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pdfU.S. Department of Justice
Office of Justice Programs
National Institute of Justice
______________________________________________________________________________
Washington, DC 20531
MEMORANDUM
To:
Joe Nye, Policy Analyst
Office of Information and Regulatory Affairs
Office of Management and Budget
Through:
Darwin Arceo, Department Clearance Officer, Justice Management Division
From:
Benjamin Adams, Social Science Analyst, NIJ
Date:
February 14, 2025
Re:
Non-substantive change request to the Juvenile Facility Census Program (OMB
#1121-0381) to align with E.O. 14168
Summary of request: The National Institute of Justice is making a change request to revise
questions in the Juvenile Residential Census Program to align with E.O. 14168 Defending
Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal
Government (Defending Women).
Description of Changes to Burden: No changes to burden are requested.
Description of Changes Request: This request updates questions, answer choices, and
definitions in the Census of Juveniles in Residential Placement form and the Juvenile Residential
Placement Facility form including revisions and deletions. The requested changes are detailed
below with screenshots of the revised content.
Census of Juveniles in Residential Facilities
Section II – Housed Youth
Item 3
• Revise the question from “What is this person’s sex assigned at birth?” to “What is this
person’s sex?”
Item 4
• Delete the question, answer choices, and definition
Item 5
• Delete the question, answer choices, and definition
Updated screenshot:
Section III – Released Youth
Item 3
• Revise the question from “What is this person’s sex assigned at birth?” to “What is this
person’s sex?”
Item 4
• Delete the question, answer choices, and definition
Item 5
• Delete the question, answer choices, and definition
Updated screenshot:
Definitions of Terms
• Delete
o “Gender Identity”
o ‘Nonbinary’
o ‘Sex assigned at birth’
o Sexual orientation
o Transgender
Updated screenshot:
Juvenile Residential Facility Census
Section 1 – General Facility Information
Item 18
• Revise answer choice 03 from cross-gender supervision to cross-sex supervision
• Delete answer choice 06 (LGBTQ+ responsiveness)
Updated screenshot:
Section 7 – The Past Year
Item 3
• Delete “gender identity” from the question
• Delete e. Gender Identity
Updated screenshot:
Definitions of Terms
• Delete
o “Gender Identity”
o “Sex assigned at birth”
Updated screenshot:
List of Appendices
A. Census of Juveniles in Residential Facilities Original Content to be Modified
B. Juveniles in Residential Facilities Original Content to be Modified
C. Revised Census of Juveniles in Residential Placement Instrument
D. Revised Juveniles Residential Facility Census Instrument
Appendix A: Original Census of Juveniles in Residential Facilities Content to be Modified or
Removed
Appendix B: Original Juvenile Residential Facility Census Content to be Modified or Removed
Attachment C: Revised Census of Juveniles in Residential Facilities Instrument
[Intentionally Left Blank]
U.S. DEPARTMENT OF COMMERCE U.S. CENSUS BUREAU
ACTING AS A COLLECTING AGENT FOR U.S. DEPARTMENT OF JUSTICE OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION
2025 Census of Juveniles in Residential
Placement
This questionnaire asks about persons who had assigned beds
in this facility on Wednesday, March 26, 2025.
Important Instructions:
1. A juvenile residential facility is a place
where young persons who have committed
offenses may be housed overnight as a direct
result of those offenses. A facility has
living/sleeping units, such as wings, floors,
dorms, barracks, or cottages on one campus
or in one building.
2. Any buildings with living/sleeping units that
are not on the same campus should be
considered separate facilities and should
submit a separate questionnaire. Please
request additional questionnaires using the
contact information below.
You may find it helpful to use this form to gather
the requested information. We ask that you submit
your response online BY APRIL 30, 2025:
https://respond.census.gov/cjrp
If you cannot submit your information online,
please mail or fax your information to the following:
U.S. Census Bureau
PO Box 5000
Jeffersonville, IN 47199-5000
GOVS/CJRP
Fax: 1–888–262–3974
If you have any questions, contact the U.S. Census Bureau: 1–800–352–7229 | [email protected]
FACILITY NAME
PERSON COMPLETING THIS QUESTIONNAIRE
Name
E-mail address
Title
Street Address or P.O. Box
Apt, Suite, or Unit (Optional)
Telephone
State
City
FORM
CJ-14 (02-07-2025)
ZIP Code
Area code
Number
Extension
OMB No. 1121-0381: Approval Expires 12-31-2027
MAILING ADDRESS OF FACILITY
Street Address or P.O. Box
Apt, Suite, or Unit (Optional)
City
State
ZIP Code
State
ZIP Code
PHYSICAL ADDRESS OF FACILITY
Physical address is the same as the mailing address
Street Address (DO NOT provide P.O. Box)
Apt, Suite, or Unit (Optional)
City
Section 1 – GENERAL FACILITY INFORMATION
1a. Is this facility part of a larger agency?
01
Yes
No ➔ Go to Note A
02
1b. What is the name of this agency?
NOTE
A
Questions 2 and 3 ask who OWNS this
facility. Later you will be asked who
OPERATES this facility.
2a. Who OWNS this facility?
Mark (X) only one.
01
a private non-profit agency
a for profit agency
02
03
a government agency ➔ Go to Question 3
2b. What is the name of the private non-profit
or for-profit agency that OWNS this facility?
➔
3.
Page 2
Go to
NOTE B
What is the level of the government agency
that OWNS this facility?
Mark (X) all that apply.
01
A Native American Tribal Government
02
Federal
03
State
04
County
Municipal (includes Washington, DC)
05
06
Other – Specify
NOTE
B
Questions 4 and 5 ask who OPERATES this
facility (either directly or under contract).
4a. Who OPERATES this facility?
Mark (X) only one.
01
a private non-profit agency
02
a for profit agency
03
a government agency ➔ Go to Question 5
4b. What is the name of the private non-profit
or for-profit agency that OPERATES this
facility?
➔
5.
Go to
Question
6
What is the level of the government agency
that OPERATES this facility?
Mark (X) all that apply.
01
A Native American Tribal Government
02
Federal
03
State
04
County
05
Municipal (includes Washington, DC)
06
Other – Specify
FORM CJ-14 (02-07-2025)
Section 1 – GENERAL FACILITY INFORMATION – Continued
6. What type of residential facility is the one
listed on the front cover?
Mark (X) all that apply.
INSTRUCTIONS
01
Detention center: A short-term facility that
provides temporary care in a physically restricting
environment for young persons in custody pending
court disposition and, often, for young persons 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 young persons committed for
short periods of time as part of their disposition (e.g.,
weekend detention).
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, March 26, 2025.
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:
02
Long-term secure facility: A specialized type of
facility that provides strict confinement and long-term
treatment generally for post-adjudication committed
young persons placed for delinquency or status
offenses. Includes training schools, juvenile
correctional facilities, youth development centers.
1. those persons under age 21; and
03
Reception or diagnostic center: A short-term
facility that screens young persons committed by the
courts and assigns them to appropriate correctional
facilities.
04
Group home or Halfway house: These facilities
are generally non-secure and typically intended for
post-adjudication commitments in which young
persons are allowed extensive contact with the
community, such as attending school or holding a
job.
05
06
07
08
09
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:
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.
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 30 and 31 of the
CJRP form.
Residential treatment center: A facility that
focuses on providing some type of individually
planned treatment program for young persons
(substance use, 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.
Ranch or Wilderness Program: A long-term
facility focused on providing structured outdoor
programs, such as farming, forestry, wildlife
conservation, and environmental education. These
facilities are generally non-secure and typically
located in a remote area.
Runaway and/or 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 young persons are
housed short-term until another placement can be
found.
Other: This includes independent living programs
and anything that cannot be classified above.
Specify
FORM CJ-14 (02-07-2025)
Please use your records to answer the
following questions.
7a. According to your records, at the end of
the day on Wednesday, March 26, 2025,
did ANY persons have assigned beds in
this facility? Include persons who were
temporarily away, but had assigned beds on March
26, 2025. Do NOT include staff.
01
02
Yes
No ➔ Go to Question 7c
7b. According to your records, at the end of
the day on March 26, 2025, how many
persons had assigned beds in this facility?
Persons
➔
Go to Question 8
Page 3
Section 1 – GENERAL FACILITY INFORMATION – Continued
7c. Specify why there were not ANY persons
assigned beds in this facility on
Wednesday, March 26, 2025:
Facility permanently closed
Date of Closure:
01
(MM/DD/YYYY)
02
Facility temporarily closed
03
Other - Specify
10. How many of the persons who had
assigned beds at the end of the day on
Wednesday, March 26, 2025, were AGE 21
or older? Include persons who were temporarily
away, but had assigned beds on March 26, 2025.
Do NOT include staff. Please write "0" if there
were NO persons age 21 or older.
Persons age 21 or older
11a. At the end of the day on Wednesday,
March 26, 2025, 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.
INSTRUCTIONS
1. If you did NOT have ANY persons
assigned beds in this facility on
Wednesday, March 26, 2025, STOP
HERE and submit this form.
2. If you DID HAVE persons assigned beds
in this facility on Wednesday,
March 26, 2025, CONTINUE BELOW.
8.
01
Yes
02
No
Go to Question 11c
11b. According to your records at the end of
the day on Wednesday, March 26, 2025,
how many persons UNDER AGE 21 had
assigned beds in this facility? Include
persons who were temporarily away but had
assigned beds on March 26, 2025. Do NOT
include staff.
What was the TOTAL NUMBER OF
STANDARD BEDS in this facility on the
night of Wednesday, March 26, 2025?
Do NOT include staff beds.
● A single bed is one standard bed
● A double bunked bed is two standard beds
➔
Persons under
age 21
➔
Go to
NOTE C
11c. Specify why there were not ANY persons
UNDER AGE 21 assigned beds in this
facility on Wednesday, March 26, 2025:
Mark (X) all that apply.
Total number of standard beds
01
02
9a. On the night of Wednesday, March 26,
2025, were there ANY OCCUPIED
MAKESHIFT BEDS in this facility?
Makeshift beds are:
●
●
●
●
●
●
Roll-out mats
Fold-out cots
Roll-away beds
Pull-out mattresses
Sofas
Any other beds that are put away or
moved during non-sleeping hours
01
Yes
02
No
➔
Go to Question 10
9b. How many makeshift beds were occupied
that night?
03
Adult only facility
No persons under age 21 were placed in
this facility
Other - Specify
As a check, the sum of question 10 (persons 21 and
NOTE older) and 11b (persons under age 21) should equal
the sum reported in question 7b (number of persons
C
assigned beds in the facility).
INSTRUCTIONS
1. If you did NOT have ANY persons
UNDER AGE 21 assigned beds in this
facility on Wednesday, March 26, 2025,
STOP HERE and submit this form.
2. If you DID HAVE persons UNDER AGE
21 assigned beds in this facility on
Wednesday, March 26, 2025,
CONTINUE BELOW.
Occupied makeshift beds
Page 4
FORM CJ-14 (02-07-2025)
Section 1 – GENERAL FACILITY INFORMATION – Continued
12a. At the end of the day on Wednesday,
March 26, 2025, did ANY of the persons
UNDER AGE 21 have assigned beds in
this facility SPECIFICALLY BECAUSE they
were CHARGED WITH OR COURTADJUDICATED 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 30.
INCLUDE in your count persons UNDER AGE 21
here BECAUSE they were CHARGED WITH OR
COURT-ADJUDICATED FOR:
12b. According to your records at the end of the
day on Wednesday, March 26, 2025, HOW
MANY PERSONS UNDER AGE 21 had
assigned beds in this facility SPECIFICALLY
BECAUSE they were CHARGED WITH OR
COURT- ADJUDICATED FOR AN OFFENSE,
as defined in question 12a?
Later you will be asked to provide information
about each of these persons. Include persons who
were temporarily away but had assigned beds on
March 26, 2025. Do NOT include staff.
Persons under age 21 here because
they were charged with or
court-adjudicated for an offense.
