Form SSV-1 Survey of Sexual Victimization Federal Form

OMB No. 1121-0292: Approval Expires 06/30/2017
U.S. DEPARTMENT OF JUSTICE

SSV-1

FORM
(4-21-2016)

BUREAU OF JUSTICE STATISTICS

SURVEY OF SEXUAL VICTIMIZATION, 2015
Federal Bureau of Prisons
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?
All confinement facilities operated by the Federal Bureau of
Prisons.
• INCLUDE prisons, penitentiaries, and correctional
institutions; boot camps; community correction facilities;
halfway houses; prison farms; reception, diagnostic, and
classification centers; road camps; forestry and
conservation camps; vocational training facilities; prison
hospitals; and drug and alcohol treatment facilities for
prisoners.
• EXCLUDE privately-operated facilities. (These
facilities will be contacted directly for data on
sexual victimization.)
What inmates and incidents are included in this
data collection?
Inmates under your custody between January 1, 2015, and
December 31, 2015.
• INCLUDE incidents involving inmates under the
authority, custody, or care of your confinement or
community-based facilities or staff.
• EXCLUDE incidents involving inmates held in
local jails and facilities in other jurisdictions.

Reporting instructions:
•
•
•
•

Please complete the entire SSV-1 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 "0," mark the
box ( X ) provided.

Substantiated incidents of sexual violence:
• Please complete an Incident Form (Adult, SSV-IA)
for each substantiated incident of sexual victimization.
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 summary and
substantiated incident forms by September 1,
2016.
• You may complete these forms online (see
enclosed instructions). Or if you prefer, you may
return these forms by mail or fax.
• MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000
• FAX (TOLL FREE): 1–888–262–3974

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 – INMATE–ON–INMATE SEXUAL VICTIMIZATION
DEFINITIONS

1. Does the Federal Bureau of Prisons record
allegations of inmate-on-inmate
NONCONSENSUAL SEXUAL ACTS?
01

The survey utilizes the definition of “sexual abuse” as
provided by 28 C.F.R. §115.6 in the National Standards to
Prevent, Detect, and Respond to Prison Rape (under the
Prison Rape Elimination Act of 2003). For purposes of SSV,
sexual abuse is disaggregated into three categories of
inmate-on-inmate sexual victimization. These categories are:

Yes ➔ a. Do you record all reported
occurrences, or only substantiated
ones?
01
All
02

Substantiated only

b. Do you record attempted
NONCONSENSUAL SEXUAL ACTS
or only completed ones?

NONCONSENSUAL SEXUAL ACTS
Sexual contact of any person without his or her consent,
or of a person who is unable to consent or refuse;
AND

02

No

01

Both attempted and completed

02

Completed only

➔ Please provide the definition used by the
Federal Bureau of Prisons for
inmate-on-inmate NONCONSENSUAL
SEXUAL ACTS in the space below. Use that
definition to complete Items 2 and 3.

• Contact between the penis and the vulva or the penis
and the anus including penetration, however slight;
OR
• Contact between the mouth and the penis, vulva, or
anus;
OR
• Penetration of the anal or genital opening of another
person, however slight, by a hand, finger, object, or
other instrument.

2. Between January 1, 2015, and December 31, 2015,
how many allegations of inmate-on-inmate
NONCONSENSUAL SEXUAL ACTS were reported?

ABUSIVE SEXUAL CONTACT
Number reported . . . . . .
Sexual contact of any person without his or her consent,
or of a person who is unable to consent or refuse;

• If an allegation involved multiple victimizations,
count only once.
• Exclude any allegations that were reported as
consensual.

AND
• 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 contact was incidental
to a physical altercation.

None

3. Of the allegations reported in Item 2, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)
a. Substantiated . . . . . . .

SEXUAL HARASSMENT

None

• The event was investigated and determined to
have occurred, based on a preponderance of the
evidence (28 C.F.R. §115.72).

Repeated and unwanted sexual advances, requests for
sexual favors, or verbal comments, gestures, or actions
of a derogatory or offensive sexual nature by one inmate
directed toward another.

b. Unsubstantiated . . . . .

None

• The investigation concluded that evidence was
insufficient to determine whether or not the event
occurred.
c. Unfounded . . . . . . . . . .

None

• The investigation determined that the event did NOT
occur.
d. Investigation ongoing .

None

• Evidence is still being gathered, processed
or evaluated, and a final determination has not yet
been made.
e. TOTAL (Sum of Items
3a through 3d) . . . . . . . . .

None

• The total should equal the number reported in Item 2.
FORM SSV-1 (4-21-2016)

Page 2

7. Does the Federal Bureau of Prisons record
allegations of inmate-on-inmate SEXUAL
HARASSMENT? (See definitions on page 2.)

4. Does the Federal Bureau of Prisons record
allegations of inmate-on-inmate ABUSIVE
SEXUAL CONTACT? (See definitions on page 2.)
01

Yes

➔ Can these be counted separately from

01

allegations of NONCONSENSUAL
SEXUAL ACTS?
01
02

02

No

Yes

Yes
No ➔ Skip to Item 7.

➔ Please provide an explanation in the space

02

below and then skip to Item 7.

