NCVSP Draft Survey Instrument

ATTACHMENT A: DRAFT 2023 NCVSP SURVEY INSTRUMENT

DRAFT 2023 NCVSP SURVEY INSTRUMENT
S1. Before you begin, please complete the following pieces of information for your organization. If
your organization is part of a multisite organization, please use the physical address of your location and
not the address of your main or headquarters office.
Organization Name: _________________________
Organization Address: _______________________
City, State, ZIP: _____________________________
Business phone number: _____________________
Organization email address: __________________
Organization web site: _______________________

S1a. Please provide information about the individual who is completing this survey.
Title: _____________________________________
Name: ____________________________________
Telephone Number: _________________________
Email: _____________________________________

S2. Has your organization or any programs/staff within your organization intentionally provided
services to victims/survivors of crime or abuse in the past six months? By ‘services to victims/survivors
of crime or abuse’ we mean direct assistance, including - but not limited to - referrals, counseling, notices
of court proceedings, legal assistance, shelter, medical response, etc. This survey will use the term victim
to mean victim or survivor from this point forward.
Yes  Skip to A1
No  Proceed to S2a
S2a. Does your organization maintain an active victim service referral program? This includes, but is
not limited to, hotlines.
Yes  Skip to A1
No  Proceed to S2a.5

S2a.5. To help us update our records, please answer a few additional questions:
a. Has your organization ever provided services to victims of crime or abuse?
Yes
No
b. Does your organization plan to provide services to victims of crime or abuse in the future?
Yes
No
c. Does your organization indirectly support victims of crime or abuse in any of the following
ways?
A. Contracting out all direct services to another organization.
Yes
No
B. Providing grants or funding to support direct services to victims of crime or abuse.
Yes
No
C. Providing training and technical assistance for direct service providers or engaging
in issue advocacy.
Yes
No
D. Other
Yes
No
[if yes] Please specify ________________

S2b. Which of the following best describes your organization? Select one response.
Tribal government or other tribal organization or entity
Campus organization or other educational institution (public or private)
Hospital, medical, or emergency facility (public or private)
Government agency
Nonprofit or faith-based entity (501c3 status)
For-profit entity
Informal entity (e.g., some other type of program or group, not formally a part of an
organization, registered nonprofit, or business; Independent survivor advocacy and support
groups; volunteer, grassroots, or survivor network)
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Thank you!
You do not need to complete the rest of this survey.

SECTION A
A1. Which of the following best describes how your organization is structured to provide services to
victims of crime or abuse?
The primary function of the organization as a whole is to provide services or programming for
victims of crime.  Skip to A1.5
Victim services or programming are one component of the larger organization’s activities (e.g.,
within a hospital, university, community center, law enforcement agency, or prosecutor’s office)
 Proceed to A1a
A1a. Does your organization have a specific program(s) or staff that are designated to work
with victims of crime or abuse?
Yes  Proceed to A1.5
No  “Thank you. You do not need to complete the rest of this survey.”

A1.5. Please check the most appropriate description of your organization.
Organization operating through one single location  Skip to A1.6
One sublocation of a multi-site organization (such as a branch or satellite office, or a local
chapter of a larger organization)  Proceed to A1.5a
The headquarters or main office of a multi-site organization (i.e., an office that exercises
operational control over other sites, not merely a membership organization)
 Skip to A 1.5b

A1.5a. Please provide the following contact information for your organization's headquarters or main
office:
Organization Name: __________________________________
Organization Address: ________________________________
City, State, ZIP: ______________________________________
 Skip to A1.6

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A1.5b. Please provide the following contact information for each of your organization's sublocations:
Sublocation Name: __________________________________
Organization Address: ________________________________
City, State, ZIP: ______________________________________
Add location?
Yes [Repeat prompts for org name, address, city/state/zip]
No  Proceed to A1.7