➔ Go to Question 13a
● ANY offense that is illegal for both adults and
underage persons.
● 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.
12c. Specify why there were not ANY persons
UNDER AGE 21 assigned beds in this
facility on Wednesday, March 26, 2025
SPECIFICALLY BECAUSE they were
CHARGED WITH OR
COURT-ADJUDICATED FOR AN OFFENSE:
Mark (X) all that apply.
01
No persons under age 21 were placed in
this facility for an offense.
02
This facility is no longer under contract to
hold persons under age 21 for offense
reasons.
03
Other – Specify
DO NOT INCLUDE here:
● Persons under age 21 who have committed one
or more offenses in the past, BUT HAVE
ASSIGNED BEDS ON MARCH 26, 2025 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 use 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 question
13b.
● 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 ➔
FORM CJ-14 (02-07-2025)
Go to Question 12c
Page 5
Section 1 – GENERAL FACILITY INFORMATION – Continued
13a. At the end of the day on Wednesday,
March 26, 2025, 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.
INSTRUCTIONS
1. If you did NOT have ANY persons under
age 21 assigned beds in this facility on
Wednesday, March 26, 2025
SPECIFICALLY BECAUSE they were
CHARGED WITH OR
COURT-ADJUDICATED FOR AN
OFFENSE, STOP HERE and submit this
form.
2. If you DID HAVE persons under age 21
assigned beds in this facility on
Wednesday, March 26, 2025
SPECIFICALLY BECAUSE they were
CHARGED WITH OR
COURT-ADJUDICATED FOR AN
OFFENSE, CONTINUE BELOW.
14a. Are ANY young persons in this facility
locked into their sleeping rooms by staff
at ANY time to confine them?
DO NOT INCLUDE here:
01
Yes
● Persons assigned beds here BECAUSE
THEY WERE CHARGED WITH OR
COURT-ADJUDICATED FOR AN OFFENSE.
These persons are counted in question 12b.
02
No
01
02
Yes
No ➔
Go to Question 15
14b. (If yes) In what situations are young
persons locked in their sleeping rooms?
Mark (X) all that apply.
Go to Note D
01
02
03
13b. According to your records at the end of
the day on Wednesday, March 26, 2025,
HOW MANY PERSONS UNDER AGE 21 had
assigned beds in this facility FOR
REASONS OTHER THAN OFFENSES, as
defined in question 13a?
Include persons who were temporarily away but
had assigned beds on March 26, 2025. Do NOT
include staff.
Persons under age 21 here
because of non-offense reasons.
04
05
06
07
When they are out of control
When they are suicidal
For medical reasons other than suicide
During shift changes
Whenever they are in their sleeping rooms
As part of a set schedule
Other – Specify
14c. (If part of a set schedule) When are young
persons in this facility locked into their
sleeping rooms?
Mark (X) all that apply.
01
As a check, the sum of questions 12b (persons
NOTE under 21 with offenses) and 13b (persons under 21
with reasons other than offenses) should equal 11b
D
(the number of persons under age 21).
Page 6
➔
02
03
04
All of the time
During the day for 2 hours or less
During the day for more than 2 hours
At night
FORM CJ-14 (02-07-2025)
Section 1 – GENERAL FACILITY INFORMATION – Continued
15. Does this facility have any of the following
features utilized by staff to secure or
confine young persons within specific
areas?
Mark (X) all that apply.
01
02
03
04
05
06
Locked doors for secure day rooms
Locked internal security doors (e.g., wing,
floor, corridor)
Locked outside doors
External fences or walls without razor wire
External fences or walls with razor wire
Other – Specify
17a. Is treatment provided INSIDE this
facility?
Inside refers to any location on the facility grounds.
01
02
17b. What kind of treatment is provided INSIDE
this facility?
Mark (X) all that apply.
01
02
03
04
07
The facility has NONE of the above features.
05
06
16a. Are outside doors to any buildings with
living/sleeping units in this facility ever
locked?
01
Yes
02
No
➔
Mark (X) all that apply.
02
To keep intruders out
To keep young persons inside this facility
16c. When are outside doors to buildings with
living/sleeping units in this facility locked?
Mark (X) all that apply.
01
02
03
04
05
All of the time
During the day for 2 hours or less
During the day for more than 2 hours
At night
Other – Specify
FORM CJ-14 (02-07-2025)
07
08
09
Mental health treatment
Treatment for substance use problems
Sex offender treatment
Treatment for arsonists
Treatment specifically for violent offenders
Behavioral modification or therapy
Trauma treatment
Anger management
Other – Specify
Go to Question 17a
16b. Why are outside doors to buildings with
living/sleeping units in this facility locked?
01
Yes
No ➔ Go to Question 18a
18a. During the YEAR between March 1, 2024
and February 28, 2025, did ANY young
persons die while assigned a bed at this
facility at a location either INSIDE or
OUTSIDE of this facility?
01
Yes
02
No
➔
Go to Section 2 on page 8
18b. How many young persons died while
assigned beds at this facility during the
year between March 1, 2024 and February
28, 2025?
Person(s)
Page 7
Section 2 – HOUSED YOUTH
INSTRUCTIONS
FOR SECTION 2
1. Record individual-level information in Section 2
for the persons under age 21 who were
assigned a bed on the reference date because
they were charged with or adjudicated for an
offense (the same persons you counted in
Section 1, question 12b).
2. You may choose one of the following ways to
record this information:
■ 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 1, Section 2, and Section 3
data.
■ Upload a data file
Go to our website at
https://respond.census.gov/cjrp
(Do not type "www" as a prefix) and
enter Section 1 data. You can then upload
data files with Section 2 and Section 3 data.
■ Manual data entry
Continue to write information directly on
this form.
3. BE SURE TO KEEP COPIES OF THE
DATA YOU SUBMIT.
Page 8
FORM CJ-14 (02-07-2025)
Section 2 – HOUSED YOUTH
☞
START HERE
Questions continue
on next page ➔
A. UNDER age 21; AND
B. assigned a bed in this facility at the end of the day on Wednesday, March 26, 2025; AND
C. charged with an offense or court-adjudicated for an offense; AND
D. assigned a bed here BECAUSE OF THE OFFENSE.
Do NOT list persons assigned beds here for reasons other than offenses, as described in Section 1, 13a.
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.
2.
3.
What is this
person’s date
of birth?
4.
5.
What is
this
person’s
sex?
What is this person’s race and/or Which one of the following
ethnicity? List all that apply. Enter the placed this person at this
code(s) on the line. If listing multiple
facility?
codes, separate with a comma.
Enter the code on the line.
Enter the 1 – White
1 – Court, probation agency, or
code on
2 – Black or African American
law enforcement agency
the line.
3 – Hispanic or Latino
1 – Male
2 – Corrections or other justice
2 – Female 4 – American Indian or Alaska Native
agency not included in 1
5 – Asian
3 – Social services agency
6 – Native Hawaiian or Pacific Islander
4 – Other – Specify
7 – Middle Eastern or North African
8 – They use a different term – Specify
For definitions of these categories,
please refer to page 29.
Mo. Day
EX
Line number
Line number
9 – Unknown
50716
Year
07 03 2011
Code
Code(s)
1
5
Specify Other only
Code
1
Specify Other only
EX
01
01
02
02
03
03
04
04
05
05
06
06
07
07
08
08
09
09
10
10
11
11
12
12
FORM CJ-14 (02-07-2025)
Page 9
Section 2 – HOUSED YOUTH
List ONLY THOSE PERSONS WHO FULFILL ALL 4 REQUIREMENTS:
A. UNDER age 21; AND
B. assigned a bed in this facility at the end of the day on Wednesday, March 26, 2025; AND
C. charged with an offense or court-adjudicated for an offense; AND
D. assigned a bed here BECAUSE OF THE OFFENSE.
Do NOT list persons assigned beds here for reasons other than offenses, as described in Section 1, 13a.
7.
8.
What was the
most serious
offense for
which this
person was
assigned a
bed in this
facility? 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.
If state is
not
known,
enter 99.
Line number
1 – Federal
2 – A Native American
Tribal Government
3 – State
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify
See Offense
Codes on pages
30 and 31.
Code
EX
4
Specify Other only
9.
On March 26, 2025, 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
10
AZ
5
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.
Mo. Day
Year
01 14 2025
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?
EX
01
01
02
02
03
03
04
04
05
05
06
06
07
07
08
08
09
09
10
10
11
11
12
12
Page 10
FORM CJ-14 (02-07-2025)
Section 2 – HOUSED YOUTH
1.
2.
Enter an identifying What is this
number or first
person’s date
name and last initial of birth?
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.
3.
4.
What is
this
person’s
sex?
What is this person’s race and/or
ethnicity? List all that apply. Enter the
code(s) on the line. If listing multiple
codes, separate with a comma.
Enter the
code on
the line.
1 – Male
2 – Female
1 – White
5.
Which one of the following
placed this person at this
facility?
Enter the code on the line.
2 – Black or African American
3 – Hispanic or Latino
1 – Court, probation agency, or
law enforcement agency
4 – American Indian or Alaska Native
2 – Corrections or other justice
agency not included in 1
5 – Asian
3 – Social services agency
6 – Native Hawaiian or Pacific Islander
7 – Middle Eastern or North African
4 – Other – Specify
8 – They use a different term – Specify
Line number
Line number
9 – Unknown
For definitions of these categories,
please refer to page 29.
Mo. Day
Year
Code
Code(s)
Specify Other only
Code
Specify Other only
13
13
14
14
15
15
16
16
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
FORM CJ-14 (02-07-2025)
Page 11
Section 2 – HOUSED YOUTH
7.
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?
What was the
most serious
offense for
which this
person was
assigned a
bed in this
facility? Enter
the code for the
most serious
offense resulting
in this placement.
1 – Federal
2 – A Native American
Tribal Government
3 – State
Line number
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify
8.
In which
state or
territory
did this
person
commit
the
offense?
State or
territory
name
may be
abbreviated.
If state is
not
known,
enter 99.
See Offense
Codes on pages
30 and 31.
Code
Specify Other only
Code
State
9.
On March 26, 2025, 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
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.
Mo. Day
Year
Line number
6.
13
13
14
14
15
15
16
16
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
Page12
FORM CJ-14 (02-07-2025)
Section 2 – HOUSED YOUTH
1.
2.
Enter an identifying What is this
number or first
person’s date
name and last initial of birth?
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.
3.
4.
What is
this
person’s
sex?
What is this person’s race and/or
ethnicity? List all that apply. Enter the
code(s) on the line. If listing multiple
codes, separate with a comma.
Enter the
code on
the line.
1 – Male
2 – Female
1 – White
5.
Which one of the following
placed this person at this
facility?
Enter the code on the line.
2 – Black or African American
3 – Hispanic or Latino
1 – Court, probation agency, or
law enforcement agency
4 – American Indian or Alaska Native
2 – Corrections or other justice
agency not included in 1
5 – Asian
3 – Social services agency
6 – Native Hawaiian or Pacific Islander
7 – Middle Eastern or North African
4 – Other – Specify
8 – They use a different term – Specify
Line number
Line number
9 – Unknown
For definitions of these categories,
please refer to page 29.
Mo. Day
Year
Code
Code(s)
Specify Other only
Code
Specify Other only
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
FORM CJ-14 (02-07-2025)
Page 13
Section 2 – HOUSED YOUTH
7.
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?
What was the
most serious
offense for
which this
person was
assigned a
bed in this
facility? Enter
the code for the
most serious
offense resulting
in this placement.
1 – Federal
2 – A Native American
Tribal Government
3 – State
Line number
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify
8.
In which
state or
territory
did this
person
commit
the
offense?
State or
territory
name
may be
abbreviated.
If state is
not
known,
enter 99.
See Offense
Codes on pages
30 and 31.
Code
Specify Other only
Code
State
9.
On March 26, 2025, 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
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.
Mo. Day
Year
Line number
6.
