Form NCVS-1 Basic Screener

NCVS-1

Implementation Date: (7/1/2019)

OMB No. 1121-0111

NATIONAL CRIME VICTIMIZATION SURVEY
NCVS-1 BASIC SCREEN QUESTIONNAIRE
NOTE: Questions are listed in the order asked. Skips in question numbering are due to questionnaire changes over time.

MOBILITY QUESTIONS
33a. TIMEATADDRESS
Before we get to the crime questions, I have some questions that are
helpful in studying where and why crimes occur.

Years (Round to nearest whole year)

506

If = 0 ASK 33b
If = DK or RF SKIP to 33c
Else SKIP to 33d

Ask or verify How long have you lived at this address?
(Enter 0 if less than 1 year.)

33b. MONTHSATADDRESS

Months (1-11) - SKIP to 33e

505

How many months?

33c. TIMEATADDRESSPROBE

1
2

Have you lived here...

3
4

Read categories 1-4:

33d.

CHECK

ITEM A

5

Less than 5 years, but more than 1 year
Less than 1 year, but more than 6 months
6 months or less
Don't Know

Number of times -

508

Altogether, how many times have you moved in the last
5 years, that is, since
, 20
?
Enter number of times.

BUSINESS OPERATED FROM SAMPLE
34. BUSINESS (Asked of Household Respondent Only)

530

Does anyone in this household operate a business from this address?

35. BUSINESSSIGN (Asked of Household Respondent Only)

SKIP
to 33e

5 years or more - If HHLD Respondent SKIP to 34, else SKIP to 36a
Less than 5 years - ASK 33e

How many years are entered in 33a?

33e. TIMEMOVEDIN5YEARS

More than 5 years - If HHLD Respondent ASK 34, else SKIP to 36a.

531

If this is a PERSONAL visit - Fill by observation.
If this is a TELEPHONE contact - Ask.
Is there a sign on the premises or some other indication to the
general public that a business is operated from this address?

Page 1

1
2

Yes - ASK 35
No - SKIP to 36a

1

Yes (Recognizable business)

2

No (Unrecognizable business)

If HHLD Respondent ASK 34,
Else SKIP to 36a

RESPONDENT'S SCREEN QUESTIONS
36a. SQTHEFT
I'm going to read some examples that will give you an idea of the

kinds of crimes this study covers.

As I go through them, tell me if any of these happened to you in the
last 6 months, that is since
, 20
.
Was something belonging to YOU stolen, such as Read each category.
(a) Things that you carry, like luggage, a wallet, purse, briefcase
book (b) Clothing, jewelry, or cellphone (c) Bicycle or sports equipment (d) Things in your home - like a TV, stereo, or tools (e) Things outside your home such as a garden hose or lawn
furniture - (Asked of Household Respondent Only)
(f) Things belonging to children in the household (Asked of Household Respondent Only)
(g) Things from a vehicle, such as a package, groceries, camera, or
CDs OR
(h) Did anyone ATTEMPT to steal anything belonging to you?
Ask only if necessary

532

1
2

Did any incidents of this type happen to you?

36b. SQTHEFTTIMES

Yes - ASK 36b
No - If Household Respondent ASK to
37a; Else SKIP to 40a

533

How many times?

Number of times (36b)

36c. SQTHEFTSPEC

Briefly describe incident(s)

What happened?

If Household Respondent ASK 37a; else SKIP to 40a

37a. SQBREAKIN (Asked of Household Respondent Only)
(Other than any incidents already mentioned,) has anyone Read each category.
(a) Broken in or ATTEMPTED to break into your home by forcing a
door or window, pushing past someone, jimmying a lock, cutting
a screen, or entering through an open door or window?
(b) Has anyone illegally gotten in or tried to get into a garage, shed,
or storage room?
OR
(c) Illegally gotten in or tried to get into a hotel or motel room or
vacation home where you were staying?
Ask only if necessary

534

Did any incidents of this type happen to you?

37b. SQBREAKINTIMES (Asked of Household Respondent Only)

1

Yes - ASK 37b

2

No - SKIP to 38

535

How many times?

Number of times (37b)

37c. SQBREAKINSPEC (Asked of Household Respondent Only)

Briefly describe incident(s)

What happened?

Page 2

RESPONDENT'S SCREEN QUESTIONS
536

38. SQTOTALVEHICLES (Asked of Household Respondent Only)

0
1

What was the TOTAL number of cars, vans, trucks, motorcycles, or
other motor vehicles owned by you or any other member of this
household during the last 6 months? Include those you no longer
own.

