SSV-3 Survey of Sexual Victimization Local Jail Summary Form

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

SSV-3

FORM
(5-18-2016)

SURVEY OF SEXUAL VICTIMIZATION, 2015
Local Jail Jurisdictions
Summary Form

BUREAU OF JUSTICE STATISTICS
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 usually operated by a local law
enforcement agency that are intended for adults but
sometimes hold juveniles.

• INCLUDE all jails and city/county correctional centers that
hold inmates beyond arraignment. Report on ALL
inmates, including those held in separate holding or
lockup areas within your facility.

Reporting instructions:
•

Please complete the entire SSV-3 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.

•
•

• INCLUDE multi-jurisdictional facilities, e.g., regional jails.
• INCLUDE special jail facilities (e.g., medical/treatment/
release centers, halfway houses, and work farms).
• EXCLUDE privately-operated jails and facilities
operated by two or more jurisdictions, i.e.,
multi-jurisdictional 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 inmates held in other jurisdictions.

Section I: when exact numeric answers are not available,
provide estimates and mark ( X ) the box beside each
figure.

•

Sections II, III, and IV: if the answer to a question is
"none" or "zero," write "0" or 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 1–888–369–3613,
option 2, or e-mail govs.ssv@census.gov
• Please return your completed summary
and substantiated incident forms by
August 15, 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 30 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 VICTIMIZATION

1. How many persons under the supervision of your
local jail jurisdiction were—

DEFINITIONS
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:

a. CONFINED in your jail facilities on
December 31, 2015?
• INCLUDE persons on transfer to treatment facilities
but who remain under your jurisdiction.
• INCLUDE persons out to court while under your
jurisdiction.

NONCONSENSUAL SEXUAL ACTS

• INCLUDE persons held for other jurisdictions.

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

• EXCLUDE persons housed in facilities operated by
two or more jurisdictions or those held in
privately-operated jails.

AND

• EXCLUDE inmates on AWOL, escape, or long-term
transfer to other jurisdictions.

• Contact between the penis and the vulva or the penis
and the anus including penetration, however slight;

• EXCLUDE all persons in non-residential
community-based programs run by your jail (e.g.,
electronic monitoring, house arrest, community
service, day reporting, work programs).

OR
• Contact between the mouth and the penis, vulva, or
anus;
OR

Male

Female

• Penetration of the anal or genital opening of another
person, however slight, by a hand, finger, object, or other
instrument.

Inmates on
December 31, 2015 . . .

ABUSIVE SEXUAL CONTACT
b. ADMITTED to your jail facilities during 2015?
• 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.
• INCLUDE repeat offenders booked on new charges.
• EXCLUDE returns from escape, work release, medical
appointments/treatment facilities, and bail or court
appearances.
Male

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.
SEXUAL HARASSMENT

Female

Repeated and unwelcome 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.

New admissions
during 2015 . . . . . . . . .

2. Between January 1, 2015, and
December 31, 2015, what was the average
daily population of all jail confinement
facilities operated by your jurisdiction?
• To calculate the average daily population, add the
number of persons for each day during the period
January 1, 2015, through December 31, 2015, and
divide the result by 365.
Male

Female

Average daily
population . . . . . . . . . . .

FORM SSV-3 (5-18-2016)

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

Page 2

3. Does your local jail jurisdiction record allegations
of inmate-on-inmate NONCONSENSUAL SEXUAL
ACTS? (See definitions on page 2.)
Yes ➔ a. Do you record all reported
01
occurrences, or only substantiated
ones?

6. Does your local jail jurisdiction record
allegations of inmate-on-inmate ABUSIVE
SEXUAL CONTACT? (See definitions on page 2.)
01

No

➔ Can these be counted separately from
allegations of NONCONSENSUAL
SEXUAL ACTS?

01

All

01

02

Substantiated only

02

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

02

Yes

01

Both attempted and completed

02

Completed only

02

No

➔

Yes
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

local jail jurisdiction for inmate-on-inmate
NONCONSENSUAL SEXUAL ACTS in the
space below. Use that definition to complete
Items 4 and 5.

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

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

Number reported . . . . . . .
None
• If an allegation involved multiple victimizations,
count only once.
• Exclude any allegations that were reported as
consensual.

