CJ-43B 2019 CCF Community-Based Correctional Facilities

Attachment 3
OMB No. XXX Approval Expires XXX.  

2019 CENSUS OF STATE AND FEDERAL ADULT
CORRECTIONAL FACILITIES
COMMUNITY-BASED CORRECTIONAL FACILITIES

Form CJ-43B

U.S. DEPARTMENT OF JUSTICE
BUREAU OF JUSTICE STATISTICS
AND ACTING AS COLLECTION AGENT:
RTI INTERNATIONAL

DATA SUPPLIED BY
Name

Title

Official
Address

Telephone

City

FAX

State

Zip

E-mail

GENERAL INFORMATION

FACILITY INFORMATION 

Please complete this questionnaire before [DATE] using one
of  the following methods:
Online: [Survey Web Link TBD]

MERGED INFORMATION ON FACILITY

Mail: RTI International, 2019 CCF, Attn: Christian Genesky
3040 Cornwallis Road, PO Box 12194, Research Triangle
Park, NC 27709-2194
Fax: 1-866-354-4993
If you have any questions, contact Christian Genesky of RTI
International at 1-866-354-4993
or bjs-prisoncensus@rti.org.

FACILITY ELIGIBILITY
The census includes all correctional facilities administered by state departments of corrections (DOC) or the Federal
Bureau of Prisons (BOP) or operated under contract to hold inmates primarily for state correctional authorities or the BOP.
These facilities are intended for adults but sometimes hold juveniles. For this data collection, each individual correctional
facility or unit holding inmates under your jurisdiction is included, even if that facility shares budget or staff with other
facilities.
The CJ-43B is intended to collect data on community-based correctional facilities administered by the state DOC or
operated under contract to primarily house inmates for state correctional authorities or the BOP.

As you complete the survey, please provide a response to each question:
 If the answer to a question is “none” or “zero”

Write “0” in the space provided.

 If an exact numeric answer is not available

Provide an estimate and check the box labeled “Check if
estimate.”

 If an exact numeric answer is not available
and you cannot provide an estimate

Write “DK” (don’t know) in the space provided.

 If you do not know the answer to a question

Write “DK” (don’t know) in the space provided.

 If the question does not apply to your agency
or those you are reporting for

Write “NA” (not applicable) in the space provided.

BURDEN STATEMENT
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB control
number. The burden of this collection is estimated to average 45 minutes per response, including reviewing instructions, searching existing data
sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or any aspect of this
survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. Do
not send your completed form to this address.

   Section I — FACILITY CHARACTERISTICS

1. As of June 30, 2019, what were the functions of this facility? Mark (X) all that apply.
a. Facility functions
General adult population confinement
Alcohol/drug treatment confinement
Reception/diagnosis/classification
Medical treatment/hospitalization confinement
Mental health/psychiatric confinement
Community corrections/work release/prerelease
Boot camp
Primarily for persons returned to custody (e.g., parole violators)
Primarily for confinement of youthful offenders
Geriatric care
Other — Specify:
b. Which facility function selected in question 2 applies to the largest number of inmates?
Mark (X) only ONE box.
General adult population confinement
Alcohol/drug treatment confinement
Reception/diagnosis/classification
Medical treatment/hospitalization confinement
Mental health/psychiatric confinement
Community corrections/work release/prerelease
Boot camp
Primarily for persons returned to custody (e.g., parole violators)
Primarily for confinement of youthful offenders
Geriatric care
Other — Specify:
2. As of June 30, 2019, what percentage of the inmates in this facility were regularly permitted to leave the
facility unaccompanied to work release, study release, rehabilitation? Mark (X) only ONE box.
50% or more
Less than 50%
None

STOP

Please review your answers to Question 1b and Question 2.

If you did not respond “Community corrections/work release/prerelease” to Question 1b and
answered “Less than 50%” or “None” to Question 2, DO NOT complete this form. Please
contact RTI at 1-866-354-4993 or bjs-prisoncensus@rti.org to receive the appropriate form for
this facility.

Otherwise, please continue completing this form.

