Attachments for Generic Clearance

Attachments B to E.pdf

Generic Clearance for Cognitive, Pilot and Field Studies for Bureau of Justice Statistics Data Collection Activities

Attachments for Generic Clearance

OMB: 1121-0339

Document [pdf]

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SSV Generic Clearance Request List of Attachments
1. Attachment B: Consent form to obtain participant consent for participation and recording of the
cognitive interview session
2. Attachment C. Recruitment email sent to participants
3. Attachment D: Screenshots of the draft instruments
4. Attachment E: 2023 SSV surveys ‐ summary and incident forms

PURPOSE
The Bureau of Justice Statistics (BJS) is conducting a short study with assistance from the U.S. Census Bureauon how
to collect information in order to produce the best statistics possible. You are invited to take part in this study, which
seeks to help BJS improve survey questions for BJS’s Survey of Sexual Victimization (SSV). If you agree to participate,
you will be asked during an interview to answer a few questions about the survey design and content and discuss
your answers to these questions. The purpose of this study is to test modifications to the questions and definitions
included in the SSV survey forms. Your responses and feedback will help BJS improve the quality of the SSV survey
form.
The Survey of Sexual Victimization, in part, fulfills BJS’s mandates under the Prison Rape Elimination Act of 2003
(PREA, P.I., 108‐79). The SSV collects information about the allegations and substantiated incidents of sexual
victimization in adult correctional and juvenile justice facilities.

AUTHORITY AND CONFIDENTIALITY
BJS is authorized by law to conduct this survey under Title 34 U.S.C. Section 10132. BJS awarded funds through
an Interagency Agreement to the U.S. Census Bureau to operate as BJS’s data collection agent and administer
the SSV survey. BJS and the Census Bureau are both required by law to protect the privacy and confidentiality of
the data you provide (Title 34 U.S.C. Section 10231 and 28 C.F.R. Part 22).
BJS and the Census Bureau can use your responses only for statistical and research purposes and are not permitted
to publicly release your responses in a way that could identify you, your business, organization, or institution.
Additionally, per the Federal Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity
risks through screening of the systems that transmit your data.
This study has been approved by the Office of Management and Budget (OMB). This eight‐digit OMB number, 1121‐
0292, confirms this approval and expires on 02/28/2024. Without this approval, we could not conduct this study.

VOLUNTARY PARTICIPATION
Your participation is completely voluntary. There is no penalty if you choose to not participate. You may tell an
interviewer at any time that you want to stop the survey, or you may skip questions you do not want to answer.

BURDEN ESTIMATE
We estimate that completing this interview will take no more than 60 minutes.

QUESTIONS
For comments regarding the burden estimate, contact econ.content@census.gov.
For questions about the SSV survey or interview procedures, contact Greta Clark at 800‐253‐2078 or
Greta.B.Clark@census.gov.
For general questions about the SSV program, contact Emily Buehler at 202‐598‐1036 or Emily.buehler@usdoj.gov.
www.census.gov

CONSENT FORM

We would like to audio record what you say during the interview. Only the project staff who work on this study will
hear the recording, which will simply be used to ensure we have understood your answers. If you don’t want to be
recorded, that’s okay.
Please Check the appropriate options below to indicate your consent.
I have read the above, understand that my participation is voluntary, and I agree to participate.
I agree for this interview to be audio‐recorded.
I do not agree for this interview to be audio‐recorded.
I do not agree to participate in the study.
_______________________________________
Signature of Research Participant
_________________________________________
Printed Name of Research Participant

_________________
Date

www.census.gov

Attachment C: Participant recruitment email
SUBJECT: 2023 Survey of Sexual Victimization (SSV) Cognitive Interview Invitation
Dear [TITLE] [NAME],
The Bureau of Justice Statistics (BJS) and its data collection partner, the U.S. Census Bureau, are
working to revise the 2023 Survey of Sexual Victimization (SSV) The SSV helps BJS meet its
mandates under the Prison Rape Elimination Act of 2003 (PREA; P.L. 108–79). It is
administered to all federal and state prison systems; all facilities operated by the U.S. military
and U.S. Immigration and Customs Enforcement; all state juvenile justice systems; and
representative samples of public and private jail jurisdictions, private prisons, jails holding adults
in Indian country, and locally and privately operated juvenile facilities. It has been administered
to annually since 2004 and provides national estimates of the number of allegations and
substantiated incidents of sexual victimization in adult correctional and juvenile justice facilities.
Importantly, before we implement any changes to this survey, we need to obtain direct feedback
from a small number of facilities to ensure the survey questions and instructions are as clear as
possible. I’m writing to ask for your facility’s participation in providing feedback. You were
specifically selected to ensure input from different types of facilities across the country, and I
sincerely hope that you can participate.
If you agree to support this data collection effort by providing feedback, we will:
‐
‐
‐

provide copies of the revised SSV summary and incident forms to your point of contact;
ask them to review the survey and think about how you would answer questions; and
schedule a 1-hour phone interview (maximum) with Census Bureau staff to discuss the
survey.

We hope to collect this feedback throughout February and March, and our team will be flexible
to accommodate your schedule.
Please let me know if you are willing to provide feedback on the 2023 SSV, or if you have
additional questions about this request.
Sincerely,
Emily D. Buehler, Ph.D.
Bureau of Justice Statistics
U.S. Department of Justice
(202) 598-1036
emily.buehler@usdoj.gov

Screenshots of the Draft Instrument
2023 Survey of Sexual Victimization (SSV)
(February 8, 2023)

Table of Contents
Draft of SSV‐2, State Prison Systems Summary Form1
Draft of New Definitions
Draft of SSV‐IA, Substantiated Incident Form (Adult)
Draft of SSV‐IJ, Substantiated Incident Form (Juvenile)

Pages 2‐6

Pages 7‐8

Pages 9‐22

Pages 23‐36

There are six different versions of the Summary Form that are sent to the different types of facilities. The
definitions, categories, and changes are all the same across the six forms.

Screenshots of the Draft Instrument
2023 Survey of Sexual Victimization (SSV)
(February 8, 2023)

OMB No. 1121-0292: Approval Expires xx/xx/xxxx
U.S. DEPARTMENT OF JUSTICE

SSV-1

FORM
(01-10-2023)

BUREAU OF JUSTICE STATISTICS

SURVEY OF SEXUAL VICTIMIZATION, 2023
Federal Bureau of Prisons
Summary Form

AND ACTING AS COLLECTION AGENT

U.S. DEPT. OF COMMERCE
U.S. CENSUS BUREAU

DATA SUPPLIED BY

TELEPHONE
E-MAIL
ADDRESS

Number and street or P.O. Box/Route Number

City

Area code

FAX
NUMBER

Number

State

▼

OFFICIAL
ADDRESS

Title

▼▼▼

Name

Area Code

ZIP Code
Number

(Please correct any error in name, mailing address, and ZIP Code)

What facilities are included in this data collection?
All confinement facilities operated by the Federal Bureau of
Prisons.
● INCLUDE prisons, penitentiaries, and correctional
institutions; boot camps; community correction facilities;
halfway houses; prison farms; reception, diagnostic, and
classification centers; road camps; forestry and
conservation camps; vocational training facilities; prison
hospitals; and drug and alcohol treatment facilities for
prisoners.
● EXCLUDE privately-operated facilities. (These
facilities will be contacted directly for data on
sexual victimization.)
What inmates and incidents are included in this
data collection?
Inmates under your custody between January 1, 2023, and
December 31, 2023.
● INCLUDE incidents involving inmates under the
authority, custody, or care of your confinement or
community-based facilities or staff.
● EXCLUDE incidents involving inmates held in
local jails and facilities in other jurisdictions.

Reporting instructions:
●
●

Please complete the entire SSV-1 Form.
If the answer to a question is "not available" or "unknown,"
write "DK" (do not know) in the space provided.
● If the answer to a question is "not applicable," write "NA"
in the space provided.
● If the answer to a question is "none" or "0," write "0" on
the line.
Substantiated incidents of sexual victimization:
● Please complete an Incident Form (Adult, SSV-IA)
for each substantiated incident of sexual victimization.
Returning forms:
●

If you need assistance, please call Greta Clark at the
U.S. Census Bureau toll–free at 1–800–253–2078,
or e-mail govs.ssv@census.gov

●

Please return your completed summary
and substantiated incident forms by November
12, 2024.

●

You may complete these forms online at:
https://ssv.census.gov/

●

MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000

●

FAX (TOLL FREE): 1–888–262–3974

Burden Statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB
control number. The burden of this collection is estimated to average 60 minutes per response, including reviewing instructions, searching
existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or
any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street,
NW, Washington, DC 20531. Do not send your completed form to this address.

Section I – INMATE–ON–INMATE SEXUAL VICTIMIZATION
DEFINITIONS

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

This survey now utilizes the PREA standard definitions for
types of sexual victimization. These categories are:

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

SEXUAL ABUSE

Sexual abuse of an inmate, detainee, or resident by
another inmate, detainee, or resident includes any of the
following acts, if the victim does not consent, is coerced
into such act by overt or implied threats of violence, or is
unable to consent or refuse:

(1) Contact between the penis and the vulva or the penis
and the anus, including penetration, however slight;

➔

Substantiated only

Please provide an explanation as to why the
Federal Bureau of Prisons does not record
inmate-on-inmate SEXUAL ABUSE
allegations, in the space below, and skip to
Item 4.

(2) Contact between the mouth and the penis, vulva, or
anus;
(3) Penetration of the anal or genital opening of another
person, however slight, by a hand, finger, object, or
other instrument; and

2. Between January 1, 2023, and December 31, 2023,
how many allegations of inmate-on-inmate
SEXUAL ABUSE were reported?

(4) Any other intentional touching, either directly or through
the clothing, of the genitalia, anus, groin, breast, inner
thigh, or the buttocks of another person, excluding
contact incidental to a physical altercation.

Number reported . . . . . .
● If an allegation involved multiple victimizations,
count only once.

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

● Exclude any allegations that were reported as
consensual.
3. Of the allegations reported in Item 2, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)
a. Substantiated . . . . . . .
● The event was investigated and determined to
have occurred, based on a preponderance of the
evidence (28 C.F.R. §115.72).
b. Unsubstantiated . . . . .
● The investigation concluded that evidence was
insufficient to determine whether or not the event
occurred.
c. Unfounded . . . . . . . . . .
● The investigation determined that the event did NOT
occur.
d. Investigation ongoing .
● Evidence is still being gathered, processed
or evaluated, and a final determination has not yet
been made.
e. TOTAL (Sum of Items
3a through 3d) . . . . . . . .
● The total should equal the number reported in Item 2.

FORM SSV-1 (01-10-2023)

Page 2

Section II – STAFF-ON-INMATE SEXUAL VICTIMIZATION

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

Yes

DEFINITIONS

➔ Do you record all reported

STAFF SEXUAL ABUSE

allegations or only substantiated
ones?
01

All

Substantiated only

Sexual abuse of an inmate, detainee, or resident by a staff
member, contractor, or volunteer includes any of the following
acts, with or without consent of the inmate, detainee, or
resident:
(1) Contact between the penis and the vulva or the penis
and the anus, including penetration, however slight;

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

5. Between January 1, 2023, and December 31, 2023,
how many allegations of inmate-on-inmate
SEXUAL HARASSMENT were reported?
Number reported

(6) Any attempt, threat, or request by a staff member,
contractor, or volunteer to engage in the activities
described in paragraphs (1)–(5) of this section;

......