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
Page 14
FORM CJ-14 (02-07-2025)
Section 2 – HOUSED YOUTH
1.
2.
Enter an identifying What is this
number or first
person’s date
name and last initial of birth?
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.
3.
4.
What is
this
person’s
sex?
What is this person’s race and/or
ethnicity? List all that apply. Enter the
code(s) on the line. If listing multiple
codes, separate with a comma.
Enter the
code on
the line.
1 – Male
2 – Female
1 – White
5.
Which one of the following
placed this person at this
facility?
Enter the code on the line.
2 – Black or African American
3 – Hispanic or Latino
1 – Court, probation agency, or
law enforcement agency
4 – American Indian or Alaska Native
2 – Corrections or other justice
agency not included in 1
5 – Asian
3 – Social services agency
6 – Native Hawaiian or Pacific Islander
7 – Middle Eastern or North African
4 – Other – Specify
8 – They use a different term – Specify
Line number
Line number
9 – Unknown
For definitions of these categories,
please refer to page 29.
Mo. Day
Year
Code
Code(s)
Specify Other only
Code
Specify Other only
47
47
48
48
49
49
50
50
51
51
52
52
53
53
54
54
55
55
56
56
57
57
58
58
59
59
60
60
61
61
62
62
63
63
FORM CJ-14 (02-07-2025)
Page 15
Section 2 – HOUSED YOUTH
7.
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?
What was the
most serious
offense for
which this
person was
assigned a
bed in this
facility? Enter
the code for the
most serious
offense resulting
in this placement.
1 – Federal
2 – A Native American
Tribal Government
3 – State
Line number
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify
8.
In which
state or
territory
did this
person
commit
the
offense?
State or
territory
name
may be
abbreviated.
If state is
not
known,
enter 99.
See Offense
Codes on pages
30 and 31.
Code
Specify Other only
Code
State
9.
On March 26, 2025, 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
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.
Mo. Day
Year
Line number
6.
47
47
48
48
49
49
50
50
51
51
52
52
53
53
54
54
55
55
56
56
57
57
58
58
59
59
60
60
61
61
62
62
63
63
Page 16
FORM CJ-14 (02-07-2025)
Section 2 – HOUSED YOUTH
1.
2.
Enter an identifying What is this
number or first
person’s date
name and last initial of birth?
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.
3.
4.
What is
this
person’s
sex?
What is this person’s race and/or
ethnicity? List all that apply. Enter the
code(s) on the line. If listing multiple
codes, separate with a comma.
Enter the
code on
the line.
1 – Male
2 – Female
1 – White
5.
Which one of the following
placed this person at this
facility?
Enter the code on the line.
2 – Black or African American
3 – Hispanic or Latino
1 – Court, probation agency, or
law enforcement agency
4 – American Indian or Alaska Native
2 – Corrections or other justice
agency not included in 1
5 – Asian
3 – Social services agency
6 – Native Hawaiian or Pacific Islander
7 – Middle Eastern or North African
4 – Other – Specify
8 – They use a different term – Specify
For definitions of these categories,
please refer to page 29.
Mo. Day
FORM CJ-14 (02-07-2025)
Line number
Line number
9 – Unknown
Year
Code
Code(s)
Specify Other only
Code
Specify Other only
Page 17
Section 2 – HOUSED YOUTH
7.
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?
What was the
most serious
offense for
which this
person was
assigned a
bed in this
facility? Enter
the code for the
most serious
offense resulting
in this placement.
1 – Federal
2 – A Native American
Tribal Government
3 – State
Line number
4 – County
5 – Municipal (includes
Washington, DC)
6 – Other – Specify
8.
In which
state or
territory
did this
person
commit
the
offense?
State or
territory
name
may be
abbreviated.
If state is
not
known,
enter 99.
See Offense
Codes on pages
30 and 31.
Code
Page 18
Specify Other only
Code
State
9.
On March 26, 2025, 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
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.
Mo. Day
Year
Line number
6.
FORM CJ-14 (02-07-2025)
Section 3 – RELEASED YOUTH
INSTRUCTIONS
FOR SECTION 3
1. Record individual-level information in Section 3
for persons under age 21, charged with or
adjudicated for an offense, who were released
from your facility from February 1, 2025
through February 28, 2025.
2. You may choose one of the following ways to
record this information:
■ 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 1, Section 2, and Section 3
data.
■ Upload a data file
Go to our website at
https://respond.census.gov/cjrp
(Do not type "www" as a prefix) and
enter Section 1 data. You can then upload
data files with Section 2 and Section 3 data.
■ Manual data entry
Continue to write information directly on
this form.
3. BE SURE TO KEEP COPIES OF THE
DATA YOU SUBMIT.
FORM CJ-14 (02-07-2025)
Page 19
Section 3 – RELEASED YOUTH
1a. According to your records, were any young
persons released from this facility from
February 1, 2025 through February 28,
2025?
INCLUDE persons who were:
● Under age 21 on date of admission; AND
● Charged with an offense or court-adjudicated for
an offense; AND
● Assigned a bed here BECAUSE OF THE
OFFENSE; AND
● RELEASED from this facility from February 1,
2025 through February 28, 2025.
DO NOT INCLUDE here:
● Young persons assigned a bed here for a
reason other than an offense.
● Young persons who were only temporarily
released, such as those released for medical
care at a hospital.
01
02
Yes
No ➔
STOP HERE and submit this form
1b. How many young persons were released
from this facility from February 1, 2025
through February 28, 2025?
persons
Page 20
➔
Go to Section 3 on
page 21
FORM CJ-14 (02-07-2025)
☞
START HERE
Section 3 – RELEASED YOUTH
Please COMPLETE a LINE on the table below for EACH person who was:
A. Under age 21 on date of admission; AND
B. charged with an offense or court-adjudicated for an offense; AND
C. assigned a bed here BECAUSE OF THE OFFENSE; AND
D. RELEASED from this facility from February 1, 2025 through February 28, 2025.
Questions continue ➔
on next page
Do NOT list persons assigned beds here for reasons other than offenses, as described in Section 1, 13a.
1.
2.
3.
4.
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
date of birth?
What is this
person’s
sex?
Enter the code
on the line.
What is this person’s race and/or
ethnicity? List all that apply. Enter the
code(s) on the line. If listing multiple
codes, separate with a comma.
1 – Male
2 – Female
2 – Black or African American
1 – White
3 – Hispanic or Latino
4 – American Indian or Alaska Native
5 – Asian
6 – Native Hawaiian or Pacific Islander
EX
8 – They use a different term – Specify
9 – Unknown
For definitions of these categories,
please refer to page 29.
50716
Mo.
Day
Year
02
14 2012
Code
Code(s)
1
1
Line number
Line number
7 – Middle Eastern or North African
Please do not include any young
persons who were only temporarily
released from this facility, such as
those released for medical care at
a hospital.
Specify Other only
EX
01
01
02
02
03
03
04
04
05
05
06
06
07
07
08
08
09
09
10
10
11
11
12
12
FORM CJ-14 (02-07-2025)
Page 21
Section 3 – RELEASED YOUTH
List ONLY THOSE PERSONS WHO FULFILL ALL 4 REQUIREMENTS:
A. Under age 21 on date of admission; AND
B. charged with an offense or court-adjudicated for an offense; AND
C. assigned a bed here BECAUSE OF THE OFFENSE; AND
D. RELEASED from this facility from February 1, 2025 through February 28, 2025.
5
6
7
What was the most serious offense for
which this person was assigned a bed in
this facility? Enter the code for the most serious
offense resulting in this placement.
On what date was this person
ADMITTED TO this facility?
On what date was this person
RELEASED FROM this facility?
Code
Mo.
Day
Year
Mo.
Day
Year
21
12
20
2024
02
28
2025
Line number
Line number
Do NOT list persons assigned beds here for reasons other than offenses, as described in Section 1, 13a.
See Offense Codes on pages 30 and 31.
EX
EX
01
01
02
02
03
03
04
04
05
05
06
06
07
07
08
08
09
09
10
10
11
11
12
12
Page 22
FORM CJ-14 (02-07-2025)
Section 3 – RELEASED YOUTH
1.
2.
3.
4.
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
date of birth?
What is this
person’s
sex?
Enter the code
on the line.
What is this person’s race and/or
ethnicity? List all that apply. Enter the
code(s) on the line. If listing multiple
codes, separate with a comma.
1 – Male
2 – Female
2 – Black or African American
1 – White
3 – Hispanic or Latino
4 – American Indian or Alaska Native
5 – Asian
6 – Native Hawaiian or Pacific Islander
7 – Middle Eastern or North African
9 – Unknown
Please do not include any young
persons who were only temporarily
released from this facility, such as
those released for medical care at
a hospital.
For definitions of these categories,
please refer to page 29.
Mo.
Day
Year
Code
Code(s)
Line number
Line number
8 – They use a different term – Specify
Specify Other only
13
13
14
14
15
15
16
16
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
FORM CJ-14 (02-07-2025)
Page 23
5.
6.
7.
What was the most serious offense for
which this person was assigned a bed in
this facility? Enter the code for the most serious
offense resulting in this placement.
On what date was this person
ADMITTED TO this facility?
On what date was this person
RELEASED FROM this facility?
Mo.
Mo.
Line number
Line number
Section 3 – RELEASED YOUTH
See Offense Codes on pages 30 and 31.
Code
Day
Year
Day
Year
13
13
14
14
15
15
16
16
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
Page 24
FORM CJ-14 (02-07-2025)
Section 3 – RELEASED YOUTH
1.
2.
3.
4.
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
date of birth?
What is this
person’s
sex?
Enter the code
on the line.
What is this person’s race and/or
ethnicity? List all that apply. Enter the
code(s) on the line. If listing multiple
codes, separate with a comma.
1 – Male
2 – Female
2 – Black or African American
1 – White
3 – Hispanic or Latino
4 – American Indian or Alaska Native
5 – Asian
6 – Native Hawaiian or Pacific Islander
7 – Middle Eastern or North African
9 – Unknown
Please do not include any young
persons who were only temporarily
released from this facility, such as
those released for medical care at
a hospital.
For definitions of these categories,
please refer to page 29.
Mo.
Day
Year
Code
Code(s)
Line number
Line number
8 – They use a different term – Specify
Specify Other only
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
FORM CJ-14 (02-07-2025)
Page 25
5.
6.
7.
What was the most serious offense for
which this person was assigned a bed in
this facility? Enter the code for the most serious
offense resulting in this placement.
On what date was this person
ADMITTED TO this facility?
On what date was this person
RELEASED FROM this facility?
Mo.
Mo.
Line number
Line number
Section 3 – RELEASED YOUTH
See Offense Codes on pages 30 and 31.
Code
Day
Year
Day
Year
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
Page 26
FORM CJ-14 (02-07-2025)
Section 3 – RELEASED YOUTH
1.
2.
3.
4.
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
date of birth?
What is this
person’s
sex?
Enter the code
on the line.
What is this person’s race and/or
ethnicity? List all that apply. Enter the
code(s) on the line. If listing multiple
codes, separate with a comma.
1 – Male
2 – Female
2 – Black or African American
1 – White
3 – Hispanic or Latino
4 – American Indian or Alaska Native
5 – Asian
6 – Native Hawaiian or Pacific Islander
7 – Middle Eastern or North African
9 – Unknown
Please do not include any young
persons who were only temporarily
released from this facility, such as
those released for medical care at
a hospital.
For definitions of these categories,
please refer to page 29.
Mo.
FORM CJ-14 (02-07-2025)
Day
Year
Code
Code(s)
Line number
Line number
8 – They use a different term – Specify
Specify Other only
Page 27
5.
6.
7.
What was the most serious offense for
which this person was assigned a bed in
this facility? Enter the code for the most serious
offense resulting in this placement.
On what date was this person
ADMITTED TO this facility?
On what date was this person
RELEASED FROM this facility?
Mo.
Mo.
Line number
Line number
Section 3 – RELEASED YOUTH
See Offense Codes on pages 30 and 31.
