSONS WHO FULFILL ALL 4 REQUIREMENTS ABOVE (A, B, C, AND D).

Enter an identifying
number or ﬁrst
name and last
initial for all
persons meeting
ALL 4 requirements
above. Use an
identiﬁer that will
allow YOU to
reidentify each
person 6 months
from now, if a
callback is needed.

What is
this
person’s
sex?
Enter the
code on
the line.

What is
this
person’s
date of
birth?

What is this person’s race?
Enter the code on the line.
1 – White, not of Hispanic origin
2 – Black or African American,
not of Hispanic origin
3 – Hispanic or Latino
(i.e., Mexican, Puerto Rican,
Cuban, Central or South American,
or other Spanish culture or origin),
regardless of race

1 – Male
2 – Female

4 – American Indian/Alaska Native,
not of Hispanic origin
5 – Asian, not of Hispanic origin

5.
Which one of the following
placed this person at this
facility? Enter the code on
the line.
1 – Court, probation agency, or
law enforcement agency
2 – Corrections or other justice
agency not included in 1
3 – Social services agency
4 – School official, parent or
guardian, or young person
him/herself
5 – Other – Specify

7 – Two or More Races, not of
Hispanic origin – Specify
For definitions of these categories,
please refer to Page 18.
Code

Line number

6 – Native Hawaiian or other Pacific
Islander, not of Hispanic origin

2071

Mo. Day

Yr.

Code

02 14 2004 3

Specify Other only

Code

Specify Other only

Page 10

IF MORE PERSONS MEET REQUIREMENTS A THROUGH D ABOVE

FORM CJ-14 (7-29-2021)

PHOTOCOPY PAGES 16 AND 17 TO MAKE MORE BLANK FORMS.

Section II – PERSON LEVEL DATA
A.
B.
C.
D.

UNDER age 21; AND
assigned a bed in this facility at the end of the day on Wednesday, October 27, 2021; AND
charged with an offense or court-adjudicated for an offense; AND
assigned a bed here BECAUSE OF THE OFFENSE.

Do NOT list persons assigned beds here for reasons other than offenses, as described in Section I, 11a.

Line number

See Offense
Codes on
Page 19 and 20.

Code

Specify Other only

In which
state or
territory
did this
person
commit
the
offense?
State or
territory
name
may be
abbreviated.
If state or
territory
is not known,
enter code
99 in the box
below.

9.
On October 27, 2021, what was this
person’s court adjudication status for the
offense listed in question 7? "Adjudication"
is the court process which determines whether or
not the person committed the offense.
01 – Agreement not to adjudicate (diversion)
02 – Awaiting adjudication hearing in
juvenile court
03 – Adjudicated, awaiting disposition by
juvenile court
04 – Adjudicated and disposed in juvenile court
and awaiting placement elsewhere
05 – Adjudicated and disposed in juvenile
court, in placement here
06 – Awaiting transfer hearing to adult criminal
court
07 – Awaiting hearing or trial in adult
criminal court
08 – Convicted in adult criminal court
99 – Don’t know
10 – Other – Specify

Code

State

Code

Vt.

Specify Other only

10.
On what
date was
this person
admitted
to this
facility for
the offense
listed in
question 7?
If more than
one date
applies,
enter the
earliest one
for the
offense listed
in question 7.

Line number

7.
What was the
most serious
offense for which
this person was
assigned a bed
here on
October 27, 2021?
Enter the code for
the most serious
offense resulting in
this placement.

1 – Federal
2 – A Native American
Tribal Government
3 – State
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify

6.
Is the court, probation
or law enforcement
agency, or other agency
referred to in question 5
at the federal, tribal,
state, county, or
municipal level?

Mo. Day

Yr.

09 15 2021

FORM CJ-14 (7-29-2021)

CONTINUE ON NEXT PAGE

Page 11

1.
Enter an identifying
number or ﬁrst
name and last
initial for all
persons meeting
ALL 4 requirements
above. Use an
identiﬁer that will
allow YOU to
reidentify each
person 6 months
from now, if a
callback is needed.

What is
this
person’s
sex?
Enter the
code on
the line.

What is this
person’s
date of
birth?

4.
What is this person’s race?
Enter the code on the line.
1 – White, not of Hispanic origin
2 – Black or African American,
not of Hispanic origin
3 – Hispanic or Latino
(i.e., Mexican, Puerto Rican,
Cuban, Central or South American,
or other Spanish culture or origin),
regardless of race

1 – Male
2 – Female

4 – American Indian/Alaska Native,
not of Hispanic origin
5 – Asian, not of Hispanic origin

Line number

6 – Native Hawaiian or other Pacific
Islander, not of Hispanic origin
7 – Two or More Races, not of
Hispanic origin – Specify
For definitions of these categories,
please refer to Page 18.
Code

Mo. Day

Yr.