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

(7) Any display by a staff member, contractor, or volunteer
of his or her uncovered genitalia, buttocks, or breast in
the presence of an inmate, detainee, or resident, and

● Exclude any allegations that were reported as
consensual.

(8) Voyeurism by a staff member, contractor, or volunteer.

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

STAFF SEXUAL HARASSMENT
Repeated verbal comments or gestures of a sexual nature to an
inmate, detainee, or resident by a staff member, contractor, or
volunteer, including demeaning references to gender, sexually
suggestive or derogatory comments about body or clothing, or
obscene language or gestures.

a. Substantiated . . . . . . . .

b. Unsubstantiated . . . . . .

c. Unfounded

..........

d. Investigation ongoing . .

e. TOTAL (Sum of Items
6a through 6d) . . . . . . . . .
● The total should equal the number reported in
Item 5.

FORM SSV-1 (01-10-2023)

(5) Any other intentional contact, either directly or through
the clothing, of or with the genitalia, anus, groin, breast,
inner thigh, or the buttocks, that is unrelated to official
duties or where the staff member, contractor, or
volunteer has the intent to abuse, arouse, or gratify
sexual desire;

Page 3

7. Does the Federal Bureau of Prisons record
allegations of STAFF SEXUAL ABUSE?
01

Yes

➔

10. Does the Federal Bureau of Prisons record
allegations of STAFF SEXUAL HARASSMENT?
(See definitions on page 3.)

Do you record all reported
occurrences, or only substantiated
ones?
01

All

Substantiated only

Yes

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

Please provide an explanation in the space
below and then skip to Item 10.

11. Between January 1, 2023, and
December 31, 2023, how many allegations
of STAFF SEXUAL HARASSMENT were
reported?
Number reported . . . . . . .
8. Between January 1, 2023, and December 31,
2023, how many allegations of STAFF SEXUAL
ABUSE were reported?
Number reported . . . . . . .
● If an allegation involved multiple victimizations,
count only once.

● If an allegation involved multiple victims or staff,
count only once.
12. Of the allegations reported in Item 11, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

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

a. Substantiated

b. Unsubstantiated

.......

b. Unsubstantiated

.......

.....

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

.....

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

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

● The total should equal the number reported in
Item 11.
d. Investigation ongoing . .
e. TOTAL (Sum of Items
9a through 9d) . . . . . . . . .
● The total should equal the number reported in
Item 8.

FORM SSV-1 (01-10-2023)

Page 4

Section III – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION

NOTES

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

➔

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

FORM SSV-1 (01-10-2023)

Page 5

OMB No. 1121-0292: Approval Expires xx/xx/xxxx
U.S. DEPARTMENT OF JUSTICE

SSV-2

FORM
(10-27-2022)

BUREAU OF JUSTICE STATISTICS

SURVEY OF SEXUAL VICTIMIZATION, 2023
State Prison Systems
Summary Form

AND ACTING AS COLLECTION AGENT

U.S. DEPT. OF COMMERCE
U.S. CENSUS BUREAU

DATA SUPPLIED BY

TELEPHONE
E-MAIL
ADDRESS

Number and street or P.O. Box/Route Number

City

Area code

FAX
NUMBER

Number

State

▼

OFFICIAL
ADDRESS

Title

▼▼▼

Name

Area Code

ZIP Code
Number

(Please correct any error in name, mailing address, and ZIP Code)

What facilities are included in this data collection?
All State-operated confinement facilities that are intended for
adults but sometimes hold juveniles.
● INCLUDE prisons, penitentiaries, and correctional
institutions; boot camps; community correction facilities;
halfway houses; prison farms; reception, diagnostic, and
classification centers; road camps; forestry and
conservation camps; vocational training facilities; prison
hospitals; and drug and alcohol treatment facilities for
prisoners.
● INCLUDE State-operated local detention facilities in
Alaska, Connecticut, Delaware, Hawaii, Rhode Island,
and Vermont.
● EXCLUDE privately operated facilities and
facilities operated and administered by local
governments. (These facilities will be
contacted directly for data on sexual
victimization.)
● EXCLUDE facilities that hold only juveniles. (These
facilities will be contacted directly for data on sexual
victimization.)
What inmates and incidents are included in this
data collection?
Inmates under your custody between January 1, 2023, and
December 31, 2023.
● INCLUDE incidents involving inmates under the
authority, custody, or care of your confinement or
community-based facilities or staff.

Reporting instructions:
●
●

Please complete the entire SSV-2 Form.
If the answer to a question is "not available" or "unknown,"
write "DK" (do not know) in the space provided.
● If the answer to a question is "not applicable," write "NA"
in the space provided.
● If the answer to a question is "none" or "0," write "0" in
the space provided.
Substantiated incidents of sexual victimization:
● Please complete an Incident Form (Adult, SSV-IA)
for each substantiated incident of sexual victimization.
Returning forms:
● If you need assistance, please call Greta Clark at the
U.S. Census Bureau toll–free at 1–800–253–2078, or
e-mail greta.b.clark@census.gov
● Please return your completed summary and
substantiated incident forms by November 12,
2024.
● You may complete these forms online at:
https://ssv.census.gov/
● MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000
● FAX (TOLL FREE): 1–888–262–3974

● EXCLUDE incidents involving inmates held in
local jails and facilities in other jurisdictions.
Burden Statement

Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB
control number. The burden of this collection is estimated to average 60 minutes per response, including reviewing instructions, searching
existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or
any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street,
NW, Washington, DC 20531. Do not send your completed form to this address.

Section I – INMATE–ON–INMATE SEXUAL VICTIMIZATION 1. Does your State prison system record
allegations of inmate-on-inmate
SEXUAL ABUSE?
DEFINITIONS
Yes ➔ Do you record all reported
01
occurrences, or only substantiated
This survey now utilizes the PREA standard definitions for
ones?
types of sexual victimization. These categories are:
SEXUAL ABUSE

All

Substantiated only

(1) Contact between the penis and the vulva or the penis
and the anus, including penetration, however slight;

➔

Please provide an explanation as to why your
State prison system does not record
inmate-on-inmate SEXUAL ABUSE
allegations, in the space below, and skip to
Item 4.

(2) Contact between the mouth and the penis, vulva, or
anus;
(3) Penetration of the anal or genital opening of another
person, however slight, by a hand, finger, object, or
other instrument; and
(4) Any other intentional touching, either directly or through
the clothing, of the genitalia, anus, groin, breast, inner
thigh, or the buttocks of another person, excluding
contact incidental to a physical altercation.

2. Between January 1, 2023, and December 31, 2023,
how many allegations of inmate-on-inmate
SEXUAL ABUSE were reported?
Number reported . . . . . .
● If an allegation involved multiple victimizations,
count only once.

a. Substantiated

.......

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

.....

● The investigation concluded that evidence was
insufficient to determine whether or not the event
occurred.
c. Unfounded . . . . . . . . . .
● The investigation determined that the event did NOT
occur.
d. Investigation ongoing

● Evidence is still being gathered, processed or evaluated,
and a final determination has not yet been made.
e. TOTAL (Sum of Items
3a through 3d . . . . . . .
● The total should equal the number reported in Item 2.

FORM SSV-2 (10-27-2022)

Page 2

Section II – STAFF-ON-INMATE SEXUAL VICTIMIZATION

4. Does your State prison system record
allegations of inmate-on-inmate SEXUAL
HARASSMENT? (See definitions on page 2.)
01

Yes

DEFINITIONS

➔ Do you record all reported

STAFF SEXUAL ABUSE

allegations or only substantiated
ones?

➔

All

Substantiated only

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

5. Between January 1, 2023, and December 31, 2023,
how many allegations of inmate-on-inmate
SEXUAL HARASSMENT were reported?

(6) Any attempt, threat, or request by a staff member,
contractor, or volunteer to engage in the activities
described in paragraphs (1)–(5) of this section;

Number reported . . . . . .
● If an allegation involved multiple victims or
inmate perpetrators, count only once.

(7) Any display by a staff member, contractor, or volunteer
of his or her uncovered genitalia, buttocks, or breast in
the presence of an inmate, detainee, or resident, and

● Exclude any allegations that were reported as
consensual.

(8) Voyeurism by a staff member, contractor, or volunteer.

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

a. Substantiated

.......

b. Unsubstantiated

.....

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

d. Investigation ongoing .

e. TOTAL (Sum of Items
6a through 6d) . . . . . . .
● The total should equal the number reported in
Item 5.

FORM SSV-2 (10-27-2022)

Page 3

Does your State prison system record
allegations of STAFF SEXUAL ABUSE?
(See definitions on page 3.)
01

Yes

10. Does your State prison system record
allegations of STAFF SEXUAL HARASSMENT?
(See definitions on page 3.)

➔ Do you record all reported

occurrences, or only substantiated
ones?
01

All

Substantiated only

Yes

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

➔ Please provide an explanation in the space
below and then skip to Item 10.

11. Between January 1, 2023, and
December 31, 2023, how many allegations
of STAFF SEXUAL HARASSMENT were
reported?
8.

Number reported . . . . . . .
● If an allegation involved multiple victimizations,
count only once.
9.

Number reported . . . . . . .
● If an allegation involved multiple victims or staff,
count only once.

Between January 1, 2023, and
December 31, 2023, how many allegations of
STAFF SEXUAL ABUSE were reported?

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

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

a. Substantiated

.......

b. Unsubstantiated . . . . .

a. Substantiated . . . . . . .

c. Unfounded . . . . . . . . . .
b. Unsubstantiated . . . . .
d. Investigation ongoing .
c. Unfounded . . . . . . . . . .

e. TOTAL (Sum of Items
12a through 12d) . . . . .
● The total should equal the number reported in
Item 11.

d. Investigation ongoing .
e. TOTAL (Sum of Items
9a through 9d) . . . . . . .
● The total should equal the number reported in
Item 8.

FORM SSV-2 (10-27-2022)

Page 4

NOTES

Section III – PRIVATE AND LOCAL ALLEGATIONS
13. Did any of the allegations reported in Items 2,
5, 8, or 11 occur in a privately operated facility?
01

Yes

14. Did any of the allegations reported in Items 2,
5, 8, or 11 occur in a facility operated and
administered by local governments?
01

Yes

No
Section IV – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION

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

➔

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

FORM SSV-2 (10-27-2022)

Page 5

OMB No. 1121-0292: Approval Expires xx/xx/xxxx
U.S. DEPARTMENT OF JUSTICE

SSV-3

FORM
(12-8-2022)

SURVEY OF SEXUAL VICTIMIZATION, 2023
Local Jail Jurisdictions
Summary Form

BUREAU OF JUSTICE STATISTICS

AND ACTING AS COLLECTION AGENT

U.S. DEPT. OF COMMERCE
U.S. CENSUS BUREAU

DATA SUPPLIED BY

TELEPHONE
E-MAIL
ADDRESS

Number and street or P.O. Box/Route Number

City

Area code

FAX
NUMBER

Number

State

▼

OFFICIAL
ADDRESS

Title

▼▼▼

Name

Area Code

ZIP Code
Number

(Please correct any error in name, mailing address, and ZIP Code)

What facilities are included in this data collection?

