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pdfOMB No. 1121-0292: Approval Expires 12/31/2007
U.S. DEPARTMENT OF JUSTICE
SSV-4
FORM
(12-13-2006)
BUREAU OF JUSTICE STATISTICS
SURVEY ON SEXUAL VIOLENCE, 2006
— Other Correctional Facilities
Summary Form
AND ACTING AS COLLECTION AGENT
U.S. DEPT. OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU
DATA SUPPLIED BY
TELEPHONE
E-MAIL
ADDRESS
City
Number and street or P.O. Box/Route Number
Area code
Number
FAX
NUMBER
State
▼
OFFICIAL
ADDRESS
Title
▼▼▼
Name
Area Code
ZIP Code
Number
(Please correct any error in name, mailing address, and ZIP Code)
What facilities are included in this data collection?
• MULTI-JURISDICTIONAL FACILITIES: Facilities
including detention centers, jails, community-based
facilities, and other correctional facilities administered by
two or more governments (or a board composed of
representatives from two or more governments) that are
intended for adults but sometimes hold juveniles.
• PRIVATELY OPERATED FACILITIES: All privately
owned or operated confinement facilities including prisons,
jails, detention centers, community-based facilities, and
other correctional facilities that are intended for adults but
sometimes hold juveniles.
• FACILITIES OPERATED BY OR FOR:
• THE UNITED STATES MILITARY
• THE BUREAU OF IMMIGRATION AND
CUSTOMS ENFORCEMENT
• TRIBAL AUTHORITIES
• THE BUREAU OF INDIAN AFFAIRS
What inmates and incidents are included in this data
collection?
Inmates under your custody between January 1, 2006, and
December 31, 2006.
• INCLUDE incidents involving inmates under the authority,
custody, or care of your confinement or community-based
facilities or staff.
• EXCLUDE inmates held in other jurisdictions.
Reporting instructions:
• Please complete the entire SSV-4 Form.
• If the answer to a question is "not available" or "unknown,"
write "DK" (do not know) in the space provided.
• If the answer to a question is "not applicable," write "NA" in
the space provided.
• If the answer to a question is "none" or "zero," mark box
( X ) provided.
• When exact numeric answers are not available, provide
estimates and mark ( X ) in the box beside each figure.
Substantiated incidents of sexual violence:
• Please complete an Incident Form (Adult, SSV-IA)
for each substantiated incident of sexual violence.
Returning forms:
• If you need assistance, please call Greta Clark at the
U.S. Census Bureau toll-free at 1–800–253–2078,
or e-mail govs.ssv@census.gov
• Please return your completed questionnaire and
substantiated incident forms by March 15, 2007.
• You may complete this survey online at:
http://harvester.census.gov/ssv/
• If you prefer, you may also return these forms by
mail or fax.
• MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000
• FAX (TOLL FREE) TO: 1–888–891–2099
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 60 minutes per response, including reviewing instructions, searching
existing data sources, gathering necessary data, and completing and reviewing this 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.
Section I – GENERAL INFORMATION
Section II – INMATE-ON-INMATE SEXUAL VIOLENCE
1. How many persons under the supervision of your
facility were –
DEFINITIONS OF SEXUAL VIOLENCE
The definition of "rape" as required under the Prison Rape
Elimination Act of 2003 will be operationalized by
disaggregating sexual assault into two categories of
inmate-on-inmate SEXUAL VIOLENCE. These categories
reflect uniform definitions formulated by the National Center
for Injury Prevention and Control, in "Sexual Violence
Surveillance: Uniform Definitions and Recommended Data
Elements," Centers for Disease Control and Prevention. The
categories of inmate-on-inmate SEXUAL VIOLENCE are:
a. CONFINED on December 31, 2006?
• INCLUDE persons on transfer to treatment
facilities but who remain under your
jurisdiction.
• INCLUDE persons out to court while under your
jurisdiction.
• INCLUDE persons held for other jurisdictions.
NONCONSENSUAL SEXUAL ACTS:
• EXCLUDE inmates on AWOL, escape, or
long-term transfer to other jurisdictions.
