Form NCVS-500, NCVS-1, NCVS-500, NCVS-1, National Crime Victimization Survey Screener and Inciden

NCVS-500 Control Card (2010 Sample Design)
KEY


Blue Diamond and text = Field Representative Instructions

[ ] Red Brackets and text = Instrument Instructions/Skip Instructions
[Green Text] = Automatically filled by instrument as appropriate
Bold Text = Question text is read aloud to the respondent
Gray Text = Optional for Field Representative to read out loud
NOTES
“Empty” means never previously answered
“Verify” means the Field Representative sees the answer prefilled from the previous enumeration period
Instrument Screen Name

START_CP
[Appears during ALL Enumeration Periods]

CENSUS CATI/CAPI SYSTEM
National Crime Victimization Survey
Case Status is: New Case
Date is: [Today’s Date Appears]
Time is: [Current Time Appears]
Incoming/Continuing Case: [Will specify whether this is an Incoming Case or Continuing Case]
Interview Number: [Will specify which interview this is from 01 to 07]
Confirmed Refusal: [Will Specify Yes or No]
1.
2.
3.
4.
5.
6.

Telephone interview
Personal interview (See notes)
Personal interview (SKIP all notes and go to GEN_INTRO_CP)
Nointerview (TYPE A/B/C)
Ready to transmit case – no followup (TYPE Z’s)
Quit: Do not attempt now

SHOW_CP_ROSTER
[Verify 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods]


LN

Status of household composition

NAME

REL

MEMBER

SEX

AGE

STATUS

PHONE #

1. Enter 1 to continue
1

SHOW_INFO_CP
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods]



INFORMATION FROM PREVIOUS SCREEN INTERVIEW
Press Control-F7 to view case level notes
Press Control-T to view interview time preference
1. Enter 1 to Continue

GEN_INTRO_CP
[Appears during ALL Enumeration Periods]




Identify yourself and show I.D.
Hello. I’m (YOUR NAME)… from the U.S. Census Bureau. Here is my identification.
If new household – give introductory letter and allow time to read

[Appears during 1st Enumeration Period]



ASK TO SPEAK TO: Eligible respondent (a household member at least 18 years of age
and knowledgeable about the household)

[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods]



ASK TO SPEAK TO: [Household Respondent]

[Appears during ALL Enumeration Periods]

 Household address is:[Address Displayed]
1. Respondent available
2. Respondent not available (SKIP to VERIFY [F10])
3. Unavailable through closeout
[Pop Up Screen:  Are you sure this person is unavailable through closeout? If so, you
must select a new household respondent.]

CAPI_INTRO_B
 Is respondent ready to complete the interview?
1. Continue
(SKIP to GETLETTER_CP during 1st Enumeration Period)
(SKIP to HHNUM_VR_CP during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods)

2. Inconvenient time. Callback needed.
(SKIP to VERIFY [F10])

3. Reluctant respondent – hold for refusal follow-up
(SKIP to VERIFY [F10] during 1st Enumeration Period)
(SKIP to HHNUM_VR_CP during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods)

4. Other outcome-problem/select new household respondent
(SKIP to HHNUM_VR_CP during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods)
5. Wrong address (wrong case selected) (SKIP to VERIFY [F10])

VERIFY
[This screen appears only when GEN_INTRO_CP = 2 and when CAPI_INTRO_B = 2, 3, or 4]

 Review information listed below
 Do you need to make any changes?
 Press “Control T” to review/update interview time preference.
TELEPHONEOK: Yes
Telephone1: () – Extn: Type:
Telephone2: () – Extn: Type:
Telephone3: () – Extn: Type:

2

HHNUM_VR_CP
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods]

 Is this a replacement household?
 If unsure, enter 2 (No)
1. Yes (SKIP to CK_REPLACE_CP)
2. No (SKIP to GETLETTER_CP)

CK_REPLACE_CP
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods]



A replacement household means that there are NO members of the household
interviewed during the previous enumeration period living at this address.
 Are you sure this is a replacement household?
1. Yes
[Pop Up Screen: This is the last screen before the roster and all incoming data is
deleted and must be re-entered. You are about to start a new case and this action
cannot be undone without the case being restarted. If “Yes”, click SUPPRESS]
2. No

GETLETTER_CP
 IF NECESSARY: Hello I’m (your name) from the U.S. Census Bureau.
I’m here concerning the National Crime Victimization Survey. The Census Bureau is
conducting a survey here and throughout the Nation to determine how often people
are victims of crime.
[Read during 1st Enumeration Period]

Did you receive our introductory letter in the mail?
[Read during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods]

We contacted your household for this survey several months ago. Did you receive our
introductory letter in the mail?
 If “No” or “Don’t know” give respondent an introductory letter and allow time to
read.
1. Yes
2. No
3. Don’t know

VERADD_CP
I have your address listed as …
 Read below
[Address Appears]
Is that your exact address?
1. SAME address
(SKIP to MAILINGSAME_CP during 1st Enumeration Period)
(SKIP to CHNGPH_CP during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods)

2. MOVED (NOT same address)
3. Haven’t moved, but address has changed (SKIP to CHNGPH_CP)
4. Incorrect address previously recorded (SKIP to CHNGPH_CP)

3

MOVED_CP
[This screen appears only when VERADD_CP = 2 during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods]

Since your address rather than you personally was chosen for inclusion in the survey, no interview is
required of you at this time. Thank you for your past cooperation. The help you gave us was an
important contribution to the National Crime Victimization Survey data.
1. Enter 1 to continue
[Pop Up Screen: This case needs to be made a replacement household. Press GOTO to
continue.]

CHNGPH_CP


Do not ask
Do you need to change the current phone number?
CURRENT NUMBER: () – EXT:
1. Yes (SKIP to NEWPH_CP)
2. No (SKIP to NEWADDHNO_CP during 1st Enumeration Period)
(SKIP to MAILINGSAME_CP during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods)

Update Physical Address Information Screen Begins
NEWPH_CP through NEWADDGQDESCRIPTION_CP appear on the same screen.

NEWPH_CP
What is the area code and telephone number where you would like to be called?
 Record new number
 Enter 0 for no telephone number

NEWADDHNO_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new house number; otherwise press “Enter” to
continue

NEWADDHNOSUF_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new house suffix; otherwise press “Enter” to continue

NEWADDSTRNAME_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new street name; otherwise press “Enter” to continue

NEWADDUNITES_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new unit designation; otherwise press “Enter” to
continue

NEWADDNONCITYSTYLEADDRESS_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter non-city style address; otherwise press “Enter” to
continue

4

NEWADDPHYSDESCRIPTION_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new physical location description; otherwise press
“Enter” to continue

NEWADDCITY_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new city name; otherwise press “Enter” to continue

NEWADDSTATE_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new state abbreviation; otherwise press “Enter” to
continue

NEWADDZIP5_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter 5-digit ZIP code; otherwise press “Enter” to continue

NEWADDZIP4_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new 4-digit ZIP code; otherwise press “Enter” to
continue

NEWADDBUILDINGNAME_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new building name; otherwise press “Enter” to
continue

NEWADDGQDESCRIPTION_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new group description; otherwise press “Enter” to
continue

Update Physical Address Information Screen Ends
ADRCHECK_CP


Enter reason why address information provided by respondent did not match
display address
OLDADDRESS
NEWADDRESS
[Address Displayed]
[Address Displayed]
 HOUSE NUMBER
NON-CITY STYLE ADDRESS
11. House number was incorrect
12. House number was missing/blank
 HOUSE NUMBER SUFFIX
13. House number suffix was incorrect (e.g. A instead of B)
14. House number suffix was missing
 STREET NAME
5

15. Street name was correct but misspelled (e.g. Pak instead ok Oak Street)
16. Street name was not correct (e.g. Oak instead of Pickford)
 UNIT DESIGNATION
17. Unit designation was incorrect (e.g. A instead of 1)
18. Unit design was missing
19. Non city style address was incorrect (P.O. Box 12 instead of P.O. Box 121)
 ZIP CODE
20. ZIP code was missing or incorrect
 STATE
21. State was missing or incorrect (ME instead of MD)
 CITY
22. City name was missing or incorrect
 GROUP QUARTERS
23. Group quarters name was missing or incorrect
24. Building name was missing or incorrect
25. 911 Address Conversion

MAILINGSAME_CP
Is your mailing address still the same as your physical address?
1. Yes (SKIP to TENURE during 1st , 3rd, 5th, and 7th Enumeration Periods)
(SKIP to STUDENTHOUSING during 2nd, 4th, and 6th Enumeration Periods)
2. No (SKIP to VERIFYMAILING_CP)

VERIFYMAILING_CP
 Read mailing address
I have your mailing address as…
MAILING ADDRESS:
[Address Displayed]
Is that correct?
1. Yes (SKIP to TENURE)
2. No (SKIP to NEWMAILHNO_CP)

Update Mailing Address Information Screen Begins
NEWMAILHNO_CP through NEWMAILGQDESCRIPTION_CP appear on the same screen.

NEWMAILHNO_CP



OLD MAILING ADDRESS:
[Previous Address Displayed]
If incorrect or missing, enter new house number; otherwise press “Enter” to
continue

NEWMAILHNOSUF_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new house number suffix; otherwise press “Enter” to
continue

NEWMAILSTRNAME_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new street name; otherwise press “Enter” to continue

6

NEWMAILUNITES_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new unit designation; otherwise press “Enter” to
continue

NEWMAILNONCITYSTYLEADDRESS_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter non-city style address; otherwise press “Enter” to
continue

NEWMAILCITY_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new city name; otherwise press “Enter” to continue

NEWMAILSTATE_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new state abbreviation; otherwise press “Enter” to
continue

NEWMAILZIP5_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter 5-digit ZIP code; otherwise press “Enter” to continue

NEWMAILZIP4_CP



OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new 4-digit ZIP code; otherwise press “Enter” to
continue

NEWMAILGQDESCRIPTION_CP


OLD ADDRESS:
[Address Appears]
If incorrect or missing, enter new group description; otherwise press “Enter” to
continue

Update Mailing Address Information Screen Ends
TENURE
[Appears during 1st Enumeration Period or when empty. Verify during 3rd, 5th and 7th Enumeration Periods]

Ask or verify
Are your living quarters...
 Read answer categories.
1. Owned or being bought by you or someone in your household?
2. Rented for cash?
3. Occupied without payment of cash rent?

7

STUDENTHOUSING
[Verify each Enumeration Period]

 If apparent, enter precode without asking.
Are your living quarters presently used as student housing by a college or university?
1. Yes
2. No

PUBLICHOUSING
[Appears during 1st Enumeration Period or when empty]
[If box 1 is marked in item TENURE, SKIP to INDIANRESERVATIONHU]
[If box 2 or box 3 is marked in TENURE, ask below]

Is this building owned by a public housing authority?
1. Yes, public housing – (SKIP to PUBLICHOUSINGMGRVERIFY)
2. No, not public housing – (SKIP to INDIANRESERVATIONHU)

PUBLICHOUSINGMGRVERIFY
[Appears when PUBLICHOUSING = 1]






If possible, verify PUBLICHOUSING entry of 1 (Yes) with the manager of building.
Able to verify
1. Public housing
2. Not public housing
Unable to verify
3. Telephone
4. Other – Specify

PUBLICHOUSINGMGRVERIFYSPEC
[Appears when PUBLICHOUSINGMGRVERIFY = 4]



Specify the reason why you are unable to verify the public housing status for this
housing unit.

INDIANRESERVATIONHU
[Appears during 1st Enumeration Period, or when empty]

 If apparent, enter precode without asking.
Are your living quarters located on an American Indian Reservation or on American
Indian Lands?
1. Yes
2. No

FARMSALES
[Appears during 1st Enumeration Period, or when empty, and address is in rural area]

During the past 12 months did sales of crops, livestock, and other farm products from
this place amount to $1,000 or more?
1. Yes
2. No

ACCESS
[Appears during 1st Enumeration Period, or when empty]



Please mark whether or not the sample household has direct access to their living
quarters.
1. Direct
2. Through another unit - Not a separate HU; combine with unit through which access is
Gained

8

TYPEOFHOUSINGUNIT
[Appears during 1st Enumeration Period, or when empty]

 Please select one box that describes the type of housing unit.
1. House, apartment, flat
2. HU in nontransient hotel, motel, etc.
3. HU permanent in transient hotel, motel, etc.
4. HU in rooming house
5. Mobile home or trailer with no permanent room added
6. Mobile home or trailer with one or more permanent rooms attached
7. HU not specified above - Describe
8. Quarters not HU in rooming or boarding house
9. Unit not permanent in transient hotel, motel, etc.
10. Unoccupied site for mobile home, trailer, or tent
11. Student quarters in college dormitory
12. Other unit not specified above – Describe

TYPEOFHOUSINGUNITSPEC7
[Appears when TYPEOFHOUSINGUNIT = 7]



Please specify the other type of "Housing Unit".

TYPEOFHOUSINGUNITSPEC12
[Appears when TYPEOFHOUSINGUNIT = 12]



Please specify the other type of "Other Unit".

NUMBEROFUNITS
[Appears during 1st Enumeration Period, or when empty]

 Observe or ask
How many housing units are in this structure?
1. 1
2. 2
3. 3
4. 4
5. 5-9
6. 10+
7. Mobile home/trailer
8. Only OTHER units

DIRECTENTRANCETOUNIT
[Appears during 1st Enumeration Period, or when empty]

 Observe or ask
Does the unit have an outside entrance, patio doors, or windows, etc., on the ground
level - or outside stairs leading directly to this unit?
1. Yes
2. No
3. Don't know

GATEDWALLEDCOMMUNITY
[Appears during 1st Enumeration Period, or when empty]

 Ask if unsure
Is this unit in a gated or walled community that restricts access by non-residents or
requires entry codes, key cards, or security guard approval to access?
1. Yes
2. No
9

RESTRICTEDACCESS
[Appears during 1st Enumeration Period, or when empty]

 Ask if unsure
Is this unit in a building that requires a special entry system such as entry codes, key
cards, or security guard approval to access?
1. Yes
2. No

Begin Initial Roster Loop
Appears when a household roster is being first established.
(Repeat for each household member)

HHROSTER_FNAME
[Appears during 1st Enumeration Period, or when empty]

What are the names of all people living or staying here?
Start with the person or one of the people who [owns/rents] this home.
 Enter first name on this screen.
 To change a non-member already listed on this roster to a member use the
up/down arrow to go to MEMBERCHANGES and enter the reason why this person is
now a member.
 Enter 999 to leave the table.
HHROSTER_LNAME
[Appears during 1st Enumeration Period, or when empty]

What are the names of all people living or staying here?
Start with the name of the person or one of the people who [owns/rents] this home.
 Enter last name on this screen.

SEX
[Appears during 1st Enumeration Period, or when empty]

 Ask if necessary
Is [household member name] male or female?
1. Male
2. Female

RELATIONSHIP
[Appears during 1st Enumeration Period, or when empty]



Review the relationship of other household members to the new reference person
and update these relationships if necessary.
What is [household member name]’s relationship to [reference person]?
11. Husband
12. Wife
13. Son
14. Daughter
15. Father
16. Mother
17. Brother
18. Sister
19. Other Relative
20. Non Relative

10

HHMEMBER
[Appears during 1st Enumeration Period, or when empty]

Does [household member name] usually live here?
 If "No", probe for usual residence elsewhere.
1. Yes
2. No

HSEMEMURE
[Appears during 1st Enumeration Period, or when empty]

Does [household member name] have a usual place of residence elsewhere?
1. Yes
2. No

End Initial Roster Loop
Begin Verify Roster Section
Appears if a roster has been established in a previous enumeration.

NAMECHECK
[Verify during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods]

I have [Read names below] listed as living or staying at this address.
[The name and information of each household member from the previous enumeration period will appear in a table
below.]