Reporting instructions:
●

All confinement facilities usually operated by a local law
enforcement agency that are intended for adults but
sometimes hold juveniles.

Please complete the entire SSV-3 Form.

●

● INCLUDE all jails and city/county correctional centers
that hold inmates beyond arraignment. Report on ALL
inmates, including those held in separate holding or
lockup areas within your facility.
● INCLUDE multi-jurisdictional facilities (e.g., regional jails).
● INCLUDE special jail facilities (e.g., medical/treatment/
release centers, halfway houses, and work farms).
● EXCLUDE privately-operated jails. (These
facilities will be contacted directly for data on
sexual victimization.)
What inmates and incidents are included in this
data collection?
Inmates under your custody between January 1, 2023, and
December 31, 2023.
● INCLUDE incidents involving inmates under the
authority, custody, or care of your confinement or
community-based facilities or staff.

If the answer to a question is "not available" or "unknown,"
write "DK" (do not know) in the space provided.
● If the answer to a question is "not applicable," write "NA"
in the space provided.
●

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

●

Sections II, III, and IV: if the answer to a question is
"none" or "zero," write "0" on the line.

Substantiated incidents of sexual victimization:
●

Returning forms:
● If you need assistance, please call Greta Clark at the
U.S. Census Bureau toll–free at 1–888–369–3613,
option 2, or e-mail govs.ssv@census.gov
● Please return your completed summary
and substantiated incident forms by
October 29, 2024.
● You may complete these forms online at:
https://ssv.census.gov/
●

● EXCLUDE inmates held in other jurisdictions.

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

•

MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000
FAX (TOLL FREE): 1–888–262–3974

Burden Statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB
control number. The burden of this collection is estimated to average 30 minutes per response, including reviewing instructions, searching
existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or
any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street,
NW, Washington, DC 20531. Do not send your completed form to this address.

Section I – GENERAL INFORMATION

Section II – INMATE-ON-INMATE SEXUAL VICTIMIZATION

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

DEFINITIONS
This survey now utilizes the PREA standard definitions for
types of sexual victimization. These categories are:

a. CONFINED in your jail facilities on
December 31, 2023?

SEXUAL ABUSE

● INCLUDE persons on transfer to treatment facilities
but who remain under your jurisdiction.

● INCLUDE persons out to court while under your
jurisdiction.
● INCLUDE persons held for other jurisdictions.

(1) Contact between the penis and the vulva or the penis
and the anus, including penetration, however slight;

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

(2) Contact between the mouth and the penis, vulva, or
anus;

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

(3) Penetration of the anal or genital opening of another
person, however slight, by a hand, finger, object, or
other instrument; and

● EXCLUDE all persons in non-residential
community-based programs run by your jail (e.g.,
electronic monitoring, house arrest, community
service, day reporting, work programs).
Male
Inmates on
December 31, 2023

Female
SEXUAL HARASSMENT

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

b. ADMITTED to your jail facilities during 2023?
● INCLUDE new admissions only, i.e., persons officially
booked into and housed in your facilities by formal legal
document and by the authority of the courts or some
other official agency.
● INCLUDE repeat offenders booked on new charges.
● EXCLUDE returns from escape, work release, medical
appointments/treatment facilities, and bail or court
appearances.
Male

Female

New admissions
during 2023 . . . . . . . . .

2. Between January 1, 2023, and
December 31, 2023, what was the average
daily population of all jail conﬁnement
facilities operated by your jurisdiction?
● To calculate the average daily population, add the
number of persons for each day during the period
January 1, 2023, through December 31, 2023, and
divide the result by 365.
Male

Female

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

FORM SSV-3 (12-8-2022)

Page 2

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

All

Substantiated only

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

➔ Please provide an explanation as to why your
local jail jurisdiction does not record
inmate-on-inmate SEXUAL ABUSE
allegations, in the space below, and skip to
Item 6.

4. Between January 1, 2023, and December 31, 2023,
how many allegations of inmate-on-inmate
SEXUAL ABUSE were reported?

➔ Do you record all reported

allegations or only substantiated
ones?

➔

All

Substantiated only

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

7. Between January 1, 2023, and December 31, 2023,
how many allegations of inmate-on-inmate
SEXUAL HARASSMENT were reported?

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

Number reported . . . . . . .
● If an allegation involved multiple victims or inmate
perpetrators, count only once.
● Exclude any allegations that were reported as
consensual.

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

Yes

8. Of the allegations reported in Item 7, how many
were—

......
a. Substantiated . . . . . . . .

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

b. Unsubstantiated . . . . . .

....

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

c. Unfounded

..........

d. Investigation ongoing

c. Unfounded . . . . . . . . .
● The investigation determined that the event did
NOT occur.
d. Investigation ongoing

e. TOTAL Sum of Items
8a through 8d) . . . . . . . . .
● The total should equal the number reported in
Item 7.

● Evidence is still being gathered, processed or evaluated,
and a final determination has not yet been made.
e. TOTAL (Sum of Items
5a through 5d) . . . . . . . . . .
● The total should equal the number reported in Item 4.

FORM SSV-3 (12-8-2022)

Page 3

Section III – STAFF-ON-INMATE SEXUAL VICTIMIZATION

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

DEFINITIONS

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

All

Substantiated only

➔ Please provide an explanation in the space
below and then skip to Item 12.

10. Between January 1, 2023, and
December 31, 2023, how many allegations of
STAFF SEXUAL ABUSE were reported?

Number reported

......

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

(6) Any attempt, threat, or request by a staff member,
contractor, or volunteer to engage in the activities
described in paragraphs (1)–(5) of this section;
(7) Any display by a staff member, contractor, or volunteer
of his or her uncovered genitalia, buttocks, or breast in
the presence of an inmate, detainee, or resident, and

a. Substantiated

.......

(8) Voyeurism by a staff member, contractor, or volunteer.
STAFF SEXUAL HARASSMENT

b. Unsubstantiated

Repeated verbal comments or gestures of a sexual nature to an
inmate, detainee, or resident by a staff member, contractor, or
volunteer, including demeaning references to gender, sexually
suggestive or derogatory comments about body or clothing, or
obscene language or gestures.

c. Unfounded

.....

..........

d. Investigation ongoing

e. TOTAL (Sum of Items
11a through 11d) . . . . . . .
● The total should equal the number
reported in Item 10.

FORM SSV-3 (12-8-2022)

Page 4

Section IV – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION

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

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

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

Yes

No ➔ Skip to Item 15.

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

➔ Please provide an explanation in the space
below and then skip to Item 15.

13. Between January 1, 2023, and
December 31, 2023, how many allegations of
STAFF SEXUAL HARASSMENT were reported?
Number reported

......

● If an allegation involved multiple victims or staff,
count only once.
14. Of the allegations reported in Item 13, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual victimization in order to fully complete this
form.)
a. Substantiated . . . . . . .

b. Unsubstantiated . . . . .

c. Unfounded

.........

d. Investigation ongoing

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

FORM SSV-3 (12-8-2022)

Page 5

➔

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

NOTES

FORM SSV-3 (12-8-2022)

Page 6

OMB No. 1121-0292: Approval Expires xx/xx/xxxx
U.S. DEPARTMENT OF JUSTICE

SSV-4

FORM
(12-8-2022)

BUREAU OF JUSTICE STATISTICS

SURVEY OF SEXUAL VICTIMIZATION, 2023
Other Correctional Facilities
Summary Form

AND ACTING AS COLLECTION AGENT

U.S. DEPT. OF COMMERCE
U.S. CENSUS BUREAU

DATA SUPPLIED BY
Title

TELEPHONE
E-MAIL
ADDRESS

Number and street or P.O. Box/Route Number

City

Area code

FAX
NUMBER

Number

State

▼

OFFICIAL
ADDRESS

▼▼▼

Name

Area Code

ZIP Code
Number

(Please correct any error in name, mailing address, and ZIP Code)

What facilities are included in this data collection?

•

•
•
•
•
•

PRIVATELY OPERATED FACILITIES: All privately
owned or operated confinement facilities including prisons,
jails, detention centers, community-based facilities, and other
correctional facilities that are intended for adults but
sometimes hold juveniles. INCLUDE privately operated
multi-jurisdictional facilities.
FACILITIES OPERATED BY OR FOR:
THE UNITED STATES MILITARY
THE BUREAU OF IMMIGRATION AND
CUSTOMS ENFORCEMENT
TRIBAL AUTHORITIES
THE BUREAU OF INDIAN AFFAIRS

What inmates and incidents are included in this data
collection?
Inmates under your custody between January 1, 2023, and
December 31, 2023.

•
•

INCLUDE incidents involving inmates under the authority,
custody, or care of your confinement or community-based
facilities or staff.
EXCLUDE inmates held in other jurisdictions.

Reporting instructions:
Please complete the entire SSV-4 Form.
If the answer to a question is "not available" or "unknown,"
write "DK" (do not know) in the space provided.
If the answer to a question is "not applicable," write "NA" in
the space provided.
Section I: when exact numeric answers are not available,
provide estimates and mark ( X ) the box beside each
figure.
Sections II, III, and IV: If the answer to a question is "none"
or "zero," write "0" on the line.

•
•
•
•
•

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

•

Returning forms:
If you need assistance, please call the U.S. Census
Bureau toll–free at 1–888–369–3613, option 2,
or e-mail govs.ssv@census.gov
Please return your completed summary and
substantiated incident forms by October
29, 2023.
You may complete these forms online at:
https://ssv.census.gov/

•
•
•
•
•

MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000
FAX (TOLL FREE) TO: 1–888–262–3974

Burden statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB
control number. The burden of this collection is estimated to average 30 minutes per response, including reviewing instructions, searching
existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or
any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street,
NW, Washington, DC 20531. Do not send your completed form to this address.

Section II – INMATE-ON-INMATE SEXUAL VICTIMIZATION

Section I – GENERAL INFORMATION
1. How many persons under the supervision of your
facility were—

DEFINITIONS
This survey now utilizes the PREA standard definitions for
types of sexual victimization. These categories are:

a. CONFINED on December 31, 2023?
● INCLUDE persons on transfer to treatment
facilities but who remain under your jurisdiction.

SEXUAL ABUSE

● INCLUDE persons held for other jurisdictions.

● EXCLUDE inmates on AWOL, escape, or longterm transfer to other jurisdictions.

(1) Contact between the penis and the vulva or the penis
and the anus, including penetration, however slight;

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

(2) Contact between the mouth and the penis, vulva, or
anus;

● INCLUDE persons out to court while under your
jurisdiction.

Male
Inmates on
December 31, 2023

(3) Penetration of the anal or genital opening of another
person, however slight, by a hand, finger, object, or
other instrument; and

Female

b. ADMITTED to your facility during 2023?
SEXUAL HARASSMENT

● INCLUDE new admissions only, i.e., persons
officially booked into and housed in your facilities by
formal legal document and by the authority of the
courts or some other official agency.