Contact of any person without his or her consent, or of a
person who is unable to consent or refuse;
• EXCLUDE all persons in non-residential
community-based programs run by your facility
(e.g., electronic monitoring, house arrest,
community service, day reporting, work
programs).
Male
AND
• Contact between the penis and the vagina or the penis
and the anus including penetration, however slight;
Female
OR
• Contact between the mouth and the penis, vagina, or
anus;
Inmates on
December 31, 2006
OR
b. ADMITTED to your facility during 2006?
• Penetration of the anal or genital opening of another
person by a hand, finger, or other object.
• INCLUDE new admissions only, i.e., persons
officially booked into and housed in your facilities by
formal legal document and by the authority of the
courts or some other official agency.
ABUSIVE SEXUAL CONTACTS:
• INCLUDE repeat offenders booked on new charges.
Contact of any person without his or her consent, or of a
person who is unable to consent or refuse;
• EXCLUDE returns from escape, work release, medical
appointments/treatment facilities, and bail or court
appearances.
Male
Female
New admissions
during 2006
• Intentional touching, either directly or through the
clothing, of the genitalia, anus, groin, breast, inner thigh,
or buttocks of any person.
• Exclude incidents in which the intent of the sexual
contact is to harm or debilitate rather than to sexually
exploit.
2. Between January 1, 2006, and
December 31, 2006, what was the average
daily population of your confinement facility?
• To calculate the average daily population, add the
number of persons for each day during the period
January 1, 2006, through December 31, 2006, and
divide the result by 365.
Male
Female
Average daily
population
FORM SSV-4 (12-13-2006)
AND
Page 2
3. Does your facility record allegations of
inmate-on-inmate NONCONSENSUAL SEXUAL
ACTS?
Yes
01
6. Does your facility record allegations of
inmate-on-inmate ABUSIVE SEXUAL
CONTACTS? (See definitions on page 2.)
➔ a. Do you record all reported
01
No
➔ Can these be counted separately from
allegations of NONCONSENSUAL
SEXUAL ACTS?
01
All
01
Yes
02
Substantiated only
02
No
b. Do you record attempted
NONCONSENSUAL SEXUAL ACTS
or only completed ones?
02
Yes
occurrences, or only substantiated
ones?
01
Both attempted and completed
02
Completed only
02
No
➔ Skip to Item 9.
➔ Please provide an explanation in the space
below and then skip to Item 9.
➔ Please provide the definition used by your facility
for inmate-on-inmate NONCONSENSUAL
SEXUAL ACTS in the space below. Use that
definition to complete Items 4 and 5.
7. Between January 1, 2006, and
December 31, 2006, how many allegations
of inmate-on-inmate ABUSIVE SEXUAL
CONTACTS were reported?
4. Between January 1, 2006, and
December 31, 2006, how many allegations
of inmate-on-inmate NONCONSENSUAL
SEXUAL ACTS were reported?
Number reported
None
• If an allegation involved multiple victimizations, count
only once.
Number reported
None
• If an allegation involved multiple victimizations, count
only once.
8. Of the allegations reported in Item 7, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual violence in order to fully complete this form.)
5. Of the allegations reported in Item 4, how many
were — (Please contact the agency or office responsible
for investigating allegations of sexual violence in order to
fully complete this form.)
a. Substantiated . . . . . . .
a. Substantiated . . . . . . .
None
b. Unsubstantiated . . . . .
None
c. Unfounded
.........
None
d. Investigation ongoing .
None
e. TOTAL (Sum of Items 8a
through 8d) . . . . . . . . . .
None
None
• The event was investigated and determined to have
occurred.
b. Unsubstantiated . . . . .
None
• Evidence was insufficient to make a final determination
that the event occurred.
c. Unfounded . . . . . . . . . .
None
• The event was determined NOT to have occurred.
d. Investigation ongoing .
None
• A final determination has not yet been made as to
whether the event occurred.
e. TOTAL (Sum of Items
5a through 5d) . . . . . . . . .