LINE NUMBER NAME RELATIONSHIP AGE SEX MARITAL STATUS STATUS
Are ALL of these people still living or staying at this address?
1. Yes (SKIP to MEMBERCHANGES if missing demographic data, else SKIP to HHLDCOVERAGE)
2. No (SKIP to REFPERSTILLLIVE)

REFPERSTILLLIVE
[Appears when NAMECHECK = 2]

Does [reference person name] still live at this address?
1. Yes
2. No (SKIP to NEWREFPER)

NEWREFPER
[Appears when REFPERSTILLLIVE = 2]

What is the name of the person (or one of the persons) who owns or rents that home?
Would that be you?
 Enter line number, or 31 if someone not listed
[The name and information of each household member from the previous enumeration period will appear in a table
below.]

LINE NUMBER NAME RELATIONSHIP SEX AGE MARITAL STATUS STATUS
01.-30. Line number 01 – Line number 30 [Names on line number 1 up to line number 30 are
displayed.]

31. Someone not listed above

Begin Verify Roster Loop
(Repeat for each household member)

MEMBERCHANGES
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods when new household member enters or leaves]




Enter reason why there is a change in household membership for this person.
If no change is needed for this person, press the ENTER key without selecting a
precode.

11



Use the arrow keys to move through the table and REVIEW/UPDATE demographics.
When done, press Page Down.
WHY ENTERED HOUSEHOLD:
11. Returned from school or college
12. Returned from institution
13. Entered because of marriage/separation/divorce
14. Person entered household for reasons other than above
WHY LEFT HOUSEHOLD:
15. Person died
16. Left for school or college
17. Entered institution
18. Left because of marriage/separation/divorce
19. Person left household for reasons other than above
20. Visitor - residence elsewhere

HHROSTER_FNAME
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods when new household member is added to roster]

What is the name of the person/people that is/are new to the household?
 Enter first name on this screen.
 To change a non-member already listed on this roster to a member use the
up/down arrow to go to MEMBERCHANGES and enter the reason why this person is
now a member.
 Enter 999 to leave the table.
HHROSTER_LNAME
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods when new household member is added to roster]

What is the name of the person/people that is/are new to the household?
 Enter last name on this screen.

SEX
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods when new household member is added to roster]

 Ask if necessary
Is [household member name] male or female?
1. Male
2. Female

RELATIONSHIP
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods when new household member is added to roster]



Review the relationship of other household members to the new reference person
and update these relationships if necessary.
What is [household member name]’s relationship to [reference person]?
11. Husband
12. Wife
13. Son
14. Daughter
15. Father
16. Mother
17. Brother
18. Sister
19. Other relative
20. Nonrelative

12

HHMEMBER
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods when new household member is added to roster]

Does [household member name] usually live here?
 If "No", probe for usual residence elsewhere.
1. Yes (SKIP to HHLDCOVERAGE)
2. No (SKIP to HSEMEMURE)

HSEMEMURE
[Appears during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods when new household member is added to roster]

Does [household member name] have a usual place of residence elsewhere?
1. Yes
2. No

End Verify Roster Loop
End Verify Roster Section
HHLDCOVERAGE
[Verify each Enumeration Period]

Have I missed anyone else living or staying here/there such as any babies, any lodgers,
or anyone who is away at present traveling or in the hospital?
[The name of each household member given will appear in a table below.]

LINE NUMBER
1. Yes
2. No

NAME

ENTIREHHURE
[Appears when all people on the household roster have a usual residence elsewhere]






All people on the household roster have a usual residence elsewhere.
Enter 1 to exit this case.
Then, reenter this case to code it a Noninterview (Type B - Entire Household URE)
via START_CP.
Enter 1 to Continue

[Appears when all household members no longer live at residence .]

PICK1STHHRESP
[Appears during 1st Enumeration Period, or when household respondent is changed]




Enter the line number for the person with whom you are speaking.
This person should be at least 18 years of age and knowledgeable about the
household.

[The name of each household member given will appear in a table below.]

LINE NUMBER NAME

Begin Additional Demographic Loop
Appears when a household is being first established AND when a household roster has been previously
established.
(Repeat for each household member)

AGECHECK
[Verify during 2nd, 3rd, 4th, 5th, 6th, and 7th Enumeration Periods]

I have [you/household member name] listed as [calculated age] years old.
Is that correct?
1. Yes, age IS correct
2. No, age is NOT correct

13

BRTHDATEMO
[Ask or Verify each Enumeration Period]

What is [your/household member name] date of birth?
 Enter month on this screen.
1. January
2. February
3. March
4. April
5. May
6. June
7. July
8. August
9. September
10. October
11. November
12. December

BRTHDATEDY
[Ask or Verify each Enumeration Period]

What is [your/household member name] date of birth?
 Enter day on this screen

BRTHDATEYR
[Ask or Verify each Enumeration Period]

What is [your/household member name] date of birth?
 Enter year on this screen
 If year is less than 1890, enter 1890

VFYAGE
[Ask or Verify each Enumeration Period]

That would make [you/household member name] [calculated age] years old.
Is that correct?
1. Yes
2. No

ESTAGE
[Appears when BRTHDATEYR is Don’t Know]
[Appears for household respondent]

Even though you don't know your exact birthdate, what is your approximate age?
[Appears for household member]

Even though you don't know [household member name]’s exact birthdate, what is
your best guess as to how old he/she was on his/her last birthday?

AGERNG
[Appears when BRTHDATEYR is Don’t Know, and ESTAGE is Don’t Know or Refused] OR
[Appears when BRTHDATEYR is Refused]
[Appears for household respondent]

Are you between 18 and 65 years old? 66 or older?
Are you…
[Appears for household member]

Is [he/she] a child, a teenager, or an adult?
Is [he/she]…
14

 Read appropriate age categories.
1. 0 - 11 years old?
2. 12 - 13 years old?
3. 14 - 15 years old?
4. 16 - 17 years old?
5. 18 - 24 years old?
6. 25 - 34 years old?
7. 35 - 49 years old?
8. 50 - 65 years old?
9. 66 years old or older?

MARITAL
[Ask or Verify each Enumeration Period]



Enter new marital status for [household member name]
LAST REPORTED AS: MARITAL
 If in doubt, ask:
[Are/Is] [you/household member name] now married, widowed, divorced, separated
or [have/has] [you/he/she] never been married?
1. Married
2. Widowed
3. Divorced
4. Separated
5. Never married

ARMEDFORCES
[Ask or Verify each Enumeration Period for persons 18-65 years old]

LAST REPORTED AS: MILITARY
[Are/Is] [you/household member name] now in the Armed Forces?
1. Yes
2. No
EDUCATIONATTAIN
[Ask or Verify during 1st, 3rd, 5th, and 7th Enumeration Periods for persons 12 years of age and older]

(Page 6)
LAST REPORTED AS: EDUCATIONATTAIN
What is the highest level of school [you/household member name] completed or the
highest degree [you/he/she] received?
1. 1st grade
2. 2nd grade
3. 3rd grade
4. 4th grade
5. 5th grade
6. 6th grade
7. 7th grade
8. 8th grade
9. 9th grade
10. 10th grade
11. 11th grade
12. 12th grade (No diploma)
13. High school graduate (Diploma or the equivalent)
14. Some college (No Degree)
15. Associate's degree
15

16. Bachelor's degree (e.g. BA, AB, BS)
17. Master's degree (e.g. MA, MS, MEng, MSW, MBA)
18. Professional School degree (e.g. MD, DDS, DVM, LLB, JD)
19. Doctorate degree (PhD, EdD)
20. Never attended, preschool, kindergarten

ATTENDINGSCHOOL
[Ask or Verify each Enumeration Period for persons 12 years of age and older]

LAST REPORTED AS: ATTENDINGSCHOOL
[Are/Is] [you/household member name] currently attending or enrolled either fulltime or part-time in a college or university, trade, or vocational school?
1. Regular school
2. College/University
3. Trade school
4. Vocational school
5. None of the above schools

SP_ORIGIN
[Appears during 1st Enumeration Period or when new household member is added]

(Page 8)
[Are/Is] [you/household member name] Spanish, Hispanic, or Latino?
1. Yes
2. No

RACE
[Appears during 1st Enumeration Period or when new household member is added]

(Page 10)
 If personal interview show flash card.
 If telephone interview read answer categories.
 Do not probe.
Please choose one or more races that [you/household member name]
consider/considers [yourself/himself/herself] to be.
1. White
2. Black or African American
3. American Indian or Alaska Native
4. Asian
5. Native Hawaiian or Other Pacific Islander
6. Other – Specify

RACE_SPECIFY


Specify the other race for this person.

End Additional Demographic Loop

16

NCVS-1

Implementation Date: (1/1/2022)

OMB No. 1121-0111: Approval Expires 11/30/2024

NATIONAL CRIME VICTIMIZATION SURVEY
NCVS-1 BASIC SCREEN QUESTIONNAIRE

NOTE: Questions are listed in the order asked. Skips in question numbering are due to questionnaire changes over time.

MOBILITY QUESTIONS
33a. TIMEATADDRESS

506

____________ Years (Round to nearest whole year)

Before we get to the crime questions, I have some questions that are
helpful in studying where and why crimes occur.

If = 0 ASK 33b
If = DK or RF SKIP to 33c
Else SKIP to 33d

Ask or verify How long have you lived at this address?
(Enter 0 if less than 1 year.)

33b. MONTHSATADDRESS

505

____________ Months (1-11) - SKIP to 33e

How many months?
1

33c. TIMEATADDRESSPROBE

2

Have you lived here...

3
4

Read categories 1-4:

33d.

CHECK

ITEM A

5

5 years or more - If HHLD Respondent SKIP to 34, else SKIP to 36a
Less than 5 years - ASK 33e

How many years are entered in 33a?

33e. TIMEMOVEDIN5YEARS

More than 5 years - If HHLD Respondent ASK 34, else SKIP to 36a.
Less than 5 years, but more than 1 year
SKIP
Less than 1 year, but more than 6 months
to 33e
6 months or less
Don't Know

508

__________ Number of times -

Altogether, how many times have you moved in the last
5 years, that is, since _________________, 20 ___?
Enter number of times.

BUSINESS OPERATED FROM SAMPLE
34. BUSINESS (Asked of Household Respondent Only)

530

Does anyone in this household operate a business from this address?

35. BUSINESSSIGN (Asked of Household Respondent Only)

531

If this is a PERSONAL visit - Fill by observation.
If this is a TELEPHONE contact - Ask.
Is there a sign on the premises or some other indication to the
general public that a business is operated from this address?

Page 1

1

Yes - ASK 35

2

No - SKIP to 36a

1

Yes (Recognizable business)

2

No (Unrecognizable business)

If HHLD Respondent ASK 34,
Else SKIP to 36a

RESPONDENT'S SCREEN QUESTIONS
36a. SQTHEFT
I'm going to read some examples that will give you an idea of the

kinds of crimes this study covers.
As I go through them, tell me if any of these happened to you in the
last 6 months, that is since __________ ______, 20 ____.
Was something belonging to YOU stolen, such as Read each category.
(a) Things that you carry, like luggage, a wallet, purse, briefcase
book (b) Clothing, jewelry, or cellphone (c) Bicycle or sports equipment (d) Things in your home - like a TV, stereo, or tools (e) Things outside your home such as a garden hose or lawn
furniture - (Asked of Household Respondent Only)
(f) Things belonging to children in the household (Asked of Household Respondent Only)
(g) Things from a vehicle, such as a package, groceries, camera, or
CDs OR
(h) Did anyone ATTEMPT to steal anything belonging to you?
Ask only if necessary

532

1
2

Did any incidents of this type happen to you?

36b. SQTHEFTTIMES

Yes - ASK 36b
No - If Household Respondent ASK to
37a; Else SKIP to 40a

533

How many times?

Number of times (36b)
Briefly describe incident(s)

36c. SQTHEFTSPEC
What happened?

If Household Respondent ASK 37a; else SKIP to 40a

37a. SQBREAKIN (Asked of Household Respondent Only)
(Other than any incidents already mentioned,) has anyone Read each category.
(a) Broken in or ATTEMPTED to break into your home by forcing a
door or window, pushing past someone, jimmying a lock, cutting
a screen, or entering through an open door or window?
(b) Has anyone illegally gotten in or tried to get into a garage, shed,
or storage room?
OR
(c) Illegally gotten in or tried to get into a hotel or motel room or
vacation home where you were staying?
534

Ask only if necessary

1

Yes - ASK 37b

2

No - SKIP to 38

Did any incidents of this type happen to you?

37b. SQBREAKINTIMES (Asked of Household Respondent Only)

535

How many times?

Number of times (37b)
Briefly describe incident(s)

37c. SQBREAKINSPEC (Asked of Household Respondent Only)
What happened?

Page 2

RESPONDENT'S SCREEN QUESTIONS
536

38. SQTOTALVEHICLES (Asked of Household Respondent Only)

0
1

What was the TOTAL number of cars, vans, trucks, motorcycles, or
other motor vehicles owned by you or any other member of this
household during the last 6 months? Include those you no longer
own.

2
3
4

None - SKIP to 40a
1
2
3
4 or more

39a. SQMVTHEFT (Asked of Household Respondent Only)
During the last 6 months, (other than any incidents already
mentioned,) (was the vehicle/were any of the vehicles) Read each category.
(a) Stolen or used without permission?
(b) Did anyone steal any parts such as a tire, car stereo, hubcap, or
battery?
(c) Did anyone steal any gas from (it/them)?
OR
(d) Did anyone ATTEMPT to steal any vehicle or parts attached to
(it/them)?
537

Ask only if necessary

1

Yes - ASK 39b

2

No - SKIP to 40a

Did any incidents of this type happen to you?

39b. SQMVTHEFTTIMES (Asked of Household Respondent Only)

538

How many times?

Number of times (39b)

39c. SQMVTHEFTSPEC (Asked of Household Respondent Only)

Briefly describe incident(s)

What happened?

40a. SQATTACKWHERE
(Other than any incidents already mentioned,) since __________ ______,
20 ____, were you attacked or threatened OR did you have something
stolen from you Read each category.
(a) At home including the porch or yard (b) At or near a friend's, relative's, or neighbor's home (c) At work or school d) In places such as a storage shed or laundry room, a shopping
mall, restaurant, bank, or airport (e) While riding in any vehicle (f) On the street or in a parking lot (g) At such places as a party, theater, gym, picnic area, bowling
lanes, or while fishing or hunting OR
(h) Did anyone ATTEMPT to attack or ATTEMPT to steal
anything belonging to you from any of these places?

539

1

Yes - ASK 40b

2

No - SKIP to 41a

Ask only if necessary
Did any incidents of this type happen to you?

40b. SQATTACKWHERETIMES

540

How many times?

Number of times (40b)
Briefly describe incident(s)

40c. SQATTACKWHERESPEC
What happened?

Page 3

RESPONDENT'S SCREEN QUESTIONS
41a. SQATTACKHOW
(Other than any incidents already mentioned,) has anyone attacked or
threatened you in any of these ways (Exclude telephone threats) Read each category.
(a) With any weapon, for instance, a gun or knife (b) With anything like a baseball bat, frying pan, scissors, or stick (c) By something thrown, such as a rock or bottle (d) Include any grabbing, punching, or choking,
(e) Any rape, attempted rape or other type of sexual attack (f) Any face to face threats OR
(g) Any attack or threat or use of force by anyone at all? Please
mention it even if you are not certain it was a crime.

541

Ask only if necessary

1
2

Yes - ASK 41b
No - SKIP to 42a

Did any incidents of this type happen to you?

41b. SQATTACKHOWTIMES

542

How many times?

Number of times (41b)

41c. SQATTACKHOWSPEC

Briefly describe incident(s)

What happened?

42a. SQTHEFTATTACKKNOWNOFF
People often don't think of incidents committed by someone they
know. (Other than any incidents already mentioned,) did you have
something stolen from you OR were you attacked or threatened by (Exclude telephone threats)
Read each category.
(a) Someone at work or school (b) A neighbor or friend (c) A relative or family member (d) Any other person you've met or known?
Ask only if necessary

543

1

Yes - ASK 42b

2

No - SKIP to 43a

Did any incidents of this type happen to you?

42b. SQTHEFTATTACKKNOWNOFFTIMES

544

How many times?

Number of times (42b)
Briefly describe incident(s)

42c. SQTHEFTATTACKKNOWNOFFSPEC
What happened?