«AGENCY ID» 

3. Is this facility administratively linked to any other facility? Facilities that share budgets or
administrators are administratively linked.
Yes
No

a. What are the names of the facilities?
Go to
question 4

4. As of June 30, 2019, who operated this facility? Mark (X) only ONE box.
Federal authority
State authority
Local authority
Joint state and local authority
Private contractor
5. As of June 30, 2019, was this facility authorized to house — Mark (X) only ONE box.
Males only
Females only
Both males and females

Section II — INMATE COUNTS
6. On June 30, 2019, what was the total number of inmates in this facility?
 INCLUDE all inmates temporarily absent from this facility (e.g., for court appearances, brief furloughs, and
medical leave).
 EXCLUDE all inmates who were on escape or absent without leave (AWOL).
a. Males

Check if estimate

b. Females

Check if estimate

c. TOTAL (Sum of questions 6a and 6b)

Check if estimate

7. On June 30, 2019, how many inmates in this facility were —
a. Males under age 18

Check if estimate

b. Females under age 18

Check if estimate

c. TOTAL (Sum of questions 7a and 7b)

Check if estimate

«AGENCY ID» 

8. On June 30, 2019, how many inmates in this facility were —
a. White, not of Hispanic origin

Check if estimate

b. Black or African American, not of Hispanic origin

Check if estimate

c. Hispanic or Latino

Check if estimate

d. American Indian/Alaska Native, not of Hispanic origin

Check if estimate

e. Asian, not of Hispanic origin

Check if estimate

f. Native Hawaiian or Other Pacific Islander, not of Hispanic origin

Check if estimate

g. Two or more races, not of Hispanic origin

Check if estimate

h. Additional categories in your information system —
Specify:

Check if estimate

i. TOTAL (Sum of questions 8a to 8h should equal question 6c)

Check if estimate

9. On June 30, 2019, how many inmates in this facility were —
a. U.S. citizens

Check if estimate

b. Not U.S. citizens

Check if estimate

c. Of unknown citizenship status

Check if estimate

d. Total (Sum of questions 9a to 9h should equal question 6c)

Check if estimate

10. On June 30, 2019, how many inmates in this facility were being held for —
a. Federal authorities
Number of inmates

Check if estimate

If zero, skip to question 10b.
If greater than zero: Of all the inmates held for federal authorities, how many were held for —

1. Federal Bureau of Prisons

Check if estimate

2. U.S. Immigration and Customs Enforcement (I.C.E.)

Check if estimate

3. U.S. Marshals Service

Check if estimate

4. Bureau of Indian Affairs

Check if estimate

5. Other — Specify:

Check if estimate

6. TOTAL (Sum of questions 10a1 to 10a5 should equal question 10a)

Check if estimate

«AGENCY ID» 

b. State prison authorities
Number of inmates

Check if estimate

If zero, skip to question 10c.
If greater than zero: Of all the inmates held for state prison authorities, how many were held for —
1. Your state

Check if estimate

2. Some other state(s) — Specify states below:

Check if estimate

3. TOTAL (Sum of questions 10b1 and 10b2 should equal
question 10b)

Check if estimate

c. Local authorities
Number of inmates

Check if estimate

d. Tribal authorities
Number of inmates

Check if estimate

e. TOTAL (Sum of questions 10a to 10d
should equal 6c)
Number of inmates

Check if estimate

Section III — FACILITY OPERATIONS AND SECURITY
11. Between July 1, 2018, and June 30, 2019, how many inmates walked away while on work detail, medical
appointment, court appearance, work release, or furlough and, as a consequence, were officially
recorded as AWOL?
 Walkaway prisoners leave custodial supervision outside a secure institution while on detail, during
transportation, medical visit, or court appearance and are recorded as AWOL. Inmates who return late from
furlough or other temporary release should be counted as walkaways, not escapees.

Number of walkaways

Check if estimate

«AGENCY ID» 

Section IV — FACILITY PROGRAMS

12. As of June 30, 2019, what types of counseling or special programs were available to inmates in this
facility? Mark (X) all that apply.
Drug dependency/counseling/awareness
Alcohol dependency/counseling/awareness
Psychological/psychiatric counseling
HIV/AIDS counseling
Sex offender counseling
Anger management
Employment (e.g., job seeking and interviewing skills)
Life skills and community adjustment (including personal finance, conflict resolution, etc.)
Parenting/child-rearing skills
Canine training
Victim services (provided to inmates who have been victims of crime prior to or during their incarceration)
Other — Specify:
None
13. As of June 30, 2019, what types of educational programs were available to inmates in this facility?
 INCLUDE only formal programs.
 EXCLUDE unscheduled activities and informal programs.
Mark (X) all that apply.
Literacy training or other lower adult basic education (ABE) — first- to fourth-grade level
Upper basic adult education — fifth- to eighth-grade level
Secondary education or High School Equivalency/GED
Special education (e.g., programs for inmates with learning disabilities)
English as a second language (ESL)
Vocational training (e.g., auto repair, drafting, and data processing)
College courses
Study release programs (i.e., release to community to attend school)
Other — Specify:
None

«AGENCY ID» 

Please use the following space to provide any comments to clarify any of your responses or describe any
challenges you had in providing a response.

«AGENCY ID»