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pdfOMB CONTROL NUMBER: 0701-IRCP
EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
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reviewing the collection of information. Send comments regarding the burden estimate or
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Respondents should be aware that notwithstanding any other provision of law, no person
shall be subject to any penalty for failing to comply with a collection of information if it
does not display a currently valid OMB control number.
Version 1.1 – Effective 7/18/2017
Installation Members
Command Team Please select the response that best describes your current duty position
o Commander or commander-equivalent
o First Sergeant
o Superintendent
o None of the above
Please select your Grade/Rank
o Drop down menu of enlisted, officer, and civilian ranks
Are you Hispanic or Latino?
Note: The U.S. Office of Management and Budget (OMB) defines "Hispanic or Latino" as a
person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture
or origin, regardless of race.
o Yes
o No
o Prefer not to answer
What is your race?
American Indian or Alaska Native. A person having origins in any of the original peoples of
North and South America (including Central America), and who maintains tribal affiliation or
community attachment. Asian. A person having origins in any of the original peoples of the
Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia,
China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and
Vietnam. Black or African American. A person having origins in any of the black racial
groups of Africa. Native Hawaiian or Other Pacific Islander. A person having origins in any of
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the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. White. A person
having origins in any of the original peoples of Europe, the Middle East, or North Africa.
o American Indian or Alaska Native
o Asian
o Black or African American
o Native Hawaiian or Other Pacific Islander
o White
o Prefer not to answer
What is your sex?
o Male
o Female
o Prefer not to answer
How long have you been physically assigned and located at this installation?
o Less than 6 month
o 6-12 months
o 1-2 years
o 2-4 years
o Over 4 years
Do you think you would receive the care you needed if you walked into the advocacy office?
o Definitely not
o Probably not
o Might or might not
o Probably yes
o Definitely yes
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If you knew someone (peer, superior, subordinate, etc.) had sought help from victim advocates
(Sexual Assault Response Coordinator, Domestic Abuse Victim Advocate, Sexual Assault
Victim Advocate, Sexual Harassment, Victim Counsel, Religious Support Team, etc.) would you
Definitely not
think
negatively of
that person?
Probably not
Might or
might not
Probably yes
Definitely yes
o
o
o
o
o
o
o
o
o
o
avoid that
person
because
there's a lot
of drama
surrounding
them?
o
o
o
o
o
treat them
exactly the
same?
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
avoid that
person
because
you're afraid
you'd say the
wrong thing
to them?
see that as a
sign of
personal
failure?
think
positively of
that person?
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How confident are you of where each of the following victim advocate offices are located?
Extremely
unsure
Somewhat
unsure
Neither
unsure nor
confident
Somewhat
confident
Extremely
confident
Sexual
Assault
Response
Coordinator
o
o
o
o
o
Domestic
Abuse Victim
Advocate
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Sexual
Harassment
victim
advocates
Religious
Support
Teams
Victim’s
Counsel
o
o
o
o
o
Are the following services located in one location at your installation?
Sexual Assault Response Coordinator, Domestic Abuse Victim Advocate, Sexual Assault Victim
Advocate, Sexual Harassment, Victim Counsel, Religious Support Team
o No
o Maybe - I'm not sure
o Yes
If you needed to speak with a victim advocate for any reason, would you be more likely to seek
services if sexual harassment, sexual assault, and domestic violence advocacy services were in
a single physical location?
o Definitely yes
o Probably yes
o Might or might not
o Probably not
o Definitely not
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How would you describe your knowledge about the specific services and support that victim
advocates can provide on your installation?
o Not knowledgeable at all
o Slightly knowledgeable
o Moderately knowledgeable
o Very knowledgeable
o Extremely knowledgeable
Did you seek advocacy care or consultation in the past 6 months?
o No
o Yes
(If no) Did you not report harassment/misconduct/violence due to fear of losing finances in
domestic abuse cases?
o Yes - I feared losing finances and did not report
o No - that was not a factor
o NA - I did not seek advocacy services related to domestic violence.
(If yes) Did you seek advocacy services from outside the DAF or DoD?
o No
o Yes - I first sought care from a civilian program that was not related to the DoD or DAF.
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(If yes) Did you eventually report the harassment/misconduct to the DAF or the DoD?
o No
o Yes
(If yes) Did you reach the correct advocate on the first try? Choose the response that best fits
your situation from your perspective.
o
o No - I did not get the right advocate on the first try. I had to leave and come back another
day.
o No - I did not get the right advocate on the first or second try. I had to leave and try again
in a different office. It took me a couple times to find the right person to help me.
o No - I was turned away for care and I did not try again.
Yes - I got the right advocate on the first try or I was immediately connected to the right
care advocate
If you were turned away for care, can you share a little about your experience? Do not use an
personally identifiable information such as names or locations.
________________________________________________________________
How much do you agree with the following statement?
The Department of the Air Force provides adequate support and resources to Airmen and
Space Professionals who have experienced any form of interpersonal violence or workplace
relation issues.
o Strongly disagree
o Somewhat disagree
o Neither agree nor disagree
o Somewhat agree
o Strongly agree
End of Block: Victim/Survivor Awareness of Co-location Advocacy Services
Page 6 of 6
| File Type | application/pdf |
| File Modified | 2022-08-23 |
| File Created | 2022-07-07 |