A1.6. Is your organization physically located at the site of another organization (such as a nonprofit
program operating out of the courthouse or a law enforcement agency; or a law enforcement victim
service program operating out of a Family Justice Center; or a nonprofit with space in a commercial
establishment)?
Yes  Display a message “For the next question, regarding organization type, please select
the answer that best describes your own organization rather than the type of organization
where you are physically located.” Skip to A2
No  Skip to A2

A1.7. In addition to support you provide to your sublocations, do you offer any direct services to
victims of crime or abuse at your location/headquarters level? (This can include a helpline or hotline.)
Yes  Proceed to A1.8
No  Skip to A1.9

A1.8. This survey includes questions about services, persons served, staffing, and funding. Please
indicate what your responses will encompass:
Responses relate ONLY to the main or headquarters location  Skip to A2
Responses relate to all locations of this organization (headquarters plus all sublocations)
 Skip to A2

A1.9. Are you able to answer questions about services, persons served, staffing, and funding for all
your organization’s sublocations?
Yes  “Please respond to the remainder of the survey as the questions relate to all of your
organization’s sublocations”  Proceed to A2
No  “Thank you. You may exit the survey.”

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A2. Which of the following best describes your organization? Select one response.
Tribal government or other tribal organization  Go to Section B [Tribal]
Campus organization or other educational institution (public or private)  Go to Section C
[Campus]
Hospital, medical, or emergency facility (public or private)  Go to Section G [Services for
Victims]
Government agency  Go to Section D [Government]
Nonprofit or faith-based organization (501c3 status)  Go to Section E [Nonprofit or faithbased]
For profit organization  Go to Section F [For profit]
Informal entity (e.g., some other type of program or group, not formally a part of an
organization, registered nonprofit, or business; Independent survivor advocacy and support
groups; volunteer, grassroots, or survivor network)  Go to Section G [Services for Victims]

SECTION B
Tribal Agencies and Organizations Only
B1. Which designation best describes your tribal agency or organization? Select one response.
Law enforcement
Prosecutor’s Office
Court
Juvenile justice
Offender custody and supervision (such as probation, parole, corrections)
Multi-agency (such as task forces, response teams, etc.)
Social services or child/adult protective services
Health services
Advocacy program
Coalition
Other (please specify)____________
All responses  Go to section G [SERVICES FOR VICTIMS]

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SECTION C
Campus Organizations Only
C1. Which designation best describes your campus organization? Select one response.
Law enforcement/campus security
Campus disciplinary body or student conduct body (including Title IX office)
Physical or mental health service program
Victim services or advocacy group
Other campus-based program (please specify) ____________
All responses  Go to section G [SERVICES FOR VICTIMS]

SECTION D
Government Agencies Only
D1. Which designation best describes your government agency? Select one response.
Law enforcement  Skip to D2
Prosecutor’s Office (such as District Attorney, County Attorney, etc.)  Skip to D2
Courts  Skip to D2
Juvenile justice  Skip to D2
Social services or child/adult protective services  Skip to D2
Offender custody and supervision (such as probation, parole, corrections)  Skip to D2
Multi-agency (such as task forces, response teams, etc.)  Skip to D2
State or territory victim compensation program  Skip to D2
State or territory victim funding administrator  Proceed to D1a
Other government agency (please specify)_____________  Skip to D2
D1a. Does your organization provide any direct victim services itself, in addition to
grantmaking?
Yes  “In completing the remainder of the survey, please confine your responses to
your own direct victim service activities, not the grant-making and related functions.”
 Go to section G [SERVICES FOR VICTIMS]
No  “Thank you. You may exit the survey.
D2. In what service area/jurisdiction does your agency operate in terms of victims served or services
delivered? Select one response.
Nationwide  Skip to G2
Statewide  Skip to G2
Regional/Multi-county/Multi-city  Proceed to G1
Countywide only  Proceed to G1
Citywide only  Proceed to G1
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Specific neighborhood only  Proceed to G1
Other (please specify) _____________________ Proceed to G1
All responses  Go to section G [SERVICES FOR VICTIMS]