Page 4

RESPONDENT'S SCREEN QUESTIONS
43a. SQSEXUAL
Incidents involving forced or unwanted sexual acts are often difficult
to talk about. (Other than any incidents already mentioned,) have you
been forced or coerced to engage in unwanted sexual activity by Read each category.
(a) Someone you didn't know (b) A casual acquaintance OR
(c) Someone you know well?

545

Ask only if necessary

1

Yes - ASK 43b

2

No - SKIP to 44a

Did any incidents of this type happen to you?
546

43b. SQSEXUALTIMES
How many times?

Number of times (43b)
Briefly describe incident(s)

43c. SQSEXUALSPEC
What happened?

44a. SQCALLPOLICECRIME

547

1
2

Yes - ASK 44b
No - SKIP to 45a

During the last 6 months, (other than any incidents already
mentioned,) did you call the police to report something that
happened to YOU which you thought was a crime?

44b. SQCALLPOLICESPEC

Briefly describe incident(s)

What happened?

44c.

CHECK

ITEM B

SQCALLPOLICEATTACKTHREAT

549

1

Yes - ASK 44d

2

No - SKIP to 45a

If not sure ask:
Were you attacked or threatened, or was something stolen or an
attempt made to steal something that belonged to you or
another household member?

44d. SQCALLPOLICEATTACKTHREATTIMES

550

How many times?

Number of times (44d)

Page 5

RESPONDENT'S SCREEN QUESTIONS
551

45a. SQNOCALLPOLICECRIME

1

Yes - ASK 45b

2

No - SKIP to 71

During the last 6 months, (other than any incidents already
mentioned,) did anything which you thought was a crime happen
to YOU, but you did NOT report to the police?

Briefly describe incident(s)

45b. SQNOCALLPOLICESPEC
What happened?

45c.

CHECK

ITEM C

SQNOCALLPOLICEATTACKTHREAT

553

1

Yes - ASK 45d

2

No - SKIP to 71

If not sure ask:

Were you attacked or threatened, or was something stolen or an
attempt made to steal something that belonged to you or another
household member?

45d. SQNOCALLPOLICEATTACKTHREATTIMES

554

How many times?

Number of times (45d)

- SKIP to 71

RESPONDENT'S CHECK ITEMS D, E, AND G
71.

CHECK

ITEM D

PRESENTFORSQS

555

1

* Personal interview - Mark all that apply.
2

Who besides the respondent was present when the screen questions
were asked? (If telephone interview, mark box 1 only.)

3
4
5
6
7
8

72.

CHECK

ITEM E

PROXYHELP

Telephone interview - SKIP to 73

556

1
2
3

No one besides respondent present
Respondent's spouse
HHLD member(s) 12+, not spouse
HHLD member(s) under 12
Nonhousehold member(s)
Someone was present - Can't say who
Don't know if someone else present

If a Proxy interview,
ASK 72,
else SKIP to 73

Yes
No
Person for whom interview taken not present

Did the person for whom this interview was taken help the proxy
respondent answer any screen questions?

73.

CHECK

ITEM G

Yes - SKIP to Crime Incident Report (Item 2a on the NCVS-2)

Is one or more crimes reported in
36b, 37b, 39b, 40b, 41b, 42b, 43b, 44d, or 45d?

No - SKIP to 81 (ASK INTRO_SOCIO_DEMO)

Page 6

RESPONDENT'S SOCIO-DEMOGRAPHIC QUESTIONS
All incident reports must be completed before asking this series of questions.

81. INTRO_SOCIO_DEMO
Now we have some questions about your demographic characteristics.

169a. DIS_HEARING
(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)
1

Are you deaf or do you have serious difficulty hearing?

2

169b. DIS_VISION

1
2

(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

Yes
No

Yes
No

Are you blind or do you have serious difficulty seeing
even when wearing glasses?

170a.

Because of a physical, mental, or emotional
condition, do you have serious difficulty:

(1) DIS_LEARN_CONCENTRATE
(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

1
2

Yes
No

Concentrating, remembering or making
decisions?

(2) DIS_PHYSICAL_LIMIT

1

(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

2

Yes
No

Walking or climbing stairs?

(3) DIS_DRESS_BATH

1

(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

2

Yes
No

Dressing or bathing?

170b. DIS_LEAVING_HOME
(Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.
Asked only of persons age 15 or older.)
1

Because of a physical, mental, or emotional condition, do you have
difficulty doing errands alone such as visiting a doctor's office or
shopping?

2

Yes
No

82. CITIZENSHIP
(Asked at 1st interview or if never asked before. Asked at subsequent
interviews if no or Don't Know/Refused at prior interview.)
Are you a citizen of the United States? That is, were you born in the
United States, born in a U.S. territory, born of U.S. citizen parent(s), or
become a citizen of the U.S. through naturalization?

1
2
3
4

Yes, born in the United States
Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands,
or North Marianas
Yes, born abroad of U.S. citizen parent or parents
Yes, U.S. citizen by naturalization

5

No, not a U.S. citizen

1

Gay

2

Straight, that is, not gay
Bisexual

83. ORIENTATION_MALE
(Asked of persons age 16 or older.
Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.
Asked if NCVS-500 roster SEX question = Male)

3

Which of the following best represents how you think of yourself?

Page 7

4

Something else

5

I don't know the answer

6

Refused

SKIP to 85

84. ORIENTATION_FEMALE
(Asked of persons age 16 or older.
Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.
Asked if NCVS-500 roster SEX question = Female or Unknown)

1

Lesbian or gay

2

4

Straight, that is, not lesbian or gay
Bisexual
Something else

3

Which of the following best represents how you think of yourself?

5

I don't know the answer

6

Refused

1

Male

2

4

Female
Refused
Don't know

1

Male

2

4

Female
Transgender
None of these

1

Yes

2

No - SKIP back to 85 and/or 86 to correct
Refused
Don't Know

85. GENID_BIRTH
(Asked of persons age 16 or older.
Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

3

What sex were you assigned at birth, on your original birth certificate?

86. GENID_DESCRIBE
(Asked of persons age 16 or older.
Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.)

3

Do you currently describe yourself as male, female or transgender?

87. GENID_CONFIRM
(Asked of persons age 16 or older.
Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before.
Asked if GENID_BIRTH and GENID_DESCRIBE do not match.)
Just to confirm, you were assigned (male/female) at birth and now
(describe yourself as male/ describe yourself as female/ describe
yourself as transgender/ do not describe yourself male, female, or
transgender). Is that correct?

3
4

The instrument prefills the question wording based on responses to GENID_BIRTH and GENID_DESCRIBE.

88. ACTIVE_DUTY
(Asked of persons age 18 or older. Asked at 1st interview or if never asked before. Asked at subsequent interviews if Never served in the military
or Don't Know/Refused at prior interview. Do not ask if age 40 or older and valid response prior interview.)

Have you ever served on active duty in the U.S. Armed Forces,
Reserves, or National Guard?

1

Never served in the military

2

Only on active duty for training in the Reserves
or National Guard

3

Mark one box.
4

- SKIP to 74

Now on active duty
On active duty in the past, but not now

- ASK 89

89. ACTIVE_DUTYWHEN
(Asked of persons age 18 or older.
Asked at 1st interview or if never asked before. Asked at subsequent interviews if no or Don't Know/Refused at prior interview.
Do not ask if age 40 or older and valid response prior interview.)
1

September 2001 or later

2

When did you serve on active duty in the U.S. Armed Forces?

3
4

Mark a box for each period in which the person served, even if just for part of
the period.

August 1990 to August 2001 (including Persian Gulf War)
May 1975 to July 1990
Vietnam era (August 1964 to April 1975)

5

February 1955 to July 1964

6

January 1947 to June 1950

8

World War II (December 1941 to December 1946)
November 1941 or earlier

9

Page 8

Korean War (July 1950 to January 1955)

7

RESPONDENT'S EMPLOYMENT QUESTIONS
74.

CHECK

ITEM H1

Is the respondent 16 years or older?

576

75a. JOBLASTWEEK

1

Yes - ASK 75a

2

No - SKIP to 80

1
2

Yes - SKIP to 76a
No - ASK 75b

Did you have a job or work at a business LAST WEEK? (Do not
include volunteer work or work around the house.)
(If farm or business operator in household, ask about unpaid work.)
577

75b. JOBDURINGREFPERIOD

1
2

Yes - ASK 75c
No - SKIP to 80

Ask or verify Did you have a job or work at a business DURING THE LAST 6 MONTHS?

75c. JOBLAST2WEEKS

578

1
2

Yes - ASK 76a
No - SKIP to 80

Did that (job/work) last 2 consecutive weeks or more?

76a. JOBDESCRIPTION
Ask or verify -

1

Medical Profession? - SKIP 76c

2

4

Mental Health Services Field? - SKIP to 76e
Teaching Profession? - SKIPto 76g
Law Enforcement or Security Field? - SKIP to 76i

5

Retail Sales? - SKIP to 76k

6

Transportation Field? - SKIP to 76m

7

Something else? - Specify - ASK 76b

3

Which of the following best describes your job?
Were you employed in the ...
Read each category until respondent says "yes", then enter appropriate precode.

76b. JOBDESCRIPTIONSPEC

Specify - SKIP to 76o

Please specify the job not covered in answer categories 1-6 in 76a.

76c. MEDICALJOB

Medical Profession

Employed in the Medical Profession:
As a Read each category.

76d. MEDICALJOBSPEC

1

Physician?

2

Nurse?

3

Technician?

4

Other medical profession? - Specify - ASK 76d

SKIP to 76o

Specify - SKIP to 76o

Please specify employed in the medical profession as a -

76e. MENTALHEALTHJOB

Mental Health Services Field
5

Employed in the Mental Health Services Field:

6

Are YOUR duties -

7

Professional (Social worker/psychiatrist)?
SKIP to 76o
Custodial care?
Some other mental health services profession? - Specify
ASK 76f

Read each category.
Specify - SKIP to 76o

76f. MENTALHEALTHJOBSPEC
Please specify duties in the mental health services field.

Page 9

RESPONDENT'S EMPLOYMENT QUESTIONS
76g. TEACHINGJOB

Teaching Profession
8

Employed in the Teaching Profession:

9
10

Were you employed in a -

11
12

Read each category.

- SKIP to 76o

14

Technical or industrial school?
Special education facility?

15

Other teaching profession? - Specify - ASK 76h

13

76h. TEACHINGJOBSPEC

Preschool?
Elementary school?
Junior high or middle school?
High school?
College or university?

Specify - SKIP to 76o

Please specify employed in the teaching profession as a Law Enforcement or Security Field

76i. LAWENFORCEJOB
Employed in the Law Enforcement or Security Field:

16
17

Were you employed as a -

18
19

Law enforcement officer?
- SKIP to 76o
Prison or jail guard?
Security guard?
Law enforcement profession? - Specify - ASK 76j

Read each category.

76j. LAWENFORCEJOBSPEC

Specify - SKIP to 76o

Please specify employed in the law enforcement or security field as a -

76k. RETAILSALESJOB

Retail Sales 20

Employed in Retail Sales:

21
22

Were you employed as a-

23

Convenience or liquor store clerk?
Gas station attendant?
- SKIP to 76o
Bartender?
Other retail sales profession? - Specify - ASK 76l

Read each category.

76l. RETAILSALESJOBSPEC

Specify - SKIP to 76o

Please specify employed in retail sales as a -

76m. TRANSPORTJOB

Transportation Field 24

Employed in the Transportation Field:

25
26

Were you employed as a-

Bus driver?
- SKIP to 76o
Taxi cab driver?
Other transportation Field profession? - Specify - ASK 76n

Read each category.

76n. TRANSPORTJOBSPEC

Specify

Please specify employed in the transportation field as a -

76o.

CHECK

579

ITEM H2

If 76a equals 7, enter 27 here., otherwise enter the number of the
employment code entered in item 76c, 76e, 76g, 76i 76k, or 76m.

77. EMPLOYERTYPECURRENT

580

Ask or verify -

1
2
3

Is your job with -

4

Read each category.

78. COLLEGEEMPLOYER

581

Are you employed by a college or university?

79. CURRENTJOBMSATYPE

582

While working at your job, do you work mostly in Read each category.

Page 10

1

A private company, business, or
individual for wages?
The Federal government?
A State, county, or local government?
Yourself (Self-employed) in your own
business, professional practice, or farm?

2

Yes
No

1

A city?

2

Suburban area?

3

Rural area?

4

Combination of any of these?

If 76o = 22
SKIP to 79,
Else ASK 78.

RESPONDENT'S CHECK ITEM I
80.

CHECK

ITEM I

Yes - If Household Respondent finish collecting income
and telephone information, then END interview.
Otherwise END interview.

Is this the last household member to be interviewed?

No - GO TO question 33a for the next respondent. See
note below before interviewing next household
member.
FIELD REPRESENTATIVE --

(Read to the Household Respondent Only.) If there are any household members under 18, tell the Household
Respondent that you will be asking the same questions you just asked him/her.

90. HOUSEHOLDINCOME (Asked of Household Respondent Only)
(Asked of household respondent.
Asked at 1st, 3rd, 5th, and 7th interview, or if never asked before. Asked at subsequent interviews if no or Don't Know/Refused at prior interview.)
214

Which category represents the TOTAL combined income of all members
of this HOUSEHOLD during the past 12 months? This includes money
from jobs, net income from business, farm or rent, pensions, dividends,
interest, Social Security payments, and any other money income
received by members of this HOUSEHOLD who are 14 years of age or
older.

Page 11

1

Less than $5,000

2

$5,000 to $7,499

3
4

$7,500 to $9,999
$10,000 to $12,499

5

$12,500 to $14,999

6

$15,000 to $17,499

7

$17,500 to $19,999

8

$20,000 to $24,999

9

$25,000 to $29,999

10

$30,000 to $34,999

11

$35,000 to $39,999

12
13

$40,000 to $49,999
$50,000 to $74,999

14

$75,000 to $99,999

15
16

$100,000 to $149,999
$150,000 to $199,999

17

$200,000 or more

NCVS-2

OMB No. 1121-0111: Approval Expires 11/30/2024

Implementation Date: (7/1/2019)

NATIONAL CRIME VICTIMIZATION SURVEY
NCVS-2 CRIME INCIDENT REPORT
NOTE: Questions are listed in the order asked. Skips in question numbering are due to questionnaire changes over time.

2a. INCIDENTINTRO
You said that during the last 6 months :
(description of the crime reported in the screen question.)

2b.

CHECK

ITEM A

Has the respondent lived at this address
for more than 6 months? (If not sure,
refer to 33a on the NCVS-1 or ASK.)

2c. INCIDENTADDRESS

Yes (more than 6 months) - SKIP to 3
No (6 months or less) - ASK 2c
605

Did (this/the first) incident happen while you
were living here or before you moved to this
address?

1
2

While living at this address
Before moving to this address

606

3. INCIDENTDATE

Month

In what month did (this/the first) incident happen?

Year

Encourage respondent to give exact month.

4. INCIDENTNUMBEROFTIMES

____________ Number of incidents

607

If unsure, ask:

Altogether, how many times did this type of
incident happen during the last 6 months?

5a.

CHECK

5b.

CHECK

ITEM B

How many incidents?
(Refer to 4.)

INCIDENTSSIMILAR

608

1
2

1-5 incidents (not a "series") - SKIP to 6
6 or more incidents - ASK 5b

609

1
2

Similar - ASK 5c
Different (not a "series") - SKIP to 6

610

1
2

Yes (not a "series")
No (is a "series")

ITEM C

If unsure, ask:

Are these incidents similar to each other in
detail or are they for different types of crimes?

5c.

CHECK

ITEM D

RECALLDETAILS

If unsure, ask:

Can you recall enough details of each incident to
distinguish them from each other?
6. INCIDENTTIME
(If Box 2 is marked in 5c, read: The following questions

refer only to the most recent incident.)
About what time did (this/the most recent)
incident happen?

612
1
2
3
4
5
6
7
8
9

During day
After 6 a.m. - 12 noon
After 12 noon - 3 p.m.
After 3 p.m. - 6 p.m.
Don't know what time of day
At night
After 6 p.m. - 9 p.m.
After 9 p.m. - 12 midnight
After 12 midnight - 6 a.m.
Don't know what time of night
OR
Don't know whether day or night

7a. INCIDENTPLACE

613

In what city, town, or village did this
incident occur?