Code
Page 28
Day
Year
Day
Year
FORM CJ-14 (02-07-2025)
The Federal Government uses the following definitions for the various racial categories:
White – Individuals with origins in any of the original peoples of Europe, including, for example,
English, German, Irish, Italian, Polish, and Scottish.
Black or African American – Individuals with origins in any of the Black racial groups of Africa,
including, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali.
Hispanic or Latino – Includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban,
Dominican, Guatemalan, and other Central or South American or Spanish culture or origin.
American Indian or Alaska Native – Individuals with origins in any of the original peoples of
North, Central, and South America, including, for example, Navajo Nation, Blackfeet Tribe of the
Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government,
Nome Eskimo Community, Aztec, and Maya.
Asian – Individuals with origins in any of the original peoples of Central or East Asia, Southeast
Asia, or South Asia, including, for example, Chinese, Asian Indian, Filipino, Vietnamese, Korean,
and Japanese.
Native Hawaiian or Pacific Islander – Individuals with origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands, including, for example, Native Hawaiian, Samoan,
Chamorro, Tongan, Fijian, and Marshallese.
Middle Eastern or North African – Individuals with origins in any of the original peoples of the
Middle East or North Africa, including, for example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and
Israeli.
Thank you for completing this questionnaire. 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.
If you would like to give us any comments on this form, please write them below.
If you cannot respond online, please mail or fax the completed form to:
U.S. Census Bureau
Fax: 1–888–262–3974
PO Box 5000
Jeffersonville, IN 47199-5000
GOVS/CJRP
Comments
FORM CJ-14 (02-07-2025)
Page 29
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.
Section 2, question 7, and Section 3, question 5 refer to these offense codes. You are asked to match each young
person’s offense to the type of offense listed below. Note the two-digit code number, and write that number on the
line for that person. Please record the most serious offense related to that person’s placement within the reference
dates.
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 31.
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
Page 30
FORM CJ-14 (02-07-2025)
DEFINITIONS OF OFFENSES
Alcohol or drugs, driving under the infiuence of –
Driving or operating a motor vehicle while under the
influence of alcohol, a drug or controlled substance.
Code 40.
Alcohol: underage use, possession, or
consumption of – Possession, use, or consumption of
alcohol by a minor. Code 64.
Arson – Actual or attempted intentional damaging or
destroying of property by fire or explosion, without the
owner’s consent. Code 10.
Assault, aggravated – An actual, attempted, or
threatened physical attack on a person that 1) involves the
use of a weapon or 2) causes serious physical harm.
Include attempted murder. Code 20. For assaults with less
than serious harm and without use of a weapon – See
Assault, simple.
Assault, simple – An actual, attempted, or threatened
physical attack on a person that causes less than serious
physical harm and without a weapon. Include non-physical
attacks causing the fear of an attack.
Code 21.
Auto theft, unauthorized use of auto, joyriding –
Actual or attempted unauthorized taking or use of a motor
vehicle, intending to deprive the owner of it temporarily or
permanently. Include joyriding and grand theft auto.
Code 11.
Burglary, breaking and entering, household
larceny – Actual or attempted unlawful entry of a building,
structure, or vehicle with intent to commit larceny or another
crime. Code 12.
Curfew violation – Violation of an ordinance forbidding
persons below a certain age from being in public places
during set hours. Code 60.
Drugs or narcotics, possession – Actual or attempted
purchase, possession or use of any illegal drug or
substance, excluding alcohol. Code 31.
Drugs or narcotics, trafficking – Actual or attempted
making, selling, or distributing of a controlled or illegal drug
or substance. Code 30.
Incorrigible, ungovernable – Being beyond the control
of parents, guardians, or custodians. Code only if this is
considered an offense in your state. Code 61.
Kidnapping – Actual or attempted unlawful
transportation or confinement of a person without his/her
consent (or, if a minor, consent of a guardian).
Code 22.
Murder/manslaughter/negligent homicide –
Causing the death of a person without legal justification.
Code 23. For attempted murder/manslaughter – See
Assault, aggravated.
Non-violent sex offense, statutory rape – Actual
or attempted offenses with a sexual element, without
violence. Include consensual sex with an underage
person, prostitution, solicitation, indecent exposure,
pornography, and obscenity. Code 42. For sexual
abuse by a minor against another minor – See Violent
sexual assault.
Obstruction of justice – Any act that intentionally
impedes the enforcement of a law or court order.
Examples: Escape from confinement, contempt of court,
perjury, failing to report a crime, nonviolently resisting
arrest, and bribery. Code 41. See Probation or parole
violation.
FORM CJ-14 (02-07-2025)
Other drug-related offense – Use this code if the drug
offense is not specifically listed on the offense codes or
definitions. Examples include: possession of drug
paraphernalia, visiting a place where drugs are found, etc.
Code 39.
Other offense that is illegal for underage persons
only – Use this code if the drug offense is not illegal for
adults and is not specifically listed on the offense codes or
definitions. Examples include: underage smoking, unruliness
in school, etc. Code 69.
Other person offense – Use this code if the person
offense is not specifically listed on the offense codes or
definitions. Examples include: harassment, coercion,
reckless endangerment, etc. Code 29.
Other property offense – Use this code if the property
offense is not specifically listed on the offense codes or
definitions. Examples include: trespassing, selling stolen
property, possession of burglar’s tools, fraud, etc. Code 19.
Other public order offense – Use this code if the public
order offense is not specifically listed on the offense codes
or definitions. Examples include: cruelty to animals,
disorderly conduct, traffic offenses, etc. Code 49.
Probation or parole violation, violation of valid
court order – Acts that disobey or go against the
conditions of probation or parole. Examples: failure to
participate in a specific program, failure to appear for
drug tests or meetings, and failure to pay restitution.
Code 50.
Property damage, vandalism – Actual or attempted
damaging or destroying of property of a person or public
property. Code 14. For destroying or damaging by fire or
explosion – See Arson.
Robbery – Actual or attempted unlawful taking of property
in the direct possession of a person by force or threat of
force. Include purse snatching with force and carjacking.
Code 25. For purse snatching without force – See Theft,
non-household larceny.
Running away – Leaving the custody and home of
parents or guardians without permission and failing to return
within a reasonable length of time. Code only if this is
considered an offense in the state in which it occurred.
Code 62. For running away from a facility – See
Obstruction of justice.
Theft, non-household larceny – Actual or attempted
taking of property (other than an auto) from a person without
force or deceit. Include shoplifting, pickpocketing, and purse
snatching without force. Code 13.
● For purse snatching with force – See Robbery.
● For theft using deceit – See Other property offense.
● For household larceny – See Burglary, breaking and
entering, household larceny.
Truancy – Violation of a compulsory school attendance
law. Code only if this is considered an offense in your state.
Code 63.
Violent sexual assault including forcible rape –
Actual or attempted sexual intercourse or sexual assaults
against a person against her/his will by force or threat of
force. Includes incest, sodomy, and sexual abuse by a minor
against another minor. Code 24. See also Non-violent sex
offense, statutory rape.
Weapons-related offenses – Actual or attempted illegal
sale, distribution, manufacture, alteration, transportation,
possession, or use of a deadly or dangerous weapon or
accessory. Code 43.
Page 31
DEFINITIONS OF TERMS
Court-adjudicated – Refers to a youth who has been
determined by a court to have committed the delinquent act
or status offense for which they were charged.
Date Admitted – The calendar date on which a youth
officially enters a residential facility or program.
Date Released – The calendar date on which a youth
officially exits or is discharged from a residential facility or
program. It does not include any temporary releases from
this facility, such as releases for medical care at a hospital.
Facility – A place that has living/sleeping units such as
wings, floors, dorms, barracks, or cottages on one campus
or in one building.
Makeshift Beds – Alternative beds including roll-out
mats, fold-out cots, roll-away beds, pull-out mattresses,
sofas, and any other beds that are put away or moved
during non-sleeping hours.
Residential Facility – A facility that houses persons
overnight.
Status Offense – An offense that is illegal in a state for
underage persons but not for adults. Examples include
running away, truancy, incorrigibility, curfew violation, and
underage liquor violations.
Page 32
FORM CJ-14 (02-07-2025)
Attachment D: Revised Juvenile Residential Facility Census Instrument
[Intentionally Left Blank]
U.S. DEPARTMENT OF COMMERCE U.S. CENSUS BUREAU
ACTING AS A COLLECTING AGENT FOR U.S. DEPARTMENT OF JUSTICE OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION
2026 Juvenile Residential Facility Census
This questionnaire asks about services, staff, and persons
assigned beds in this facility on Wednesday, March 25, 2026.
Instructions:
1. A juvenile residential facility is a place
where young persons who have committed
offenses may be housed overnight as
direct result of those offenses. A facility
has living/sleeping units, such as wings,
floors, dorms, barracks, or cottages on one
campus or in one building.
2. Any buildings with living/sleeping units that
are not on the same campus should be
considered separate facilities and should
submit a separate questionnaire. Please
request additional questionnaires using the
contact information below.
You may find it helpful to use this form to gather
the requested information. We ask that you submit
your response online BY APRIL 30, 2026:
https://respond.census.gov/jrfc
If you cannot submit your information online,
please mail or fax your information to the following:
U.S. Census Bureau
PO Box 5000
Jeffersonville, IN 47199-5000
GOVS/JRFC
Fax: 1–888–262–3974
If you have any questions, contact the U.S. Census Bureau: 1–800–352–7229 | [email protected]
FACILITY NAME
PERSON COMPLETING THIS QUESTIONNAIRE
Name
E-mail address
Title
Street Address or P.O. Box
Apt, Suite, or Unit (Optional)
City
FORM CJ-15 (03-15-2026)
Telephone
State
ZIP Code
Area code
Number
Extension
OMB No. XXXX-XXXX: Approval Expires [TBD]
MAILING ADDRESS OF FACILITY
Street Address or P.O. Box
Apt, Suite, or Unit (Optional)
City
State
ZIP Code
PHYSICAL ADDRESS OF FACILITY
Physical address is the same as mailing address
Street Address (DO NOT provide P.O. Box)
Apt, Suite, or Unit (Optional)
City
State
ZIP Code
Section 1 – GENERAL FACILITY INFORMATION
1a. Is this facility part of a larger agency?
Yes
02
No ➔ Go to NOTE A
What is the name of this agency?
01
1b.
NOTE
B
4a.
Questions 2 and 3 ask who OWNS
NOTE
this
facility. Later you will be asked
A
who OPERATES this facility.
2a. Who OWNS this facility?
Mark (X) only one.
a private non-profit agency
a for profit agency
02
a government agency ➔
03
for-profit agency that OPERATES this facility?
Go to Question 3
Go to
➔ Question
2b. What is the name of the private non-profit or
6
for-profit agency that OWNS this facility?
Go to
➔ NOTE
B
3.
Page 2
Go to Question 5
4b. What is the name of the private non-profit or
Mark (X) only one.
a private non-profit agency
a for profit agency
02
a government agency ➔
Who OPERATES this facility?
01
01
03
Questions 4 and 5 ask who OPERATES
this facility (either directly or under
contract).
What is the level of the government agency
that OWNS this facility?
Mark (X) all that apply.
A Native American Tribal Government
01
Federal
02
State
03
County
04
Municipal (includes Washington, DC)
05
Other – Specify
06
5.
What is the level of the government agency
that OPERATES this facility?
Mark (X) all that apply.
01
A Native American Tribal Government
02
Federal
03
State
04
County
05
Municipal (includes Washington, DC)
06
Other – Specify
FORM CJ-15 (03-15-2026)
Section 1 – GENERAL FACILITY INFORMATION - Continued
6. What type of residential facility is the
INSTRUCTIONS
one listed on the front cover?
Mark (X) all that apply.
01
02
03
04
05
06
07
Detention Center: A short-term facility that
provides temporary care in a physically restricting
environment for young persons in custody pending
court disposition and, often, for young persons 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 young persons committed for
short periods of time as part of their disposition
(e.g., weekend detention).
