ncvs basic screen questionnaire 2008

11
OMB No. 1121-0111: Approval Expires 07/31/2009 FORM Implementation Date: (01-01-2007)  U.S. DEPARTMENT OF COMMERCE  NATIONAL CRIME VICTIMIZATION SURVEY 10a. 1. Field representative identification 201 Code Name 1 Unit in sample the previous enumeration period - Fill 3 Unit in sample first time this period - SKIP to 4 2 2. Unit status 202 1 Same household interviewed the previous enumeration 3. Household status - Mark first box that applies. 203 2 Replacement household since the previous enumeration 3 4 Noninterview the previous enumeration Other - Specify 4. Line number of household respondent ____________ Go to page 2 Use of telephone 5. Group Quarters [GQ] type code ____________ 204 1 Owned or being bought 6. Tenure 206 2 Rented for cash 3 No cash rent 1 Urban 7. Land Use 207 2 Rural X Item blank 8. Farm Sales 208 1 $1,000 or more 2 Less than $1,000 9. Type of living quarters Housing unit 1 2 3 4 5 House, apartment, flat HU in nontransient hotel, motel, etc. HU permanent in transient hotel, motel, etc 209 Mobile home or trailer with one or more permanent rooms added 7 6 OTHER unit Quarters not HU in rooming or boarding house 8 Unit not permanent in transient hotel, motel, etc. 9 Unoccupied site for mobile home, trailer, or tent 10 Student quarters in college dormitory OTHER unit not specified above - Describe 11 12 Phone in unit ................... 1 2 Phone in common area (hallway, etc.) .... Phone in another unit (neighbor, friend, etc.) Work/office phone ................ No phone - SKIP to 11a 3 4 5 10b. Is phone interview acceptable? Fill 10b 210 1 Yes 211 2 No 3 Refused to give number 11a. Number of housing units in structure 1 2 3 1 - SKIP to 11c 2 3 213 4 5 6 4 5-9 10+ 7 Mobile home/trailer - SKIP to 11c 8 Only OTHER units 11b. Restricted access 1 Yes 3 DK 12a. Household Income 214 8 9 10 20,000 - 24,999 25,000 - 29,999 30,000 - 34,999 13. Proxy information - Fill for all proxy interviews a. Proxy interview obtained for Line No. b. Reason c. Reason 301 303 302 Name Line No. 304 306 305 307 309 308 310 312 311 Codes for item 13c 14. Type Z noninterview a. Interview not obtained for Line No. b. Proxy respondent 313 315 317 319 314 316 318 320 Complete 17-28 for each Line No. in 14a Codes for item 14b 15a. Household members 12 years of age and OVER  ____________ Total number 321 15b. Household members UNDER 12 years of age  ____________ Total number 322 0 None 15d. Crime Incident Reports filled  ____________ Total number of NCVS-2s filled 323 0 None Fill BOUNDING INFORMATION N C V S 1 2 No Item blank 6 7 1 2 3 4 5 Less than $5,000 $5,000 - 7,4 99 7,500 - 9,999 10,000 - 12,499 12,500 - 14,999 12c. Public Housing 1 Yes (public housing) 219 12d. Manager Verification of Public Housing Unable to verify 1 2 Public housing Not public housing 220 3 4  Telephone Other - Specify NCVS-1 BASIC SCREEN QUESTIONNAIRE 12b. College/University 1 Yes 2 No Able to verify 218 X X Item blank No (not public housing) 2 b. Reason (Enter code) 16. Changes in Household Composition a. Line No. 324 326 328 330 15,000 - 17,499 17,500 - 19,999 11 12 13 14 35,000 - 39,999 40,000 - 49,999 50,000 - 74,999 75,000 and over 325 327 329 331 Only enter changes discovered during the current enumeration  ACTING AS COLLECTING AGENT FOR THE BUREAU OF JUSTICE STATISTICS  U.S. DEPARTMENT OF JUSTICE Control number PSU Segment/Suffix 3- TA and won't return before closeout American Indian Reservation or American Indian Lands Yes 1 221 2 No 12e.  Economics and Statistics Administration  U.S. CENSUS BUREAU 212 6-Office use only 3-Physically/ mentally unable to answer-no proxy available 4-TA and no proxy available .... 1-Never available NCVS-1 NOTICE - We are conducting this survey under the authority of Title 13, United States Code, Section 8. Section 9 of this law requires us to keep all information about you and your household strictly confidential. We may use this information only for statistical purposes. Also, Title 42,  Section 3732, United States Code, authorizes the Bureau of Justice Statistics, Department of Justice, to collect information using this survey. Title 42, Sections 3789g and 3735, United States Code, also requires us to keep all information about you and your household strictly confidential. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB number. 205 2-Refused .... 5-Other ...... Location of phone - Mark first box that applies. 1-12-13 years old and parent refused permission for self interview 2- Physically/mentally unable to answer 11c. 222 Gated or walled community 1 Yes X Item blank 2 No Building with restricted access 1 Yes 2 No X Item blank Direct outside access USCENSUSBUREAU 223 Sample designation/Suffix Serial/ Suffix 15c. Number of Type Z noninterview household members 12 years of age and OVER  ____________ Total number 332 None 0 HH No. Spinoff Indicator HU in rooming house Mobile home or trailer with no permanent room added HU not specified above - Describe (Enter code) (Enter code)