1
2
3
4
5

7b. INCIDENTPLACESPEC

Outside U.S. - SKIP to 10a
Not inside a city/town/village - ASK 8a
SAME city/town/village as present residence - SKIP to 9
DIFFERENT city/town/village from present
residence - ASK 7b
Don't know - ASK 8a

Specify

Please specify the city, town, or village, in which the
incident occurred.
8a. INCIDENTSTATE

614

State ________________

In what state did it occur?
8b. INCIDENTCOUNTY

County ________________

In what county did it occur?
8c. COUNTYSTATE

615

1
2

Yes
No

633

1

Yes

2

No

1

In your home or lodging? - SKIP to 10b
Near your home? - SKIP to 10c
At, in or near a friend's/relative's/neighbor's
home? - SKIP to 10d

Ask or verify:
Is this the same county and state as your
present residence?
9. INCIDENTAIR
Did this incident occur on an American Indian
Reservation or on American Indian Lands?

10a. LOCATION_GENERAL
Did this incident happen ...
Read each category until respondent says "yes", then
enter appropriate precode.

2
3
4
5
6

Page 2

At a commercial place? - SKIP to 10e
In a parking lot or garage? - SKIP to 10f

7

At school? - SKIP to 10g
In open areas, on the street, or
on public transportation? - SKIP to - 10h

8

Some where else? - SKIP to 10i

10b. LOCATION_IN_HOME

616

1

In own dwelling, own attached garage,
or enclosed porch (Include illegal entry
or attempted illegal entry of same)

2

In detached building on own property,
such as detached garage, storage shed,
etc. (Include illegal entry of same)

Ask if necessary:
Where in your home or lodging did this
incident happen?

10c. LOCATION_NEAR_HOME

3

In vacation home/second home
(Include illegal entry or attempted
illegal entry of same)

4

In hotel or motel room respondent
was staying in (Include illegal entry or
attempted illegal entry of same)

5

Own yard, sidewalk, driveway, carport,
unenclosed porch (does not include
apartment yards)
Apartment hall, storage area, laundry
room (does not include apartment
parking lot/garage)
On street immediately adjacent to own
home or lodging

Ask if necessary:
6

Where near your home or lodging did this
incident happen?
7

8

At or in home or other building on their
property

Ask if necessary:

9

Where at, in, or near a friend's/relative's/
neighbor's home did this incident happen?

10

Yard, sidewalk, driveway, carport (does
not include apartment yards)
Apartment hall, storage area, laundry
room (does not include apartment
parking lot/garage)
On street immediately adjacent to their
home

10d. LOCATION_OTHER_HOME

11

10e. LOCATION_COMMERCE

12
24

Ask if necessary:
At what type of a commercial place did this
incident happen?

10f. LOCATION_PARKING
Ask if necessary:

25

14

Inside other commercial building, such
as a store
Inside office

27

Inside factory or warehouse

15

Commercial parking lot/garage

16

Noncommercial parking lot/garage

17

Apartment/townhouse parking lot/
garage

18

Inside school building
On school property (school parking
area, play area, school bus, etc.)

26

In what type of a parking lot or garage did this
incident happen?
10g. LOCATION_SCHOOL

Inside restaurant, bar, nightclub
Inside bank
Inside gas station

19

Ask if necessary:

SKIP
to 11

SKIP
to 18

SKIP
to 18

SKIP
to 17c

SKIP
to 17c

SKIP to 17a
SKIP to 17c

Where at school did this incident happen?
10h. LOCATION_OPEN_AREA
Ask if necessary:
Where in an open area, on the street, or on
public transportation did this incident
happen?

10i. LOCATION_SPEC

20
21

22

23

In apartment yard, park, field,
playground (other than school)
On the street (other than immediately
adjacent to own/friend's/relative's/
neighbor's home)
On public transportation or in station
(bus, train, plane, airport, depot, etc.)
Other - Specify

SKIP
to 18

SKIP to 17c

Please specify the other location where this
incident occurred.

Page 3

11. OFFENDERLIVE

617

2

Did the offender live (here/there) or have a
right to be (here/there), for instance, as a guest
or a repairperson?
12. OFFENDERINSIDE

3

618

Did the offender actually get INSIDE your
(house/apartment/room/garage/ shed/
enclosed porch)?
13. OFFENDERTRY

619

Did the offender TRY to get in your (house/
apartment/room/garage/shed/porch)?
14. FORCEDENTRY

1

620

1
2

Yes - SKIP to 14
No

3

Don't know

1
2

Yes - ASK 14
No - SKIP to 19

3

Don't know - ASK 14

1

Yes - ASK 15a
No - SKIP to 16a

2

Was there any evidence, such as a broken lock
or broken window, that the offender(s) (got in
by force/TRIED to get in by force)?

Yes - SKIP to 19
No
ASK 12
Don't know

ASK 13

Window

15a. EVIDENCE
625

1

Damage to window (include frame,
glass broken/removed/cracked)

2

Screen damaged/removed

3

Lock on window damaged/tampered
with in some way

4

Other - Specify

What was the evidence?
Probe: Anything else?
Enter all that apply.

SKIP
to 19

SKIP to 15b

Door

626

5

Damage to door (include frame, glass
panes or door removed)

6

Screen damaged/removed

7

Lock or door handle damaged/tampered
with in some way

8

Other - Specify

SKIP
to 19

SKIP to 15c

Other
9

15b. EVIDENCE_SPEC14

Other than window or door - Specify

Specify - SKIP to 19

Please specify what was the other evidence related
to a window.
15c. EVIDENCE_SPEC18

Specify - SKIP to 19

Please specify what was the other evidence related
to a door.
15d. EVIDENCE_SPEC19
Please specify what was the evidence other than to a
window or door.

Page 4

Specify - SKIP to 19

SKIP to 15d

16a. OFFENDERGETIN

627

1

Let in

2

Offender pushed his/her way in after
door opened

3

Through OPEN DOOR or other opening

4

Through UNLOCKED door or window
Through LOCKED door or window - Had
key
Through LOCKED door or window Picked lock, used credit card, etc., other
than key
Through LOCKED door or window Don't know how

How did the offender (get in/TRY to get in)?

5
6

7
8

Don't know

9

Other - Specify

SKIP
to 19

SKIP to 16b

Specify - SKIP to 19

16b. OFFENDERGETIN_SPEC
Please specify - how the offender got in/TRIED to get
in.

17a. RESPONDENTSSCHOOL

628

Was it your school?

17b. PARTSCHOOLBLDG

629

1

Yes

2

No - SKIP to 17c

1

Classroom
Hallway/Stairwell

2

In what part of the school building did it
happen?

3
4

17c. RESTRICTEDAREA

630

1

Ask or verify -

2

Did the incident happen in an area restricted to
certain people or was it open to the public at
the time?

3
4

Bathroom/Locker room
Other (library, gym, auditorium, cafeteria)
Open to the public
Restricted to certain people (or nobody
had a right to be there)
Don't know
Other - Specify - ASK 17d

SKIP
to 18

Specify

17d. RESTRICTEDAREA_SPEC
Please specify.
18. INSIDEOROUT

631

Ask or verify -

1

Indoors (inside a building or enclosed space)

2

Outdoors
Both

3

Did it happen outdoors, indoors, or both?
19. FARFROMHOME

6

At, in, or near the building containing
the respondent's home/next door
A mile or less
Five miles or less
Fifty miles or less
More than 50 miles
Don't know how far

634

1
2

Yes - ASK 20b
No - SKIP to 56

635

1

Respondent only
Respondent and other household
member(s)

632

Ask or verify-

1
2
3
4

How far away from home did this happen?

5

PROBE: Was it within a mile, 5 miles, 50 miles or
more?
Enter the code for the first answer category that the
respondent is sure of.
20a. HHMEMBERPRESENT
Ask or verify Were you or any other member of this
household present when this incident
occurred?
You may need to probe to obtain more details to
determine if respondent was present.
20b. WHICHMEMBER
Ask or verify -

2

Which household members were present?

3

Ask 21

Only other household member(s), not
respondent - SKIP to 59a
Page 5

21. SEEOFFENDER

636

1
2

Yes
No

637

1
2
3

Yes - ASK 23a
No
Don't know

Ask or verify Did you personally see an offender?
22. WEAPONPRESENT
Did the offender have a weapon such as a gun
or knife, or something to use as a weapon, such
as a bottle or wrench?
23a. WEAPON

638

What was the weapon?
Probe: Anything else?
Enter all that apply.

1
2
3
4
5
6

SKIP to 24

Hand gun (pistol, revolver, etc.)
Other gun (rifle, shotgun, etc.)
Knife
Other sharp object (scissors, ice pick, axe,
etc.)
Blunt object (rock, club, blackjack, etc.)
Other - Specify - ASK 23b

SKIP
to 24

Specify

23b. WEAPON_SPEC
Please specify the other weapon.
24. ATTACK

639

1
2

Yes - SKIP to 29a
No - ASK 25

640

1
2

Yes - SKIP to 28a
No - ASK 26

641

1
2

Yes - SKIP to 28c
No - ASK 27a

642

1
2

Did the offender hit you, knock you down or
actually attack you in any way?
25. TRYATTACK
Did the offender TRY to attack you?
26. THREATEN
Did the offender THREATEN you with harm in
any way?
27a. WHATHAPPEN
What actually happened?
Probe: Anything else?
Enter all that apply.

3
4
5
6
7
8
9
10

27b. WHATHAPPEN_SPEC

Something taken without permission
SKIP
Attempted or threatened to take
to 35c
something
Harassed, argument, abusive language
Unwanted sexual contact with force
SKIP to 27c
(grabbing, fondling, etc.)
Unwanted sexual contact without force
(grabbing, fondling, etc.)
Forcible entry or attempted forcible
entry of house/apartment
SKIP
Forcible entry or attempted forcible entry
to 35c
of car
Damaged or destroyed property
Attempted or threatened to damage or
destroy property
Other - Specify - ASK 27b

Specify - SKIP to 35c

Please specify what actually happened.
27c. SEXCONFORCEPROBE_1
You mentioned some type of unwanted sexual
contact with force. Do you mean forced or
coerced sexual intercourse including attempts?

Page 6

1
2

Yes - SKIP to 29a
No - SKIP to 35c

28a. HOWTRYATTACK
How did the offender TRY to attack you?

643

Probe: Any other way?

1
2
3
4
5

Enter all that apply.
6
644

7
8
9
10

645

11
12
13
14

Verbal threat of rape
Verbal threat to kill
SKIP
Verbal threat of attack other than to kill or rape
to 35c
Verbal threat of sexual assault other than rape
Unwanted sexual contact with force
SKIP to 28e
(grabbing, fondling, etc.)
Unwanted sexual contact without force
(grabbing, fondling, etc.)
Weapon present or threatened with weapon
Shot at (but missed)
Attempted attack with knife/sharp weapon
Attempted attack with weapon other
SKIP
than gun/knife/sharp weapon
to 35c
Object thrown at person
Followed or surrounded
Tried to hit, slap, knock down, grab, hold,
trip, jump, push, etc.
Other - Specify - ASK 28b

Specify

28b. HOWTRYATTACK_SPEC

- SKIP to 35c

Please specify how the offender TRIED to attack you.

28c. HOWTHREATEN
How were you threatened?

643

Probe: Any other way?

1
2
3
4
5

Enter all that apply.
6
644

7
8
9
10

645

11
12
13
14

Verbal threat of rape
Verbal threat to kill
SKIP
Verbal threat of attack other than to kill or rape
to 35c
Verbal threat of sexual assault other than rape
Unwanted sexual contact with force
SKIP to 28e
(grabbing, fondling, etc.)
Unwanted sexual contact without force
(grabbing, fondling, etc.)
Weapon present or threatened with weapon
Shot at (but missed)
Attempted attack with knife/sharp weapon
Attempted attack with weapon other
SKIP
than gun/knife/sharp weapon
to 35c
Object thrown at person
Followed or surrounded
Tried to hit, slap, knock down, grab, hold,
trip, jump, push, etc.
Other - Specify - ASK 28d

Specify - SKIP to 35c

28d. HOWTHREATEN_SPEC
Please specify how you were threatened.

1
2

28e. SEXCONFORCEPROBE_2
You mentioned some type of unwanted sexual
contact with force. Do you mean forced or
coerced sexual intercourse including
attempts?
29a. HOWATTACK

646

How were you attacked?
Probe: Any other way?

1
2
3
4

647

5
6
7
8
9
10

648

11

Enter all that apply.

12
13
14

29b. HOWATTACK_SPEC

Yes - ASK 29a
No - SKIP to 35c

ASK 29c
Raped
ASK 29d
Tried to rape
Sexual assault other than rape or
attempted rape
Shot
Shot at (but missed)
Hit with gun held in hand
Stabbed/cut with knife/sharp weapon
Attempted attack with knife/sharp weapon
SKIP
Hit by object (other than gun) held in hand
to 30a
Hit by thrown object
Attempted attack with weapon other
than gun/knife/sharp weapon
Hit, slapped, knocked down
Grabbed, held, tripped, jumped, pushed, etc.
Other - Specify - ASK 29b

Specify

- SKIP to 30a

Please specify how you were attacked.

Page 7

29c. RAPE_CK1

Yes - SKIP to 30a
No - go back to 29a

You mentioned rape. Do you mean forced or
coerced sexual intercourse?
If "no", then ask: What do you mean?
29d. ATTRAPE_CK1

Yes - SKIP to 30a
No - go back to 29a

You mentioned attempted rape. Do you mean
attempted forced or coerced sexual
intercourse?
If "no", then ask: What do you mean?
30a. PRETHREATEN

649

Did the offender THREATEN to hurt you before
you were actually attacked?

1
2
3

Yes
SKIP to 31a
No
Other - Specify - ASK 30b

Specify

30b. PRETHREATEN_SPEC
Please specify.
31a. INJURY

655

What were the injuries you suffered, if any?
Probe: Anything else?
Enter all that apply.
656

1
2
3
4

5
6
7
8
9
10
11

None
Raped
Attempted rape
Sexual assault other than rape or
attempted rape
Knife or stab wounds
Gun shot, bullet wounds
Broken bones or teeth knocked out
Internal injuries
Knocked unconscious
Bruises, black eye, cuts, scratches,
swelling, chipped teeth

SKIP to 32a
SKIP to 33a

SKIP to
32a

Other - Specify - ASK 31b

Specify

31b. INJURY_SPEC

SKIP to 35c
SKIP to 31c
SKIP to 31d

- SKIP to 32a

Please specify the injuries you suffered.
31c. RAPE_CK2

Yes - SKIP to 32a
No - go back to 31a

You mentioned rape. Do you mean forced or
coerced sexual intercourse?
If "no", then ask: What do you mean?
31d. ATTRAPE_CK2

Yes - SKIP to 32a
No - go back to 31a

You mentioned attempted rape. Do you mean
attempted forced or coerced sexual
intercourse?
If "no", then ask: What do you mean?
32a. INJURYNOTGUN

657

1
2

Yes - ASK 32b
No - SKIP to 33a

658

2
3
4

Raped
Attempted rape
Sexual assault other than rape or attempted rape

7
8
9

11

Broken bones or teeth knocked out
Internal injuries
Knocked unconscious
Bruises, black eye, cuts, scratches,
swelling, chipped teeth
Other - Specify

1
2

Yes - ASK 33b
No - SKIP to 35c

Ask or verifyWere any of the injuries caused by a weapon
other than a gun or knife?
32b. FIRSTINJURY
Which injuries were caused by a weapon
OTHER than a gun or knife?
Enter all that apply.

10

33a. MEDICALCARE
Were you injured to the extent that you
received any medical care, including self
treatment?
Page 8

659

33b. RECEIVECAREWHERE
Where did you receive this care?

660

Probe: Anywhere else?

1
2
3
4
5
6
7

Enter all that apply.