Long-term Secure Facility: A specialized type
of facility that provides strict confinement and longterm treatment generally for post-adjudication
committed young persons placed for delinquency or
status offenses. Includes training schools, juvenile
correctional facilities, youth development centers.
Reception or Diagnostic Center: A shortterm facility that screens young persons committed
by the courts and assigns them to appropriate
correctional facilities.
Group home or Halfway House: These facilities
are generally non-secure and typically 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 young persons
(substance use, 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 Medicaidreimbursable.
Ranch or Wilderness Camp: A long-term facility
focused on providing structured outdoor programs,
such as farming, forestry, wildlife conservation, and
environmental education. These facilities are
generally non-secure and typically located in a
remote area.
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.
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, March 25, 2026. 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 this 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 just
one of the two following categories:
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.
2. those here for reasons other than offenses.
7a. According to your records, at the
end of the day on Wednesday, March
25, 2026, did ANY persons have
assigned beds in this facility?
Include persons who were temporarily away, but
had assigned beds on March 25. Do NOT include
staff
01
Yes
02
No ➔
Go to Question 7c
7b. According to your records, at the end of
the day on March 25, 2026, how many
persons had assigned beds in this facility?
Persons
➔ Go to Question 8
7c. Specify why there were not ANY persons
assigned beds in this facility on
Wednesday, March 25, 2026:
01
Facility permanently closed
Date of Closure:
(MM/DD/YYYY)
Other Type of Shelter: This includes emergency
08
non-secure shelters where young persons are
housed short-term until another placement can be
found.
02
Facility temporarily closed
03
Other - Specify
Other: This includes independent living programs
09
and anything that cannot be classified above.
Specify
INSTRUCTIONS
If you did NOT have ANY persons assigned beds
in this facility on Wednesday, March 25, 2026
STOP HERE and submit this form.
FORM CJ-15 (03-15-2026)
Page 3
Section 1 – GENERAL FACILITY INFORMATION - Continued
8. What was the TOTAL NUMBER OF
STANDARD BEDS in this facility on the
night of Wednesday, March 25, 2026?
11a. At the end of the day on
Wednesday, March 25, 2026 did
ANY persons UNDER AGE 21 have
assigned beds in this facility?
Do NOT include staff beds.
Include persons being tried as adults in criminal
court. Do NOT include staff.
• A single bed is one standard bed
• A double bunk bed is two standard beds
Total number of standard beds
9a. On the night of Wednesday, March 25,
2026, were there ANY OCCUPIED
MAKESHIFT BEDS in this facility?
Makeshift beds are:
• Roll-out mats
• Fold-out cots
• Roll-away beds
• Pull-out mattresses
• Sofas
• Any other beds that are put away or
moved during non-sleeping hours
01
Yes
02
No ➔ Go to Question 10
assigned beds at the end of the day on
Wednesday, March 25, 2026 were AGE
21 or older?
Include persons who were temporarily away, but
had assigned beds on Wednesday, March 25,
2026. Do NOT include staff. Please write "0" if
there are NO persons age 21 or older.
Persons age 21 or older
02
No
➔ Go to Question 11c
Include persons who were temporarily away but
had assigned beds on March 25. Do NOT
include staff.
Persons under age 21
Go to
➔ NOTE C
11c. Specify why there were not ANY persons
UNDER 21 assigned beds in this facility
on Wednesday, March 25, 2026:
Mark (X) all that apply.
01
Adult only facility
02
No persons under age 21 were placed in
this facility
03
Other - Specify
Occupied makeshift beds
10. How many of the persons who had
Yes
11b. According to your records, at the end of the
day on Wednesday, March 25, 2026 how
many persons under age 21 had assigned
beds in this facility?
9b. How many makeshift beds were occupied
that night?
01
As a check, the sum of question 10 (persons
NOTE 21 and older) and 11b (persons under age 21) should
c
equal the sum reported in question 7b
(number of persons assigned beds in the facility).
INSTRUCTIONS
1. If you DID NOT have ANY persons
UNDER AGE 21 assigned beds in this
facility on Wednesday, March 25, 2026,
STOP HERE and submit this form.
2. If you DID HAVE persons UNDER
AGE 21 assigned beds in this facility on
Wednesday, March 25, 2026,
CONTINUE BELOW.
FORM CJ-15 (03-15-2026)
Page 4
Section 1 – GENERAL FACILITY INFORMATION - Continued
12a. At the end of the day on Wednesday,
March, 25, 2026, 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.
INCLUDE in your count persons UNDER AGE 21 here
BECAUSE they were CHARGED WITH OR COURTADJUDICATED FOR:
12c. Specify why there were not ANY persons
UNDER AGE 21 assigned beds in this
facility on Wednesday, March 25, 2026
SPECIFICALLY BECAUSE they were
CHARGED WITH OR COURT-ADJUDICATED
FOR AN OFFENSE:
Mark (X) all that apply.
02
No persons under age 21 were placed in
this facility for an offense
This facility is no longer under contract to
hold persons under age 21 for offense
reasons
03
Other - Specify
01
● ANY offense that is illegal for both adults and underage
persons.
● AN 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
MARCH 25 FOR REASONS OTHER THAN OFFENSES.
● Persons under 21 assigned beds here BECAUSE OF
REASONS OTHER THAN OFFENSES, such as neglect,
abuse, dependency, abandonment, mental health
problems, substance use problems. These persons will
be counted in questions 13a and 13b.
● Persons under 21 who have run away, been truant or
incorrigible, or violated curfew, IF THESE BEHAVIORS
ARE NOT CONSIDERED ILLEGAL IN YOUR STATE.
These young persons will be counted in questions 13a
and 13b.
● 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. These persons will be counted in
questions 13a and 13b.
01
Yes
02
No ➔
13a. At the end of the day on Wednesday,
March, 25, 2026, 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 NONOFFENSE REASONS, such as neglect, abuse,
dependency, abandonment, mental health problems,
substance use problems, or another non-offense
reason
● Persons under age 21 who have committed one or
more offenses in the past, BUT ARE ASSIGNED
BEDS HERE ON MARCH 25, 2026 FOR REASONS
OTHER THAN THESE OFFENSES
● 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 nonoffense related admissions.
Do NOT INCLUDE here:
Go to Question 12c
12b. According to your records for the end of the
day on Wednesday, March, 25, 2026, 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 12a?
● Persons assigned beds here BECAUSE THEY WERE
CHARGED WITH OR COURT-ADJUDICATED FOR
AN OFFENSE. These persons are counted in
question 12b.
01
Yes
02
No ➔
Go to NOTE D
Include persons who were temporarily away
but had assigned beds on March 25. Do NOT
include staff.
Persons under age 21
here because they
Go to
were charged with or
➔ Question
court-adjudicated for
13a
an offense
FORM CJ-15 (03-15-2026)
Page 5
Section 1 – GENERAL FACILITY INFORMATION - Continued
13b. According to your records for the end of the
day on Wednesday, March, 25, 2026, HOW MANY
PERSONS UNDER AGE 21 had assigned beds in this
facility FOR REASONS OTHER THAN OFFENSES, AS
DEFINED IN 13a?
14c. (If part of a set schedule) When are young
persons in this facility locked into their
sleeping rooms by staff?
Mark (X) all that apply.
01
Include persons who were temporarily away but had
assigned beds on March 25. Do NOT include staff.
02
03
Persons under age 21 here
because of non-offense reasons
As a check, the sum of questions
NOTE 12b (persons under 21 with offense) and 13b
D
(persons under 21 with non-offense) should
equal 11b (total persons under age 21).
INSTRUCTIONS
1. If you DID NOT have ANY persons UNDER AGE 21
assigned beds in this facility on Wednesday, March
25, 2026, SPECIFICALLY BECAUSE they were
CHARGED WITH OR COURT-ADJUDICATED FOR
AN OFFENSE, STOP HERE and submit this form.
2. If you DID HAVE persons UNDER AGE 21 assigned
beds in this facility on Wednesday, March 25, 2026,
SPECIFICALLY BECAUSE they were CHARGED
WITH OR COURT-ADJUDICATED FOR AN
OFFENSE CONTINUE BELOW.
14a. Are ANY young persons in this facility locked
into their sleeping rooms by staff at ANY
time to confine them?
01
Yes
02
No ➔
Go to Question 15
14b. (If yes) In what situations are young persons
in this facility locked into their sleeping rooms?
Mark (X) all that apply.
Page 6
01
When they are out of control
02
When they are suicidal
03
For medical reasons other than suicide
04
During shift changes
05
Whenever they are in their sleeping rooms
06
As part of a set schedule
07
Other - Specify
04
All of the time
During the day for 2 hours or less
During the day for more than 2 hours
At night
15. Does this facility have any of the following
features intended to secure or confine
young persons within specific areas?
Mark (X) all that apply.
01
Locked doors for secure day rooms
02
Locked internal security doors (e.g., wing, floor, corridor)
03
Locked outside doors
04
Fences or walls without razor wire
05
Fences or walls with razor wire
06
Other - Specify
07
None of the above
16a. Are outside doors to any buildings with
living/sleeping units in this facility ever
locked?
01
Yes
02
No ➔
Go to Question 17a
16b. Why are outside doors to buildings with living/
sleeping units in this facility locked?
Mark (X) all that apply.
01
To keep intruders out
02
To keep young persons inside this facility
16c. When are outside doors to buildings with
living/sleeping units in this facility locked?
Mark (X) all that apply.
01
All of the time
02
During the day for 2 hours or less
03
During the day for more than 2 hours
04
At night
05
Other – Specify
FORM CJ-15 (03-15-2026)
Section 1 – GENERAL FACILITY INFORMATION - Continued
18. Which of the following training requirements
are front-line supervision staff and direct
care staff required to take before working
with young persons?
Mark (X) all that apply.
17a. Is treatment provided INSIDE this facility?
Inside refers to any location on the facility grounds.
01
Yes
02
No
➔ Go to Question 18
01
17b.What kind of treatment is
provided INSIDE this facility?
02
Mark (X) all that apply.
01
Mental health treatment
03
02
Substance use treatment
04
03
Sex offender treatment
05
04
Treatment for arsonists
05
Treatment specifically for violent offenders
06
Behavioral modification or therapy
07
Trauma treatment
08
Anger management
09
Other – Specify
06
07
08
09
10
Behavioral health interventions and resources
Conflict de-escalation training and communication
with young persons
Cross-sex supervision
Defensive tactics and restraint techniques
Gang identification, prevention, and management
Managing young persons with mental health
problems
Professional Conduct and Ethics
Staff boundaries
Trauma informed care
Other - Specify
19a. Does this facility provide any of the following activities or services for the young persons in
this facility through either the facility's own staff or by bringing in external providers?
Mark (X) all that apply.
Provided by the
facility's staff
(1)
Provided by
bringing in
external providers
(2)
This facility
does not
provide this
(3)
a. Artistic opportunities (e.g., music, painting, drama)
01
02
03
b. Formal mentoring program
01
02
03
c. Recreation (e.g., team sports, playing games)
01
02
03
d. Reentry planning
01
02
03
e. Religious/Spiritual/Faith Based
01
02
03
f. Wellness (e.g, yoga, meditation)
01
02
03
g. Workforce development or vocational training
01
02
03
19b. Are there any other activities or services not listed above that are provided
for young persons in this facility?
Please list any other activities or services provided.
FORM CJ-15 (03-15-2026)
Page 7
Section 1 – GENERAL FACILITY INFORMATION - Continued
20. Which of the following best describes
the physical layout of this facility?
Mark (X) only one.
This facility is 01
02
03
04
a part of one building
all of one building
more than one building at a single site or on
one campus
Other – Specify
22a. Are there any other juvenile residential facilities
located within the same building or on the same
campus as the facility being reported on here?
01
Yes
02
No
01
Yes
02
No
Go to Section 2
22b. How many OTHER juvenile residential facilities are
located within the same building or on the same
campus as the facility being reported on here?