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  • OMB No. 1121-0111: Approval Expires 07/31/2009

    FORM

    Implementation Date: (01-01-2007)

    U.S. DEPARTMENT OF COMMERCE

    NATIONAL CRIME VICTIMIZATION SURVEY

    10a.

    1. Field representative identification

    201Code Name

    1 Unit in sample the previous enumeration period - Fill 3 Unit in sample first time this period - SKIP to 4 2

    2. Unit status202

    1 Same household interviewed the previous enumeration3. Household status - Mark first box that applies.

    2032 Replacement household since the previous enumeration3

    4

    Noninterview the previous enumeration Other - Specify

    4. Line number of household respondent____________ Go to page 2

    Use of telephone

    5. Group Quarters [GQ] type code____________

    204

    1 Owned or being bought

    6. Tenure206 2 Rented

    for cash3 No cash

    rent

    1 Urban7. Land Use

    207 2 Rural

    X Item blank8. Farm Sales

    208 1 $1,000 or more 2 Less than $1,000

    9. Type of living quarters Housing unit

    12345

    House, apartment, flatHU in nontransient hotel, motel, etc. HU permanent in transient hotel, motel, etc

    209

    Mobile home or trailer with one or more permanent rooms added

    7

    6

    OTHER unitQuarters not HU in rooming or boarding house8Unit not permanent in transient hotel, motel, etc.9Unoccupied site for mobile home, trailer, or tent10Student quarters in college dormitory OTHER unit not specified above - Describe

    1112

    Phone in unit ...................12 Phone in common area (hallway, etc.) ....

    Phone in another unit (neighbor, friend, etc.) Work/office phone ................ No phone - SKIP to 11a

    345

    10b. Is phone interview acceptable?

    Fill 10b

    210

    1 Yes211 2 No 3 Refused to give number

    11a. Number of housing units in structure 123

    1 - SKIP to 11c 23

    213

    456

    45-910+

    7 Mobile home/trailer -SKIP to 11c

    8 Only OTHER units

    11b.

    Restricted access

    1 Yes 3 DK

    12a. Household Income 214

    89

    10

    20,000 - 24,99925,000 - 29,99930,000 - 34,999

    13. Proxy information - Fill for all proxy interviews a. Proxy interview obtained for Line No.

    b. Reason

    c. Reason

    301 303302

    Name Line No.

    304 306305

    307 309308

    310 312311

    Codes for item 13c

    14. Type Z noninterviewa. Interview not

    obtained forLine No.

    b. Proxy respondent

    313

    315

    317

    319

    314

    316

    318

    320

    Complete 17-28 for each Line No. in 14a

    Codes for item 14b

    15a. Household members 12 years of age and OVER

    ____________ Total number321

    15b. Household members UNDER 12 years of age

    ____________ Total number322 0 None

    15d. Crime Incident Reports filled

    ____________ Total number of NCVS-2s filled323 0 None

    Fill BOUNDING INFORMATION

    NCVS

    1

    2 No Item blank

    67

    12345

    Less than $5,000$5,000 - 7,4997,500 - 9,999

    10,000 - 12,49912,500 - 14,999

    12c. Public Housing 1 Yes (public

    housing)219

    12d. Manager Verification of Public Housing

    Unable to verify12

    Public housing Not public housing

    220

    34

    TelephoneOther - Specify

    NCVS-1 BASIC SCREEN QUESTIONNAIRE

    12b. College/University 1 Yes 2 No

    Able to verify

    218

    X

    X Item blank No (not public housing)