.....

allegations or only substantiated
ones?
01

All

02

Substantiated only

➔ Please provide an explanation in the space
below and then skip to Section II.

5. Between January 1, 2015, and December 31, 2015,
how many allegations of inmate-on-inmate
ABUSIVE SEXUAL CONTACT were reported?

Number reported

No

➔ Do you record all reported

8. Between January 1, 2015, and December 31, 2015,
how many allegations of inmate-on-inmate
SEXUAL HARASSMENT were reported?

Number reported . . . . . .

None

None

• If an allegation involved multiple victimizations,
count only once.

• If an allegation involved multiple victims or
inmate perpetrators, count only once.

• Exclude any allegations that were reported as
consensual.

• Exclude any allegations that were reported as
consensual.

6. Of the allegations reported in Item 5, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

9. Of the allegations reported in Item 8, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

a. Substantiated . . . . . . .

None

a. Substantiated

b. Unsubstantiated . . . . .

None

b. Unsubstantiated

.....

None

c. Unfounded

None

c. Unfounded . . . . . . . . . .

None

d. Investigation ongoing

None

d. Investigation ongoing .

None

e. TOTAL (Sum of Items
6a through 6d) . . . . . . . . .

None

e. TOTAL (Sum of Items
9a through 9d) . . . . . . . . .

None

.........

None

• The total should equal the number reported in
Item 8.

• The total should equal the number reported in
Item 5.

FORM SSV-1 (4-21-2016)

.......

Page 3

SECTION II – STAFF-ON-INMATE SEXUAL ABUSE
DEFINITIONS

10. Does the Federal Bureau of Prisons
record allegations of STAFF SEXUAL
MISCONDUCT?

The survey utilizes the definition of “sexual abuse” by a staff
member, contractor or volunteer as provided by 28 C.F.R.
§115.6 in the National Standards to Prevent, Detect, and
Respond to Prison Rape (under the Prison Rape Elimination
Act of 2003). For purposes of SSV, sexual abuse is
disaggregated into two categories of staff-on-inmate sexual
abuse. These categories are:

01

STAFF SEXUAL MISCONDUCT

02

Yes

No

➔ Do you record all reported

occurrences, or only substantiated
ones?
01

All

02

Substantiated only

➔ Please provide an explanation in the space
below and then skip to Item 13.

Any behavior or act of a sexual nature directed toward an
inmate by an employee, volunteer, contractor, official visitor or
other agency representative (exclude family, friends or other
visitors).
Sexual relationships of a romantic nature between staff and
inmates are included in this definition. Consensual or
nonconsensual sexual acts include—
• Intentional touching, either directly or through the clothing,
of the genitalia, anus, groin, breast, inner thigh, or buttocks
that is unrelated to official duties or with the intent to abuse,
arouse, or gratify sexual desire;
OR
• Completed, attempted, threatened, or requested sexual acts;

11. Between January 1, 2015, and
December 31, 2015, how many allegations of
STAFF SEXUAL MISCONDUCT were reported?

OR

Number reported

• Occurrences of indecent exposure, invasion of privacy,
or staff voyeurism for reasons unrelated to official duties
or for sexual gratification.

......

None

• If an allegation involved multiple victimizations,
count only once.

STAFF SEXUAL HARASSMENT
Repeated verbal statements, comments or gestures of a sexual
nature to an inmate by an employee, volunteer, contractor,
official visitor, or other agency representative (exclude family,
friends, or other visitors). Include—

12. Of the allegations reported in Item 11, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

• Demeaning references to gender; or sexually suggestive
or derogatory comments about body or clothing;
OR
• Repeated profane or obscene language or gestures.

a. Substantiated . . . . . . .

None

b. Unsubstantiated . . . . .

None

c. Unfounded

.........

None

d. Investigation ongoing .

None

e. TOTAL (Sum of Items
12a through 12d) . . . . . . .

None

• The total should equal the number reported in
Item 11.

FORM SSV-1 (4-21-2016)

Page 4

Section III – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION

13. Does the Federal Bureau of Prisons record
allegations of STAFF SEXUAL HARASSMENT?
(See definitions on page 4.)
01

Yes

➔ Can these allegations be counted

16. What is the total number of substantiated
incidents reported Items 3a, 6a, 9a, 12a, and 15a?

separately from allegations of STAFF
SEXUAL MISCONDUCT?

02

No

01

Yes

02

No

Total substantiated
incidents . . . . . . . . . . . . .

➔

➔ Skip to Item 16.

➔ Please provide an explanation in the space

None

Please complete a
a Substantiated Incident Form
(Adult, SSV-IA) for each substantiated
incident of sexual victimization.

below and then skip to Item 16.

NOTES

14. Between January 1, 2015, and
December 31, 2015, how many allegations
of STAFF SEXUAL HARASSMENT were
reported?
Number reported

......

None

• If an allegation involved multiple victims or staff,
count only once.
15. Of the allegations reported in Item 14, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

a. Substantiated . . . . . . .

None

b. Unsubstantiated

....

None

.........

None

d. Investigation ongoing .

None

e. TOTAL (Sum of Items
15a through 15d) . . . . . . .

None

c. Unfounded

• The total should equal the number reported in
Item 14.

FORM SSV-1 (4-21-2016)

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