Juvenile residential facilities
21. Are there any other buildings with
living/sleeping units that are associated with this
facility that are not next to this facility building or
on the same campus?
➔
22c.Does the facility being reported on here share
any of the following with the other facilities
located in the same building or on the same
campus?
Mark (X) all that apply.
INSTRUCTIONS
Please use the contact information on Page 1 to request
additional questionnaires for each building with living/
sleeping units associated with this facility that is not at
the site of this facility building or campus.
01
02
03
04
05
06
07
08
09
10
11
The same agency affiliation
The same mailing address
The same on-site administrators
One or more staff directly caring for the young persons
One or more security staff
The same school rooms
The same infirmary
The same food services
The same dining room
The same laundry services
None of the above services are shared
11
FORM CJ-15 (03-15-2026)
Page 8
Section 2 – MENTAL HEALTH SERVICES
1a. For each of the following behavioral/mental health providers, please indicate if young persons have
access to these providers as paid facility employees, contract staff, or are available as needed in
the community.
Mark (X) all that apply.
Available as
paid facility
employees
(1)
Available as
contract staff
(2)
Available as
needed in the
community
(3)
Not available
(4)
a. Psychiatrists (MDs or DOs)
01
02
03
04
b. Licensed clinical psychologists (PhDs)
01
02
03
04
01
02
03
04
c. Licensed clinical social worker or licensed
mental health clinicians (e.g., persons
with a master's degree in social work)
1b. Do young persons have access to any other behavioral/mental health providers not listed above?
Please list any other behavioral/mental health providers.
2a. After arrival in this facility, are ANY young
persons asked questions or administered a
form which asks questions to determine risk
for suicide?
01
02
Yes
No ➔ Go to Question 7 on page 9
2b. What best describes the process through
which young persons are asked questions or
administered a form which asks questions to
determine risk of suicide?
Mark (X) all that apply.
01
One or more questions about suicide
incorporated into the medical history or
intake process
A form or questions designed by this facility
02
to assess suicide risk
A form or questions designed by a county
03
or state juvenile justice system to assess
suicide risk
MAYSI- Full Form
04
MAYSI- Suicide/depression module
05
C-SSRS
06
Other – Specify
07
INSTRUCTIONS
Mental health professionals are limited in this census to:
● psychiatrists
● psychologists with at least a Master’s degree in
PSYCHOLOGY
● social workers with at least a Master’s in
SOCIAL WORK (MSW, LCSW)
Counselors in this census are:
● persons with a Master’s degree in a field other than
psychology or social work
● persons whose highest degree is a Bachelor’s in any field
3. Who asks questions or administers a form
which asks questions to determine risk of
suicide?
Mark (X) all that apply.
01
Counselors/intake workers who have NOT been
trained by mental health professionals
03
Counselors/intake workers who have been
trained by mental health professionals
A mental health professional
04
Some other person – Specify
02
4. When are young persons FIRST asked
questions or administered a form which asks
questions to determine risk of suicide?
Mark (X) all that apply.
Within less than 24 hours after arrival
02
Between 24 hours and less than 7 days
after arrival
Seven or more days after arrival
03
Other – Specify
04
01
FORM CJ-15 (03-15-2026)
Page 9
Section 2 – MENTAL HEALTH SERVICES - Continued
5. Which young persons are asked questions
or administered a form which asks questions
to determine risk of suicide?
Mark (X) all that apply.
01
02
03
04
05
06
ALL young persons are asked questions or
administered a form which asks questions to
determine suicide risk ➔
Go to Question 6a
Young persons who come directly from home,
rather than from another facility
Young persons who display or communicate
suicide risk
Young persons known to have prior suicide
attempts
Young persons for whom no mental health care
record is available
Other young persons not listed above – Specify
NOTE
E
The following questions ask about
preventative measures taken once a
young person is identified to be at risk for
suicide. Please include all levels of
suicide risk used by this facility, if any,
when answering these questions.
8a. Are young persons who are determined to
be at risk for suicide ever placed in a
sleeping room or observation room that is
locked or under staff security?
01
02
Yes
No ➔
Go to Question 9
8b. Which of the following best describes what
happens in the sleeping room or observation
room that is locked or under staff security?
Mark (X) all that apply.
01
Camera observation
6a. Are ANY young persons re-asked questions
or re-administered a form which asks
questions to determine risk for suicide?
01
02
Yes
No ➔
Go to Question 7
02
15 minute staff checks
03
5 minute staff checks
04
Line of site supervision (direct or through glass)
05
Staff assigned to doorway or in sleeping room/
One-on-one supervision/Arms length supervision
06
Other – Specify
6b. Which best describes the conditions under
which young persons are re-asked questions
or re-administered a form that asks questions
to determine suicide risk?
Mark (X) all that apply.
As necessary on a case-by-case basis
01
02
03
Systematically, based on length of stay, facility
events, or negative life events (for example,
after each court appearance, every time the
young person re-enters the facility, after a
death in the family)
Other – Specify
7. Does this facility assign different levels of
risk to young persons based on their
perceived risk of suicide?
01
Yes
02
No
FORM CJ-15 (03-15-2026)
9. Are any of the following preventative
measures taken when a young person is
determined to be at risk for suicide?
Mark (X) all that apply.
01
No preventative measures are taken when a young
person is determined to be at risk for suicide
02
One-on-one supervision/Arms length supervision
03
Line-of-sight supervision
04
Special clothing to identify young persons as at risk
for suicide
05
Special clothing designed to prevent suicide attempts
06
Restraints used to prevent suicide attempts
07
Removal of personal items that may be used to
attempt suicide
08
Removal from the general population
09
Other – Specify
Page 10
Section 2 – MENTAL HEALTH SERVICES - Continued
NOTE
F
Questions 10 through 15 ask about mental
health services provided at a location either
INSIDE or OUTSIDE this facility. INSIDE
refers to any location on the facility grounds.
OUTSIDE refers to any location in the
community or off facility grounds.
10. Do young persons assigned beds receive mental
health services other than a suicide evaluation
either INSIDE or OUTSIDE this facility?
Mental health services include:
• evaluations and appraisals conducted by
mental health professionals to diagnose or to
identify mental health needs
• ongoing mental health therapy
• ongoing counseling
01
02
03
04
Yes, provided both INSIDE and OUTSIDE
this facility
Yes, provided INSIDE this facility
Yes, provided OUTSIDE this facility
No, this facility does not provide mental health
services ➔ Go to Question 13a on page 11
11a. Is ongoing COUNSELING for mental health
problems provided INSIDE or OUTSIDE this
facility by a COUNSELOR?
Counselors are limited to:
● persons with a Master’s degree in a field
other than psychology or social work
● persons whose highest degree is a Bachelor’s
in any field.
01
Yes, INSIDE and OUTSIDE this facility
Yes, INSIDE this facility
02
Yes, OUTSIDE this facility
03
04 ● No, ongoing counseling
12b.When are young persons evaluated or
appraised by a MENTAL HEALTH
PROFESSIONAL?
Mark (X) all that apply.
01
Within less than 24 hours
02
Between 24 hours and less than 7 days
after arrival
03
Seven or more days after arrival
04
Other – Specify
12c. Which young persons are evaluated or
appraised by a MENTAL HEALTH PROFESSIONAL?
Mark (X) all that apply.
01
ALL young persons are evaluated or appraised
by a MENTAL HEALTH PROFESSIONAL?
02
Young persons who come directly from home,
rather than from another facility
mental health problems are provided by a
COUNSELOR?
03
Young persons who are ordered by the court to
get an evaluation
Mark (X) all that apply.
Individual counseling
01
04
Young persons whom staff identify as needing
an evaluation
05
Young persons known to have mental health
problems
06
Young persons for whom no mental health
record is available
07
Other young persons not listed above – Specify
is not provided ➔ Go to Question 12a
11b. Which forms of ongoing COUNSELING for
Page 11
12a.Are ANY young persons evaluated or appraised
by a MENTAL HEALTH PROFESSIONAL at a
location INSIDE or OUTSIDE this facility?
Evaluations and appraisals are conducted by
mental health professionals to diagnose or to
identify mental health needs.
Mental health professionals are limited to:
• psychiatrists
• psychologists with at least a Master’s
degree in PSYCHOLOGY
• social workers with at least a Master’s
degree in SOCIAL WORK (MSW, LCSW)
01
Yes, INSIDE and OUTSIDE this facility
02
Yes, INSIDE this facility
03
Yes, OUTSIDE this facility
No ➔ Go to Question 15a on page 11
04
02
Group counseling
03
Family counseling
04
Other – Specify
FORM CJ-15 (03-15-2026)
Section 2 – MENTAL HEALTH SERVICES - Continued
13a. Is ongoing THERAPY for mental health
problems provided to young persons by a
MENTAL HEALTH PROFESSIONAL INSIDE or
OUTSIDE this facility?
Mental health professionals are limited to:
• psychiatrists
• psychologists with at least a Master’s degree in
PSYCHOLOGY
• social workers with at least a Master’s degree
in SOCIAL WORK (MSW, LCSW)
01
02
03
04
Yes, INSIDE and OUTSIDE this facility
Yes, INSIDE this facility
Yes, OUTSIDE this facility
No, ongoing THERAPY is
not provided ➔ Go to Question 14a
13b. Which forms of ongoing THERAPY for mental
health problems are provided by MENTAL
HEALTH PROFESSIONALS?
15a. Upon a young person’s departure from this
facility, is information regarding their mental
health status, services and/or needs
communicated to the young person's new
placement or residence?
01
Yes
02
No
Individual therapy
02
Group therapy
03
Family therapy
04
Other – Specify
Go to Section 3 on page 12
15b. For which young persons is this information
shared?
Mark (X) all that apply.
01
All young persons that depart from
the facility ➔
Go to Section 3 on page 12
02
Young persons being placed in other juvenile
justice facilities, including halfway houses, shelters
or other transition homes
03
Young persons returning to the community under
juvenile justice supervision through probation,
parole, or aftercare
04
Young persons returning to the community (their
homes, independent living, foster care, or another
type of guardian’s care) without further juvenile
justice supervision
Young persons being placed in adult criminal justice
facilities (prisons, jails)
Mark (X) all that apply.
01
➔
05
06
Young persons going to another living or placement
situation – Please explain
14a. Are there one or more special living/sleeping
unit(s) in this facility reserved just for young
persons with mental health problems that are
separate from other living/sleeping units?
01
Yes
02
No ➔
Go to Question 15a
14b. What are the differences between special
living/sleeping units reserved just for young
persons with mental health problems and
the other living/sleeping units?
Mark (X) all that apply.
01
average length of stay
03
physical security and/or monitoring of
young persons
number of staff per young persons
04
type of treatment program
02
05
06
07
characteristics of young persons
specialized criteria for staff selection
specialized curriculum of treatment for
the residents of these units
08
Other – Specify
09
No differences between units
FORM CJ-15 (03-15-2026)
Page 12
Section 3 – EDUCATIONAL SERVICES
1. After arrival in this facility, are ANY young
persons evaluated to determine their educational
grade levels and their educational needs at a
location either INSIDE or OUTSIDE this facility?
01
Yes
02
No ➔
NOTE
G
Go to Question 5a
2. After arrival in this facility, when are young
persons evaluated to determine their
educational grade level?
Mark (X) all that apply.
Questions 5 through 7 ask about
educational services provided either
INSIDE and/or OUTSIDE this facility.
INSIDE this facility refers to any location on
the facility grounds. OUTSIDE this facility
refers to any location in the community or off
facility grounds.
5a. Do ANY young persons assigned beds here
attend school or receive teacher instruction at
a location either INSIDE or OUTSIDE this
facility?
Mark (X) only one.