    2

    b. Reason (Enter code) 16. Changes in Household Composition

    a. Line No. 324

    326

    328

    330

    15,000 - 17,49917,500 - 19,999

    11121314

    35,000 - 39,99940,000 - 49,99950,000 - 74,99975,000 and over

    325

    327

    329

    331

    Only enterchanges discoveredduring the currentenumeration

    ACTING AS COLLECTING AGENT FOR THEBUREAU OF JUSTICE STATISTICS

    U.S. DEPARTMENT OF JUSTICE

    Control numberPSU Segment/Suffix

    3- TA and won't return before closeout

    American Indian Reservation or American Indian Lands

    Yes1221 2 No

    12e.

    Economics and Statistics Administration U.S. CENSUS BUREAU

    212

    6-Office use only

    3-Physically/ mentally unable to answer-no proxy available

    4-TA and no proxy available ....

    1-Never available

    NCVS-1NOTICE - We are conducting this survey under the authority of Title 13, United States Code, Section 8. Section 9 of this law requires us to keep all information about you and your household strictly confidential. We may use this information only for statistical purposes. Also, Title 42, Section 3732,United States Code, authorizes the Bureau of Justice Statistics, Department of Justice, to collect information using this survey. Title 42, Sections 3789g and 3735, United States Code, also requires us to keep all information about you and your household strictly confidential. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless suchcollection displays a valid OMB number.

    205

    2-Refused ....

    5-Other ......

    Location of phone - Mark first box that applies.

    1-12-13 years old and parent refused permission for self interview 2- Physically/mentally unable to answer

    11c.222 Gated or walled community 1 Yes X Item blank2 No

    Building with restricted access 1 Yes 2 No X Item blank

    Direct outside access

    USCENSUSBUREAU

    223

    Sample designation/Suffix

    Serial/Suffix

    15c. Number of Type Z noninterview household members 12 years of age and OVER

    ____________ Total number332 None0

    HH No. SpinoffIndicator

    HU in rooming houseMobile home or trailer with no permanent room added

    HU not specified above - Describe

    (Enter code)

    (Enter code)

  • RESPONDENT'S PERSONAL CHARACTERISTICS

    17. Name of respondent

    Last

    First

    Type of interviewLineNo.

    401

    1234

    Per. - Self-respondentTel. - Self-respondentPer. - ProxyTel. - Proxy

    18. 19.

    Fill 13 on cover page ________Line No.

    29. Date of interview 501

    33a. If unsure, ASK OR VERIFY - How long have you lived at this address? (Enter 0 if less than 1 year.)

    ____________ Months (1-11) - SKIP to 33e 505

    ____________ Years (Round to nearest whole year) - 506

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

    CHECKITEM A

    How many years are entered in 33a?

    33e. Altogether, how many times have you moved in the last 5 years, that is, since _________________, 20 ___?

    __________ Number of times - If HHLD Respondent ASK 34, else SKIP to 36a

    508

    Page 2

    402

    20.

    Relationship toreferenceperson

    21.

    Age last Birthday

    22a.

    Marital status THIS survey period

    22b.

    Maritalstatus LASTsurvey period

    23.

    Sex

    24.

    Armed Forces Member

    25.

    Educational attainment

    28.

    Race

    27.

    Hispanic Origin

    403

    1

    2

    3

    4

    5

    6

    7

    8

    9

    10

    11

    HusbandWifeSonDaughterFatherMotherBrotherSisterOther relativeNonrelativeRef. person

    ________

    Age

    405

    12345

    MarriedWidowedDivorcedSeparatedNevermarried

    406

    12345

    MarriedWidowedDivorcedSeparatedNevermarriedNot inter-viewedlastsurveyperiod

    6

    407

    12

    MF

    408

    12

    YesNo

    413

    12

    YesNo

    404

    ____________

    Highest level completed

    409 412

    12

    White

    AmericanIndian/AlaskaNativeAsian

    Other - Specify

    4

    6

    26.