At the scene
At home/neighbor's/friend's
Health unit at work/school, first aid
station at a stadium/park, etc.
Doctor's office/health clinic
Emergency room at hospital/emergency clinic
Hospital (other than emergency room)
Other - Specify - ASK 33c

SKIP
to
33d

Specify

33c. RECEIVECAREWHERE_SPEC
Please specify where you received this care.
33d.

CHECK

ITEM E1

Is (Box 6) "Hospital" marked in
35a?

34a. CAREOVERNIGHT

1
2

Yes - ASK 34a
No - SKIP to 35a

662

1
2

Yes - ASK 34b
No - SKIP to 35a

663

____________ Number of days

664

1

Did you stay overnight in the hospital?
34b. CAREDAYHOSPIT
How many days did you stay in the hospital?
35a. MEDICALINSURANCE
At the time of the incident, were you covered
by any medical insurance, or were you eligible
for benefits from any other type of health
benefits program, such as medicaid, Veterans
Administration, or Public Welfare?

35b. MEDICALEXPENSES
What was the total amount of your medical
expenses resulting from this incident
(INCLUDING anything paid by insurance)?
Include hospital and doctor bills, medicine,
therapy, braces, and any other injury related
expenses.

2
3

665

Yes
No
Don't know

$ ____________ .

00

0

No cost

1
2

Yes - ASK 36a
No - SKIP to 39

1
2

Yes
No

1
2

Yes
No

1
2

Not at all distressing
Mildly distressing
Moderately distressing
Severely distressing

Total amount

Obtain an estimate, if necessary.
35c.

CHECK

ITEM E2

Is (Box 1) "Yes" marked in 24, 25 or
26 or are (Box 4 or 5) "Unwanted
sexual contact with or without
force" marked in 27?

36a. EMO_TOLL_IMPACT_JOB

971

Being a victim of crime affects people in
different ways. Next I would like to ask you
some questions about how being a crime
victim may have affected you.
Did being a victim of this crime lead you to
have significant problems with your job or
schoolwork, or trouble with your boss,
coworkers, or peers?
36b. EMO_TOLL_IMPACT_FAMILY

972

Did being a victim of this crime lead you to
have significant problems with family
members or friends, including getting into
more arguments or fights than you did before,
not feeling you could trust them as much, or
not feeling as close to them as you did before?

36c. EMO_TOLL_IMPACT_DISTRESSING
How distressing was being a victim of this
crime to you? Was it not at all distressing,
mildly distressing, moderately distressing, or
severely distressing?

973

3
4

Page 9

36d.

CHECK

ITEM E3

37.

Is (Box 1) "Yes" marked in 36a or
36b or are (Box 3 or 4)
"Moderately or severely
distressing" marked in 36c?

1
2

Yes - ASK 37
No - SKIP to 39

Still thinking about your distress
associated with being a victim of this crime
did you feel any of the following ways for A
MONTH OR MORE? Did you feel ...

(a) EMO_TOLL_FEEL_WORRIED

974

Worried or anxious?
(b) EMO_TOLL_FEEL_ANGRY

2

No

1

Yes

2

No

1

Yes

2

No

1

Yes

2

No

1

Yes

2

No

1

Yes

2

No

1

Yes

2

No

980

Unsafe?
(h) EMO_TOLL_FEEL_OTHER_WAY

Yes

979

Like you couldn't trust people?
(g) EMO_TOLL_FEEL_UNSAFE

1

978

Violated?
(f) EMO_TOLL_FEEL_MISTRUST

No

977

Vulnerable?
(e) EMO_TOLL_FEEL_VIOLATED

2

976

Sad or depressed?
(d) EMO_TOLL_FEEL_VULNERABLE

Yes

975

Angry?
(c) EMO_TOLL_FEEL_SAD

1

981

Some other way?
Specify

37i. FEEL_OTH_WAY_SP
What other way did being a victim of this
crime make you feel?
37j.

CHECK

ITEM E4

Is (Box 1) "Yes" marked in any of
37a through 37h?

37k. EMO_TOLL_SEEK_PRO_HELP

Did you seek any kind of professional help for
the feelings you experienced as a result of
being a victim of this crime?
Enter all that apply.

Yes - ASK 37k
No - SKIP to 38

1
2

Yes - ASK 37l
No - SKIP to 38

1
2

Counseling/therapy
Medication
Visited a doctor or nurse
Visted ER/hospital/clinic
Other - Specify - ASK 37m

982

Did you seek any kind of professional help for
the feelings you experienced as a result of
being a victim of this crime?
37l. EMO_TOLL_PRO_HELP_SOUGHT

1
2

983

3
4
5

37m. HELP_SOUGHT_SP
What other kind of professional help did you seek?

Page 10

Specify

SKIP
to 38

38.

Did you experience any of the following
physical problems associated with being a
victim of this crime for A MONTH OR MORE?
Did you experience ...

(a) EMO_TOLL_HAVE_HEADACHES

984

Headaches?
(b) EMO_TOLL_TRBL_SLEEPING

2

No

1

Yes

2

No

1

Yes

2

No

1

Yes

2

No

1

Yes

2

No

1

Yes

2

No

1

Yes

2

No

990

Muscle tension or back pain?
(h) EMO_TOLL_OTHER_PHYSICAL

Yes

989

High blood pressure?
(g) EMO_TOLL_MUSCLE_TENSION

1

988

Fatigue?
(f) EMO_TOLL_HIGH_BLOOD_PRESS

No

987

Upset stomach?
(e) EMO_TOLL_FATIGUE

2

986

Changes in your eating or drinking habits?
(d) EMO_TOLL_UPSET_STOMACH

Yes

985

Trouble sleeping?
(c) EMO_TOLL_EATING_PROBS

1

991

Some other physical problem?
Specify

38i. OTH_PHY_SP
What other physical problem did you
experience for A MONTH OR MORE?
38j.

CHECK

ITEM E5

Is (Box 1) "Yes" marked in any of
38a through 38h?

38k. EMO_TOLL_SEEK_HELP_PHYPROBS

Yes - ASK 38k
No - SKIP to 39

1
2

Yes - ASK 38l
No - SKIP to 39

1
2

Counseling/therapy
Medication
Visited a doctor or nurse
Visted ER/hospital/clinic
Other - Specify - ASK 38m

992

Other than any medical care you received for
the injury(ies) you suffered) did you seek any
professional or medical help for the physical
problems you experienced as a result of being
a victim of this crime?
38l. EMO_TOLL_KIND_HELP_PHYPROBS

1
2

993

What type of professional or medical help did
you seek?
Enter all that apply.

3
4
5

SKIP
to 39

Specify

38m. KIND_HELP_PHYOTH_SP
What other kind of professional help did you seek?

39.

CHECK

ITEM F1

Is respondent female and
between the ages of 18-49?

40. PREGATTIMEOFINC
Research shows that pregnant women may be
at a higher risk of being the victim of a violent
crime.

960

1
2

Yes - ASK 40
No - SKIP to 41a

1

Yes

2

No

Were you pregnant at the time of this incident?

Page 11

666

41a. PROTECTSELF

2

Did you do anything with the idea of
protecting YOURSELF or your PROPERTY while
the incident was going on?
41b. DURINGINCIDENT
Was there anything you did or tried to do
about the incident while it was going on?

42a. ACTIONSDURINGINC

1

667

1

668

1
2

What did you do?

2

3
4
5
6

Probe: Anything else?
Enter all that apply.
669

7
8

670

Yes - SKIP to 42a
No/took no action/kept still - ASK 41b

Yes - SKIP to 42a
No/took no action/kept still - ASK 47

USED PHYSICAL FORCE TOWARD OFFENDER
Attacked offender with gun; fired gun
Attacked with other weapon
Attacked without weapon (hit, kicked, etc.)
Threatened offender with gun
Threatened offender with other weapon
Threatened to injure, no weapon
RESISTED OR CAPTURED OFFENDER
Defended self or property (struggled,
ducked, blocked blows, held onto property)
Chased, tried to catch or hold offender

9

SCARED OR WARNED OFF OFFENDER
Yelled at offender, turned on lights,
threatened to call police, etc.

10
11

PERSUADED OR APPEASED OFFENDER
Cooperated, or pretended to (stalled, did
what they asked)
Argued, reasoned, pleaded, bargained, etc.

12

ESCAPED OR GOT AWAY
Ran or drove away, or tried; hid, locked door
GOT HELP OR GAVE ALARM

671

13
14

15

Called police or guard
Tried to attract attention or help, warn others
(cried out for help, called children inside)
REACTED TO PAIN OR EMOTION
Screamed from pain or fear
OTHER

16

Other - Specify - ASK 42b

Specify

42b. ACTIONDURINGINC_SPEC
Please specify what you did.
42c.

CHECK

ITEM F2

Was the respondent injured in
this incident? (Are any of the
Boxes 2-11 marked in 31a?)

43a. INJACTION

672

1
2

Yes - ASK 43a
No - SKIP to 43b

1

Actions taken before injury
Actions taken after injury
Actions taken at same time as injury

2

Did you take these actions before, after, or at
the same time that you were injured?

3

Enter all that apply.
43b. INJACTIONHELP
Did (any of) your action(s) help the situation in
any way?
Probe: Did your action(s) help you avoid injury,
protect your property, escape from the
offender - or were they helpful in some other
way?

Page 12

673

1
2
3

Yes - ASK 44a
No
Don't know

SKIP to 45

SKIP
to 42c

SKIP
to 42c

44a. HELP

674

How were they helpful?

1
2
3
4

Probe: Any other way?

5

Enter all that apply.

6

Helped avoid injury or greater injury to
respondent
Scared or chased offender off
Helped respondent get away from offender
Protected property
Protected other people
Other - Specify - ASK 44b

SKIP
to 45

Specify

44b. HELP_SPEC
Please specify how were they helpful.
45. ACTIONWORSE

675

1
2

Did (any of) your action(s) make the situation
worse in any way?

3

Yes - ASK 46a
No
Don't know

SKIP to 47

Probe: Did your action(s) lead to injury, greater
injury, loss of property, make the offender
angrier, or make the situation worse in some
other way?
46a. WORSE

676

How did they make the situation worse?

1
2

Probe: Any other way?

3
4

Enter all that apply.

5
6

Led to injury or greater injury to
respondent
Caused greater loss of property or
damage to property
Other people got hurt (worse)
Offender got away
Made offender angrier, more
aggressive, etc.
Other - Specify - ASK 46b

SKIP
to 47

Specify

46b. WORSE_SPEC
Please specify how the respondent's actions made
the situation worse.
47. ANYONEPRESENT

677

Was anyone present during the incident
besides you and the offender? (Other than
children under age 12.)
48. OTHERSACTIONS

3

678

1
2

Did the actions of (this person/any of these
people) help the situation in any way?

49a. HOWOTHERSHELP

1
2

3

679

How did they help the situation?

1
2
3
4

Probe: Any other way?

5

Enter all that apply.

6

Yes - ASK 48
No
Don't know

SKIP to 54c

Yes - ASK 49a
No
Don't know

SKIP to 50

Helped avoid injury or greater injury to
respondent
Scared or chased offender off
Helped respondent get away from offender
Protected property
Protected other people
Other - Specify - ASK 49b

SKIP
to 50

Specify

49b. HOWOTHERSHELP_SPEC
Please specify how they helped the situation.
50. OTHERSACTIONSWORSE
Did the actions of (this person/any of these
people) make the situation worse in any way?

680

1
2
3

Yes - ASK 51a
No
Don't know

SKIP to 52

Page 13

51a. OTHWORSE

681

How did they make the situation worse?

1
2

Probe: Any other way?

3
4

Enter all that apply.

5
6

Led to injury or greater injury to
respondent
Caused greater loss of property or
damage to property
Other people got hurt (worse)
Offender got away
Made offender angrier, more
aggressive, etc.
Other - Specify - ASK 51b

Specify

51b. OTHWORSE_SPEC
Please specify how they made the situation worse.
52. PERSONSHARMED

682

2

Not counting yourself, were any of the persons
present during the incident harmed (Pause),
threatened with harm (Pause), or robbed by
force or threat of harm? (Do not include
yourself, the offender, or children under 12
years of age.)
53. PERSONSHARMEDNUM
How many? (Do not include yourself, the
offender or children under 12 years of age.)

54a. HHMEMHARMED

1
3

Yes - ASK 53
No
Don't know

SKIP to 54c

683

____________ Number of persons

684

____________ Number of persons

How many of these persons are members of
your household now? (Do not include yourself,
the offender or children under 12 years of age.)

0

None - SKIP to 54c

Line number(s)

54b. HHMEMHARMED_NAMES
If not sure ask:
Who are these household members? (Do not
include yourself, the offender, or children
under 12 years of age)
Enter the line number(s) of other household
members.
54c.

CHECK

ITEM G

RESPONDENTUSEFORCE

685

1
2

Yes - ASK 55
No - SKIP to 60

686

1
2
3

Respondent
Offender(s)
Someone else

687

1
2

Yes - ASK 57
No - SKIP to 88

688

1
2
3

Suspicion
Fairly sure
Certain

Did the respondent use or
threaten to use physical force
against the offender? (Are any of
the Boxes 1-6 marked in 42a?)

55. FIRSTTOUSEFORCE
Who was the first to use or threaten to use
physical force - you, the offender, or someone
else?
56. KNOWLEARNOFFENDERS
Do you know or have you learned anything
about the offender(s) - for instance, whether
there was one or more than one offender
involved, whether it was someone young or
old, or male or female?
57. SUREOFINFO
How sure are you of this information? Do you
have a suspicion, are you fairly sure or are you
certain?

Page 14

SKIP to 60

SKIP
to 52

58a. LEARNOFFENDERS
How did you learn about the offender(s)?

689

1
2
3

Probe: Any other way?

4

Enter all that apply.
690

5
6
7
8
9
10

Respondent saw or heard offender
From other member of household who
was eyewitness
From eyewitness(es) other than
household member(s)
From police
Other person (not eyewitness)
Offender(s) admitted it
Offender(s) had threatened to do it
Stolen property found on offender's
property or in offender's possession
Figured it out by who had motive,
opportunity, or had done it before
Other - Specify - ASK 58b

SKIP
to 88

Specify - SKIP to 88

58b. LEARNOFFENDERS_SPEC
Please specify how you learned about the offender(s).

59a. HAPPEN
What actually happened?

691

Probe: Anything else?

1
2
3
4
5
6

Enter all that apply.

7
8

Something taken without permission
Attempted or threatened to take something
Harassed, argument, abusive language
Forcible entry or attempted forcible entry
of house/apartment
Forcible entry or attempted forcible
entry of car
Damaged or destroyed property
Attempted or threatened to damage or
destroy property
Other - Specify - ASK 59b

SKIP
to 60

Specify

59b. HAPPEN_SPEC
Please specify what actually happened.
60. ONEORMOREOFFENDERS
Ask or verify -

692

1
2
3

Only one - SKIP to 62
More than one - SKIP to 74
Don't know - ASK 61

693

1
2

Yes - ASK 62
No - SKIP to 88

703

1
2
3

Knew or had seen before - SKIP to 64
Stranger
Don't know

704

1
2
3

Yes
Not sure (possibly or probably)
No - SKIP to 67

1
2
3

Sight only - ASK 65a
Casual acquaintance
Well known

1
2
3

Yes
SKIP to 67
No
Other - Specify - ASK 65b

Was the crime committed by only one or by
more than one offender?
61. KNOWOFFENDERS
Do you know anything about one of the
offenders?
62. SINGOFFENDERKNEW
Was the offender someone you knew or a
stranger you had never seen before?
63. SINGOFFENDERRECOG
Would you be able to recognize the offender if
you saw him/her?

64. SINGOFFENDERHOWWELL

705

How well did you know the offender - by sight
only, casual acquaintance, or well known?

65a. SINGOFFENDERSIGHT
Would you have been able to tell the police
how they might find the offender, for instance,
where he/she lived, worked, went to school, or
spent time?
65b. SINGOFFENDERSIGHT_SPEC

706

SKIP to 65a

SKIP to 66a

Specify - SKIP to 67

Page 15

66a. SINGOFFENDERRELATION

707
1
2
3
4

How well did you know the offender? For
example, was the offender a friend, cousin,
etc.?

