CMEC-X 2023 Census of Medical Examiners and Coroners Offices (d

Form CMEC-X OMB No. : Approval Expires

Acting as collection agent: RTI International

Please use this form to provide information on behalf of the following agency:

[FILL AGENCY NAME HERE]

If the agency name printed above is incorrect, please call us at 1-866-662-8134.

Survey Instructions:

• Submit this form using one of the following four methods:

  • Online: https://www.bjscmec.org

    Agency ID:
    Password:

  • E-mail: CMEC@rti.org

  • Fax: 1-800-647-9660 (toll-free)

  • Mail: Use the enclosed postage-paid envelope

• Please do not leave any items blank.

• If the answer to a question is none or zero, write “0” in the space provided. When exact numeric answers are not available, please provide estimates and mark the estimate check box where appropriate.

• Use blue or black ink and print as neatly as possible.

• Use an X when marking an answer in a box.

Please indicate the primary person who completed this form:

Name:
	Last Name					First Name	MI
Title:
Phone:			—
	Area Code	Number			Extension
Fax:			—
	Area Code	Number
E-mail:
Agency Website:

If you have any questions, call RTI toll-free at 1-866-662-8134, or send an e-mail to CMEC@rti.org. If you have general project-related questions, please contact Connor Brooks of BJS at (202) 514-8633 or Connor.Brooks@usdoj.gov.

Burden Statement

Federal agencies may not conduct or sponsor an information collection, and a person is not required to respond to a collection of information, unless it displays a currently valid OMB Control Number. Public reporting burden for this collection of information is estimated to average 90 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate, or any other aspects of this collection of information, including suggestions for reducing this burden, to the Director, Bureau of Justice Statistics, 810 Seventh Street, NW, Washington, DC 20531. The Omnibus Crime Control and Safe Streets Act of 1968, as amended (34 USC 10132), authorizes this information collection. Although this survey is voluntary, we urgently need your cooperation to make the results comprehensive, accurate, and timely. We greatly appreciate your assistance.

AD1. If you have a sudden unexpected infant death case, which of the following procedures would your office conduct, or request, if warranted, to determine cause and manner of death?

Procedure	Yes	No	Decision made elsewhere (e.g. state medical examiners’ office)
Scene investigation
Doll re-enactment
Imaging, including x-ray, CT, or MRI
Autopsy
Forensic toxicology
Microbiology
Histology
Genetic testing (e.g., sudden cardiac deaths)

AD2. Does your office use the Sudden Infant Death Syndrome, or SIDS, diagnosis?

	Yes
	No

AD3. Do you record decedents’ sex?

	Always
	Sometimes
	No

AD4. Do you record decedents’ gender?

	Always
	Sometimes
	No

AD5. Do you capture race and/or ethnicity for decedents?

	Yes
	No  SKIP to AD6 on Page 3

AD5. Which of the following race and ethnicity categories do you capture for decedents?

	White
	Black or African American
	Hispanic
	American Indian or Alaska Native
	Asian
	Native Hawaiian or Other Pacific Islander
	We do not capture race or ethnicity for decedents
	Other (please specify)

AD6. How does your office dispose of unclaimed human remains? Please select all that apply.

	Bury
	Cremate
	Donate body to a body donation program
	Donate body to other program(s) (e.g., museum)
	Our office holds unclaimed remains indefinitely
	Other (please specify)

AD7. For unclaimed remains, does your office work with Veterans Administration or other groups to determine if the decedent is a veteran?

	Yes
	No

AD8. When your office receives a death of a foreign national do you notify the consulate of the decedent’s country of origin?

	Yes
	No

AD9. Are you aware of genetic screening as a test that medical examiner and coroner offices are starting to use?

	Yes
	No

AD10. In the last 5 years have you sent any cases for genetic testing?

	Yes
	No

AD11. Are you aware of the new Centers for Disease Control and Prevention’s Collaborating Office for Medical Examiners and Coroners (COMEC) and the resources it offers MEC offices?

	Yes
	No

AD12. Does your office have access to a computerized axial tomography (CAT or CT) scan, either directly or through a partner agency?

	Yes, directly
	Yes, through a partner agency
	No

AD13. Does your office have access to magnetic resonance imaging (MRI), either directly or through a partner agency?

	Yes, directly
	Yes, through a partner agency
	No

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