Number reported . . . . .
None
If
an
allegation
involved
multiple
victimizations,
count only
•
once.
• Exclude any allegations that were reported as consensual.

5. Of the allegations reported in Item 4, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

8. Of the allegations reported in Item 7, 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

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

.....

a. Substantiated . . . . . . . .

None

b. Unsubstantiated

.....

None

..........

None

None
c. Unfounded

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

d. Investigation ongoing
c. Unfounded . . . . . . . . . .

None

.

None

• Evidence is still being gathered, processed or evaluated,
and a final determination has not yet been made.
e. TOTAL (Sum of Items
5a through 5d) . . . . . . . . .

None

• The total should equal the number reported in Item 4.
FORM SSV-3 (5-18-2016)

None

e. TOTAL (Sum of Items
None
8a through 8d) . . . . . . . . . .
• The total should equal the number reported in
Item 7.

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

.

Page 3

Section III – STAFF-ON-INMATE SEXUAL ABUSE

9. Does your local jail jurisdiction record
allegations of inmate-on-inmate SEXUAL
HARASSMENT? (See definitions on page 2.)
01

02

Yes

No

DEFINITIONS

➔ Do you record all reported

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:

allegations or only substantiated
ones?

➔

01

All

02

Substantiated only

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

STAFF SEXUAL MISCONDUCT
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;

10. Between January 1, 2015, and December 31,
2015, how many allegations of
inmate-on-inmate SEXUAL HARASSMENT were
reported?
None
Number reported . . . . . . .
• If an allegation involved multiple victims or
inmate perpetrators, count only once.
• Exclude any allegations that were reported as
consensual.

OR
• Completed, attempted, threatened, or requested
sexual acts;
OR

11. Of the allegations reported in Item 10, how many
were—

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

None

STAFF SEXUAL HARASSMENT

b. Unsubstantiated . . . . . .

None

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—

c. Unfounded

None

• Demeaning references to gender; or sexually suggestive
or derogatory comments about body or clothing;

a. Substantiated . . . . . . . .

..........

d. Investigation ongoing

.

OR

None

• Repeated profane or obscene language or gestures.

e. TOTAL (Sum of Items
None
11a through 11d) . . . . . . . .
• The total should equal the number reported in
Item 10.

FORM SSV-3 (5-18-2016)

Page 4

15. Does your local jail jurisdiction record
allegations of STAFF SEXUAL HARASSMENT?
(See definitions on page 4.)

12. Does your local jail jurisdiction record
allegations of STAFF SEXUAL MISCONDUCT?
(See definitions on page 4.)
01

02

Yes ➔ Do you record all reported
occurrences, or only substantiated
ones?

No

01

Yes ➔ Can these allegations be counted
separately from allegations of
STAFF SEXUAL MISCONDUCT?

01

All

01

Yes

02

Substantiated only

02

No ➔ Skip to Item 18.

➔ Please provide an explanation in the space

02

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

.....

➔ Please provide an explanation in the space

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

Number reported

None

.....

None

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

• If an allegation involved multiple victimizations, or
staff, count only once.
14. Of the allegations reported in Item 10, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

No

below and then skip to Item 18.

below and then skip to Item 15.

17. Of the allegations reported in Item 16, 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 . . . . . . .

None

b. Unsubstantiated . . . . . .

None

b. Unsubstantiated . . . . .

None

c. Unfounded

None

c. Unfounded

.........

None

None

d. Investigation ongoing .

None

None

e. TOTAL (Sum of Items 17a
through 17d) . . . . . . . . . .

None

..........

d. Investigation ongoing

.

e. TOTAL (Sum of Items
14a through 14d) . . . . . . . .
• The total should equal the number
reported in Item 13.

FORM SSV-3 (5-18-2016)

• The number should equal the number
reported in Item 16.

Page 5

Section IV – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION

NOTES

18. What is the total number of substantiated
incidents reported in Items 5a, 8a, 11a,
14a, and 17a?
Total substantiated
incidents . . . . . . . . . . . .

➔

None

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

FORM SSV-3 (5-18-2016)

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Page 6

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