    Attending School

    411

    2 College/Univer-sityTradeschoolVoca-tionalschool

    5 None oftheaboveschools

    3

    4

    (From previousenumeration)

    Month Day Year

    Regular school

    1

    MOBILITY QUESTIONS

    BUSINESS OPERATED FROM SAMPLE ADDRESS

    34. (Asked of Household Respondent Only) Does anyone in this household operate a business from this address?

    35. (Asked of Household Respondent Only) Is there a sign on the premises or some other indication to the general public that a business is operated from this address?

    PERSONAL - Fill by observation. TELEPHONE - Ask.

    1

    2

    Yes - ASK 35

    No - SKIP to 36a

    530

    1

    2

    Yes (Recognizable business)No (Unrecognizable business)

    531

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

    Black/AfricanAmerican

    NativeHawaiian/OtherPacific Islander

    5

    3

    *

    Mark all thatapply.

    33b. How many months?

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

    33c.

    Have you lived here... Read appropriate categories:

    1234

    More than 5 years - If HHLD Respondent SKIP to 34, else SKIP to 36a.

    Less than 5 years, but more than 1 year

    Less than 1 year, but mroe than 6 months6 months or lessDon't Know5

    SKIP to 33e

    Enter number of times.

    33d.

  • RESPONDENT'S SCREEN QUESTIONS

    36a. I'm going to read some examples that will give you an

    idea of the kinds of crimes this study covers.

    Page 3

    Was something belonging to YOU stolen, such as - (a) Things that you carry, like luggage, a wallet,

    purse, briefcase, book -

    As I go through them, tell me if any of these happened to you in the last 6 months, that is since __________ ______, 20 ____.

    (b) Clothing, jewelry, or cellphone - (c) Bicycle or sports equipment -(d) Things in your home - like a TV, stereo, or tools - (e) Things outside your home such as a garden hose or furniture - (Asked of Household Respondent only)(f) Things belonging to children in the household - (Asked of Household Respondent only) (g) Things from a vehicle, such as a package, groceries, camera, or CDs -

    (h) Did anyone ATTEMPT to steal anythingbelonging to you?

    OR

    Did any incidents of this type happen to you?

    ASK only if necessary

    36b. How many times?

    37a. (Asked of Household Respondent Only) (Other than any incidents already mentioned,) has anyone -

    (a) Broken in or ATTEMPTED to break into yourhome by forcing a door or window, pushing past someone, jimmying a lock, cutting a screen, or entering through an open door or window?

    (c) Illegally gotten in or tried to get into a hotel ormotel room or vacation home where you were staying?

    (b) Has anyone illegally gotten in or tried to get

    into a garage, shed, or storage room? OR

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

    37b. (Asked of Household Respondent Only) How many times?

    Briefly describe incident(s)

    1

    Yes - ASK 37b

    532

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

    533

    No - SKIP to 38

    2

    Briefly describe incident(s)

    1534

    Number of times (37b)

    535

    2

    Yes - ASK 36b

    No - If Household Respondent SKIP to 37a; else SKIP to 40a

    36c.

    37c. (Asked of Household Respondent Only)

    Read each category.

    What happened?

    What happened?

    Number of times (36b)

  • RESPONDENT'S SCREEN QUESTIONS

    39a. (Asked of Household Respondent Only)

    38. (Asked of Household Respondent Only)

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

    During the last 6 months, (other than any incidents already mentioned,) (was the vehicle/were any of the vehicles) -

    Page 4

    (a) Stolen or used without permission?

    (Other than any incidents already mentioned,) since __________ ______, 20 ____, were you attacked or threatened OR did you have something stolen from you -

    (b) Did anyone steal any parts such as a tire, carstereo, hubcap, or battery?

    (c) Did anyone steal any gas from (it/them)?

    (d) Did anyone ATTEMPT to steal any vehicle or partsattached to (it/them)?

    OR

    Did any incidents of this type happen to you?

    Ask only if necessary

    39b. (Asked of Household Respondent Only) How many times?

    40a.

    (a) At home including the porch or yard -

    (c) At work or school -

    (b) At or near a friend's, relative's, orneighbor's home -

    OR

    Did any incidents of this type happen to you?

    Ask only if necessary

    40b. How many times?