● INCLUDE repeat offenders booked on new charges.
● EXCLUDE returns from escape, work release, medical
appointments/treatment facilities, and bail or court
appearances.
Male

Female

New admissions
during 2023 . . . . . . . . .
2. Between January 1, 2023, and
December 31, 2023, what was the average
daily population of your conﬁnement facility?
● To calculate the average daily population, add the
number of persons for each day during the period
January 1, 2023, through December 31, 2023, and
divide the result by 365.
Male

Female

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

FORM SSV-4 (12-8-2022)

Page 2

3. Does your facility record allegations of
inmate-on-inmate SEXUAL ABUSE?
(See definitions on page 2.)
Yes

6. Does your facility record allegations of inmate-oninmate SEXUAL HARASSMENT? (See definitions on
page 2.)

➔ Do you record all reported occurrences,

or only substantiated ones?
01

All

Substantiated only

➔ Please provide an explanation as to why your
facility does not record inmate-on-inmate
SEXUAL ABUSE allegations, in the space
below, and skip to item 6.

Yes

➔ Do you record all reported

allegations or only substantiated
ones?
01

All

Substantiated only

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

4. Between January 1, 2023, and
December 31, 2022, how many allegations
of inmate-on-inmate SEXUAL ABUSE were
reported?
Number reported . . . . . .
● If an allegation involved multiple victimizations, count
only once.
● Exclude any allegations that were reported as consensual.

7. Between January 1, 2023, and
December 31, 2023, how many allegations of
inmate-on-inmate SEXUAL HARASSMENT
were reported?

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

Number reported . . . . . . .
● If an allegation involved multiple victims or inmate
perpetrators, count only once.
● Exclude any allegations that were reported as consensual.

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

8. Of the allegations reported in Item 7, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)

....

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

a. Substantiated . . . . . .

.........

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

b. Unsubstantiated . . . . .

● Evidence is still being gathered, processed or evaluated,
and a final determination has not yet been made.

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

e. TOTAL (Sum of Items
5a through 5d) . . . . . . . .
● The total should equal the number reported in Item 4.

d. Investigation ongoing .

e. TOTAL (Sum of Items 8a
through 8d) . . . . . . . . . .
● The total should equal the number reported in Item 7.
FORM SSV-4 (12-8-2022)

Page 3

Section III – STAFF-ON-INMATE SEXUAL VICTIMIZATION

9. Does your facility record allegations of STAFF
SEXUAL ABUSE? (See definitions on page 4.)

DEFINITIONS

STAFF SEXUAL ABUSE

Yes

➔ Do you record all reported

occurrences, or only substantiated
ones?
01

All

Substantiated only

➔ Please provide an explanation in the space
below and then skip to Item 12.

(2) Contact between the mouth and the penis, vulva, or
anus;
(3) Contact between the mouth and any body part where
the staff member, contractor, or volunteer has the intent
to abuse, arouse, or gratify sexual desire;
(4) Penetration of the anal or genital opening, however
slight, by a hand, finger, object, or other instrument, that
is unrelated to official duties or where the staff member,
contractor, or volunteer has the intent to abuse, arouse,
or gratify sexual desire;
(5) Any other intentional contact, either directly or through
the clothing, of or with the genitalia, anus, groin, breast,
inner thigh, or the buttocks, that is unrelated to official
duties or where the staff member, contractor, or
volunteer has the intent to abuse, arouse, or gratify
sexual desire;

10. Between January 1, 2023, and
December 31, 2023, how many allegations of
STAFF SEXUAL ABUSE were reported?

(6) Any attempt, threat, or request by a staff member,
contractor, or volunteer to engage in the activities
described in paragraphs (1)–(5) of this section;

Number reported . . . . . . .
● If an allegation involved multiple victimizations, count
only once.

(7) Any display by a staff member, contractor, or volunteer
of his or her uncovered genitalia, buttocks, or breast in
the presence of an inmate, detainee, or resident, and

11. Of the allegations reported in Item 10, how
many were — (Please contact the agency or
office responsible for investigation allegations of
sexual victimization in order to fully complete this
form.)

(8) Voyeurism by a staff member, contractor, or volunteer.
STAFF SEXUAL HARASSMENT
Repeated verbal comments or gestures of a sexual nature to an
inmate, detainee, or resident by a staff member, contractor, or
volunteer, including demeaning references to gender, sexually
suggestive or derogatory comments about body or clothing, or
obscene language or gestures.

a. Substantiated . . . . . . .

b. Unsubstantiated . . . . .

c. Unfounded

.........

d. Investigation ongoing .

e. TOTAL (Sum of Items 11a
through 11d) . . . . . . . . . .
● The total should equal the number reported in Item 10.

FORM SSV-4 (12-8-2022)

Page 4

Section IV – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION

12. Does your facility record allegations of STAFF
SEXUAL HARASSMENT? (See definitions on page 4.)
01

Yes

➔ Can these allegations be counted

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

separately from allegations of
STAFF SEXUAL ABUSE?
01

Yes

No ➔ Skip to Item 15.

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

➔ Please provide an explanation in the space
below and skip to Item 15.

➔ Please complete a Substantiated Incident

Form (Adult, SSV-IA) for each substantiated
incident of sexual victimization.

13. Between January 1, 2023, and
December 31, 2023, how many allegations of
STAFF SEXUAL HARASSMENT were reported?

Number reported . . . . . .
● If an allegation involved multiple victims or staff, count
only once.
14. Of the allegations reported in Item 13, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual victimization in order to fully complete this
form.)
a. Substantiated . . . . . . .

b. Unsubstantiated . . . . .

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

d. Investigation ongoing .

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

FORM SSV-4 (12-8-2022)

Page 5

NOTES

FORM SSV-4 (12-8-2022)

Page 6

OMB No. 1121-0292: Approval Expires xx/xx/xxxx
U.S. DEPARTMENT OF JUSTICE

SSV-5

FORM
(12-9-2022)

BUREAU OF JUSTICE STATISTICS

SURVEY OF SEXUAL VICTIMIZATION, 2023
State Juvenile Systems
Summary Form

AND ACTING AS COLLECTION AGENT

U.S. DEPT. OF COMMERCE

U.S. CENSUS BUREAU

DATA SUPPLIED BY

TELEPHONE
E-MAIL
ADDRESS

Number and street or P.O. Box/Route Number

City

Area code

FAX
NUMBER

Number

State

▼

OFFICIAL
ADDRESS

Title

▼▼▼

Name

Area Code

ZIP Code
Number

(Please correct any error in name, mailing address, and ZIP Code)

What facilities are included in this data collection?
All State-operated juvenile residential placement facilities
used to house juveniles and youthful offenders, regardless of
age or reason for placement.
● INCLUDE State-operated juvenile residential facilities
such as: detention centers, training schools, long-term
secure facilities; reception or diagnostic centers; group
homes or halfway houses; boot camps; ranches; forestry
camps, wilderness or marine programs, or farms;
runaway or homeless shelters; and residential treatment
centers for juveniles.
● EXCLUDE privately operated facilities and
facilities operated or administered by local
governments. (These facilities will be
contacted directly for data on sexual
victimization.)
What persons and incidents are included in this
data collection?
Juveniles and youthful offenders, regardless of age or reason
for placement, under your custody between January 1, 2023,
and December 31, 2023.
● INCLUDE incidents involving juveniles or youthful
offenders under the authority, custody, or care of your
confinement or community-based facilities or staff.
● EXCLUDE incidents involving juveniles or
youthful offenders not held in facilities
operated by your State juvenile system.

Reporting instructions:
●
●

Please complete the entire SSV-5 Form.
If the answer to a question is "not available" or "unknown,"
write "DK" (do not know) in the space provided.
● If the answer to a question is "not applicable," write "NA"
in the space provided.
● Section I: when exact numeric answers are not available,
provide estimates and mark ( X ) the box beside each
figure.
● Sections II, III, and V: if the answer to a question is
"none" or "zero," write "0" on the line.
Substantiated incidents of sexual violence:
● Please complete an Incident Form (Juvenile, SSV-IJ)
for each substantiated incident of sexual victimization.
Returning forms:
● If you need assistance, please call the U.S. Census
Bureau toll-free at 1–800–253–2078 or email
greta.b.clark@census.gov
● Please return your completed summary and
substantiated incident forms by November 12,
2024.
● You may complete these forms online at:
https://ssv.census.gov/
● MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000
● FAX (TOLL FREE): 1–888–262–3974

2. On December 31, 2023, how many persons
held in the facilities reported in Item 1 were —

DEFINITIONS
JUVENILES and YOUTHFUL OFFENDERS
● Any person under the jurisdiction of your State’s juvenile
system or youthful offender authority, regardless of age
or reason for placement.

a. Males . . . . . . . . . . . . . . . . .

FACILITIES

b. Females . . . . . . . . . . . . . . .

INCLUDE all State-operated facilities used to house juveniles
or youthful offenders charged with or court-adjudicated for:
c. TOTAL (Sum of Items 2a and 2b)

● Any offense that is illegal for both adults and juveniles;

● Count persons held in the facilities reported in Item 1
regardless of age or reason for placement. Include
persons who were temporarily away but had assigned
beds on December 31, 2023.

OR
● An offense that is ILLEGAL in your State for juveniles,
but not for adults (running away, truancy, incorrigibility,
curfew violations, and liquor violations).

3. On December 31, 2023, how many persons
held in the facilities reported in Item 1 were —

EXCLUDE State-operated facilities used ONLY to house
juveniles for:
● Non-criminal purposes (neglect, abuse, abandonment, or
dependency);

a. Age 17 or younger . . . . . .

OR
b. Age 18 to 20 . . . . . . . . . . . . .

● Being Persons in Need of Services (PINS) or Children in
Need of Services (CHINS) who have assigned beds for
reasons other than offenses.

c. Age 21 or older . . . . . . . . . .
d. TOTAL (Sum of Items 3a through
3c should equal Item 2c) . . . . . .

Section I – GENERAL INFORMATION

● Count all persons held in the facilities reported in Item 1
regardless of age or reason for placement. Include
persons who were temporarily away but had assigned
beds on December 31, 2023.

1. On December 31, 2023, how many facilities
operated by your State held juveniles or
youthful offenders CHARGED WITH or
COURT-ADJUDICATED FOR AN OFFENSE?

Number of facilities

....

4. Between January 1, 2023, and December 31, 2023,
how many persons were admitted to or discharged
from the facilities reported in Item 1?

● Count all juvenile residential facilities where young
persons who have committed offenses may be
housed overnight.

a. TOTAL number admitted . . .

● Count each facility with a separate physical location
only once. Do not count separate living/sleeping units,
wings, floors, dorms, barracks, or cottages within a
single facility.

b. TOTAL number discharged .
● Include all persons admitted into your State-operated
juvenile residential facilities by a formal legal document,
by the authority of the courts, or by some other official
agency.
● Include all persons discharged from your
State-operated juvenile residential facilities after a
period of confinement including sentence completion,
pretrial releases, transfers to adult jurisdictions or to
other States, and deaths.
● Exclude admissions and discharges resulting from
returns from escape, administrative transfers to other
juvenile facilities operated by your State, or temporary
release including work/school release, medical
appointments, other treatment facilities, or court
appearances.