01
Yes, provided both INSIDE and OUTSIDE
this facility
01
Within less than 24 hours after arrival
02
Between 24 hours and less than 7 days
after arrival
03
Seven or more days after arrival
02
Yes, provided INSIDE this facility
04
Other – Specify
03
Yes, provided OUTSIDE this facility
04
3. Which of the following methods are used to
evaluate young persons to determine their
educational grade levels and their
educational needs?
No, educational services are not provided
to young persons while assigned beds
here ➔ Go to Section 4 on page 14
5b. Which young persons attend school or receive
teacher instruction?
01
Review of previous academic records
Mark (X) all that apply.
01
ALL young persons are required to
attend school or receive teacher
instruction ➔
Go to Question 6
02
Interview with an education specialist
02
03
Administration of one or more written
or computerized tests
Those young persons who have not completed
high school or their GED
03
04
Interview with an intake or
admissions counselor
Those young persons with special needs for
remedial education
04
05
Interview with guidance counselor
Those young persons who have been in the facility
long enough to receive educational services
06
Other – Specify
05
Those young persons who are required by the
state to attend school because of their age
06
Those young persons assigned beds in special
living/sleeping units –Specify unit type
Mark (X) all that apply.
4. Which young persons are evaluated to
determine their educational grade levels and
their educational needs?
Mark (X) all that apply.
01
07
Other young persons not listed
above – Specify
ALL young persons are
evaluated ➔ Go to Question 5a
02
Young persons who come directly from home,
rather than from another facility
03
Young persons whom the staff identify as
needing an assessment
04
Young persons for whom no educational record
is available
05
Young persons with known educational problems
06
Other young persons not listed above – Specify
FORM CJ-15 (03-15-2026)
Page 13
Section 3 – EDUCATIONAL SERVICES – Continued
6. Which of the following educational services
are provided to young persons assigned beds
here at a location either INSIDE or OUTSIDE this
facility?
Mark (X) all that apply.
01
Elementary-level education
02
Middle school-level education
03
High school-level education
04
Special education
05
GED preparation
06
GED testing
07
Post-high school education or post-high
school correspondence courses
08
Vocational/technical education
09
Life skills training
10
Other – Specify
7a. Upon a young person’s departure from this
facility, is information regarding their
educational status, services and/or
needs communicated to the young
person's new placement or residence?
01
Yes
02
No
➔
Go to Section 4 on page 14
7b. For which young persons is this information
shared?
Mark (X) all that apply.
01
All young persons that depart from
the facility ➔ Go to Section 4 on page 14
02
Young persons being placed in other juvenile
justice facilities, including halfway houses,
shelters or other transition homes
03
Young persons returning to the community under
juvenile justice supervision through probation,
parole, or aftercare
04
Young persons returning to the community (their
homes, independent living, foster care, or
another type of guardian’s care) without further
juvenile justice supervision
Young persons being placed in adult criminal
justice facilities (prisons, jails)
05
06
Page 14
Young persons going to another living or
placement situation – Please explain
FORM CJ-15 (03-15-2026)
Section 4 – SUBSTANCE USE SERVICES
1a. After arrival in this facility, are ANY young
2. When are young persons FIRST evaluated to
determine whether they have substance use
problems?
persons evaluated to determine whether
they have substance use problems?
Substance use problems include problems with
drugs and/or alcohol.
01
Yes
02
No ➔
Mark (X) all that apply.
Go to Question 4a
1b. Which of the following methods are used
to evaluate persons after arrival in this
facility to determine whether they have
substance use problems?
Mark (X) all that apply.
01
Visual observation
01
Within less than 24 hours after arrival
02
Between 24 hours and less than 7 days
after arrival
03
Seven or more days after arrival
04
Other – Specify
3a. Are ALL young persons evaluated after
02
Standardized self-report instruments, such as
the SASSI, JASI, ACDI, ASI
03
Self-report check list inventory which asks
about substance use
04
A staff-administered series of questions
which asks about substance use
05
None of these methods are used
06
Other – Specify
arrival in this facility to determine whether
they have substance use problems?
01
Yes ➔
02
No
Go to Question 4a
3b. After arrival in this facility, which young
persons are evaluated for substance use
problems?
Mark (X) all that apply.
01
Young persons charged with or adjudicated for a
drug or alcohol-related offense
02
Young persons identified by the court or a
probation officer as potentially having substance
use problems
03
Young persons identified by facility staff as
potentially having substance use problems
04
Other young persons not listed above – Specify
4a. Are ANY young persons required to provide urine FOR DRUG ANALYSIS after arrival IN
THIS FACILITY?
01
Yes
02
No ➔ Go to NOTE H on page 15
4b. Which statements below describe the circumstances under which young persons are required to
provide urine INSIDE this facility FOR DRUG ANALYSIS? Mark (X) all that apply.
PERSONS
PROVIDING URINE
SAMPLE
a. Young persons who are suspected
of recent drug or alcohol use
b. Young persons with substance
use problems
c. ALL young persons assigned beds
here
Page 15
After initial
arrival in this
facility
(1)
CIRCUMSTANCES OF TESTING
Each time young
When drug use
At randomly
persons reenter
is suspected or
scheduled times
the facility during
drug is present
their stay
(2)
(3)
(4)
At the request of
the court or
probation officer
(5)
01
02
03
04
05
01
02
03
04
05
01
02
03
04
05
FORM CJ-15 (03-15-2026)
Section 4 – SUBSTANCE USE SERVICES – Continued
NOTE
H
Questions 5 through 9 ask about substance
use services provided at a location either
INSIDE or OUTSIDE this facility. INSIDE
refers to any location on the facility grounds.
OUTSIDE refers to any location in the
community or off facility grounds.
INSTRUCTIONS
Substance use services include:
● developing a substance use treatment
plan
● assigning a case manager to oversee
substance use treatment
● assigning young persons to special
living units just for those with substance
use problems
● ongoing substance use therapy or
counseling
● substance use education
Substance use treatment professionals
are limited in this census to:
● CERTIFIED substance use or
addictions counselors
● psychiatrists
● psychologists with at least a
Master’s degree in PSYCHOLOGY
● social workers with at least a
Master’s degree in SOCIAL WORK
(MSW, LCSW)
Counselors who are NOT substance use
treatment professionals are limited to:
● persons with a Master’s degree in a
field other than psychology or social
work
● persons whose highest degree is a
Bachelor’s in any field
5. Do ANY young persons assigned beds here
receive substance use services INSIDE or
OUTSIDE this facility other than urinalysis or a
substance use screening?
01
Yes, provided both INSIDE and OUTSIDE this facility
02
Yes, provided INSIDE this facility
03
Yes, provided OUTSIDE this facility
04
No, this facility does not provide substance use
services ➔ Go to Section 5 on page 17
6. Which of the following SUBSTANCE USE
services are provided INSIDE or OUTSIDE this
facility?
Mark (X) all that apply.
01
Substance use education
02
Assignment of a case manager to oversee
substance use treatment
03
Development of a treatment plan to specifically
address substance use problems
04
Special living units in which all young persons
have substance use offenses and/or problems
05
None of these services are offered
7. Which of the following self-led, self-help
groups are provided INSIDE or OUTSIDE
this facility?
Mark (X) all that apply.
01
Alcoholics Anonymous or other related groups
02
Narcotics Anonymous or other related groups
03
Other – Specify
04
No self-led, self-help groups are provided
8a. Is ongoing COUNSELING for substance
use problems provided to young persons
INSIDE or OUTSIDE this facility by a
COUNSELOR who is NOT a substance use
treatment professional?
Counselors who are NOT substance use
treatment professionals are:
● persons with a Master’s degree in a field other
than psychology or social work
● persons whose highest degree is a Bachelor’s in any
field
01
Yes, provided both INSIDE and OUTSIDE this facility
02
Yes, provided INSIDE this facility
03
04
Yes, provided OUTSIDE this facility
No, ongoing COUNSELING for substance use problems
is not provided ➔ Go to Question 9a on page 16
8b. Which forms of ongoing COUNSELING for
substance use problems are provided
INSIDE or OUTSIDE this facility to young
persons by a COUNSELOR who is NOT a
substance use treatment professional?
Mark (X) all that apply.
Individual counseling
01
FORM CJ-15 (03-15-2026)
02
Group counseling
03
Family counseling
04
None of these are provided
Page 16
Section 4 – SUBSTANCE USE SERVICES – Continued
9a. Is ongoing THERAPY for substance use
problems provided to young persons INSIDE
or OUTSIDE this facility by a SUBSTANCE
USE TREATMENT PROFESSIONAL?
Substance use treatment professionals are
limited to:
01
02
03
04
● CERTIFIED substance use/addictions
counselors
● psychiatrists
● psychologists with at least a Master’s degree
in psychology
● social workers with a Master’s degree in
SOCIAL WORK (MSW, LCSW)
Yes, provided both INSIDE and OUTSIDE this facility
● Yes, provided INSIDE this facility
Yes, provided OUTSIDE this facility
No, ongoing THERAPY for substance use problems is
not provided ➔ Go to Section 5 on page 17
9b. Which forms of ongoing THERAPY for
substance use problems are provided
INSIDE or OUTSIDE this facility to young
persons by a SUBSTANCE USE
TREATMENT PROFESSIONAL?
Mark (X) all that apply.
Individual therapy
01
Page 17
02
Group therapy
03
Family therapy
04
None of these are provided
10a. Upon a young person’s departure from this
facility, is information regarding their
substance use status, services and/or
needs communicated to the young
person's new placement or residence?
01
Yes
02
No ➔
Go to Section 5 on page 17
10b. For which young persons is this information
shared?
Mark (X) all that apply.
01
All young persons that depart from
the facility➔ Go to Section 5 on page 17
02
Young persons being placed in other
juvenile justice facilities, including halfway
houses, shelters or other transition homes
Young persons returning to the community
under juvenile justice supervision through
probation, parole, or aftercare
03
04
05
06
Young persons returning to the community
(their homes, independent living, foster care,
or another type of guardian’s care) without
further juvenile justice supervision
Young persons being placed in adult criminal
justice facilities (prisons, jails)
Young persons going to another living or
placement situation – Please explain
FORM CJ-15 (03-15-2026)
Section 5 – MEDICAL SERVICES
INSTRUCTIONS
Questions 1 through 7 ask about the availability of medical services at locations either INSIDE and/or OUTSIDE
this facility.
INSIDE this facility refers to any location on the facility grounds.
OUTSIDE this facility refers to any location in the community or off facility grounds.
1. For each of the following medical providers, please indicate if this facility has access to these providers
as paid facility employees, contract staff, available as needed in the community, or if the medical providers
are not available.
Mark (X) all that apply.
Available as
paid facility
employee
(1)
Available as
paid contract
staff
(2)
Available as
needed in the
community
(3)
Not available
(4)
01
02
03
04
01
02
03
04
01
02
03
04
d. Licensed practical nurses (LPNs) or
licensed vocational nurses (LVNs)
01
02
03
04
e. Certified nursing assistants, nursing
assistants, medication technicians or
medication aides
01
02
03
04
01
02
03
04
a. Physicians (MDs or DOs)
b. Nurse practitioners (NPs) or physician
assistants (PAs)
c. Registered nurses (RNs)
f. Licensed social workers or persons with a
bachelor's or master's degree in social work
2. Do ANY young persons assigned beds here receive the following examinations by a physician (MD or DO),
nurse practitioner (NP), or physician assistant (PA), at a location either INSIDE or OUTSIDE of this facility?
Yes, provided
INSIDE and
OUTSIDE this
facility
(1)
Yes, provided
only INSIDE
this facility
(2)
Yes, provided
only OUTSIDE
this facility
(3)
No, not
provided
(4)
a. Physical Examination
01
02
03
04
b. Dental Examination
01
02
03
04
c. Vision Examination
01
02
03
04
d. Hearing Examination
01
02
03
04
Page 18
FORM CJ-15 (03-15-2026)
Section 5 – MEDICAL SERVICES - Continued
3. When a medical provider orders vaccinations
for ANY young persons assigned beds here, can
the young persons receive the vaccinations at a
location either INSIDE or OUTSIDE of this
facility?