    01234

    None - SKIP to 40a 1234 or more

    536

    Briefly describe incident(s)

    1 Yes - ASK 39b537

    Number of times (39b)

    538

    No - SKIP to 40a 2

    Number of times (40b)

    540

    (d) In places such as a storage shed or laundryroom, a shopping mall, restaurant, bank, or airport -

    (e) While riding in any vehicle - (f) On the street or in a parking lot - (g) At such places as a party, theater, gym,

    picnic area, bowling lanes, or while fishing or hunting -

    Briefly describe incident(s)

    (h) Did anyone ATTEMPT to attack or ATTEMPTto steal anything belonging to you from any of these places?

    39c. (Asked of Household Respondent Only)

    No - SKIP to 41a 2

    Yes - ASK 40b1539

    40c.

    What happened?

    What happened?

  • RESPONDENT'S SCREEN QUESTIONS

    Page 5

    (Other than any incidents already mentioned,) has anyone attacked or threatened you in any of these ways (Exclude telephone threats) -

    41a.

    (a) With any weapon, for instance, a gun orknife -

    (c) By something thrown, such as a rock orbottle -

    (b) With anything like a baseball bat, fryingpan, scissors, or stick -

    OR

    Did any incidents of this type happen to you?

    ASK only if necessary

    41b. How many times?

    Briefly describe incident(s)

    1 Yes - ASK 41b541

    Number of times (41b)

    542

    No - SKIP to 42a 2

    (d) Include any grabbing, punching, or choking, (e) Any rape, attempted rape or other type of sexual attack -(f) Any face to face threats -

    (g) Any attack or threat or use of force by anyoneat all? Please mention it even if you are not certain it was a crime.

    People often don't think of incidents committed by someone they know. (Other than any incidents already mentioned,) did you have something stolen from you ORwere you attacked or threatened by (Exclude telephone threats) -

    42a.

    (a) Someone at work or school -(b) A relative or family member - (c) A neighbor or friend -

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

    42b. How many times?

    Briefly describe incident(s)

    1 Yes - ASK 42b543

    Number of times (42b)

    544

    No - SKIP to 43a 2

    (d) Any other person you've met or known?

    Incidents involving forced or unwanted sexual acts are often difficult to talk about. (Other than any incidents already mentioned,) have you been forced or coerced to engage in unwanted sexual activity by -

    43a.

    (a) Someone you didn't know before -

    (c) Someone you know well?

    (b) A casual acquaintance -

    Did any incidents of this type happen to you?

    ASK only if necessary

    43b. How many times?

    Briefly describe incident(s)

    1 Yes - ASK 43b545

    Number of times (43b)

    546

    No - SKIP to 44a 2

    OR

    41c.

    42c.

    43c.

    What happened?

    What happened?

    What happened?

  • RESPONDENT'S SCREEN QUESTIONS

    Page 6

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

    44a.

    Briefly describe incident(s)

    1 Yes - ASK 44b547

    No - SKIP to 45a 2

    44d. How many times?

    CHECKITEM B

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

    1

    2Yes - ASK 44d

    No - SKIP to 45a

    549

    Number of times (44d)

    550

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

    45a.

    Briefly describe incident(s)

    1 Yes - ASK 45b551

    No - If Household Respondent ASK 60, else SKIP to 71

    2

    45d. How many times?

    CHECKITEM C

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

    1

    2

    Yes - ASK 45d 553

    NOTES

    554

    Number of times (45d) If Household Respondent SKIP to 60, else SKIP to 71

    44b.

    45b.

    If not sure ask:

    If not sure ask:

    What happened?

    What happened?

    44c.

    45c.

    No - If Household Respondent SKIP to 60, else SKIP to 71

  • Page 7

    60.

    1

    23

    4

    Motor vehicle (including parts)Bicycle (including parts)MailboxHouse window/screen/doorYard or garden (trees, shrubs, fence, etc.) Furniture, other household goodsClothingAnimal (pet, livestock, etc.)

    558

    Now I'd like to ask about ALL acts of vandalism that may have been committed during the last 6 months against YOUR household. Vandalism is the deliberate, intentional damage to or destruction of household property. Examples are breaking windows, slashing tires, and painting graffiti on walls.

    61a.

    What kind of property was damaged or destroyed in this/these act(s) of vandalism? Probe: Anything else?

    Since __________ ______, 20 ____, has anyone intentionally damaged or destroyed property owned by you or someone else in your household?