FORM SSV-5 (12-9-2022)

Page 2

Section II – YOUTH–ON–YOUTH SEXUAL VICTIMIZATION 5. Does your State juvenile system record

allegations of youth-on-youth SEXUAL ABUSE?

DEFINITIONS

This survey now utilizes the PREA standard definitions for
types of sexual victimization. These categories are:

Yes ➔ Do you record all reported
occurrences, or only substantiated
ones?
01

SEXUAL ABUSE

All
Substantiated only

➔ Please provide an explanation as to why

your State juvenile system does not record
youth-on-youth SEXUAL ABUSE
allegations, in the space below, and skip to
item 8.

6. Between January 1, 2023, and December 31, 2023,
how many allegations of youth-on-youth SEXUAL
ABUSE were reported?

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

7. Of the allegations reported in Item 6, how
many were — (Please contact the agency or office
responsible for investigating allegations of sexual
victimization in order to fully complete this form.)
a. Substantiated . . . . . . . .
● The event was investigated and determined to have
occurred, based on a preponderance of the evidence
(28 C.F.R. §115.72).
b. Unsubstantiated . . . . . .
● The investigation concluded that evidence was
insufficient to determine whether or not the event
occured.
c. Unfounded . . . . . . . . . .
● The investigation determined that the event did NOT
occur.
d. Investigation ongoing . .
● Evidence is still being gathered, processed or evaluated,
and a final determination has not yet been made.
e. TOTAL (Sum of Items
7a through 7d) . . . . . . . . .
● The total should equal the number reported in
Item 6.

FORM SSV-5 (12-9-2022)

Page 3

Section III – STAFF-ON-YOUTH
SEXUAL VICTIMIZATION

8. Does your State juvenile system record
allegations of youth-on-youth SEXUAL
HARASSMENT? (See definitions on page 3.)
01

Yes

allegations or only substantiated
ones?
01
All
02

DEFINITIONS

➔ Do you record all reported

Substantiated only

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

STAFF SEXUAL ABUSE
Sexual abuse of an inmate, detainee, or resident by a staff
member, contractor, or volunteer includes any of the following
acts, with or without consent of the inmate, detainee, or
resident:
(1) Contact between the penis and the vulva or the penis
and the anus, including penetration, however slight;
(2) Contact between the mouth and the penis, vulva, or
anus;
(3) Contact between the mouth and any body part where
the staff member, contractor, or volunteer has the intent
to abuse, arouse, or gratify sexual desire;
(4) Penetration of the anal or genital opening, however
slight, by a hand, finger, object, or other instrument, that
is unrelated to official duties or where the staff member,
contractor, or volunteer has the intent to abuse, arouse,
or gratify sexual desire;

9. Between January 1, 2023, and
December 31, 2023, how many allegations of
youth-on-youth SEXUAL HARASSMENT were
reported?

Number reported . . . . . . .
● If an allegation involved multiple victims or youth
perpetrators, count only once.

(6) Any attempt, threat, or request by a staff member,
contractor, or volunteer to engage in the activities
described in paragraphs (1)–(5) of this section;

● Exclude any allegations that were reported as
consensual.

(7) Any display by a staff member, contractor, or volunteer
of his or her uncovered genitalia, buttocks, or breast in
the presence of an inmate, detainee, or resident, and

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

a. Substantiated . . . . . .

b. Unsubstantiated . . . .

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

d. Investigation ongoing .
e. TOTAL (Sum of Items
10a through 10d) . . . . . . .
● The total should equal the number reported in
Item 9.

FORM SSV-5 (12-9-2022)

Page 4

11. Does your State juvenile system record
allegations of STAFF SEXUAL ABUSE?
01

Yes

➔ Do you record all reported

14. Does your State juvenile system record
allegations of STAFF SEXUAL ABUSE? (See
definitions on page 4.)

occurrences, or only substantiated
ones?
01

All

Substantiated only

Yes

➔ Please provide an explanation in the space
below and then skip to Item 14.

➔ Can these allegations be counted
separately from allegations of
STAFF SEXUAL ABUSE?
01

Yes

➔ Skip to Item 17.

➔ Please provide an explanation in the space
below and then skip to Item 17.

12. Between January 1, 2023, and
December 31, 2023, how many allegations
of STAFF SEXUAL ABUSE were reported?

Number reported . . . . . . .

15. Between January 1, 2023, and
December 31, 2023, how many allegations of
STAFF SEXUAL HARASSMENT were reported?

● If an allegation involved multiple victimizations, count
only once.
13. Of the allegations reported in Item 12, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual victimization in order to fully complete this
form.)

a. Substantiated . . . . . . .

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

b. Unsubstantiated . . . . .

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

d. Investigation ongoing .

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

e. TOTAL (Sum of Items
13a through 13d) . . . . . . . .

d. Investigation ongoing .

● The total should equal the number reported in
Item 12.

e. TOTAL (Sum of Items 16a
through 16d) . . . . . . . . . .
● The total should equal the number reported in
Item 15.

FORM SSV-5 (12-9-2022)

Page 5

Section IV – PRIVATE AND LOCAL ALLEGATIONS

NOTES

17. Did any of the allegations reported in Items 6,
9, 12, or 15 occur in a privately operated
facility?
01

Yes

18. Did any of the allegations reported in Items 6,
9, 12, or 15 occur in a facility operated or
administered by local governments?
01

Yes

Section V – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION
19. What is the total number of substantiated
incidents reported in Items 7a, 10a, 13a,
and 16a?
Total substantiated
incidents . . . . . . . . . . . . . .

➔ Please complete a Substantiated Incident Form
(Juvenile, SSV-IJ) for each substantiated
incident of sexual victimization.

FORM SSV-5 (12-9-2022)

Page 6

OMB No. 1121-0292: Approval Expires xx/xx/xxxx
U.S. DEPARTMENT OF JUSTICE

SSV-6

FORM
(12-9-2022)

SURVEY OF SEXUAL VICTIMIZATION, 2023
Locally or Privately-Operated Juvenile Facilities

BUREAU OF JUSTICE STATISTICS

AND ACTING AS COLLECTION AGENT

Summary Form
DATA SUPPLIED BY

TELEPHONE
E-MAIL
ADDRESS

Number and street or P.O. Box/Route Number

City

Area code

FAX
NUMBER

Number

State

▼

OFFICIAL
ADDRESS

U.S. CENSUS BUREAU

Title

▼▼▼

Name

U.S. DEPT. OF COMMERCE

Area Code

ZIP Code
Number

(Please correct any error in name, mailing address, and ZIP Code)

What facilities are included in this data collection?
All juvenile residential placement facilities operated or
administered by a local government and all privately owned or
operated facilities that are used to house juveniles and
youthful offenders, regardless of age or reason for placement.
● INCLUDE locally-operated juvenile residential facilities;
privately owned or operated juvenile residential facilities;
detention centers, training schools, long-term secure
facilities; reception or diagnostic centers; group homes or
halfway houses; boot camps; ranches; forestry camps,
wilderness or marine programs, or farms; runaway or
homeless shelters; and residential treatment centers for
juveniles.
● EXCLUDE State operated juvenile residential
facilities. (These facilities will be contacted
directly for data on sexual victimization.)

Reporting instructions:
●
●
●

Please complete the entire SSV-6 Form.
If the answer to a question is "not available" or "unknown,"
write "DK" (do not know) in the space provided.
If the answer to a question is "not applicable," write "NA"
in the space provided.

●

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

●

Sections II, III, and V: if the answer to a questions "none"
or "zero," write "0" on the line.

Substantiated incidents of sexual violence:
● Please complete an Incident Form (Juvenile, SSV-IJ)
for each substantiated incident of sexual victimization.
Returning forms:

What persons and incidents are included in this
data collection?
Juveniles and youthful offenders, regardless of age or
reason for placement, under your custody between
January 1, 2023, and December 31, 2023.
● INCLUDE incidents involving juveniles or youthful
offenders under the authority, custody, or care of your
confinement or community-based facilities or staff.
● EXCLUDE incidents involving juveniles or
youthful offenders held in facilities operated
by your State juvenile system.

● If you need assistance, please call the U.S. Census
Bureau toll–free at 1–888–369–3613, option 2, or
e-mail govs.ssv@census.gov
● Please return your completed summary and
substantiated incident forms by
November 12, 2024.
● You may complete these forms online at:
https://ssv.census.gov/
● MAIL TO: U.S. Census Bureau, P.O. Box 5000,
Jeffersonville, IN 47199-5000
● FAX (TOLL FREE): 1–888–262–3974

Burden Statement
Under the Paperwork Reduction Act, we cannot ask you to respond to a collection of information unless it displays a currently valid OMB
control number. The burden of this collection is estimated to average 30 minutes per response, including reviewing instructions, searching
existing data sources, gathering necessary data, and completing and reviewing this form. Send comments regarding this burden estimate or
any aspect of this survey, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street,
NW, Washington, DC 20531. Do not send your completed form to this address.

DEFINITIONS

3. On December 31, 2023, how many persons
held in this facility were —

JUVENILES and YOUTHFUL OFFENDERS
● Any person under the custody or care of a juvenile
residential facility owned or operated by a local
government or private agency.

a. Males

................

FACILITIES

b. Females

INCLUDE all juvenile residential placement facilities operated
or administered by a local government and all privately owned
or operated facilities that are used to house juveniles and
youthful offenders charged with or court-adjudicated for:

c. TOTAL(Sum of Items 3a and 3b) .

● Any offense that is illegal for both adults and juveniles;

..............

● Count persons held in the facility regardless of age or
reason for placement. Include persons who were
temporarily away but had assigned beds on
December 31, 2023.

OR
● An offense that is ILLEGAL in your State for juveniles,
but not for adults (running away, truancy, incorrigibility,
curfew violations, and liquor violations).

4. On December 31, 2023, how many persons
held in this facility were —

EXCLUDE all State-operated facilities and locally or
privately-operated facilities used ONLY to house juveniles for:
a. Age 17 or younger

● Non-criminal behavior (neglect, abuse, abandonment, or
dependency);
OR

b. Age 18 to 20

● Being Persons in Need of Services (PINS) or Children in
Need of Services (CHINS) who have assigned beds for
reasons other than offenses.

d. TOTAL (Sum of Items 4a through
4c should equal Item 3c) . . . . . .

1. Is this facility owned by a
Private agency

Native American Tribal Government

State

County

Local or municipal government

Other – Specify

...........

c. Age 21 or older . . . . . . . . .

Section I – GENERAL INFORMATION

......

● Count all persons held in the facility regardless of age
or reason for placement. Include persons who were
temporarily away but had assigned beds on
December 31, 2023.
5. Between January 1, 2023, and
December 31, 2023, how many persons were
admitted to or discharged from this facility?

a. TOTAL number admitted

2. Is this facility operated by a
01

Private agency

Native American Tribal Government

State

County

Local or municipal government

Other – Specify

b. TOTAL number discharged .
● Include all persons admitted to this facility by a formal
legal document, by the authority of the courts, or by
some other official agency.
● Include all persons discharged from this facility after a
period of confinement including sentence completion,
pretrial releases, transfers to adult jurisdictions or to
other States, and deaths.
● Exclude admissions and discharges resulting from
returns from escape, administrative transfers to other
juvenile facilities, or temporary release including
work/school release, medical appointments, other
treatment facilities, or court appearances.