SECTION E
Non-Profit or Faith-Based Organizations Only
E1. In what service area/jurisdiction does your non-profit organization operate? Select one response.
Nationwide  Skip to G2
Statewide  Skip to G2
Regional/Multi-county/Multi-city  Proceed to G1
Countywide only  Proceed to G1
Citywide only  Proceed to G1
Specific neighborhood only  Proceed to G1
Other (please specify) ________________________ Proceed to G1
All responses  Go to section G [SERVICES FOR VICTIMS]

SECTION F
For-Profit Organizations Only
F1. What designation best describes your for-profit organization? Select one response.
Private legal office/law firm
Private counseling service or other mental health care provider
Funeral home
Other commercial or professional entity (please specify) ____________________
All responses  Go to section G [SERVICES FOR VICTIMS]

SECTION G
Services for Victims
G1. How would you best describe your service area? (An urban area is within a principal city of a
Metropolitan Statistical Area (MSA). A suburban area is within an MSA but not within the principal city
of that MSA and a rural area is outside of an MSA. An MSA can generally be defined as an area with a
city and surrounding communities closely linked to one another by social and economic factors.)
Urban
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Suburban
Rural

G2. Does your organization operate/report data on a calendar year or fiscal year?
Calendar year  Skip to G3
Fiscal year  Proceed to G2.1
Both  Proceed to G2.1
G2.1. What is the date of the beginning of the fiscal year at your organization?

[MM/DD]

For the remainder of the survey, unless indicated otherwise, provide your answers based on the most
recent 12 months of data – calendar year or fiscal year, depending on how your organization operates as
answered in Question G2.

Did your organization provide any of the following services to victims within the past calendar/fiscal
year? We recognize that victim service organizations provide a wide array of services to victims. For the
purposes of this survey, we are asking about general categories of services your organization provided to
victims, which may not capture your victim service offerings in detail. Do your best to place the services
your organization provided within the general categories.
Information and referral services
G3. Did your organization provide (…)
Justice related information and referrals? (e.g., information about the
justice system and the victim’s role; notification of events and
proceedings; justice referrals; etc.)

Yes

No

Service or victimization information and referrals? (e.g., information
about crime and victimization; medical referrals; legal referrals;
financial counseling referrals; other referrals; etc.)
Financial and material assistance services
G4. Did your organization provide (…)

Yes

Monetary assistance? (e.g., providing funds or offering assistance in
seeking victim compensation; public benefits assistance; other
emergency funds assistance; etc.)
Shelter or housing assistance (emergency or transitional)
Other material assistance (e.g., food, clothing, utility, public assistance,
employment assistance)
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No

Mental health support and safety
G5. Did your organization provide (…)

Yes

No

Yes

No

Yes

No

Yes

No

Mental health services? (e.g., individual or group counseling; support
groups; other therapy; social programming for children; etc.)
Crisis Counseling?
Substance abuse treatment?
Safety services? (Safety planning; witness protection; address
confidentiality; self-defense; etc.) (Does NOT include protective orders)
Medical and health assistance
G6. Did your organization provide (…)
Accompaniment to medical care or forensic examinations?
Emergency or follow-up medical care? (provision of care)
Forensic examinations? (provision of care)
STD/HIV testing?
Legal and victims’ rights assistance
G7. Did your organization provide (…)
Criminal/juvenile/military/tribal justice-related assistance? (e.g.,
representation; advocacy; accompaniment; assistance in exercising
victims’ rights; etc.)
Civil justice-related assistance? (e.g., protective or restraining order;
assistance with family law matters; assistance with landlord/tenant
matters; etc.)
Immigration assistance? (e.g., assistance seeking special visas;
continued presence applications; other immigration relief; etc.)
Other services
G8. Did your organization provide (…)
Case management?
Supervised child visitation?

