D
FORMER PRISONER SURVEY Records
Form
FORM FPS-1 U.S. DEPARTMENT OF
JUSTICE
Bureau of Justice Statistics
BUREAU OF JUSTICE STATISTICS
Reporting Instructions
Please complete one
form for each sampled individual.
The term, Parolee,
is used to refer to any subject provided
in the sample. If the
information is unavailable in the parole office’s files or you
are unaware of the information, please check
the box for
‘Unknown.’
If you need assistance, please contact Tim Mulcahy at XXXX or XXXX at XXXX.
__ __ __ __ __ __ __ __ __ __ __ __
Case ID Number:
What is the parolee’s gender?
Male Female
What is the parolee’s date of birth?
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Unknown, if Unknown go to 3b.
3
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or Unknown
Is the parolee of Hispanic or Latino origin?
Yes
No
Unknown
Which of these categories describes the parolee’s race? Mark all that apply.
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
Information not available
Burden Statement: Under
the Paperwork Reduction Act, we cannot ask you to respond to a
collection of information unless it displays a currently valid OMB
control number. The burden of this collection is estimated to
average 5 minutes per response, including reviewing instructions,
searching existing data sources, gathering necessary data, and
completing the review form. Send comments regarding this burden
estimate or any aspect of this survey, including suggestions for
reducing this burden, to the Director, Bureau of Justice
Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do not
send your completed form to this address.
What was the parolee’s date of RELEASE TO PAROLE?
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or
Unknown
What
was the parolee’s date of ADMISSION TO PRISON?
Include
the last continuous period of confinement even if transferred. If
the parolee was recommitted after escape or parole, only address
the recommitment offense and time.
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or
Unknown, if Unknown go to 7b.
7 b. If date of admission is unknown, what was the length of time last served in prison?
Months
Years
or
Unknown
How many contacts are required per month between the parolee and the parole office?
File Type | application/msword |
Author | Demus-Imelda |
Last Modified By | lbryant |
File Modified | 2007-11-02 |
File Created | 2007-11-02 |