FORM SSV-6 (12-9-2022)

Page 2

Section II – YOUTH-ON-YOUTH SEXUAL VICTIMIZATION

6. Does your facility record allegations of
youth-on-youth SEXUAL ABUSE?

DEFINITIONS

This survey now utilizes the PREA standard definitions for
types of sexual victimization. These categories are:

Yes ➔ Do you record all reported
occurrences, or only substantiated
ones?
01

SEXUAL ABUSE

All
Substantiated only

➔ Please provide an explanation as to why your
facility does not record youth-on-youth
SEXUAL ABUSE allegations, in the space
below, and skip to item 9.

(1) Contact between the penis and the vulva or the penis
and the anus, including penetration, however slight;
(2) Contact between the mouth and the penis, vulva, or
anus;
(3) Penetration of the anal or genital opening of another
person, however slight, by a hand, finger, object, or
other instrument; and
(4) Any other intentional touching, either directly or through
the clothing, of the genitalia, anus, groin, breast, inner
thigh, or the buttocks of another person, excluding
contact incidental to a physical altercation.

7. Between January 1, 2023 and December 31, 2023,
how many allegations of youth-on-youth SEXUAL
ABUSE were reported?
Number reported . . . . . .
● If an allegation involved multiple victimizations, count only
once.

● Exclude any allegations that were reported as consensual.
8. Of the allegations reported in Item 7, how many
were — (Please contact the agency or office responsible
for investigating allegations of sexual victimization in order
to fully complete this form.)

a. Substantiated

......

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

....

● The investigation concluded that evidence was insufficient
to determine whether or not the event occurred.
c. Unfounded . . . . . . . . .
● The investigation determined that the event did NOT occur.
d. Investigation ongoing

● Evidence is still being gathered, processed or evaluated,
and a final determination has not yet been made.
e. TOTAL (Sum of Items
8a through 8d) . . . . . . . . .
● The total should equal the number reported in Item 7.

FORM SSV-6 (12-9-2022)

Page 3

Section III – STAFF-ON-YOUTH
SEXUAL VICTIMIZATION

9. Does your facility record allegations of
youth-on-youth SEXUAL HARASSMENT?
(See definitions on page 3.)
01

Yes

DEFINITIONS

➔ Do you record all reported

allegations or only substantiated
ones?
01

All

Substantiated only

➔ Please provide an explanation in the space

(1) Contact between the penis and the vulva or the penis
and the anus, including penetration, however slight;

below and then skip to Section III.

10. Between January 1, 2023, and
December 31, 2023, how many allegations of
youth-on-youth SEXUAL HARASSMENT were
reported?

Number reported . . . . . . . .
● If an allegation involved multiple victims or youth
perpetrators, count only once.
● Exclude any allegations that were reported as consensual.
11. Of the allegations reported in Item 10, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual victimization in order to fully complete this
form.)
a. Substantiated

......

b. Unsubstantiated

....

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

d. Investigation ongoing

e. TOTAL (Sum of Items
11a through 11d) . . . . . . .
● The total should equal the number reported in Item 10.

FORM SSV-6 (12-9-2022)

Page 4

12. Does your facility record allegations of STAFF
SEXUAL ABUSE?
Yes

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

➔ Do you record all reported

Yes

occurrences, or only substantiated
ones?

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

All

Yes

Substantiated only

➔ Please provide an explanation in the space

below and then skip to Item 15.

➔ Skip to Item 18

➔ Please provide an explanation in the space
below and then skip to Item 18.

16. Between January 1, 2023, and
December 31, 2023, how many allegations of
STAFF SEXUAL HARASSMENT were reported?

13. Between January 1, 2023, and
December 31, 2023, how many allegations of
STAFF SEXUAL ABUSE were reported?

Number reported . . . . . .

Number reported . . . . . . .

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

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

17. Of the allegations reported in Item 16, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual victimization in order to fully complete this
form.)

14. Of the allegations reported in Item 13, how
many were — (Please contact the agency or
office responsible for investigating allegations of
sexual victimization in order to fully complete this
form.)

a. Substantiated . . . . . .

b. Unsubstantiated . . . .

c. Unfounded

........

d. Investigation ongoing

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

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

FORM SSV-6 (12-9-2022)

........

Page 5

●

The total should equal the number reported in Item 16.

Section IV – TOTAL SUBSTANTIATED
INCIDENTS OF SEXUAL VICTIMIZATION

NOTES

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

➔ Please complete a Substantiated Incident Form
(Juvenile, SSV-IJ) for each substantiated
incident of sexual victimization.

FORM SSV-6 (12-9-2022)

Page 6

Survey of Sexual Victimization, YYYY
Substantiated Incident Form (Adult) – SSV-IA

1. On what date did the incident occur?
(If more than one date, report the most recent and check the box.)
MM DD YYYY [BOX] multiple dates
2. In what facility did the incident occur?
Name ______
City/Place ______
3. Did the incident occur in the following locations?
Yes

01. In the victim’s cell or room (e.g., if the victim and perpetrator share a cell or room, count
as the victim’s cell)
02. In the perpetrator’s cell or room
03. In a dormitory or other multiple housing unit
04. In a common area (e.g., shower, dayroom, bathroom)
05. In a temporary holding cell or intake area within the facility
06. In a program service area (e.g., commissary, kitchen, storage, laundry, cafeteria,
workshop, hallway)
07. In an instructional area (e.g. classroom, school, library, conference room)
08. In a recreation area (e.g., yard, courtyard, gymnasium)
09. In a medical area (e.g., infirmary, health clinic)
10. In a staff area (e.g., office, break room, counselor’s office)
11. Offsite or while in transit
12. Other – specify [BOX]
13. Location unknown
14. Location not applicable (e.g., involved written, phone, or virtual communication)

4. Did the incident take place in an area subject to video monitoring?

[ ] Yes [ ] No [ ] Unknown

5. Did the incident occur during the following times?

Yes
01.
02.
03.
04.
05.

Morning (6 a.m. to noon)
Afternoon (noon to 6 p.m.)
Evening (6p.m. to midnight)
Overnight (midnight to 6 a.m.)
Time unknown

6. Who reported the incident?
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.

Victim
Another inmate (non-victim)
Victim’s family or friend
Correctional officer or front line staff
Administrative staff
Medical, healthcare, or mental health staff
Instructor, teacher, or counselor
Other staff (e.g., kitchen worker, maintenance staff)
Chaplain or other religion official
Perpetrator
Perpetrator’s family or friend
Grievance coordinator, grievance process, or ombudsman
Attorney or legal guardian (e.g., other than family member)
Confidential informant, anonymous tip, hotline, or through monitoring (e.g., camera,
telephone, or mail)
15. Other – specify [BOX]

7. What was the type of sexual victimization incident? (See definitions on page 13.)
01. Inmate-on-inmate sexual abuse
 Complete sections A and B
02. Inmate-on-inmate sexual harassment
 Complete sections A and B
03. Staff-on-inmate sexual abuse
 Complete sections A and C
04. Staff-on-inmate sexual harassment
Complete sections A and C

SECTION A – VICTIMS OF SEXUAL VICTIMIZATION
8. How many victims were involved in the incident?
Number of victims _____
 If more than two victims were involved, please complete this form online.
9. Victim #1: What was the victim’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex
10. Victim #1: What was the victim’s gender identity? (See definitions on page 14.)
01. Male
02. Female
03. Transgender
04. Gender nonconforming
05. Unknown

11. Victim #1: What was the victim’s age at the time of the incident?
____ years

12. Victim #1: What was the victim’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Other Pacific Islander

13. Victim #1. Did the victim sustain any physical injury during the incident?

[ ] Yes

[ ] No

If “Yes”  a. Did the following injuries occur?
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.

Bruises, black eye, sprains, cuts, scratches, swelling, welts
Bites
Burns
Chipped or knocked out teeth
Anal or vaginal tearing
Knocked unconscious
Broken bones
Knife or stab wounds
Internal injuries
Other – specify [BOX]

 b. Did the victim receive medical treatment for these injuries? [ ] Yes

[ ] No

14. Victim #1: After the incident was reported, was the victim –
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.

Provided with counseling or mental health treatment
Given a medical examination
Administered a rape kit
Given post-exposure prophylaxis (PEP) and/or emergency contraception
Tested for HIV/AIDS
Tested for other sexually transmitted infections
Offered but declined testing, treatment and/or counseling
Already released/discharged
None of the above

15. Victim #1: After the incident was reported, was the victim –
Yes

01. Separated from perpetrator
02. Confined to own cell or room
03. Placed in or returned to administrative segregation, protective custody, or disciplinary
segregation
04. Placed in a medical unit, ward, or hospital
05. Placed in a camera room, under close surveillance, or increased supervision
06. Transferred to another housing unit or dorm, or given a single room or cell
07. Given a higher custody level or different unit within the facility
08. Transferred to another facility
09. Issued a disciplinary report or loss of privileges
10. Other – specify [BOX]
11. None of the above
 If there were no other victims, please skip to Section B on pages 6-8 if the incident involved an inmate
perpetrator or Section C on pages 9-12 if the incident involved a staff perpetrator.
16. Victim #2: What was the victim’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex
17. Victim #2: What was the victim’s gender identity? (See definitions on page 14.)
01. Male
02. Female
02. Transgender
03. Gender nonconforming
04. Unknown
18. Victim #2: What was the victim’s age at the time of the incident?
___ years

19. Victim #2: What was the victim’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander

20. Victim #2. Did the victim sustain any physical injury during the incident?
If “Yes”  a. Did the following injuries occur?
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.

 b. Did the victim receive medical treatment for these injuries? [ ] Yes

[ ] No

21. Victim #2: After the incident was reported, was the victim –
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.

22. Victim #2: After the incident was reported, was the victim –
Yes
12. Separated from perpetrator
13. Confined to own cell or room
14. Placed in or returned to administrative segregation, protective custody, or disciplinary
segregation
15. Placed in a medical unit, ward, or hospital
16. Placed in a camera room, under close surveillance, or increased supervision
17. Transferred to another housing unit or dorm, or given a single room or cell
18. Given a higher custody level or different unit within the facility
19. Transferred to another facility
20. Issued a disciplinary report or loss of privileges
21. Other – specify [BOX]
22. None of the above

 If the perpetrator was a staff member, go to Section C on pages 9-12.
SECTION B – INMATE-PERPETRATED SEXUAL VICTIMIZATION
23. Did the following occur as part of the substantiated incident?
Yes

01. Verbal comments or gestures of a derogatory or offensive sexual nature
02. Repeated and unwelcome sexual advances or requests for sexual favors
03. Indecent exposure, masturbation, voyeurism, or other actions of a derogatory sexual
nature
04. Intentional and non-consensual or coerced touching of the genitalia, anus, groin, breast
inner thigh, or the buttocks
05. Nonconsensual sexual act that resulted from pressure or coercion (without force)
06. Nonconsensual sexual act that resulted from physical force (or the threat of force)
07. Other – specify [BOX]
24. Did the incident involve the following types of pressure, coercion, or force?
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.