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On-scene coordinated response?
Education classes for survivors regarding victimization dynamics?
Transportation services?
Language access? (e.g., translation or interpretation services, or
bilingual staff)
Services designed to meet the needs of culturally or ethnically-specific
populations?
G9. Did your organization operate a hotline/helpline or crisis line at any time during the past
calendar/fiscal year?
Yes  Proceed to G9a
No  Skip to G10

G9a. How many hotline/helpline or crisis line calls did your organization receive from victims in the
past calendar/fiscal year? Estimates are acceptable.
__________________ Check box if estimate

G10. Excluding hotline/helpline or crisis line calls, how many unique victims received direct services
from your organization during the past calendar/fiscal year? Estimates are acceptable. (Exclude victims
who only received information through the mail.)
__________________ Check box if estimate

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G 11. Please report whether your organization provided services for victims of the following types of
crime or abuse during the past calendar/fiscal year. (Include any crime types for which your
organization provided services regardless of whether it was the presenting or a secondary crime type.)
Youth (under age 18)
Child physical abuse or neglect
Child rape/sexual assault/sexual abuse
Child witness of violence
Child marriage or forced marriage
Adults molested/abused as children
Adults
Domestic violence/dating violence/violation of DV protective orders
Stalking/violation of stalking protective orders
Rape/sexual assault/sexual abuse (other than against children)
Physical Assault (other than domestic/dating violence, child/elder
abuse, or rape/sexual assault/sexual abuse) (including attempted
homicide; gun violence; strangulation; threat with a weapon, etc.)
Robbery
Elder physical abuse or neglect
Survivors of homicide (including murder, non-negligent
manslaughter)
Targeted crime types
Hate crimes (racial/religious/ethnic or national
origin/disability/gender/sexual orientation)
Honor related violence (physical violence/threats/retaliation in the
name of family honor, female genital mutilation)
Human trafficking (labor)
Human trafficking (sex)
Victim witness intimidation
DUI/DWI crashes
Community violence/gang violence
Terrorism/mass violence
Financial crimes
Identity theft
Financial fraud and exploitation (other than identity theft)
Property crimes
Motor vehicle theft
Burglary
Other specify categories
Other violent crimes – specify _____________________
Other property crimes – specify __________________
Other – specify ____________________

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Yes

No

Organizations restricted to serving certain groups of victims or victims of certain crimes.
G12. Do any of the following statements describe the types of victims or survivors your organization
serves? (select only one)
We only provide services to victims of particular types of crimes (such as domestic
violence, trafficking, identity theft, etc.)  Proceed to G12.1
We only provide services to specific populations of victims, regardless of the type of crime
(such as children, immigrants, etc.)  Skip to G12.2]
We only provide services to specific populations who have experienced specific types of
crime or abuse (such as child victims of sexual abuse, older adults who experienced identity
theft, etc.)  Proceed to G12.1 and G12.2
None of the above  Skip to Section H [staffing]
G12.1 Indicate the specific type(s) of crime or abuse you are able to serve: (i.e., you could provide
services to a victim of this crime, even if they had not suffered any other type of crime) Please do your
best to fit your organization within the general categories provided.)
Check all that apply

Yes

Any/all felonies
Any/all violent crime
Community violence/gang violence
Domestic violence/dating violence
DUI/DWI crashes
Financial exploitation/identity theft/fraud
Hate crimes
Human trafficking (sex)
Human trafficking (labor)
Physical abuse/neglect
Physical assault (including attempted homicide; gun violence; strangulation;
threat with a weapon, etc.)
Rape/sexual assault/sexual abuse
Stalking
Survivors of homicide (including murder, non-negligent manslaughter)
Terrorism/mass violence
Other (specify)

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No

G12.2 Indicate the specific populations of victims you are able to serve: (i.e., you could provide
services to a victim who was within this population) Please do your best to fit your organization within
the general categories provided.)
Check all that apply