2
3
4

None - SKIP to 40a
1
2
3
4 or more

39a. SQMVTHEFT (Asked of Household Respondent Only)
During the last 6 months, (other than any incidents already
mentioned,) (was the vehicle/were any of the vehicles) Read each category.
(a) Stolen or used without permission?
(b) Did anyone steal any parts such as a tire, car stereo, hubcap, or
battery?
(c) Did anyone steal any gas from (it/them)?
OR
(d) Did anyone ATTEMPT to steal any vehicle or parts attached to
(it/them)?
537

Ask only if necessary

1

Yes - ASK 39b

2

No - SKIP to 40a

Did any incidents of this type happen to you?

39b. SQMVTHEFTTIMES (Asked of Household Respondent Only)

538

How many times?

Number of times (39b)
Briefly describe incident(s)

39c. SQMVTHEFTSPEC (Asked of Household Respondent Only)
What happened?

40a. SQATTACKWHERE
(Other than any incidents already mentioned,) since
,
20
, were you attacked or threatened OR did you have something
stolen from you Read each category.
(a) At home including the porch or yard (b) At or near a friend's, relative's, or neighbor's home (c) At work or school d) In places such as a storage shed or laundry room, a shopping
mall, restaurant, bank, or airport (e) While riding in any vehicle (f) On the street or in a parking lot (g) At such places as a party, theater, gym, picnic area, bowling
lanes, or while fishing or hunting OR
(h) Did anyone ATTEMPT to attack or ATTEMPT to steal
anything belonging to you from any of these places?

539

1

Yes - ASK 40b

2

No - SKIP to 41a

Ask only if necessary
Did any incidents of this type happen to you?

40b. SQATTACKWHERETIMES

540

How many times?

Number of times (40b)

40c. SQATTACKWHERESPEC

Briefly describe incident(s)

What happened?

Page 3

RESPONDENT'S SCREEN QUESTIONS
41a. SQATTACKHOW
(Other than any incidents already mentioned,) has anyone attacked or
threatened you in any of these ways (Exclude telephone threats) Read each category.
(a) With any weapon, for instance, a gun or knife (b) With anything like a baseball bat, frying pan, scissors, or stick (c) By something thrown, such as a rock or bottle (d) Include any grabbing, punching, or choking,
(e) Any rape, attempted rape or other type of sexual attack (f) Any face to face threats OR
(g) Any attack or threat or use of force by anyone at all? Please
mention it even if you are not certain it was a crime.

541

Ask only if necessary

1

Yes - ASK 41b

2

No - SKIP to 42a

Did any incidents of this type happen to you?

41b. SQATTACKHOWTIMES

542

How many times?

Number of times (41b)

41c. SQATTACKHOWSPEC

Briefly describe incident(s)

What happened?

42a. SQTHEFTATTACKKNOWNOFF
People often don't think of incidents committed by someone they
know. (Other than any incidents already mentioned,) did you have
something stolen from you OR were you attacked or threatened by (Exclude telephone threats)
Read each category.
(a) Someone at work or school (b) A neighbor or friend (c) A relative or family member (d) Any other person you've met or known?
Ask only if necessary

543

1

Yes - ASK 42b

2

No - SKIP to 43a

Did any incidents of this type happen to you?

42b. SQTHEFTATTACKKNOWNOFFTIMES

544

How many times?

Number of times (42b)

42c. SQTHEFTATTACKKNOWNOFFSPEC

Briefly describe incident(s)

What happened?

Page 4

RESPONDENT'S SCREEN QUESTIONS
43a. SQSEXUAL
Incidents involving forced or unwanted sexual acts are often difficult
to talk about. (Other than any incidents already mentioned,) have you
been forced or coerced to engage in unwanted sexual activity by Read each category.
(a) Someone you didn't know (b) A casual acquaintance OR
(c) Someone you know well?

545

Ask only if necessary

1

Yes - ASK 43b

2

No - SKIP to 44a

Did any incidents of this type happen to you?
546

43b. SQSEXUALTIMES
How many times?

Number of times (43b)

43c. SQSEXUALSPEC

Briefly describe incident(s)

What happened?

44a. SQCALLPOLICECRIME

547

1
2

Yes - ASK 44b
No - SKIP to 45a

During the last 6 months, (other than any incidents already
mentioned,) did you call the police to report something that
happened to YOU which you thought was a crime?

44b. SQCALLPOLICESPEC

Briefly describe incident(s)

What happened?

44c.