Yes, provided INSIDE and OUTSIDE this facility
Yes, provided INSIDE this facility
Yes, provided OUTSIDE this facility
No, vaccinations are not provided
01
02
03
04
4. Do medical providers INSIDE or OUTSIDE
this facility prescribe psychotropic
medication for young persons?
01
02
03
04
Yes, prescribed INSIDE and OUTSIDE this facility
Yes, prescribed INSIDE this facility
Yes, prescribed OUTSIDE this facility
No, psychotropic medications are not prescribed
5. Do medical providers INSIDE or OUTSIDE
this facility monitor psychotropic
medication for young persons?
Yes, monitored INSIDE and OUTSIDE this facility
Yes, monitored INSIDE this facility
Yes, monitored OUTSIDE this facility
No, psychotropic medications are not monitored
01
02
03
04
7a. Were ANY young persons assigned beds in
this facility known by facility staff to be
pregnant between March 1, 2025 and February
28, 2026?
01
02
Yes
No ➔
Go to Section 6 on page 19
7b. How many young persons assigned beds
in this facility were pregnant between
March 1, 2025 and February 28, 2026?
Number of pregnant young persons
7c. Did ANY young persons assigned beds in this
facility who were pregnant between March 1,
2025 and February 28, 2026 receive prenatal
care by a physician (MD or DO), nurse
practitioner (NP), or physician assistant (PA)
at a location either INSIDE or OUTSIDE of this
facility?
01
02
03
04
Yes, provided INSIDE and OUTSIDE this facility
Yes, provided INSIDE this facility
Yes, provided OUTSIDE this facility
No, prenatal care was not provided
6. Do ANY female young persons assigned beds
here receive a gynecological examination by a
physician(MD or DO), nurse practitioner (NP), or
physician assistant (PA) at a location either
INSIDE or OUTSIDE of this facility?
A gynecological examination involves the medical
provider gathering a medical history regarding
reproductive health and sexual behavior and conducting
a pelvic and breast exam.
01
02
03
04
05
Page 19
Yes, provided INSIDE and OUTSIDE this facility
Yes, provided INSIDE this facility
Yes, provided OUTSIDE this facility
No, gynecological examinations are not provided
No, this facility does not house female young
persons
FORM CJ-15 (03-15-2026)
Section 6 – THE PRIOR MONTH
INSTRUCTIONS
The following items ask you to answer questions
about different events that may have occurred at this
facility over a 28-day period.
3. During the month of February 2026, were
ANY of the young persons assigned beds here
restrained by facility staff with a mechanical
restraint?
Mechanical restraints include handcuffs, leg cuffs, waist
bands, leather straps, restraining chairs, strait jackets
or other mechanical devices
The 28-day REFERENCE PERIOD for this section
covers the time between the beginning of the day,
February 1, 2026 and the end of the day on
February 28, 2026.
If the facility staff ONLY used mechanical restraints
during transportation to and from this facility answer
NO.
01
1. During the month of February 2026, were there
ANY UNAUTHORIZED DEPARTURES of any young
persons who were assigned beds at this facility?
An "unauthorized departure" includes any incident in
which a young person leaves without staff permission or
approval for more than 10 minutes from:
● The physical security perimeter of the facility
● The mandatory supervision of a staff member when
02
4.
Yes
No
During the month of February 2026 were ANY of the
young persons assigned beds here locked for more
than four hours alone in an isolation, seclusion, or
sleeping room to regain control of their unruly
behavior?
01 ●
Yes
Answer NO if:
● Young persons were locked in their sleeping rooms
as part of the facility routine
OR
● Young persons were locked in their rooms ONLY
for purposes of quarantine, suicide watch, facility
wide lockdown, or self-requested seclusion
02
No
01
there is no physical security
● The mandatory supervision of transportation staff
● Any other approved area
2a. During the month of February 2026, were
02
Yes
No
ANY young persons assigned beds at this
facility transported to a hospital emergency
room by facility staff, transportation staff,
or by an ambulance?
01
02
Yes
No ➔
Go to Question 3
2b. For what reason(s) were the young persons
transported to a hospital emergency room
DURING THIS 28 DAY PERIOD in February?
Mark (X) all that apply.
01
02
03
04
05
06
07
08
09
10
11
Sports-related injury
Work or chore-related injury
An injury that resulted from interpersonal conflict
between one or more young persons, not
including a sports-related injury
An injury that resulted from interpersonal conflict
between a young person and a non-resident
(including staff, visitors, or persons from the
community).
Illness
Pregnancy complications
Labor and delivery
Suicide attempt
A non-emergency injury or illness that occurred
when no physical health professional was
available at the facility or on call
A non-emergency injury or illness that
occurred when no doctor’s appointment could
be obtained in the community
Other – Specify
FORM CJ-15 (03-15-2026)
Page 20
Section 7 – THE PAST YEAR
INSTRUCTIONS
Questions 1 through 3 ask about deaths of young persons at locations either INSIDE and/or OUTSIDE this
facility during the period between March 1, 2025 and February 28, 2026.
INSIDE this facility refers to any location on the facility grounds.
OUTSIDE this facility refers to any location in the community or off facility grounds.
1. During the YEAR between March 1, 2025 and February 28, 2026, did ANY young persons die
while assigned a bed at this facility at a location either INSIDE or OUTSIDE of this facility?
01
02
Yes
No ➔
Go to page 21
2. How many young persons died while assigned beds at this facility during the year between
March 1, 2025 and February 28, 2026?
Person(s)
3. What was the cause of death, location of death, age, sex, race, date of admission to the facility, and
date of death for each young person who died while assigned a bed at this facility?
a. Cause of death
1 – Illness/natural causes
2 – Injury suffered prior to
placement here
3 – Suicide
4 – Homicide or manslaughter
by another resident
5 – Homicide or manslaughter
by non-resident(s)
6 – Accidental death
7 – Other – Specify in box ➔
Young person 1
(1)
Young person 2
(2)
Young person 3
(3)
Code
Code
Code
Code
Code
Code
Code
Code
Code
b. Location of death
1 – Inside this facility
2 – Outside this facility
c. Age at death (in years)
d. Sex
1 – Male
2 – Female
e. Race and/or Ethnicity
(List all that apply)
1 – White, not Hispanic origin
2 – Black or African American,
not of Hispanic origin
3 – Hispanic or Latino
4 – American Indian/
Alaskan Native
5 – Asian
6 – Native Hawaiian or other
Code(s)
Code(s)
Code(s)
Pacific Islander
7 – Middle Eastern or
North African
8 – Other – Specify in box
➔
f. Date of admission to
facility (mm/dd/yyyy)
g. Date of death
(mm/dd/yyyy)
Page 21
FORM CJ-15 (03-15-2026)
COMMENTS
Thank you for completing this questionnaire. If you would like to give us any comments
on this form, please write them on this page or attach another sheet.
NOTE
I
Please make a copy of this questionnaire for your records so that if we need to contact you
about a response, you will be able to refer to your copy.
If you are unable to submit online, please mail the completed form to U.S. Census Bureau
P.O. Box 5000
Jeffersonville, IN 47199–5000
ERD/JRFC
or FAX toll free to: 1–888–262–3974.
Comments
FORM CJ-15 (03-15-2026)
Page 22
DEFINITIONS OF TERMS
Campus: A self-contained environment that includes
multiple structures or areas dedicated to different aspects
of the juveniles' daily lives.
On-site Residential Treatment: Structured,
therapeutic services provided on the grounds of a
residential facility, either by facility staff or contracted staff.
CHINS [Children in Need of Services]: Persons
under age 21 in need of services for a reason other than
an offense, such as neglect, abuse, dependency,
abandonment, etc.
Operator: An agency that operates a facility is
responsible for the day-to-day management,
administration, and provision of services within that facility.
They oversee staffing, programming, security, and services
provided within physical space. The agency may operate a
facility on behalf of the owning agency, under a contract or
agreement, or they may be the same entity that owns the
facility.
Court-adjudicated: Refers to a youth who has been
determined by a court to have committed the delinquent
act for which they were charged.
Counselors: Individuals with a master’s degree in a field
other than psychology or social work, or persons whose
highest degree is a Bachelor’s in any field.
Educational Instruction: The structured teaching
and learning activities provided to residents. These
activities are designed to meet the educational needs of
juveniles, helping them achieve academic goals, develop
essential skills, or prepare for reintegration into traditional
educational settings or the workforce.
Evaluations / Appraisals: Any form of assessment
conducted by [specialized field] professionals to diagnose
or to identify a young person’s needs.
Facility: A place that has living/sleeping units such as
wings, floors, dorms, barracks, or cottages on one
campus or in one building.
Gynecological Exam: Involves the medical provider
gathering a medical history regarding reproductive health
and sexual behavior and conducting a pelvic and breast
exam.
Juveniles: Persons younger than 21.
Juvenile Offenders: Persons under the age 21 that
commit an act that is illegal, in the specific state, if
committed by either underage persons only or if
committed by either underage persons or adults.
Makeshift Beds: Alternative beds including roll-out
mats, fold-out cots, roll-away beds, pull-out mattresses,
sofas, and any other beds that are put away or moved
during non-sleeping hours.
Medical Providers: Licensed physicians (such as MDs
or DOs), registered nurses (RNs), nurse practitioners
(NPs), and physician assistants (PAs) who are authorized
to practice by the State and performing within the scope
of their practice as defined by State law. - orAn individual with a medical degree who is authorized to
practice by the state and is performing within the scope of
their practice as defined by state law, such as physicians
(MDs or DOs), registered nurses (RNs), nurse
practitioners (NPs), etc.
Mental Health Professionals: Individuals that are
Psychiatrists or Psychologists with at least a master’s
degree in psychology, and Social Workers with at least a
Master’s in social work (MSW, LCSW).
Mental Health Services: Includes evaluations and
appraisals conducted by mental health professionals to
diagnose or to identify mental health needs, as well as
ongoing mental health therapy and ongoing counseling.
FORM CJ-15 (03-15-2026)
Owner: An agency that owns a facility is the legal entity
or organization that has legal rights to the property, assets,
and physical infrastructure. They have title and financial
responsibility for the facility and the land where the facility
is situated. The owner may directly operate the facility or
contract with another agency for operations on their behalf.
They may also lease or allocate the facility to another
agency.
PINS [Persons in Need of Services]:
Residential Facility: A facility that houses persons
overnight.
Services “Inside” a Facility: A service provided at
any location on the facility grounds.
Services “Outside” a Facility: A service provided at
any location in the community or off facility grounds.
Standard Beds: A regular, fixed bed that is permanently
set up for use and does not need to be assembled,
unfolded, or moved for sleeping purposes. These include,
but are not limited to, traditional fixed-frame beds, bunk
beds, or any bed that remains in place regardless of the
time of day.
Status Offense: An offense that is illegal in a state for
underage persons but not for adults. Examples include
running away, truancy, incorrigibility, curfew violation, and
underage liquor violations.
Substance Use Services: Include developing a
substance use treatment plan, assigning a case manager
to oversee substance use treatment, assigning young
persons to special living units for those with substance use
problems, ongoing substance use therapy or counseling,
and substance use education.
Substance Use Treatment Professionals:
Individuals that are certified substance use or addiction
counselors, psychiatrists, or psychologists, with at least a
master’s degree in psychology, as well as social workers
with at least a Master’s degree in social work (MSW,
LCSW).
Therapy: Treatment of physical, mental, or behavioral
disorders or disease.
Treatment: Intervention designed to manage illness,
injury, disease or disorders.
Unauthorized Departures: Incidents in which a young
person leaves without staff permission or approval for
more than 10 minutes from the following: the physical
security perimeter of the facility, the mandatory supervision
of a staff member when there is no physical security; the
mandatory supervision of transportation staff, or any other
approved area.
Page 23
File Type | application/pdf |
Author | Sill, Kaitlyn (OJP) |
File Modified | 2025-02-13 |
File Created | 2025-02-13 |