Yes

No

Child victims
Adolescent/teen victims
Elder victims/dependent adult victims
Female victims
Male victims
Victims of color OR victims of specific racial or ethnic groups please specify?
Indigenous victims, including Native American or Alaska Native
Immigrant/refugee/limited English proficiency victims
LGBTQ victims
Victims with disabilities
Deaf or hard-of-hearing victims
Formerly incarcerated victims
Incarcerated victims
Other (specify) ___________________________________________________

SECTION H
Staffing
The following questions concern staff dedicated to working with victims of crime or abuse during the
past calendar/ fiscal year. Provide your answer based on the past fiscal year or the past calendar year
depending on how your organization operates as answered in Question G1.

Staff at the beginning of the previous completed calendar/fiscal year
H1. How many paid full-time staff (35 hours or more/week) dedicated to working with victims worked
at your organization at the beginning of the past calendar/fiscal year? Count each person only once.
Enter ‘0’ if there are no paid staff of that type. Include contractual workers in your counts. Estimates are
acceptable.
_________

Check box if estimate □

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H2. How many paid part-time staff (less than 35 hours/week) designated to working with victims
worked at your organization at the beginning of the past calendar/fiscal year? Count each person only
once. Enter ‘0’ if there are no paid staff of that type. Include contractual workers in your counts.
Estimates are acceptable.
_________

Check box if estimate □

New staff hired during the previous completed calendar/fiscal year
H3. How many paid full-time staff (35 hours or more/week) dedicated to working with victims did
your organization hire in the past calendar/ fiscal year, whether to fill new positions or to fill
vacancies? Count each person only once. Enter ‘0’ if there are no paid staff of that type. Include
contractual workers in your counts. Estimates are acceptable.
________

Check box if estimate □

H4. How many paid part-time staff (less than 35 hours/week) designated to working with victims did
your organization hire in the past calendar/fiscal year, whether to fill new positions or to fill
vacancies? Count each person only once. Enter ‘0’ if there are no paid staff of that type. Include
contractual workers in your counts. Estimates are acceptable.
________

Check box if estimate □

Staff that left during the previous completed calendar/fiscal year
H5. How many paid full-time staff (35 hours or more/week) dedicated to working with victims left
their position with your organization during the past calendar/ fiscal year, whether dismissed,
resigned, retired, transferred to a non-direct services position, etc.? Count each person only once. Enter
‘0’ if there are no paid staff of that type. Include contractual workers in your counts. Estimates are
acceptable.
________

Check box if estimate □

H6. How many paid part-time staff (less than 35 hours/week) designated to working with victims left
their position with your organization during the past calendar/fiscal year whether dismissed, resigned,
retired, transferred to a non-direct services position, etc.? Count each person only once. Enter ‘0’ if
there are no paid staff of that type. Include contractual workers in your counts. Estimates are
acceptable.
________

Check box if estimate □

“Based on your previous responses, the number of full-time staff you had at the beginning of the current
fiscal/calendar year was _________[auto calculate] – is that correct?”
“Based on your previous responses, the number of part-time staff you had at the beginning of the
current fiscal/calendar year was ________[auto calculate] - is that correct?”

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H8. Does your organization use volunteers (i.e., staff that are not paid) to provide direct services to
victims?
Yes
No

SECTION I
Funding
[programming: remind people who are Parent/HQ organizations that they previously indicated they
were responding either
a) for just their location OR
b) across all locations]

I1. What was your organization’s total annual budget for the past calendar/fiscal year?
Amount $_________________

Check box if estimate

[For embedded programs other than nonprofits:]
I2. Was all or part of your victim services programming supported by your organization’s internal
budget in the past calendar/fiscal year?
Yes
No
Amount $___________________________

check box if estimate

I3. What was your organization’s total budget for victim-related programming and services during the
past calendar/fiscal year? $___________ Check box if estimate