Persuasion or talked into sexual activity
Bribery or blackmail
Gave the victim drugs or alcohol
Offered protection from other inmates
Threats made (e.g., threatened harm to victim or victim’s family, threatened with a
weapon)
Unwanted touching, grabbing, or groping of the victim by surprise or while the victim was
asleep or incapacitated
Physically held victim down or restrained in some way, including having other inmates
restrain the victim
Physical harm or injury
Other – specify [BOX]
None of the above

25. How many inmate perpetrators were involved in the incident?
Number of inmate perpetrators ____
 If more than two inmate perpetrators were involved, please complete this form online.
26. Perpetrator #1: What was the inmate perpetrator’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex
27. Perpetrator #1: What was the inmate perpetrator’s gender identity? (See definitions on page 14.)
01. Male
02. Female
03. Transgender
04. Gender nonconforming
05. Unknown

28. Perpetrator #1: What was the inmate perpetrator’s age at the time of the incident?
_____ years

29. Perpetrator #1: What was the perpetrator’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Other Pacific Islander

30. Perpetrator #1: After the incident, was the inmate perpetrator –
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.

Confined to own cell or room
Placed in solitary confinement or disciplinary segregation
Placed in higher custody level, restricted unit or program, within the same facility
Transferred to other unit/cell or separated from victim
Transferred to another facility
Sent to counseling and/or provided other treatment (e.g. post-exposure prophylaxis)
Loss of “good/gain” time, increased in “bad” time or delayed release
Given extra work
Loss of privileges, disciplinary report or conduct violations, or other reprimand
Arrested or referred to law enforcement agency
Referred for prosecution or indicted
Convicted, plead guilty, given new sentence, or fined
Awaiting a legal outcome
Other – specify [BOX]

 If there were no other perpetrators, please skip to Notes on page 12 (if applicable) or submit form.
31. Perpetrator #2: What was the inmate perpetrator’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex
32. Perpetrator #2: What was the inmate perpetrator’s gender identity? (See definitions on page 14.)
01. Male
02. Female
03. Transgender
04. Gender nonconforming
05. Unknown
33. Perpetrator #2: What was the inmate perpetrator’s age at the time of the incident?
___ years

34. Perpetrator #2: What was the perpetrator’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander
35. Perpetrator #2: After the incident, was the inmate perpetrator – (Mark [X] for all that apply.)
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.

 If the perpetrator was an inmate, go to Section B on pages 6-8.
SECTION C. STAFF PERPETRATORS OF SEXUAL VICTIMZATION
36. Did the following occur as part of the substantiated incident?
Yes
01. Repeated suggestive, derogatory, or obscene verbal comments or gestures of a sexual
nature
02. Wrote letters, showed pictures, talked on the phone, or through video conferencing
03. Exhibited grooming behaviors such as providing gifts, special privileges, or favors to inmate
04. Indecent exposure, invasion of privacy, or voyeurism
05. Any attempt, threat, or request related to abusive sexual contact or nonconsensual sexual
act
06. Any touching or kissing for sexual gratification
07. Pressure or abuse of power resulting in a nonconsensual sexual act
08. Physical force resulting in a nonconsensual sexual act
09. Other – specify [BOX]
37. How many staff perpetrators were involved in the incident?
Number of staff _____
 If more than two staff were involved, please complete this incident form online.
38. Staff #1: What was the staff perpetrator’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex
39. Staff #1: What was the staff perpetrator’s gender identity? (See definitions on page 14.)
01. Male
02. Female
03. Transgender
04. Gender nonconforming
05. Unknown
40. Staff #1: What was the age of the staff perpetrator at the time of the incident?
____ years

41. Staff #1: What was the staff’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander

42. Staff #1: Was the staff perpetrator involved in the incident –
01. Full- or part-time paid employee
02. Contract employee or vendor
03. Volunteer or intern
04. Other – specify [BOX]
43. Staff #1: What was the primary position description of the staff perpetrator involved in the incident?
01. Correctional officer or supervisory staff
02. Maintenance and other facility support staff, including groundskeepers, janitors, cooks, and drivers
03. Medical or healthcare staff, including counselors, doctors, dentists, psychologists, psychiatrists, social
workers, nurses, and medical assistants
04. Education staff, including instructors, teachers, librarians, and education assistants
05. Administrator, including wardens, superintendents, assistants, and others in administrative positions
06. Clerical staff, including secretaries, clerks, receptionists, and other administrative support
07. Other program staff
08. Volunteer or intern
09. Other staff – specify [BOX]
44. Staff #1: At the time of the incident, how long had the staff perpetrator worked at the facility?
01. Less than 6 months
02. 6 months to 1 year
03. 1 to 5 years
04. 5 to 10 years
05. More than 10 years
45. Staff #1: After the incident, was the staff perpetrator–
Yes

01. Sent to training or counseling
02. Reprimanded or disciplined
03. Demoted, diminished responsibilities, suspended temporarily, or placed on administrative
leave
04. Transferred to another facility or unit
05. Discharged, terminated, or contract not renewed
06. Staff resigned (prior to completion of investigation)
07. Staff resigned (after investigation was completed)
08. Arrested or referred to law enforcement agency
09. Referred for prosecution or indicted
10. Convicted, plead guilty, sentenced, or fined
11. Awaiting a legal outcome
12. Other – specify [BOX]
13. No action taken
 If there were no other staff perpetrators involved, please skip to Notes on page 12 (if applicable) or
submit form.

46. Staff #2: What was the staff perpetrator’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex

49. Staff #2: What was the staff’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander
50. Staff #2: Was the staff perpetrator involved in the incident –
01. Full- or part-time paid employee
02. Contract employee or vendor
03. Volunteer or intern
04. Other – specify [BOX]
51. Staff #2: What was the primary position description of the staff perpetrator involved in the incident?
01. Correctional officer or supervisory staff
02. Maintenance and other facility support staff, including groundskeepers, janitors, cooks, and drivers
03. Medical or healthcare staff, including counselors, doctors, dentists, psychologists, psychiatrists, social
workers, nurses, and medical assistants
04. Education staff, including instructors, teachers, librarians, and education assistants
05. Administrator, including wardens, superintendents, assistants, and others in administrative positions
06. Clerical staff, including secretaries, clerks, receptionists, and other administrative support
07. Other program staff
08. Volunteer or intern
09. Other staff – specify [BOX]
52. Staff #2: At the time of the incident, how long had the staff perpetrator worked at the facility?
01. Less than 6 months
02. 6 months to 1 year
03. 1 to 5 years
04. 5 to 10 years
05. More than 10 years

53. Staff #2: After the incident, was the staff perpetrator—
Yes
01. Sent to training or counseling
02. Reprimanded or disciplined
03. Demoted, diminished responsibilities, suspended temporarily, or placed on
administrative leave
04. Transferred to another facility or unit
05. Discharged, terminated, or contract not renewed
06. Staff resigned (prior to completion of investigation)
07. Staff resigned (after investigation was completed)
08. Arrested or referred to law enforcement agency
09. Referred for prosecution or indicted
10. Convicted, plead guilty, sentenced, or fined
11. Awaiting a legal outcome
12. Other – specify [BOX]
13. No action taken

NOTES

DEFINITIONS
Sexual Victimization
Inmate-on-inmate sexual abuse: Sexual abuse of an inmate, detainee, or resident by another inmate, detainee, or
resident includes any of the following acts, if the victim does not consent, is coerced into such act by overt or implied
threats of violence, or is unable to consent or refuse:
1) Contact between the penis and the vulva or the penis and the anus, including penetration, however slight;
2) Contact between the mouth and the penis, vulva, or anus;
3) Penetration of the anal or genital opening of another person, however slight, by a hand, finger, object, or other
instrument; and
4) Any other intentional touching, either directly or through the clothing, of the genitalia, anus, groin, breast, inner thigh, or
the buttocks of another person, excluding contact incidental to a physical altercation.
Inmate-on-inmate sexual harassment: Repeated and unwelcome sexual advances, requests for sexual favors, or
verbal comments, gestures, or actions of a derogatory or offensive sexual nature by one inmate, detainee, or resident
directed toward another.
Staff-on-inmate sexual abuse: Sexual abuse of an inmate, detainee, or resident by a staff member, contractor, or
volunteer includes any of the following acts, with or without consent of the inmate, detainee, or resident:
1) Contact between the penis and the vulva or the penis and the anus, including penetration, however slight;
2) Contact between the mouth and the penis, vulva, or anus;
3) Contact between the mouth and any body part where the staff member, contractor, or volunteer has the intent to abuse,
arouse, or gratify sexual desire;
4) Penetration of the anal or genital opening, however slight, by a hand, finger, object, or other instrument, that is
unrelated to official duties or where the staff member, contractor, or volunteer has the intent to abuse, arouse, or gratify
sexual desire;
5) Any other intentional contact, either directly or through the clothing, of or with the genitalia, anus, groin, breast, inner
thigh, or the buttocks, that is unrelated to official duties or where the staff member, contractor, or volunteer has the intent
to abuse, arouse, or gratify sexual desire;
6) Any attempt, threat, or request by a staff member, contractor, or volunteer to engage in the activities described in
paragraphs (1)-(5) of this section;
7) Any display by a staff member, contractor, or volunteer of his or her uncovered genitalia, buttocks, or breast in the
presence of an inmate, detainee, or resident, and
8) Voyeurism by a staff member, contractor, or volunteer.
Staff-on-inmate sexual harassment: Repeated verbal comments or gestures of a sexual nature to an inmate, detainee,
or resident by a staff member, contractor, or volunteer, including demeaning references to gender, sexually suggestive or
derogatory comments about body or clothing, or obscene language or gestures.

Sex and gender categories
Intersex: A person whose sexual or reproductive anatomy or chromosomal pattern does not seem to fit typical definitions
or male or female. Intersex medical conditions are sometimes referred to as disorders of sex development.
Gender nonconforming: A person whose appearance or manner does not conform to traditional societal gender
expectations.
Transgender: A person whose gender identity (i.e., internal sense of feeling male or female) is different from the person’s
assigned sex at birth.

Survey of Sexual Victimization, YYYY
Substantiated Incident Form (Juvenile) – SSV-IJ

4. Did the incident take place in an area subject to video monitoring?

[ ] Yes [ ] No [ ] Unknown

5. Did the incident occur during the following times?

Yes
01.
02.
03.
04.
05.