5
6
7
8
9
10
11
12
14
15
16
17
18
13

RELATIVE
Spouse at time of incident
Ex-spouse at time of incident
Parent or step-parent
Own child or step-child
Brother/sister
Other relative - Specify - ASK 66b

SKIP
to 67

NONRELATIVE
Boyfriend or girlfriend, ex-boyfriend or
ex-girlfriend
Friend or ex-friend
Roommate, boarder
Schoolmate
Neighbor
Customer/client
Patient
Supervisor (current or former)
Employee (current or former)
Co-worker (current or former)
Teacher/school staff
Other nonrelative - Specify - ASK 66c

SKIP
to 67

Specify - SKIP to 67

66b. SINGOFFENDERRELATION_SPEC_16
Please specify the other relative.

Specify

66c. SINGOFFENDERRELATION_SPEC_28
Please specify the other nonrelative.

67. SINGOFFENDERGENDER

698

1
2
3

Male
Female
Don't know

699

1
2
3
4

Under 12
12-14
15-17
18-20

1
2
3

Yes
No
Don't know

1

5
6

White?
Black or African American?
American Indian or Alaska Native?
Asian?
Native Hawaiian or Other Pacific Islander?
Don't know

700

1
2
3

Yes (a member of a street gang)
No (not a member of a street gang)
Don't know (if a member of a street gang)

701

1
2
3

Yes (drinking or on drugs) - ASK 72b
No (not drinking/not on drugs)
Don't know (if drinking or on drugs)

702

1
2
3
4

Drinking
On drugs
Both (drinking and on drugs)
Drinking or on drugs - could not tell which

709

1
2
3

Yes (only time)
No (there were other times)
Don't know

Was the offender male or female?
68. SINGOFFENDERAGE
How old would you say the offender was?

69. SINGOFFETHNICITY

994

Was the offender Hispanic or Latino?
70. SINGOFFENDERRACE

708

2
3

What race or races was the offender? You may
select more than one. Was the offender...

4

Enter all that apply.
71. SINGOFFENDERGANG
Was the offender a member of a street gang, or
don't you know?
72a. SINGOFFENDERDRINKDRUG
Was the offender drinking or on drugs, or don't
you know?

72b. SINGOFFENDERDRINKORDRUG
Which was it? (Drinking or on drugs?)

73. SINGOFFENDERONLYTIME
Was this the only time this offender committed
a crime against you or your household or made
threats against you or your household?

74. HOWMANYOFFENDERS
How many offenders?

Page 16

5
6
7

21-29
30 or older
Don't know

710

Number of offenders

SKIP to 73

SKIP to 88

75. MULTOFFENDERKNEW

3
4

All known
Some known
All strangers
Don't know

719

1
2
3

Yes
Not sure (possibly or probably)
No - SKIP to 80a

720

1
2
3

Sight only
Casual acquaintance
Well known

718

Were any of the offenders known to you, or
were they strangers you had never seen
before?
76. MULTOFFENDERRECOG
Would you be able to recognize any of them if
you saw them?

77a. MULTOFFENDERHOWWELL
How well did you know the offender(s) - by
sight only, casual acquaintance, or well
known?

1
2

SKIP to 77a
ASK 76

SKIP to 78a

Probe: Anything else?
Enter all that apply.

77b.

CHECK
ITEM H

Is "casual acquaintance" or "well
known" marked in 77a?

78a. MULTOFFENDERSIGHT
Would you have been able to tell the police
how they might find any of them, for instance,
where they lived, worked, went to school, or
spent time?

Yes - SKIP to 79a
No - ASK 78a

722

1
2
3

Yes
No

SKIP to 80a

Other - Specify - ASK 78b

Specify - SKIP to 80a

78b. MULTOFFENDERSIGHT_SPEC
Please specify.
79a. MULTOFFENDERRELATION
How did you know them? For example, were
they friends, cousins, etc.?

961

1
2
3
4

Probe: Anything else?

5
6

Enter all that apply.
962

7
8
9
10

963

11
12
13

964

14
15
16
17

965

18

RELATIVE
Spouse at time of incident
Ex-spouse at time of incident
Parent or step-parent
Own child or step-child
Brother/sister
Other relative - Specify - ASK 79b

SKIP
to 80a

NONRELATIVE
Boyfriend or girlfriend, ex-boyfriend or
ex-girlfriend
Friend or ex-friend
Roommate, boarder
Schoolmate
Neighbor
Customer/client
Other nonrelative - Specify - ASK 79c
Patient
Supervisor (current or former)
Employee (current or former)
Co-worker (current or former)
Teacher/school staff

SKIP
to 80a

SKIP
to 80a

Specify - SKIP to 80a

79b. MULTOFFENDERRELATION_SPEC_16
Please specify the other relative.

Specify

79c. MULTOFFENDERRELATION_SPEC_28
Please specify the other nonrelative.
80a. MULTOFFENDERGENDER

711

Were they male or female?

80b. MULTOFFENDERMOSTGENDER
Were they mostly male or mostly female?

712

1
2
3
4

All male
All female
Don't know sex of any offenders
Both male and female

1
2
3
4

Mostly male
Mostly female
Evenly divided
Don't know

SKIP to 81
(If only two offenders,
SKIP to 81
otherwise ASK 80b)

Page 17

81. MULTOFFENDERYOUNG

713

1
2
3
4

Under 12
12-14
15-17
18-20

5
6
7

21-29
30 or older
Don't know

714

1
2
3

5
6
7

21-29
30 or older
Don't know

4

Under 12
12-14
15-17
18-20

1
2
3

Yes - ASK 83b
No
Don't know

996

1
2
3
4

Mostly Hispanic or Latino
Mostly non-Hispanic
Equal number of Hispanic and non-Hispanic
Don't know

726

1
2
3

White?
Black or African American?
American Indian or Alaska Native?
Asian?
Native Hawaiian or Other Pacific Islander?
Don't know

How old would you say the youngest was?

82. MULTOFFENDEROLD
How old would you say the oldest was?

83a. MULTIPLEOFFENDERETHNICITY

995

Were any of the offenders Hispanic or Latino?

83b. MULTIPLEOFFENDERMOSTETHNICITY
Were the offenders mostly Hispanic, mostly
non-Hispanic, or an equal number of Hispanic
and non-Hispanic?
84a. MULTOFFENDERRACE
What race or races were the offenders? Were
they...
Enter all that apply.

84b.

CHECK
ITEM I

4
5
6

Is more than one box marked in
84a?

84c. MULTOFFENDERRACEMOST

SKIP to 84a

Yes - ASK 84c
No - SKIP to 85
727

What race were most of the offenders?

1
2
3
4
5
6
7

Mostly White
Mostly Black or African American
Mostly American Indian or Alaska Native
Mostly Asian
Mostly Native Hawaiian or Other Pacific Islander
Equal number of each race
Don't know

85. MULTOFFENDERGANG
Were any of the offenders a member of a street
gang, or don't you know?

715

1
2
3

Yes (a member of a street gang)
No (not a member of a street gang)
Don't know (if a member of a street gang)

86a. MULTOFFENDERDRINKDRUG

716

1
2
3

Yes (drinking or on drugs) - ASK 86b
No (not drinking/not on drugs)
Don't know (if drinking or on drugs)

717

1
2
3
4

Drinking
On drugs
Both (drinking and on drugs)
Drinking or on drugs - could not tell which

730

1
2
3

Yes (only time)
No (there were other times)
Don't know

731

1

Yes - SKIP to 96a
No
Don't know

Were any of the offenders drinking or on
drugs, or don't you know?
86b. MULTOFFENDERDRINKORDRUG
Which was it? (Drinking or on drugs?)

87. MULTOFFENDERONLYTIME
Was this the only time any of these offenders
committed a crime against you or your
household or made threats against you or your
household?
88. THEFT

2

Ask or verify:
Was something stolen or taken without
permission that belonged to you or others in the
household? (Include anything stolen from the
business operated from the respondent's home.)
Include anything stolen from an unrecognizable
business. Do not include anything stolen from a
recognizable business in respondent's home or
another business, such as merchandise or cash from a
register.

Page 18

3

SKIP to 87

89. ATTEMPTTHEFT

732

1
2
3

Ask or verify:

Yes - ASK 90a
No
Don't know

SKIP to 110

Did the offender(s) ATTEMPT to take something
that belonged to you or others in the
household? (Include anything stolen from the
operated from the respondent's home.)
Do not include anything the offender tried to steal
from a recognizable business in respondent's home or
another business, such as merchandise or cash from a
register.

90a. ATTEMPTTHEFTWHAT

733

1
2
3
4
5
6

734

7

735

8
9
10

What did the offender try to take?
Probe: Anything else?
Enter all that apply.

11
12
736

13

737

14
15
16
17

Cash
Purse
Wallet
Credit cards, checks, bank cards
Car
Other motor vehicle
Part of motor vehicle (tire, hubcap,
attached car stereo or satellite radio,
attached CB radio, etc.)
Gasoline or oil
Bicycle or parts
TV, DVD player, VCR, stereo, other
household appliances
Silver, china, art objects
Other household furnishings (furniture,
rugs, etc.)
Personal effects (clothing, jewelry, toys,
etc.)
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)
Other - Specify - ASK 90b
Don't know - SKIP to 91a

SKIP
to 91a

Specify

90b. ATTEMPTTHEFTWHAT_SPEC
Please specify what the offender(s) tried to take.
91a. ATTEMPTTHEFTOWNER
Did the (property/money) the offender tried to
take belong to you personally, to someone else
in the household, or to both you and other
household members?

738

1
2
3
4
5

Respondent only - SKIP to 92a
Respondent and other household
member(s)
SKIP to 91c
Other household member(s) only
Nonhousehold member(s) only - SKIP to 92a
Other - Specify - ASK 91b

Specify - SKIP to 92a

91b. ATTEMPTTHEFTOWNER_SPEC
Please specify who the (property/money) the
offender(s) tried to take belonged to.
91c.

CHECK

ITEM J

ATTEMPTHEFTLNS

739

Line number

If not sure, ask:

Line number

Besides the respondent, which household
member(s) owned the (property/money) the
offender tried to take?

Line number
OR

Enter appropriate line number(s).

92a. ATTEMPTTHEFTITEMSINMV
Ask or verify:

740

40

Household property

1
2

Yes
No

(Was/Were) the article(s) IN or ATTACHED to a
motor vehicle when the attempt was made to
take (it/them)?

Page 19

92b.

CHECK

ITEM K

Yes - ASK 93
No - SKIP to 94

Did the offender try to take cash,
a purse, or a wallet?
(Is Box 1, 2, or 3 marked in 90a?)

93. ATTEMPTTHEFTONPERSON
Ask or verify:

742

1
2

Yes
No

745

1
2

Yes - ASK 95
No - SKIP to 110

746

4
5
6

Credit cards, checks, bank cards
Car
Other motor vehicle
Part of motor vehicle (tire, hubcap,
attached car stereo or satellite radio,
attached CB radio, etc.)
Gasoline or oil
Bicycle or parts
TV, DVD player, VCR, stereo, other
household appliances
Silver, china, art objects
Other household furnishings (furniture,
rugs, etc.)
Personal effects (clothing, jewelry, toys,
etc.)
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)
Other
Tried to take everything marked in 90a
directly from respondent

Was the (cash/purse/wallet) on your person,
for instance, in a pocket or being held?
94. ATTEMPTTHEFTITEMONPERSON
Ask or verify:
Was there anything (else) the offender(s) tried
to take directly from you, for instance, from
your pocket or hands, or something that you
were wearing?
Exclude property not belonging to respondent or
other household member

95. ATTEMPTTHEFTITEMS
Which items did the offender(s) try to take
directly from you?
Exclude property not belonging to respondent or
other household member.

7

8
9
10
11
12
13
14
15
16
40

Page 20

SKIP
to 110

96a. WHATWASTAKEN
What was taken that belonged to you or
others in the household?

748

Probe: Anything else?
Enter all that apply.
749

1
2
3
4

5
6
7
8
9
10

750

11
12
13

751

753

VEHICLE OR PARTS
Car
Other motor vehicle
Part of motor vehicle (tire, hubcap, attached car
stereo or satellite radio, attached CB radio, etc.)
Unattached motor vehicle accessories or equipment
(unattached CD player or satellite radio, etc.)
Gasoline or oil
Bicycle or parts
HOUSEHOLD FURNISHINGS
TV, DVD player, VCR, stereo, other household
appliances
Silver, china, art objects
Other household furnishings (furniture, rugs, etc.)

19

PERSONAL EFFECTS
Portable electronic and photographic gear
(Personal stereo, TV, cellphone, camera, etc.)
Clothing, furs, luggage, briefcase
Jewelry, watch, keys
Collection of stamps, coins, etc.
Toys, sports and recreation equipment
(not listed above)
Other personal and portable objects

20
21

FIREARMS
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)

14
15
16

752

CASH/PURSE/WALLET/CREDIT CARDS
Cash
Purse
Wallet
Credit cards, check, bank cards

17
18

MISCELLANEOUS
754

755

22
23
24
25
26
27

96b.

CHECK

ITEM L1

If Box 26 is marked in 96a - ASK 96c
If Box 2 and/or 3 is marked in 96a - SKIP to 96d
If Box 1 is marked in 96a - SKIP to 96e
If none of the conditions above are met - SKIP to 97a

Follow the skip pattern for the
first category met, based on the
entries in 96a.

Specify - If Box 2 and/or 3 is marked in 96a - ASK 96d
If Box 1 is marked in 96a - SKIP to 96e
Otherwise SKIP to 97a

96c. WHATWASTAKEN_SPEC
Please specify what was taken.

1
2

96d. PRSWLT_CONTAINMONEY
Did the stolen (purse/wallet) contain any
money?

96e. AMOUNTCASHTAKEN

Tools, machines, office equipment
Farm or garden produce, plants, fruit, logs
Animals - pet or livestock
Food or liquor
Other - Specify
Don't know

747

Yes - ASK 96e
No
If Box 1 is marked in 96a ASK 96e
otherwise SKIP to 97a

$ ____________ .

00

Amount of cash taken

If not sure, ask:
How much cash was taken?
97a. WHOOWNEDSTOLENPROPERTY
Did the stolen (property/money) belong to you
personally, to someone else in the household,
or to both you and other household members?

97b. ATTEMPTTHEFTOWNER_SPEC

760

1
2
3
4
5

Respondent only - SKIP to 97d
Respondent and other household
member(s)
SKIP to 97c
Other household member(s) only
Nonhousehold member(s) only - SKIP to 97d
Other - Specify - ASK 97b

Specify - SKIP to 97d

Please specify who the stolen (property/money)
belonged to.

Page 21

97c.

CHECK

ITEM L2

OTHERSOWNEDSTOLENPROPERTY

761

Line number

If not sure, ask:

Line number

Besides the respondent, which household
member(s) owned the stolen (property/
money)?

Line number
OR
40

Enter appropriate line number(s).
97d.

CHECK

ITEM M1

Yes - ASK 98
No - SKIP to 100a

Was a car or other motor vehicle
stolen?
(Is Box 5 or 6 marked in 96a?)

98. PERMISSIONGIVEN

1
2
3

Yes - ASK 99
No
Don't know

764

1
2

Yes
No

765

1
2

Yes
No

763

Had permission to use the (car/motor vehicle)
ever been given to the offender(s)?

99. RETURNCAR
Did the offender return the (car/motor vehicle)
this time?
100a. ARTICLEINCAR

Household property

Ask or verify:

SKIP to 100b

SKIP to 100b

(Was/Were) the article(s) IN or ATTACHED to a
motor vehicle when (it was/they were) taken?
100b.

CHECK

ITEM M2

Yes - ASK 101a
No - SKIP to 101b

Did the offender(s) take a
handgun?
(Is Box 20 marked in 96a?)

101a. NUMBERHANDGUNS

923

Number of handguns

How many handguns were taken?
101b.

CHECK

ITEM M3

Yes - ASK 101a
No - SKIP to 101b

Did the offender(s) take some
other type of firearm?
(Is Box 21 marked in 96a?)

101c. NUMBERFIREARMS

924

Number of handguns

How many other types of firearms were taken?
101d.

CHECK

ITEM N1

Yes - ASK 102a
No - SKIP to 102b

Was cash, a purse, or a wallet
taken? (Is Box 1, 2, or 3 marked
in 96a?)