CHECK

ITEM B

SQCALLPOLICEATTACKTHREAT

549

If not sure ask:

1

Yes - ASK 44d

2

No - SKIP to 45a

Were you attacked or threatened, or was something stolen or an
attempt made to steal something that belonged to you or
another household member?

44d. SQCALLPOLICEATTACKTHREATTIMES

550

How many times?

Number of times (44d)

Page 5

RESPONDENT'S SCREEN QUESTIONS
45a. SQNOCALLPOLICECRIME

551

1

Yes - ASK 45b

2

No - SKIP to 71

During the last 6 months, (other than any incidents already
mentioned,) did anything which you thought was a crime happen
to YOU, but you did NOT report to the police?

45b. SQNOCALLPOLICESPEC

Briefly describe incident(s)

What happened?

45c.

CHECK

ITEM C

SQNOCALLPOLICEATTACKTHREAT

553

1

Yes - ASK 45d

2

No - SKIP to 71

If not sure ask:

Were you attacked or threatened, or was something stolen or an
attempt made to steal something that belonged to you or another
household member?

45d. SQNOCALLPOLICEATTACKTHREATTIMES

554

How many times?

Number of times (45d)

- SKIP to 71

RESPONDENT'S CHECK ITEMS D, E, AND G
71.

CHECK

ITEM D

PRESENTFORSQS

555

1

2

Who besides the respondent was present when the screen questions
were asked? (If telephone interview, mark box 1 only.)

3
4
5
6
7
8

72.

CHECK

ITEM E

PROXYHELP

556

1
2
3

Did the person for whom this interview was taken help the proxy
respondent answer any screen questions?

73.

CHECK

ITEM G

Telephone interview - SKIP to 73

* Personal interview - Mark all that apply.
No one besides respondent present
Respondent's spouse
HHLD member(s) 12+, not spouse
HHLD member(s) under 12
Nonhousehold member(s)
Someone was present - Can't say who
Don't know if someone else present

If a Proxy interview,
ASK 72,
else SKIP to 73

Yes
No
Person for whom interview taken not present

Yes - SKIP to Crime Incident Report (Item 2a on the NCVS-2)

Is one or more crimes reported in
36b, 37b, 39b, 40b, 41b, 42b, 43b, 44d, or 45d?

No - SKIP to 81 (ASK INTRO_SOCIO_DEMO)

Page 6

RESPONDENT'S SOCIO-DEMOGRAPHIC QUESTIONS
All incident reports must be completed before asking this series of questions.

81. INTRO_SOCIO_DEMO
Now we have some questions about your demographic characteristics.

169a. DIS_HEARING
(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)
1

Are you deaf or do you have serious difficulty hearing?

2

169b. DIS_VISION

1
2

(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

Yes
No

Yes
No

Are you blind or do you have serious difficulty seeing
even when wearing glasses?

170a.

Because of a physical, mental, or emotional
condition, do you have serious difficulty:

(1) DIS_LEARN_CONCENTRATE
(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

1
2

Concentrating, remembering or making
decisions?

(2) DIS_PHYSICAL_LIMIT

1

(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

2

Yes
No

Yes
No

Walking or climbing stairs?

(3) DIS_DRESS_BATH

Yes
No

1

(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

2

Dressing or bathing?

170b. DIS_LEAVING_HOME
(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before
Asked only of persons age 15 or older.)

1

Because of a physical, mental, or emotional condition, do
you have difficulty doing errands alone such as visiting a
doctor's office or shopping?

2

Yes
No

82. CITIZENSHIP
(Asked at 1st interview or if never asked before.
Asked at subsequent interviews if no or Don't Know/Refused at prior interview.)
Are you a citizen of the United States? That is, were you born in the
United States, born in a U.S. territory, born of U.S. citizen parent(s), or
become a citizen of the U.S. through naturalization?

1
2
3
4

Yes, born in the United States
Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands,
or North Marianas
Yes, born abroad of U.S. citizen parent or parents
Yes, U.S. citizen by naturalization

5

No, not a U.S. citizen

(Asked of persons age 16 or older.
Asked only if reported a crime and if never asked before.
Asked if NCVS-500 roster SEX question = Male)

1

Gay

2
3

Straight, that is, not gay
Bisexual

4

Something else

Which of the following best represents how you think of yourself?