The following questions ask about external sources of funding and will help us better understand the
mix of funding supporting victim service programming.
Please indicate whether your victim services budget in the past calendar/fiscal year included funding
from any of the following. If so, please provide an amount (estimates acceptable).
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I4. Local government funding specifically for victim services?
Yes
No
Amount) $__________________________

Check box if estimate

I5. Tribal government funding specifically for victim services?
Yes
No
Amount $___________________________

Check box if estimate

I6. Foundations, private donations, and other fundraising specifically for victim services?
Yes
No
Amount $ ____________________________

Check box if estimate

I7. Which of the following federal and state sources support your victim services budget, if any?

Federal funding, including funding passed through a state administrator as a subgrant
Victims of Crime Act (VOCA) Funding

 Yes  No

Other funding from the Office for Victims of Crime

 Yes  No

Services, Training, Officers, and Prosecutors (STOP) grant

 Yes  No

Sexual Assault Services Program funding

 Yes  No

Other funding from the Office on Violence Against Women

 Yes  No

Family Violence Prevention Services Act (FVPSA) funding

 Yes  No

Other federal funding

 Yes  No

If yes, please specify ____________________________
State funding

 Yes  No

I8. Do you receive victim services funding from any additional sources in the past calendar/fiscal year?
Yes

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No

Amount $ ____________________________

Check box if estimate

I9. Did your organization receive any federal funding for victim programming or services within the
past 5 years? (This could include funding from VOCA grants; OVC grants; a STOP, SASP, or other VAWA
grant; or some other funding coming from a federal agency.)
Yes
No

SECTION J
Record Keeping
J1. Does your organization use an electronic records system to maintain case files?
Yes
No  Skip to Section K
J2. Does your organization’s electronic records system track individual cases?
Yes
No

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SECTION K
Current Issues of Concern to Victim Service Providers
K1. How concerned are you about vicarious trauma and staff burnout at your organization? (“Vicarious
trauma” refers to exposure to the trauma of others that puts people at risk for a range of negative
consequences.)
Very concerned
Somewhat concerned
A little concerned
Not concerned at all
K2. How concerned are you about your organization’s ability to reach and serve all people equally?
(This includes but is not limited to racial equity, gender identity/sexual orientation equity, equity for
those with disabilities, and equity for those with limited English proficiency.)
Very concerned
Somewhat concerned
A little concerned
Not concerned at all
K3. How concerned are you about the amount of victim service funding that your organization
received in the past year?
Very concerned
Somewhat concerned
A little concerned
Not concerned at all
K4. How concerned are you about the predictability of future funding for your organization?
Very concerned
Somewhat concerned
A little concerned
Not concerned at all
K5. How concerned are you about the burden of grant reporting?
Very concerned
Somewhat concerned
A little concerned
Not concerned at all
K6. How concerned are you about your organization’s ability to access technology?
Very concerned
Somewhat concerned
A little concerned
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Not concerned at all

COVID-Related Organizational Impacts
March of 2020 is generally recognized as the start of the COVID-19 global pandemic. Many activities
were affected, including victim services delivery.
K.7 Have you made or experienced any changes in your organization or the way you deliver services
because of the COVID-19 pandemic?
□ YES [Complete table]
□ NO
This change did
not happen

This change
happened
temporarily

Staff resigned
Staff were laid-off
Staff worked partially or fully
remote
In-person meetings with
victims were suspended
Virtual and phone meetings
with victims increased
Psychological services or
support groups were
conducted via phone or
online video platform
Shelters were partially or
fully closed
Court-services were partially
or fully suspended
Court proceedings were held
virtually

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This change has
continued through
the present

Service needs changed as
some crimes increased or
decreased
Service needs changed due
to increased levels or severity
of violence
Other changes

K.7a. If you had other changes in your services or service delivery, what were they?
_____________________

Thank you for taking the time to complete this important survey!

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