102a. CASHONPERSON
Ask or verify:

767

1
2

Yes
No

768

1
2

Yes - ASK 103
No - SKIP to 104a

Was the (cash/purse/wallet) on your person,
for instance, in a pocket or being held?
102b. OTHERONPERSON
Ask or verify:
Was there anything (else) the offender(s) took
directly from you, for instance, from your
pocket or hands, or something that you were
wearing?
Exclude property not belonging to respondent or
other household member

Page 22

103. ITEMSTAKEN
Which items did the offender(s) take directly
from you?

769

4
5
6
7

Exclude property not belonging to respondent or
other household member.

8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
40

104a.

CHECK

ITEM N2

Yes - SKIP to 106
No - ASK 104b

Were only cash, a purse, or a
wallet taken? (Are Boxes 1, 2, or
3 the only Boxes marked in 96a?)

104b. PROPERTYVALUE
What was the value of the PROPERTY that was
taken? Include recovered property. (Exclude
any stolen (cash/checks/credit cards) If jointly
owned with a nonhousehold member(s),
include only the share owned by household
members.)

Credit cards, check, bank cards
Car
Other motor vehicle
Part of motor vehicle (tire, hubcap, attached car
stereo or satellite radio, attached CB radio, etc.)
Unattached motor vehicle accessories or equipment
(unattached CD player or satellite radio, etc.)
Gasoline or oil
Bicycle or parts
TV, DVD player, VCR, stereo, other household
appliances
Silver, china, art objects
Other household furnishings (furniture, rugs, etc.)
Portable electronic and photographic gear
(Personal stereo, TV, cellphone, camera, etc.)
Clothing, furs, luggage, briefcase
Jewelry, watch, keys
Collection of stamps, coins, etc.
Toys, sports and recreation equipment
(not listed above)
Other personal and portable objects
Handgun (pistol, revolver)
Other firearm (rifle, shotgun)
Tools, machines, office equipment
Farm or garden produce, plants, fruit, logs
Animals -pet or livestock
Food or liquor
Other
Everything marked in 96a was taken
directly from respondent

770

$ ____________ .

00

Value of property taken

Enter total dollar value for all items taken.
105a. DECIDEDVALUE
How did you decide the value of the property
that was taken?

771

Probe: Any other way?
Enter all that apply.

1
2
3
4
5
6
7

Original cost
Replacement cost
Personal estimate of current value
Insurance report estimate
Police estimate
Don't know
Other - Specify - ASK 105b

SKIP to 106

Specify

105b. DECIDEDVALUE_SPEC
Please specify how the value of the property (that
was taken) was decided.
106. ALLPARTRECOVERED

772

Was all or part of the stolen (money/property)
recovered, not counting anything received
from insurance?
107a. WHATRECOVERED
What was recovered?
Probe: Anything else?
Enter all that apply.
107b.

CHECK

ITEM N3

Follow the skip pattern for the
first category met, based on the
entries in 107a.

776

3

All - SKIP to 107d
Part - ASK 107a
None - SKIP to 109

1
2
3
4
5
6

Cash recovered
Purse
Wallet
Credit cards, checks, bank cards
Car or other motor vehicle
Property other than the above

1
2

If Box 2 and/or 3 is marked in 107a - ASK 107c
If Box 1 is marked in 107a - SKIP to 107d
If none of the conditions above are met - SKIP to 107e

Page 23

1
2

107c. CONTAINMONEY
Did the recovered (purse/wallet) contain any
money?
107d. CASHRECOVERED

775

Yes - ASK 107d
No
If Box 1 is marked in 107a ASK 107d
otherwise SKIP to 107e

$ ____________ .

00

Amount of cash recovered

If necessary:
How much cash was recovered?
107e.

CHECK

NONCASHPROPERTYRECOVERED

777

1
2

778

$ ____________ .

779

1
2
3
4

Yes
No
Don't have insurance
Don't know

780

1
2

Yes - ASK 111
No - SKIP to 115

781

1
2
3

Yes, all
Yes, part
No, none - ASK 112

ITEM O

Yes - ASK 108
No - SKIP to 109

Was PROPERTY other than cash,
checks, or credit cards
recovered? (Are Boxes 2, 3, 5, or
6 marked in 107a?)
108. RECOVEREDCASHVALUE

00

Value of property recovered

Considering any damage, what was the value
of the property after it was recovered? Do not
include recovered (cash/checks/credit cards)
If value of recovered property is the same as value of
property taken then enter the amount from 104b
above.

109. REPORTEDTOINSURANCE
Was the theft reported to an
insurance company?

110. DAMAGED
(Other than any stolen property) was
anything that belonged to you or other
members of the household damaged in this
incident?
Probe: For example, was (a lock or window
broken/clothing damaged/damage done to a
car), or something else?

111. DAMAGEDREPAIRED
(Was/Were) the damaged item(s) repaired or
replaced?
112. ESTCOSTREPAIRREPLACE

782

How much would it cost to repair or replace the
damaged item(s)?

113. ACTCOSTREPAIRREPLACE

0

783

How much was the repair or replacement cost?

114a. PAIDREPAIRS

$ ____________ .

784

Who (paid/will pay) for the repairs or
replacement?
Probe: Anyone else?

1
2
3
4
5
6

Cost to repair/replace -

00

Cost to repair/replace - ASK 114a

No cost - SKIP to 115
Items will not be repaired or replaced
Household member
Landlord or landlord's insurance
Victim's (or household's) insurance
Offender
Other - Specify - ASK 114b

Enter all that apply.
Specify

114b. PAIDREPAIRS_SPEC
Please specify who (paid/will pay) for the repairs or
replacement.
115. POLICEINFORMED
Were the police informed or did they find out
about this incident in any way?

Page 24

800

1
2
3

SKIP
to 114a

00

No cost - SKIP to 115

$ ____________ .
0

SKIP to 113

Yes - ASK 116a
No - SKIP to 117a
Don't know - SKIP to 130

SKIP
to 115

116a. POLICEFINDOUT

801

How did the police find out about it?
Enter first precode that applies.

1
2
3
4
5
6
7

If proxy interview, we want the proxy
respondent to answer questions 116a - 134b for
herself/himself, not for the person for whom the
proxy interview is being taken.

Respondent - SKIP to 119a
Other household member
Someone official called police (guard, apt.
manager, school official, etc.)
Someone else
Police were at scene - SKIP to 123a
Offender was a police officer - SKIP to 124
Some other way - Specify - ASK 116b

SKIP
to 121

Specify - SKIP to 124

116b. POLICEFINDOUT_SPEC
Please specify how the police found out about it.

117a. NOTREPORTEDPOLICE
What was the reason it was not reported to the
police?

802

1
2

Probe: Can you tell me a little more? Any other
reason?
3

Enter all that apply.
4
5

STRUCTURED PROBE Was the reason because you dealt with it
another way, it wasn't important enough to
you, insurance wouldn't cover it, police
couldn't do anything, police wouldn't help, or
was there some other reason?

6

803

7
8
9

10

804

11

12
13

805

14

806

15
16
17
18
19

117b. NOTREPORTEDPOLICE_SPEC

DEALT WITH ANOTHER WAY
Reported to another official (guard, apt.
manager, school official, etc.)
Private or personal matter or took care of it
myself or informally; told offender's parent
NOT IMPORTANT ENOUGH TO RESPONDENT
Minor or unsuccessful crime, small or no
loss, recovered property
Child offender(s), "kid stuff"
Not clear it was a crime or that harm was
intended
INSURANCE WOULDN'T COVER
No insurance, loss less than deductible, etc.
POLICE COULDN'T DO ANYTHING
Didn't find out until too late
Could not recover or identify property
Could not find or identify offender, lack of
proof

Codes
1-17
SKIP
to 117c

POLICE WOULDN'T HELP
Police wouldn't think it was important
enough, wouldn't want to be bothered or
get involved
Police would be inefficient, ineffective
(they'd arrive late or not at all, wouldn't do a
good job, etc.)
Police would be biased, would harass/insult
respondent, cause respondent trouble, etc.)
Offender was police officer
OTHER REASON
Did not want to get offender in trouble with
the law
Was advised not to report to police
Afraid of reprisal by offender or others
Did not want to or could not take time - too
inconvenient
Other - Specify - ASK 117b
Respondent not present or doesn't know
why it wasn't reported - SKIP to 117c

Specify

Please specify the reason it was not reported to the
police.
117c.

CHECK

ITEM P

Is more than one reason marked
in 117a?

1
2

Yes - ASK 118
No - SKIP to 130

Page 25

118. NOTREPORTIMPORTANT

808

Which of these would you say was the most
important reason why the incident was not
reported to the police?

1
2

3
4
5
6
7
8
9
10

11

12

13
14
15
16
17
18
19

119a. REASONREPORT
Besides the fact that it was a crime, did YOU
have any other reason for reporting this
incident to the police?

809

1
2

Probe: Any other reason?
3
4

Enter all that apply.
STRUCTURED PROBE Did you report it to get help with this incident,
to recover your loss, to stop or punish the
offender, to let police know about it, or was
there some other reason?

5

6
810

7
8

9
10
811

11
12

119b. REASONREPORT_SPEC

Reported to another official (guard, apt.
manager, school official, etc.)
Private or personal matter or took care of
it myself or informally; told offender's
parent
Minor or unsuccessful crime, small or no
loss, recovered property
Child offender(s), "kid stuff"
Not clear it was a crime or that harm was
intended
No insurance, loss less than deductible,
etc.
Didn't find out until too late
Could not recover or identify property
Could not find or identify offender, lack
of proof
Police wouldn't think it was important
enough, wouldn't want to be bothered
or get involved
Police would be inefficient, ineffective
(they'd arrive late or not at all, wouldn't
do a good job, etc.)
Police would be biased, would harass/
insult respondent, cause respondent
trouble, etc.)
Offender was police officer
Did not want to get offender in trouble
with the law
Was advised not to report to police
Afraid of reprisal by offender or others
Did not want to or could not take time too inconvenient
Other - Specify
No one reason more important
TO GET HELP WITH THIS INCIDENT
Stop or prevent THIS incident from
happening
Needed help after incident due to injury,
etc.
TO RECOVER LOSS
To recover property
To collect insurance
TO GET OFFENDER
To prevent further crimes against
respondent/ respondent's household
by this offender
To stop this offender from committing
other crimes against anyone
To punish offender
Catch or find offender - other reason
or no reason given
TO LET POLICE KNOW
To improve police surveillance of
respondent's home, area, etc.
Duty to let police know about crime
OTHER
Other reason - Specify - ASK 119b
No other reason - SKIP to 121

Specify

Please specify other reason for reporting this
incident to the police.
119c.

CHECK

ITEM Q

Page 26

Is more than one reason marked
in 119a?

1
2

All
codes,
SKIP
to 130

Yes - ASK 120
No - SKIP to 121

SKIP
to 119c

120. REPORTIMPORTANT

813

22

Stop or prevent THIS incident from
happening
Needed help after incident due to injury, etc.
To recover property
To collect insurance
To prevent further crimes against
respondent/ respondent's household
by this offender
To stop this offender from committing
other crimes against anyone
To punish offender
Catch or find offender - other reason
or no reason given
To improve police surveillance of
respondent's home, area, etc.
Duty to let police know about crime
Other reason
No one reason more important
Because it was a crime was most important

814

1
2
3
4

Yes - ASK 122
No
SKIP to 124
Don't know
Respondent went to police - SKIP to 123a

815

1
2
3
4
5
6

Within 5 minutes
Within 10 minutes
Within an hour
Within a day
Longer than a day
Don't know how soon

816

1
2
3
4
5
6
7

Took report
Searched/looked around
Took evidence (fingerprints, inventory, etc.)
Questioned witnesses or suspects
Promised surveillance
Promised to investigate
Made arrest
Other - Specify - ASK 123b
Don't know - SKIP to 124

Which of these would you say was the most
important reason why the incident was
reported to the police?

1
2
3
4
5

6
7
8
9
10
11
21

121. POLICEARRIVE
Did the police come when they found out
about the incident?
122. TIMEPOLICEARRIVE
How soon after the police found out did they
respond? Was it within 5 minutes, within 10
minutes, an hour, a day, or longer?
Enter the code for the first answer category
respondent is sure of.
123a. POLICEACTION
What did they do while they were (there/here)?
Probe: Anything else?
Enter all that apply.

817

8
9

SKIP
to 124

Specify

123b. POLICEACTION_SPEC
Please specify what they did while they were (there/
here).
124. POLICECONTACT

818

Did you (or anyone in your household) have
any later contact with the police about the
incident?
125a. POLICEINTOUCH

819

Did the police get in touch with you or did you
get in touch with them?

1
2
3

Yes - ASK 125a
No
Don't know

1

Police contacted respondent or other
HHLD member
Respondent (or other HHLD member)
contacted police
Both
Don't know
Other - Specify - ASK 125b

2
3
4
5

SKIP to 128

SKIP
to 126

Specify

125b. POLICEINTOUCH_SPEC
Please specify did the police get in touch with you or
did you get in touch with them.
126. HOWPOLICECONTACT
Was that in person, by phone, or some other
way?

820

1
2
3
4

In person
Not in person (by phone, mail, etc.)
Both in person and not in person
Don't know

Page 27

127a. POLICEFOLLOWUP

821

What did the police do in following up this
incident?
Probe: Anything else?
822

Enter all that apply.

1
2
3
4
5
6
7
8
9

Took report
Questioned witnesses or suspects
SKIP
Did or promised surveillance/investigation
to 128
Recovered property
Made arrest
Stayed in touch with respondent/household
Other - Specify - ASK 127b
Nothing (to respondent's knowledge)
SKIP to 128
Don't know

Specify

127b. POLICEFOLLOWUP_SPEC
Please specify what the police did in following up
this incident.
128. SIGNCOMPLAINT

825

1
2

Yes
No

826

1
2
3

Yes
No
Don't know

827

1
2
3

Yes - ASK 131a
No
Don't know

1
2
3

Government
Private
Don't know

1
2

Yes - ASK 132
No - SKIP to 135a

1
2
3

Yes - ASK 133a
No
Don't know

1
2
3
4
5

Prosecutor, district attorney
Magistrate
Court
Juvenile, probation or parole officer
Other - Specify - ASK 133b

Did you (or someone in your household) sign a
complaint against the offender(s) to the police
department or the authorities?
129. ARRESTMADE
Ask or verify:
As far as you know, was anyone arrested or
were charges brought against anyone in
connection with this incident?
130. AGENCYHELP
Did you (or someone in your household)
receive any help or advice from any office or
agency - other than the police - that deals with
victims of crime?
131a. TYPEOFAGENCY

828

Was that a government or private agency?
131b.

CHECK

ITEM R

Were the police informed? (Is
"Yes" marked in 115?

132. CONTACTAUTHORITIES

829

Have you (or someone in your household) had
contact with any other authorities about this
incident (such as a prosecutor, court, or
juvenile officer)?
133a. AUTHORITIES

830

Which authorities?
Probe: Any others?

SKIP to 131b

SKIP to 134a

Enter all that apply.
Specify

133b. AUTHORITIES_SPEC
Please specify which authorities.

134a. ANYTHINGFURTHER
Do you expect the police, courts, or other
authorities will be doing anything further in
connection with this incident?
134b. ANYTHINGFURTHER_SPEC
Please specify what you expect the police, courts, or
other authorities will be doing (further) in
connection with this incident.

Page 28

831

1
2
3

Yes - Specify - ASK 134b
No
SKIP to 135a
Don't know

Specify

SKIP to 134a

135a. DOINGATINCIDENTTIME
Ask or verify:

832

What were you doing when this incident
(happened/started)?