5

I don't know the answer
Refused

83. ORIENTATION_MALE

6

Page 7

SKIP to 85

84. ORIENTATION_FEMALE
(Asked of persons age 16 or older.
Asked only if reported a crime and if never asked before.
Asked if NCVS-500 roster SEX question = Female or Unknown)

1

Lesbian or gay

2

Straight, that is, not lesbian or gay
Bisexual
Something else

3
4

Which of the following best represents how you think of yourself?

85. GENID_BIRTH
(Asked of persons age 16 or older.
Asked only if reported a crime and if never asked before.)

5

I don't know the answer

6

Refused

1

Male

2
4

Female
Refused
Don't know

1

Male

2
4

Female
Transgender
None of these

1

Yes

2

No - SKIP back to 85 and/or 86 to correct
Refused
Don't Know

3

What sex were you assigned at birth, on your original birth certificate?

86. GENID_DESCRIBE
(Asked of persons age 16 or older.
Asked only if reported a crime and if never asked before.)

3

Do you currently describe yourself as male, female or transgender?

87. GENID_CONFIRM
(Asked of persons age 16 or older.
Asked only if reported a crime and if never asked before.
Asked if GENID_BIRTH and GENID_DESCRIBE do not match.)
Just to confirm, you were assigned (male/female) at birth and now
(describe yourself as male/ describe yourself as female/ describe
yourself as transgender/ do not describe yourself male, female, or
transgender). Is that correct?

3
4

The instrument prefills the question wording based on responses to GENID_BIRTH and GENID_DESCRIBE.

88. ACTIVE_DUTY
(Asked of persons age 18 or older.
Asked at 1st interview or if never asked before. Asked at subsequent interviews if Never served in the military or Don't Know/Refused at prior interview.
Do not ask if age 40 or older and valid response prior interview.)
1

Have you ever served on active duty in the U.S. Armed Forces,
Reserves, or National Guard?

2

Mark one box.

3
4

Never served in the military
Only on active duty for training in the Reserves - SKIP to 74
or National Guard
Now on active duty
- ASK 89
On active duty in the past, but not now

89. ACTIVE_DUTYWHEN
(Asked of persons age 18 or older.
Asked at 1st interview or if never asked before. Asked at subsequent interviews if no or Don't Know/Refused at prior interview.
Do not ask if age 40 or older and valid response prior interview.)
1

September 2001 or later

2

4

August 1990 to August 2001 (including Persian Gulf War)
May 1975 to July 1990
Vietnam era (August 1964 to April 1975)

5

February 1955 to July 1964

3

When did you serve on active duty in the U.S. Armed Forces?
Mark a box for each period in which the person served, even if just for part of
the period.

6

January 1947 to June 1950

8

World War II (December 1941 to December 1946)
November 1941 or earlier

9

Page 8

Korean War (July 1950 to January 1955)

7

RESPONDENT'S EMPLOYMENT QUESTIONS
74.

CHECK

ITEM H1

Is the respondent 16 years or older?

576

75a. JOBLASTWEEK

1

Yes - ASK 75a

2

No - SKIP to 80

1

Yes - SKIP to 76a
No - ASK 75b

2

Did you have a job or work at a business LAST WEEK? (Do not
include volunteer work or work around the house.)
(If farm or business operator in household, ask about unpaid work.)
577

75b. JOBDURINGREFPERIOD

1
2

Yes - ASK 75c
No - SKIP to 80

Ask or verify Did you have a job or work at a business DURING THE LAST 6 MONTHS?

75c. JOBLAST2WEEKS

578

1
2

Yes - ASK 76a
No - SKIP to 80

Did that (job/work) last 2 consecutive weeks or more?

76a. JOBDESCRIPTION
Ask or verify -

1

Medical Profession? - SKIP 76c

2

Mental Health Services Field? - SKIP to 76e
Teaching Profession? - SKIPto 76g
Law Enforcement or Security Field? - SKIP to 76i

3
4

Which of the following best describes your job?

6

Retail Sales? - SKIP to 76k
Transportation Field? - SKIP to 76m

7

Something else? - Specify - ASK 76b

5

Were you employed in the ...
Read each category until respondent says "yes", then enter appropriate precode.

76b. JOBDESCRIPTIONSPEC

Specify - SKIP to 76o

Please specify the job not covered in answer categories 1-6 in 76a.

76c. MEDICALJOB

Medical Profession

Employed in the Medical Profession:
As a Read each category.

76d. MEDICALJOBSPEC

1

Physician?

2

Nurse?

3

Technician?