    12

    Yes - ASK 61a557

    Other - Specify - ASK 61b

    *

    Enter all that apply for property that was damaged or destroyed by vandalism during reference period.

    (EXCLUDE any damage done in conjunction with incidents already mentioned. )

    No - SKIP to 71

    61b.

    Please specify the kind of property damaged or destroyed in this/these act(s) of vandalism.

    Specify

    SKIP to 62a 5

    6

    7

    89

    HOUSEHOLD RESPONDENT'S VANDALISM QUESTIONS (Asked of Household Respondent Only)

    1 Broken glass: window, windshield, glass in door, mirror

    55962a.

    What kind of damage was done in this/these act(s) of vandalism? Probe: Anything Else?

    Defaced: marred, graffiti, dirtied Burned: use of fire, heat or explosives Drove into or ran over with vehicleOther breaking or tearingInjured or killed animalsOther - Specify - ASK 62b

    *

    63a.

    What was the total dollar amount of the damage caused by this/these act(s) of vandalism during the last 6 months? (Use repair costs if the property was repaired.)

    560 $ .- SKIP to 64a

    0 No cost - SKIP to 64a (If DK or RF are entered, ASK 63b)

    63b. 123

    Under $100$100 or moreDon't know

    561

    If unsure, ASK, In the vandalism just mentioned, were you (was the respondent) attacked or threatened, or was something stolen or an attempt made to steal something that belonged to you (the respondent) or another household member? (other than any incident(s) already mentioned)

    Briefly describe incident(s)

    1 Yes - ASK 64b562

    No - SKIP to 65 2

    Number of times (64b)

    563

    CHECKITEM F1

    00

    Enter all that apply for property that was damaged or destroyed by vandalism during the reference period.

    62b.

    Please specify the kind of damage done in this/these act(s) of vandalism.

    (INCLUDE total amount for all incidents of vandalism during the last 6 mon.ths.)

    (EXCLUDE any damage done in incidents already mentioned.)

    Was the damage under $100 or $100 or more?

    64b.

    How many times?

    What happened?

    64c.

    SKIP to 63a

    Specify

    2

    34

    5

    67

    64a.

  • Page 8

    CHECKITEM F2 Are one or more boxes marked "Yes" in 66a - 66f

    OR 67a or 67c?

    Yes - ASK 69a

    No - SKIP to 71

    65.

    Yes1 2 No

    No

    587

    3 Don't know

    3 Don't know

    HOUSEHOLD RESPONDENT'S HATE CRIME SCREEN QUESTIONS (Asked of the Household Respondent Only)

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

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

    Yes - ASK 66a No

    Don't know

    123

    586

    66.

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

    If "Yes," SAY - (by this we mean homosexual, bisexual, or heterosexual)

    Yes1 2 No 3 Don't know

    Yes1 2 No 3 Don't know

    Yes 2 No 3 Don't know

    Yes1 2 No 3 Don't know

    Yes1 2 No 3 Don't know

    564

    565

    566

    567

    568

    569

    67a.

    Some offenders target people because they associate with certain people or the (offender perceives/offenders perceive) them as having certain characteristics or religious beliefs.

    Do you suspect you were targeted because of...

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

    67b.

    67c. The offender(s)'s perception of your characteristics or religious beliefs (for example, the offender(s) thought you were Jewish because you went into a synagogue)?

    Yes - ASK 67b

    No

    589

    3 Don't know

    Yes - ASK 67d

    69a.

    Do you have any evidence that this vandalism was a hate crime or crime of prejudice or bigotry?

    ASK 69b

    123

    591

    Did the offender(s) say something, write anything, or leave anything behind at the crime scene that would suggest you were targeted because of your characteristics or religious beliefs?

    SKIP to 71

    Yes - SKIP to 70a No

    Don't know

    588

    590

    (a) Your race?

    (b) Your religion?

    (c) Your ethnic background or national origin (for example, people of Hispanic origin)? ........

    (d) Any disability (by this I mean physical, mental, or developmental disabilities) you may have? ....

    (e) Your gender?

    (f) Your sexual orientation?

    Please specify why the respondent suspects they were targeted because of their association with people who have certain characteristics or religious beliefs.

    2

    1

    2

    1

    67d. Please specify why the respondent suspects they were targeted because of the offender(s)'s perception of their characteristics or religious beliefs.