Morning (6 a.m. to noon)
Afternoon (noon to 6 p.m.)
Evening (6p.m. to midnight)
Overnight (midnight to 6 a.m.)
Time unknown

6. Who reported the incident?
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.

Victim
Another youth (non-victim)
Victim’s family or friend
Correctional officer or front line staff
Administrative staff
Medical, healthcare, or mental health staff
Instructor, teacher, or counselor
Other staff (e.g., kitchen worker, maintenance staff)
Chaplain or other religion official
Perpetrator
Perpetrator’s family or friend
Grievance coordinator, grievance process, or ombudsman
Attorney or legal guardian (e.g., other than family member)
Confidential informant, anonymous tip, hotline, or through monitoring (e.g., camera,
telephone, or mail)
15. Other – specify [BOX]

7. What was the type of sexual victimization incident? (See definitions on page 13.)
01. Youth-on-youth sexual abuse
 Complete sections A and B
02. Youth-on-youth sexual harassment
 Complete sections A and B
03. Staff-on-youth sexual abuse
 Complete sections A and C
04. Staff-on-youth sexual harassment
Complete sections A and C

11. Victim #1: What was the victim’s age at the time of the incident?
_____ years
12. Victim #1: What was the victim’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander

13. Victim #1. Did the victim sustain any physical injury during the incident?

[ ] Yes

[ ] No

If “Yes”  a. Did the following injuries occur?
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.

 b. Did the victim receive medical treatment for these injuries? [ ] Yes

[ ] No

14. Victim #1: After the incident was reported, was the victim –
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.

15. Victim #1: After the incident was reported, was the victim –
Yes

01. Separated from perpetrator
02. Confined to own cell or room
03. Placed in or returned to administrative segregation, protective custody, or disciplinary
segregation
04. Placed in a medical unit, ward, or hospital
05. Placed in a camera room, under close surveillance, or increased supervision
06. Transferred to another housing unit or dorm, or given a single room or cell
07. Given a higher custody level or different unit within the facility
08. Transferred to another facility
09. Issued a disciplinary report or loss of privileges
10. Other – specify [BOX]
11. None of the above
 If there were no other victims, please skip to Section B on pages 6-8 if the incident involved a youth
perpetrator or Section C on pages 9-12 if the incident involved a staff perpetrator.
16. Victim #2: What was the victim’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex
17. Victim #2: What was the victim’s gender identity? (See definitions on page 14.)
01. Male
02. Female
02. Transgender
03. Gender nonconforming
04. Unknown
18. Victim #2: What was the victim’s age at the time of the incident?
____ years
19. Victim #2: What was the victim’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black of African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander

20. Victim #2. Did the victim sustain any physical injury during the incident?
If “Yes”  a. Did the following injuries occur?
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.

 b. Did the victim receive medical treatment for these injuries? [ ] Yes

[ ] No

21. Victim #2: After the incident was reported, was the victim –
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.

22. Victim #2: After the incident was reported, was the victim –
Yes
01. Separated from perpetrator
02. Confined to own cell or room
03. Placed in or returned to administrative segregation, protective custody, or disciplinary
segregation
04. Placed in a medical unit, ward, or hospital
05. Placed in a camera room, under close surveillance, or increased supervision
06. Transferred to another housing unit or dorm, or given a single room or cell
07. Given a higher custody level or different unit within the facility
08. Transferred to another facility
09. Issued a disciplinary report or loss of privileges
10. Other – specify [BOX]
11. None of the above

 If the perpetrator was a staff member, go to Section C on pages 9-12.
SECTION B – YOUTH-PERPETRATED SEXUAL VICTIMIZATION
23. Did the following occur as part of the substantiated incident?
Yes

Persuasion or talked into sexual activity
Bribery or blackmail
Gave the victim drugs or alcohol
Offered protection from other youths
Threats made (e.g., threatened harm to victim or victim’s family, threatened with a
weapon)
Unwanted touching, grabbing, or groping of the victim by surprise or while the victim was
asleep or incapacitated
Physically held victim down or restrained in some way, including having other youths
restrain the victim
Physical harm or injury
Other – specify [BOX]
None of the above

25. How many youth perpetrators were involved in the incident?
Number of youth perpetrators ____
 If more than two youth perpetrators were involved, please complete this form online.
26. Perpetrator #1: What was the youth perpetrator’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex
27. Perpetrator #1: What was the youth perpetrator’s gender identity? (See definitions on page 14.)
01. Male
02. Female
03. Transgender
04. Gender nonconforming
05. Unknown

28. Perpetrator #1: What was the youth perpetrator’s age at the time of the incident?
____ years
29. Perpetrator #1: What was the perpetrator’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander

30. Perpetrator #1: After the incident, was the youth perpetrator –
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.

 If there were no other perpetrators, please skip to Notes on page 12 (if applicable) or submit form.
31. Perpetrator #2: What was the youth perpetrator’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex
32. Perpetrator #2: What was the youth perpetrator’s gender identity? (See definitions on page 14.)
01. Male
02. Female
03. Transgender
04. Gender nonconforming
05. Unknown
33. Perpetrator #2: What was the youth perpetrator’s age at the time of the incident?
_____ years

34. Perpetrator #2: What was the perpetrator’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander
35. Perpetrator #2: After the incident, was the youth perpetrator – (Mark [X] for all that apply.)
Yes
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.

 If the perpetrator was a youth, go to Section B on pages 6-8.
SECTION C. STAFF PERPETRATORS OF SEXUAL VICTIMZATION
36. Did the following occur as part of the substantiated incident?
Yes
01. Repeated suggestive, derogatory, or obscene verbal comments or gestures of a sexual
nature
02. Wrote letters, showed pictures, talked on the phone, or through video conferencing
03. Exhibited grooming behaviors such as providing gifts, special privileges, or favors to youth
04. Indecent exposure, invasion of privacy, or voyeurism
05. Any attempt, threat, or request related to abusive sexual contact or nonconsensual sexual
act
06. Any touching or kissing for sexual gratification
07. Pressure or abuse of power resulting in a nonconsensual sexual act
08. Physical force resulting in a nonconsensual sexual act
09. Other – specify [BOX]
37. How many staff perpetrators were involved in the incident?
Number of staff _____
 If more than two staff were involved, please complete this form online.
38. Staff #1: What was the staff perpetrator’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex
39. Staff #1: What was the staff perpetrator’s gender identity? (See definitions on page 14.)
01. Male
02. Female
03. Transgender
04. Gender nonconforming
05. Unknown
40. .Staff #1: What was the age of the staff perpetrator at the time of the incident?
_____ years
41. Staff #1: What was the staff’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander

42. Staff #1: Was the staff perpetrator involved in the incident –
01. Full- or part-time paid employee
02. Contract employee or vendor
03. Volunteer or intern
04. Other – specify [BOX]
43. Staff #1: What was the primary position description of the staff perpetrator involved in the incident?
01. Correctional officer or supervisory staff
02. Maintenance and other facility support staff, including groundskeepers, janitors, cooks, and drivers
03. Medical or healthcare staff, including counselors, doctors, dentists, psychologists, psychiatrists, social
workers, nurses, and medical assistants
04. Education staff, including instructors, teachers, librarians, and education assistants
05. Administrator, including wardens, superintendents, assistants, and others in administrative positions
06. Clerical staff, including secretaries, clerks, receptionists, and other administrative support
07. Other program staff
08. Volunteers or interns
09. Other staff – specify [BOX]
44. Staff #1: At the time of the incident, how long had the staff perpetrator worked at the facility?
01. Less than 6 months
02. 6 months to 1 year
03. 1 to 5 years
04. 5 to 10 years
05. More than 10 years
45. Staff #1: After the incident, was the staff perpetrator–
Yes

46. Staff #2: What was the staff perpetrator’s sex? (See definitions on page 14.)
01. Male
02. Female
03. Intersex

47. Staff #2: What was the staff perpetrator’s gender identity? (See definitions on page 14.)
01. Male
02. Female
03. Transgender
04. Gender nonconforming
05. Unknown
48. Staff #2: What was the age of the staff perpetrator at the time of the incident?
____ years
49. Staff #2: What was the staff’s race or ethnicity? (Select [X] all that apply.)
01. White
02. Hispanic or Latino
03. Black or African American
04. Asian
05. American Indian or Alaska Native
06. Middle Eastern or North African
07. Native Hawaiian or Pacific Islander

50. Staff #2: Was the staff perpetrator involved in the incident –
01. Full- or part-time paid employee
02. Contract employee or vendor
03. Volunteer or intern
04. Other – specify [BOX]
51. Staff #2: What was the primary position description of the staff perpetrator involved in the incident?
01. Correctional officer or supervisory staff
02. Maintenance and other facility support staff, including groundskeepers, janitors, cooks, and drivers
03. Medical or healthcare staff, including counselors, doctors, dentists, psychologists, psychiatrists, social
workers, nurses, and medical assistants
04. Education staff, including instructors, teachers, librarians, and education assistants
05. Administrator, including wardens, superintendents, assistants, and others in administrative positions
06. Clerical staff, including secretaries, clerks, receptionists, and other administrative support
07. Other program staff
08. Volunteers or interns
09. Other staff – specify [BOX]

52. Staff #2: At the time of the incident, how long had the staff perpetrator worked at the facility?
01. Less than 6 months
02. 6 months to 1 year
03. 1 to 5 years
04. 5 to 10 years
05. More than 10 years

NOTES

DEFINITIONS
Sexual Victimization
Youth-on-youth sexual abuse: Sexual abuse of a youth, detainee, or resident by another youth, detainee, or resident
includes any of the following acts, if the victim does not consent, is coerced into such act by overt or implied threats of
violence, or is unable to consent or refuse:
1) Contact between the penis and the vulva or the penis and the anus, including penetration, however slight;
2) Contact between the mouth and the penis, vulva, or anus;
3) Penetration of the anal or genital opening of another person, however slight, by a hand, finger, object, or other
instrument; and
4) Any other intentional touching, either directly or through the clothing, of the genitalia, anus, groin, breast, inner thigh, or
the buttocks of another person, excluding contact incidental to a physical altercation.
Youth-on-youth sexual harassment: Repeated and unwelcome sexual advances, requests for sexual favors, or verbal
comments, gestures, or actions of a derogatory or offensive sexual nature by one youth, detainee, or resident directed
toward another.
Staff-on-youth sexual abuse: Sexual abuse of a youth, detainee, or resident by a staff member, contractor, or volunteer
includes any of the following acts, with or without consent of the youth, detainee, or resident:
1) Contact between the penis and the vulva or the penis and the anus, including penetration, however slight;
2) Contact between the mouth and the penis, vulva, or anus;
3) Contact between the mouth and any body part where the staff member, contractor, or volunteer has the intent to abuse,
arouse, or gratify sexual desire;
4) Penetration of the anal or genital opening, however slight, by a hand, finger, object, or other instrument, that is
unrelated to official duties or where the staff member, contractor, or volunteer has the intent to abuse, arouse, or gratify
sexual desire;
5) Any other intentional contact, either directly or through the clothing, of or with the genitalia, anus, groin, breast, inner
thigh, or the buttocks, that is unrelated to official duties or where the staff member, contractor, or volunteer has the intent
to abuse, arouse, or gratify sexual desire;
6) Any attempt, threat, or request by a staff member, contractor, or volunteer to engage in the activities described in
paragraphs (1)–(5) of this section;
7) Any display by a staff member, contractor, or volunteer of his or her uncovered genitalia, buttocks, or breast in the
presence of a youth, detainee, or resident, and
8) Voyeurism by a staff member, contractor, or volunteer.
Staff-on-youth sexual harassment: Repeated verbal comments or gestures of a sexual nature to a youth, detainee, or
resident by a staff member, contractor, or volunteer, including demeaning references to gender, sexually suggestive or
derogatory comments about body or clothing, or obscene language or gestures.

File Type	application/pdf
Author	buehlere
File Modified	2023-02-09
File Created	2023-02-09