1
2
3
4
5
6
7
8
9
10
11

Working or on duty - SKIP to 138a
On the way to or from work - SKIP to 142b
On the way to or from school
On the way to or from other place
Shopping, errands
Attending school
Leisure activity away from home
Sleeping
Other activities at home
Other - Specify - ASK 135b
Don't know - SKIP to 136

SKIP
to 136

Specify

135b. DOINGATINCIDENTTIME_SPEC
Please specify what you were doing when this
incident (happened/started).
136. JOBDURINGINCIDENT

840

1
2

Yes - SKIP to 142b
No - ASK 137a

841

1
2
3
4
5
6

Looking for work
Keeping house
Going to school
Unable to work
Retired
Other - Specify - SKIP to 137b

Ask or verify:
Did you have a job at the time of the incident?
137a. MAJORACTIVITY
What was your major activity the week of the
incident - were you looking for work, keeping
house, going to school, or doing something
else?

SKIP to 151

Specify - SKIP to 151

137b. MAJORACTIVITY_SPEC
Please specify what was your major activity the week
of the incident.
138a. EMPLOYERTYPE

843

Now I have a few questions about the job at
which you worked during the time of the
incident.

2
3
4

Were you employed by -

5

(Read each category - then enter appropriate code)

138b. INCORPORATED

953

Is this business incorporated?

138c. EMPLOYERNAME

1

A private company, business, or
individual for wages? - Ask 138b
The Federal government?
A State, county, or local
SKIP to 138c
government?
Yourself (Self-employed) in your own
business, professional practice, or farm?
Ask
138b
A private, not-for-profit, tax-exempt, or
charitable organization?

1
2
3

Yes
No
Don't know

1
2
3
4

Manufacturing?
Retail trade?
Wholesale trade?
Something else?

954

What is the name of the (company/government
agency/business/non-profit organization) for
which you worked at the time of the incident?
138d. TYPEOFBUSINESS

955

What kind of business or industry is this?
Read if necessary: What do they make or do
where you worked at the time of the incident?
138e. BUSINESSSECTOR

956

Is this mainly...
(Read answer categories) 138f. OCCUPATIONDESC

957

What kind of work did you do, that is, what
was your occupation at the time of the
incident?
(For example: plumber, typist, farmer)

Page 29

139. USUALJOBDUTIES

958

What were your usual activities or duties at
this job?

140. JOBMSATYPE

844

1
2
3
4

A city?
Suburban area?
Rural area?
Combination of any of these?

845

1
2
3
4

Yes
SKIP to 141c
No
Don't know
Other - Specify - ASK 141b

While working at this job, did you work mostly
in (Read category - then enter the appropriate code).
141a. INCIDENTHAPPENATWORK
Ask or verify:
Did this incident happen at your work site?

Specify

141b. INCIDENTHAPPENATWORK_SPEC
Please specify
141c. WORKDAYNIGHT

1
2
3

Days

1
2

Yes
No

1
2

Yes (injury marked in 31a - ASK 143
No (blank or "None" marked in 31a - SKIP to 147a

870

1
2

Yes - ASK 144
No - SKIP to 147a

871

____________ Number of days - ASK 145

846

Did you usually work days or nights?

142a. ISCURRENTJOB

959

Is this your current job?
142b.

CHECK

ITEM S

Was the respondent injured in
this incident? (Is Box 2-11
marked in 31a?)

143. LOSTWORKTIME
Did YOU lose time from work because of the
injuries you suffered in this incident?
144. AMOUNTTIMELOST
How much time did you lose because of
injuries?
145. LOSTPAYNOMEDINS

872

During these days, did you lose any pay that
was not covered by unemployment insurance,
sick leave, or some other source?
146. AMOUNTLOSTPAYNOMED

Nights
Both days and nights/rotating shifts

0

Less than one day - SKIP to 147a

1
2

Yes - ASK 146
No - SKIP to 147a

873

$ ____________ .

00

Amount of pay lost

About how much pay did you lose?
147a. LOSTOTHERWORKTIME

874

Did YOU lose any (other) time from work
because of this incident for such things as
cooperating with a police investigation,
testifying in court, or repairing or replacing
damaged or stolen property?

1
2
3
4
5
6

Police related activities
Court related activities
Repairing damaged property
Replacing stolen items
Other - Specify - ASK 147b
None (did not lose time from work for
any of these reasons) - SKIP to 151

Probe: Any other reason?
Enter all that apply.

Specify

147b. LOSTOTHERWORKTIME_SPEC
Please specify the (time/other time) lost from work
because of this incident.
148. DAYLOSTWORK
How much time did you lose altogether
because of (name all reasons marked in 147a)?

Page 30

875

____________ Number of days - ASK 149
0

Less than one day - SKIP to 151

ASK 148

149. LOSTPAYNOEMPINS

876

During these days, did you lose any pay that
was not covered by unemployment insurance,
paid leave, or some other source?
150. AMOUNTLOSTNOPAYEMP

1
2

877

Yes - ASK 150
No - SKIP to 151

$ ____________ .

00

Amount of pay lost

About how much pay did you lose?
151. HHMEMLOSTWORKTIME

1
2

879

____________ Number of days

Were there any (other) household members 16
years or older who lost time from work
because of this incident?
152a. AMOUNTHHMEMTIMELOST
How much time did they lose altogether?

152b.

CHECK

ITEM T

Was the respondent on the way
to or from work, school, or some
other place when the incident
(happened/started)? (Is Box 2, 3,
or 4 marked in 135a?)

153a. TYPETRANSPORTATION

Yes - ASK 152a
No - SKIP to 152b

878

881

Ask or verify:
You told me earlier you were on the way (to/
from) (work/school/some place) when the
incident happened.

0

Less than one day

1
2

Yes - ASK 153a
No - SKIP to 153c

1
2
3
4
5

Car, truck or van
Motorcycle
Bicycle
On foot
School bus (private or public)
Bus or trolley
Subway or rapid transit
Train
Taxi
Other - Specify - Ask 153b

6
7
8
9
10

What means of transportation were you using?

SKIP
to 153c

Specify

153b. TYPETRANSPORTATION_SPEC
Please specify what means of transportation you
were using.
153c.

CHECK

ITEM U

Is this incident part of a series of
crimes? (Is Box 2 (is a "series")
marked in 5c?)

154a. SERIESNUMTIMES

1
2

883

____________ Number of incidents - SKIP to 155a

You have told me about the most recent
incident. How many times did this kind of
thing happen to you during the last 6 months?
154b. SERIESDK
Is that because there is no way of knowing, or
because it happened too many times, or is
there some other reason?
154c. SERIESDKSPEC

Yes - ASK 154a
No - SKIP to 161

Don't know - ASK 154b

884

1
2
3

No way of knowing
SKIP to 155a
Happened too many times
Some other reason - Specify - ASK 154c

Specify

Please specify the other reason the respondent
doesn't know the number of times.

Page 31

Number of incidents per quarter

155a. SERIESWHICHMONTHQ1
In what month or months did these incidents
take place?

885

Jan., Feb., or Mar.
(Qtr. 1)

886

Apr., May, or Jun.
(Qtr. 2)

887

Jul., Aug., or Sept.
(Qtr. 3)

888

Oct., Nov., or Dec.
(Qtr. 4)

Probe: How many in (name months)?
155b. SERIESWHICHMONTHQ2
In what month or months did these incidents
take place?
Probe: How many in (name months)?
155c. SERIESWHICHMONTHSQ3
In what month or months did these incidents
take place?
Probe: How many in (name months)?
155d. SERIESWHICHMONTHQ4
In what month or months did these incidents
take place?
Probe: How many in (name months)?
156. SERIESLOCATION

889

1
2
3

All in the same place
Some in the same place
None in the same place

890

1
2
3
4

All by same person
Some by same person
None by same person
Don't know - SKIP to 159a

1
2
3

RELATIVE
Spouse at time of incident
Ex-spouse at time of incident
Parent or step-parent
Other relative - Specify - ASK 158b

Did all, some, or none of these incidents occur
in the same place?
157. SERIESOFFENDER
Were all, some, or none of these incidents
done by the same person(s)?
158a. SERIESOFFENDERRELATION
What (was/were) the relationship(s) of the
offender(s) to you? For example, friend,
spouse, schoolmate, etc?

966

4

Probe: Anything else?

5

Enter all that apply.
967

6
7
8
10

968

969

11
12
13
14
15

16
17
970

18
19

NONRELATIVE
Friend or ex-friend
Neighbor
Schoolmate
Roommate, boarder
Other nonrelative - Specify - ASK 158c
Customer/client
Patient
Supervisor (current or former)
Employee (current or former)
Co-worker (current or former)
(RELATIVE)
Own child or step-child
Brother/sister
(NONRELATIVE)
Boyfriend or girlfriend, ex-boyfriend or
ex-girlfriend
Teacher/school staff

Specify - SKIP to 159a

158b. SERIESOFFENDERRELATION14SPEC
Please specify the other relative.

Specify

158c. SERIESOFFENDERRELATION26SPEC
Please specify the other nonrelative.
159a. SAMETHINGEACHTIME
Did the same thing happen each time?

159b. HOWINCIDENTSDIFFER
How did the incidents differ?
Page 32

893

1
2

SKIP
to 159a

Yes - SKIP to 160a
No - ASK 159b

Specify

SKIP
to 159a

SKIP
to 159a

160a. TROUBLEONGOING

894

Is the trouble still going on?

1
2

Yes - SKIP to 160c
No - ASK 160b

Specify

160b. WHATENDEDIT
What ended it?
160c. CHECK
ITEM V1

SERIESCONTACTORNOT

895
1

Do not read to respondent.
Enter precode that best describes this series of
crimes. If more than one category describes this
series, enter the appropriate precode with the lowest
number.

2

3
4

5
6

7

8
9

10

11

12

CONTACT CRIMES
Completed or threatened violence in the
course of the victim's job (police officer,
security guard, psychiatric social worker,
etc.)
Completed or threatened violence
between spouses, other relatives,
friends, neighbors, etc.
Completed or threatened violence at
school or on school property
Other contact crimes (other violence,
pocket picking, purse snatching, etc.) Specify - ASK 160d
NONCONTACT CRIMES
Theft or attempted theft of motor
vehicles
Theft or attempted theft of motor
vehicle parts (tire, hubcap, battery,
attached car stereo, etc.)
Theft or attempted theft of contents of
motor vehicle, including unattached
parts
Theft or attempted theft at school or on
school property
Illegal entry of, or attempt to enter,
victim's home, other building on
property, second home, hotel, motel
Theft or attempted theft from victim's
home or vicinity by person(s) KNOWN to
victim (roommate, babysitter, etc.)
Theft or attempted theft from victim's
home or vicinity by person(s)
UNKNOWN to victim
Other theft or attempted theft (at work,
while shopping, etc.) - Specify - ASK 160e

SKIP
to 161

SKIP
to 161

Specify - SKIP to 161

160d. SERIESCONTACTORNOT14SPEC
Please specify the other contact crime.

Specify

160e. SERIESCONTACTORNOT22SPEC
Please specify the other noncontact crime.

161. INCIDENTHATECRIME
Hate crimes or crimes of prejudice or bigotry
occur when (an offender/offenders) target(s)
people because of one or more of their
characteristics or religious beliefs.

910

1
2

Yes - ASK 162
No - SKIP to 174

Do you have any reason to suspect the
incident just discussed was a hate crime or
crime of prejudice or bigotry?

Page 33

An offender/Offenders can target people
for a variety of reasons, but we are only
going to ask you about a few today. Do
you suspect the offender(s) targeted you
because of...

162.

(a) INCIDENTHATETARGETREASON_RACE
Your race?

896

1

Yes

2

No

3

Don't know

897

1

Yes

2

No

3

Don't know

898

1

Yes

2

No

3

Don't know

899

1

Yes

2

No

3

Don't know

900

1

Yes

2

No

3

Don't know

901

1

Yes

2

No

3

Don't know

911

1

Yes - Specify - ASK 163b
No
SKIP to 163c
Don't know

(b) INCHATETARGETREASONS_RELIGION
Your religion?
(c) INCHATETARGETREASONS_ETHNICITY
Your ethnic background or national origin (for
example, people of Hispanic origin)?
(d) INCHATETARGETREASONS_DISABILITY
Any disability (by this I mean physical, mental,
or developmental disabilities) you may have?
(e) INCIDENTHATETARGETREASONS_GENDER
Your gender?
(f) INCIDENTHATETARGETREASONS_SEXUAL
Your sexual orientation?
If "Yes," SAY - (by this we mean homosexual,
bisexual, or heterosexual)
Some offenders target people because
they associate with certain people or the
(offender perceives/offenders perceive)
them as having certain characteristics or
religious beliefs.

163.

Do you suspect you were targeted
because of...
(a) INCIDENTHATETARGETWHOYOUKNOW

2

Your association with people who have certain
characteristics or religious beliefs (for
example, a multiracial couple)?
(b) INCHATETARGETWHOYOUKNOW_SPEC

3

912

Specify

913

1

Please specify why you suspect you were targeted
because of your association with people who have
certain characteristics or religious beliefs.
(c) INCIDENTHATETARGETRELIGION

2

The offender(s)'s perception of your
characteristics or religious beliefs (for
example, the offender(s) thought you were
Jewish because you went into a synagogue)?
(d) INCIDENTHATETARGETRELIGION_SPEC

3

914

Yes - Specify - ASK 163d
No
SKIP to 163e
Don't know

Specify

Please specify why you suspect you were
targeted because of the offender(s)'s perception
of your characteristics or religious beliefs.
163e.

CHECK

ITEM V2

Are one or more boxes marked
"Yes" in 162a through 163c?

164a. INCIDENTHAVEEVIDENCEHATE
Do you have any evidence that this incident
was a hate crime or crime of prejudice or
bigotry?
164b. INCIDENTHAVEEVIDENCE_SUGGEST
Did the offender(s) say something, write
anything, or leave anything behind at the
crime scene that would suggest you were
targeted because of your characteristics or
religious beliefs?

Page 34

915

1
2

Yes - ASK 164a
No - SKIP to 174

1

Yes - SKIP to 165
No
ASK 164b
Don't know

2
3

1
2

Yes - ASK 165
No - SKIP to 174

The next questions ask about the
evidence you have that makes you
suspect this incident was a hate crime or
a crime of prejudice or bigotry. As I read
the following questions, please tell me if
any of the following happened:
(a) INCIDENTEVIDENCEHATE_MAKEFUN
165.

Did the offender(s) make fun of you, make
negative comments, use slang, hurtful words,
or abusive language?

916

1

Yes

2

No

3

Don't know

917

1

Yes

2

No

3

Don't know

918

1

Yes

2

No

3

Don't know

919

1

Yes

2

No

3

Don't know

920

1

Yes

2

No

3

Don't know

921

1

Yes

2

No

3

Don't know

922

1

Yes

2

No

3

Don't know

908

1

Yes
No

(b) INCIDENTEVIDENCEHATE_SYMBOLS
Were any hate symbols present at the crime
scene to indicate the offender(s) targeted you
for a particular reason (for example, a
swastika, graffiti on the walls of a temple, a
burning cross, or written words)?
(c) INCEVIDENCEHATE_POLICETARGET
Did a police investigation confirm the
offender(s) targeted you (for example, did the
offender(s) confess a motive, or did the police
find books, journals, or pictures that
indicated the offender(s) (was/were)
prejudiced against people with certain
characteristics or religious beliefs)?
(d) INCEVIDENCEHATE_OFFENDERDIDSAME
Do you know if the offender(s) (has/have)
committed similar hate crimes or crimes of
prejudice or bigotry in the past?
(e) INCIDENTEVIDENCEHATE_NEARHOLIDAY
Did the incident occur on or near a holiday,
event, location, gathering place, or building
commonly associated with a specific group
(for example, at the Gay Pride March or at a
synagogue, Korean church, or gay bar)?
(f) INCEVIDENCEHATE_OTHERLIKECRIMES
Have other hate crimes or crimes of prejudice
or bigotry happened to you or in your area/
neighborhood where people have been
targeted?
(g) INCEVIDENCEHATE_FELT_BELIEVED
Do your feelings, instincts, or perception lead
you to suspect this incident was a hate crime or
crime of prejudice or bigotry, but you do not
have enough evidence to know for sure?
166. TELLPOLICEHATECRIME
At any time, did you tell the police that you
believed the incident was a hate crime or crime
of prejudice or bigotry?

174.

2

CHECK

SUMMARY
ITEM W
Summarize this incident. Also include any details
about the incident that were not asked about in the
incident report that might help clarify the incident.

Page 35