FORM SSV-4 (12-13-2006)
None
Page 3
Section III – STAFF SEXUAL MISCONDUCT
AND HARASSMENT
10. Between January 1, 2006, and
December 31, 2006, how many allegations
of STAFF SEXUAL MISCONDUCT were
reported?
DEFINITION OF STAFF SEXUAL MISCONDUCT
The definition of STAFF SEXUAL MISCONDUCT is based on
"Training for Investigators of Staff Sexual Misconduct,"
prepared by the National Institute of Corrections. STAFF
SEXUAL MISCONDUCT includes any behavior or act of a
sexual nature directed toward an inmate by an employee,
volunteer, contractor, official visitor, or other agency
representative (exclude inmate family, friends, or other
visitors). Sexual relationships of a romatic nature between
staff and inmates are included in this definition.
Consensual or nonconsensual sexual acts including:
Number reported
None
• If an allegation involved multiple victims or staff, count
only once.
11. Of the allegations reported in Item 10, how
many were — (Please contact the agency or
office responsible for investigation allegations of
sexual violence in order to fully complete this form.)
• Intentional touching of the genitalia, anus, groin, breast,
inner thigh, or buttocks with the intent to abuse, arouse,
or gratify sexual desire;
OR
• Completed, attempted, threatened, or requested sexual
acts;
a. Substantiated . . . . . . .
None
b. Unsubstantiated . . . . .
None
c. Unfounded . . . . . . . . . .
None
d. Investigation ongoing .
None
e. TOTAL (Sum of Items 11a
through 11d) . . . . . . . . . .
None
OR
• Occurrences of indecent exposure, invasion of privacy,
or staff voyeurism for sexual gratification.
DEFINITION OF STAFF SEXUAL HARASSMENT
The definition of STAFF SEXUAL HARASSMENT was also
developed by the National Institute of Corrections. STAFF
SEXUAL HARASSMENT includes repeated verbal statements
or comments of a sexual nature to an inmate by an employee,
volunteer, contractor, official visitor, or other agency
representative (exclude inmate family, friends, or other
visitors).
• Demeaning references to gender or derogatory
comments about body or clothing;
OR
12. Does your facility record allegations of STAFF
SEXUAL HARASSMENT?
• Repeated profane or obscene language or gestures.
01
Yes
9. Does your facility record allegations of STAFF
SEXUAL MISCONDUCT?
Yes
01
02
No
➔ Do you record all reported
02
occurrences, or only
substantiated ones?
01
All
02
Substantiated only
No
➔ Can these allegations be counted
separately from allegations of
STAFF SEXUAL MISCONDUCT?
01
Yes
02
No ➔ Skip to Item 15.
➔ Please provide an explanation in the space
below and skip to Item 15.
➔ Please provide an explanation in the space
below and then skip to Item 12.
13. Between January 1, 2006, and
December 31, 2006, how many allegations
of STAFF SEXUAL HARASSMENT were
reported?
Number reported
None
• If an allegation involved multiple victims or staff, count
only once.
FORM SSV-4 (12-13-2006)
Page 4
NOTES
14. Of the allegations reported in Item 13, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual violence in order to fully complete this form.)
a. Substantiated
.......
None
.....
None
c. Unfounded . . . . . . . . . .
None
d. Investigation ongoing
.
None
e. TOTAL (Sum of Items 14a
through 14d) . . . . . . . . . .
None
b. Unsubstantiated
Section IV – TOTAL OF SUBSTANTIATED
INCIDENTS OF SEXUAL VIOLENCE
15. What is the total number of substantiated
incidents reported in Items 5a, 8a, 11a,
and 14a?
Total substantiated
incidents . . . . . . . . . . . . .
None
➔ Please complete an Incident Form
(Adult, SSV-IA) for each substantiated
incident of sexual violence.
FORM SSV-4 (12-13-2006)
Page 5
| File Type | application/pdf |
| File Modified | 2007-12-12 |
| File Created | 2006-12-13 |