4

Other medical profession? - Specify - ASK 76d

SKIP to 76o

Specify - SKIP to 76o

Please specify employed in the medical profession as a -

76e. MENTALHEALTHJOB

Mental Health Services Field

Employed in the Mental Health Services Field:

5
6

Are YOUR duties -

7

Professional (Social worker/psychiatrist)? SKIP to 76o
Custodial care?
Some other mental health services profession? - Specify
ASK 76f

Read each category.

76f. MENTALHEALTHJOBSPEC

Specify - SKIP to 76o

Please specify duties in the mental health services field.

Page 9

RESPONDENT'S EMPLOYMENT QUESTIONS
76g. TEACHINGJOB

Teaching Profession
8

Employed in the Teaching Profession:

9
10

Were you employed in a -

11
12

Read each category.

- SKIP to 76o

14

Technical or industrial school?
Special education facility?

15

Other teaching profession? - Specify - ASK 76h

13

76h. TEACHINGJOBSPEC

Preschool?
Elementary school?
Junior high or middle school?
High school?
College or university?

Specify - SKIP to 76o

Please specify employed in the teaching profession as a -

76i. LAWENFORCEJOB

Law Enforcement or Security Field

Employed in the Law Enforcement or Security Field:

16
17

Were you employed as a -

18
19

Read each category.

76j. LAWENFORCEJOBSPEC

Law enforcement officer?
- SKIP to 76o
Prison or jail guard?
Security guard?
Law enforcement profession? - Specify - ASK 76j

Specify - SKIP to 76o

Please specify employed in the law enforcement or security field as a -

76k. RETAILSALESJOB

Retail Sales 20

Employed in Retail Sales:

21
22

Were you employed as a-

23

Convenience or liquor store clerk?
Gas station attendant?
- SKIP to 76o
Bartender?
Other retail sales profession? - Specify - ASK 76l

Read each category.

76l. RETAILSALESJOBSPEC

Specify - SKIP to 76o

Please specify employed in retail sales as a -

76m. TRANSPORTJOB

Transportation Field 24

Employed in the Transportation Field:

25
26

Were you employed as a-

Bus driver?
- SKIP to 76o
Taxi cab driver?
Other transportation Field profession? - Specify - ASK 76n

Read each category.

76n. TRANSPORTJOBSPEC

Specify

Please specify employed in the transportation field as a -

76o.

CHECK

ITEM H2

579

If 76a equals 7, enter 27 here., otherwise enter the number of the
employment code entered in item 76c, 76e, 76g, 76i 76k, or 76m.

77. EMPLOYERTYPECURRENT

580

1

Ask or verify -

2

Is your job with -

3
4

Read each category.

78. COLLEGEEMPLOYER

581

Are you employed by a college or university?

79. CURRENTJOBMSATYPE

1
2

582

While working at your job, do you work mostly in -

A city?

2

Suburban area?

4

Page 10

Yes
No

1

3

Read each category.

A private company, business, or
individual for wages?
The Federal government?
A State, county, or local government?
Yourself (Self-employed) in your own
business, professional practice, or farm?

Rural area?
Combination of any of these?

If 76o = 22
SKIP to 79,
Else ASK 78.

RESPONDENT'S CHECK ITEM I
80.

CHECK

ITEM I

Yes - If Household Respondent finish collecting income
and telephone information, then END interview.
Otherwise END interview.

Is this the last household member to be interviewed?

No - GO TO question 33a for the next respondent. See
note below before interviewing next household
member.
FIELD REPRESENTATIVE --

(Read to the Household Respondent Only.) If there are any household members under 18, tell the Household
Respondent that you will be asking the same questions you just asked him/her.

90. HOUSEHOLDINCOME (Asked of Household Respondent Only)
(Asked of household respondent.
Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before. Asked at subsequent interviews if no or Don't Know/Refused at prior interview.)
214

Which category represents the TOTAL combined income of all members
of this HOUSEHOLD during the past 12 months? This includes money
from jobs, net income from business, farm or rent, pensions, dividends,
interest, Social Security payments, and any other money income
received by members of this HOUSEHOLD who are 14 years of age or
older.

Page 11

1

Less than $5,000

2

$5,000 to $7,499

3
4

$7,500 to $9,999
$10,000 to $12,499

5

$12,500 to $14,999

6

$15,000 to $17,499

7

$17,500 to $19,999

8

$20,000 to $24,999

9

$25,000 to $29,999

10

$30,000 to $34,999

11

$35,000 to $39,999

12
13

$40,000 to $49,999
$50,000 to $74,999

14

$75,000 to $99,999

15
16

$100,000 to $149,999
$150,000 to $199,999

17

$200,000 or more