Code

Specify Other only

Code

Specify Other only

Page 12

FORM CJ-14 (7-29-2021)

7.
What was the
most serious
offense for which
this person was
assigned a bed
here on
October 27, 2021?
Enter the code for the
most serious offense
resulting in this
placement.
See Offense
Codes on
Page 19 and 20.

Line number

1 – Federal
2 – A Native American
Tribal Government
3 – State
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify

Code

Specify Other only

Code

8.
In which
state or
territory
did this
person
commit
the
offense?
State or
territory
name
may be
abbreviated.
If state or
territory
is not known,
enter code
99 in the box
below.

State

Specify Other only

10.
On what
date was
this person
admitted
to this
facility for
the offense
listed in
question 7?
If more than
one date
applies,
enter the
earliest one
for the
offense listed
in question 7.

Line number

6.
Is the court, probation
or law enforcement
agency, or other agency
referred to in question 5
at the federal, tribal,
state, county, or
municipal level?

Mo. Day

Yr.

FORM CJ-14 (7-29-2021)

Page 13

2.
What is
this
person’s
sex?
Enter the
code on
the line.

What is this
person’s
date of
birth?

1 – Male
2 – Female

4 – American Indian/Alaska Native,
not of Hispanic origin
5 – Asian, not of Hispanic origin

Line number

6 – Native Hawaiian or other Pacific
Islander, not of Hispanic origin
7 – Two or More Races, not of
Hispanic origin – Specify
For definitions of these categories,
please refer to Page 18.
Code

Mo. Day

Yr.

Code

Specify Other only

Code

Specify Other only

Page 14

FORM CJ-14 (7-29-2021)

10.

What was the
most serious
offense for which
this person was
assigned a bed
here on
October 27, 2021?
Enter the code for the
most serious offense
resulting in this
placement.

In which
state or
territory
did this
person
commit
the
offense?
State or
territory
name
may be
abbreviated.

On October 27, 2021, what was this
person’s court adjudication status for the
offense listed in question 7? "Adjudication"
is the court process which determines whether or
not the person committed the offense.

On what
date was
this person
admitted
to this
facility for
the offense
listed in
question 7?
If more than
one date
applies,
enter the
earliest one
for the
offense listed
in question 7.

See Offense
Codes on
Page 19 and 20.

Line number

1 – Federal
2 – A Native American
Tribal Government
3 – State
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify

Code

Specify Other only

Code

If state or
territory
is not known,
enter code
99 in the box
below.

State

01 – Agreement not to adjudicate (diversion)
02 – Awaiting adjudication hearing in
juvenile court
03 – Adjudicated, awaiting disposition by
juvenile court
04 – Adjudicated and disposed in juvenile court
and awaiting placement elsewhere
05 – Adjudicated and disposed in juvenile
court, in placement here
06 – Awaiting transfer hearing to adult criminal
court
07 – Awaiting hearing or trial in adult
criminal court
08 – Convicted in adult criminal court
99 – Don’t know
10 – Other – Specify
Code

Specify Other only

Line number

6.
Is the court, probation
or law enforcement
agency, or other agency
referred to in question 5
at the federal, tribal,
state, county, or
municipal level?

Mo. Day

Yr.

FORM CJ-14 (7-29-2021)

Page 15

2.
What is
this
person’s
sex?
Enter the
code on
the line.

What is this
person’s
date of
birth?

1 – Male
2 – Female

4 – American Indian/Alaska Native,
not of Hispanic origin
5 – Asian, not of Hispanic origin

Line number

6 – Native Hawaiian or other Pacific
Islander, not of Hispanic origin
7 – Two or More Races, not of
Hispanic origin – Specify
For definitions of these categories,
please refer to Page 18.
Code

Mo. Day

Yr.

Code

Specify Other only

Code

Specify Other only

Page 16

FORM CJ-14 (7-29-2021)

Line number

1 – Federal
2 – A Native American
Tribal Government
3 – State
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify

Code

Specify Other only

Code

8.
In which
state or
territory
did this
person
commit
the
offense?
State or
territory
name
may be
abbreviated.
If state or
territory
is not known,
enter code
99 in the box
below.

State

Specify Other only

10.
On what
date was
this person
admitted
to this
facility for
the offense
listed in
question 7?
If more than
one date
applies,
enter the
earliest one
for the
offense listed
in question 7.

Line number

6.
Is the court, probation
or law enforcement
agency, or other agency
referred to in question 5
at the federal, tribal,
state, county, or
municipal level?

Mo. Day

Yr.

FORM CJ-14 (7-29-2021)

Page 17

2.
What is
this
person’s
sex?
Enter the
code on
the line.

What is this
person’s
date of
birth?

1 – Male
2 – Female

4 – American Indian/Alaska Native,
not of Hispanic origin
5 – Asian, not of Hispanic origin

7 – Two or More Races, not of
Hispanic origin – Specify
For definitions of these categories,
please refer to Page 18.
Code

Page 18

Line number

6 – Native Hawaiian or other Pacific
Islander, not of Hispanic origin

Mo. Day

Yr.

Code

Specify Other only

Code

Specify Other only

FORM CJ-14 (7-29-2021)

If state or
territory
is not known,
enter code
99 in the box
below.

Line number

1 – Federal
2 – A Native American
Tribal Government
3 – State
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify

Code

Specify Other only

FORM CJ-14 (7-29-2021)

8.
In which
state or
territory
did this
person
commit
the
offense?
State or
territory
name
may be
abbreviated.

Code

State

Specify Other only

10.
On what
date was
this person
admitted
to this
facility for
the offense
listed in
question 7?
If more than
one date
applies,
enter the
earliest one
for the
offense listed
in question 7.

Line number

6.
Is the court, probation
or law enforcement
agency, or other agency
referred to in question 5
at the federal, tribal,
state, county, or
municipal level?

Mo. Day

Yr.

Page 19

The Federal Government uses the following definitions for the various racial categories.
White – A person having origins in any of the original peoples of Europe, the Middle East, or North
Africa.
Black or African American – A person having origins in any of the black racial groups of Africa.
Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American or
other Spanish culture or origin, regardless of race.
American Indian or Alaska Native – A person having origins in any of the original peoples of
North America and South America (including Central America) and who maintains tribal affiliations or
community attachment.
Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or
the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand, and Vietnam.
Native Hawaiian or other Paciﬁc Islander – A person having origins in any of the original
peoples of Hawaii, Guam, Samoa or other Pacific Islands.
Two or More Races, not of Hispanic origin – Refers to combinations of two or more of the
following race categories: White, Black or African American, American Indian/Alaska Native, Asian,
Native Hawaiian or other Pacific Islander. In cases of Hispanic origin, regardless of race(s), mark
"Hispanic or Latino".

Thank you for completing this questionnaire. If you would like to give us any comments on this
form, please write them below.
Please make copies for your own records of this completed questionnaire, so that if we need to
call you about an answer, you will be able to refer to your copies.
Please mail the completed form in the enclosed envelope to:
U.S. Census Bureau
P.O. Box 5000
Jeffersonville, IN 47199-5000
GOVS/CJRP
Comments

Page 20

FORM CJ-14 (7-29-2021)

OFFENSE CODES
Census of Juveniles in Residential Placement
These Offense Codes are divided into two main categories: (1) offenses for both underage persons and for adults,
and (2) possible offenses for underage persons only. Information on these codes may make it easier for you to
classify persons placed in the facility because of an offense.
In Section II, question 7, you are again referred to these offense codes. There, you are asked to match each young
person’s offense to the category and type of offense listed below. Note the two-digit code number, and write that
number in Section II, question 7, on the line for that person. Please record the most serious offense for which this
person had an assigned bed here on October 27, 2021.
Attempted offenses should be coded as if they were actual offenses, except for attempted murder which should be
coded as 20 (assault, aggravated).
Definitions of the offenses are provided on Page 20.

OFFENSES FOR BOTH UNDERAGE PERSONS AND ADULTS
OFFENSES AGAINST PROPERTY

DRUG-RELATED OFFENSES

10 Arson
11 Auto theft, unauthorized use of auto, joyriding
12 Burglary, breaking and entering, household
larceny
13 Theft, non-household larceny
14 Property damage, vandalism
19 Other property offense

30 Drugs or narcotics, trafficking
31 Drugs or narcotics, possession
39 Other drug-related offense

OFFENSES AGAINST THE PUBLIC ORDER
40 Alcohol or drugs, driving under the
influence of
41 Obstruction of justice
42 Non-violent sex offense, statutory rape
43 Weapons-related offenses
49 Other public order offense

OFFENSES AGAINST PERSONS
20 Assault, aggravated
(include attempted murder)
21 Assault, simple
22 Kidnapping
23 Murder, manslaughter, negligent homicide
24 Violent sexual assault including forcible
rape
25 Robbery
29 Other person offense

PROBATION OR PAROLE VIOLATION
50 Probation or parole violation,
violation of a valid court order

POSSIBLE OFFENSES FOR UNDERAGE PERSONS ONLY
The behaviors identified below are considered offenses in this census ONLY IF THEY ARE ILLEGAL in your state for
underage persons:
60 Curfew violation
61 Incorrigible, ungovernable
62 Running away

63 Truancy
64 Alcohol: underage use, possession or consumption of
69 Other offense that is illegal for underage persons only

UNKNOWN OFFENSES
97 Unknown offense for both underage persons and adults
98 Unknown offense for underage persons only
99 Unknown offense
FORM CJ-14 (7-29-2021)

Page 21

File Type	application/pdf
Author	OneFormUser
File Modified	2021-08-18
File Created	2021-07-29