    69b.

    1

    2

    Yes - ASK 70a

    No - SKIP to 71

    SKIP to 67c

    SKIP to 68

    1

    68.

  • Page 9

    CHECK ITEM G

    Is one or more crimes reported in 36b, 37b, 39b, 40b, 41b, 42b, 43b, 44d, 45d, or 64b?

    Yes - SKIP to CRIME INCIDENT Report (INCIDENTINTRO)

    HOUSEHOLD RESPONDENT'S HATE CRIME SCREEN QUESTIONS (Asked of Household Respondent Only)

    70.

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

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

    (b) Were any hate symbols present at the crime scene to indicate the offender(s) targeted you for a particular reason (for example, a swastika, graffiti on the walls of a temple, a burning cross, or written words)?

    (c)

    Did a police investigation confirm the offender(s) targeted you (for example, did the offender(s) confess a motive, or did the police find books, journals, or pictures that indicated the offender(s) (was/were) prejudiced against people with certain characteristics or religious beliefs)?

    (d)

    Do you know if the offender(s) (has/have) committed similar hate crimes or crimes of prejudice or bigotry in the past?

    (e) Did the vandalism occur on or near a holiday, event, location, gathering place, or building commonly associated with a specific group (for example, at the Gay Pride March or at a synagogue, Korean church, or gay bar)?

    (f) Have other hate crimes or crimes of prejudice or bigotry happened to you or in your area/ neighborhood where people have been targeted?

    (g)

    Do your feelings, instincts, or perception lead you to suspect this vandalism was a hate crime or crime of prejudice or bigotry, but you do not have enough evidence to know for sure?

    Yes1 2 No 3 Don't know592

    Yes1 2 No 3 Don't know593

    Yes1 2 No 3 Don't know594

    Yes1 2 No 3 Don't know595

    Yes1 2 No 3 Don't know596

    Yes1 2 No 3 Don't know597

    Yes1 2 No 3 Don't know598

    11 Telephone interview - SKIP to 73. Personal interview - Mark all that apply.

    555

    No one besides respondent present Respondent's spouse

    HHLD member(s) 12+, not spouse HHLD member(s) under 12

    Nonhousehold member(s) Someone was present - Can't say who Don't know if someone else present

    Who besides the respondent was present when the screen questions were asked? (If telephone interview, mark box 1 only or box 11 only.)

    *

    CHECKITEM D

    123

    Yes No Person for whom interview taken not present

    556Did the person for whom this interview was taken help the proxy respondent answer any screen questions?

    CHECKITEM E

    (a)

    RESPONDENT'S CHECK ITEMS D, E, AND G

    12

    13

    14

    15

    16

    17

    18

    71.

    72.

    73.

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

    No - SKIP to 74

  • Page 10

    11 Physician?Nurse?Technician?

    Other Medical Profession? - Specify - ASK 76d

    579

    Did you have a job or work at a business LAST WEEK? (Do not include volunteer work or work around the house.)

    75a. 576 1

    2Yes - SKIP to 76a No - ASK 75b

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

    75b.

    Ask OR Verify -

    577

    578 12

    12

    Yes - ASK 75c

    No - SKIP to 80

    Yes - ASK 76a

    No - SKIP to 80 Did that (job/work) last 2 consecutive weeks or more?

    75c.

    76a.

    Ask OR Verify -

    Medical Profession

    Mental Health Services Field

    Teaching Profession

    Law Enforcement or Security Field

    15 Professional (Social worker/psychiatrist)? Custodial care?

    Some other Mental Health Services Profession? - Specify - ASK 76f

    18 Preschool?

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

    Technical or industrial school?Special education facility?

    Specify - SKIP to 77

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

    26

    27

    28

    29

    (If farm or business operator in household, ask about unpaid work.)

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

    CHECKITEM H Is the respondent 16 years or older?

    12

    Yes - ASK 75a

    No - SKIP to 80

    RESPONDENT'S EMPLOYMENT QUESTIONSAll incident reports must be completed before asking this series of questions.

    Medical Profession? - SKIP 76c

    Mental Health Services Field? - SKIP to 76e

    Teaching Profession? - SKIPto 76g

    Law Enforcement or Security Field? - SKIP to 76i

    Retail Sales? - SKIPto 76k

    Something else? - Specify - ASK 76b

    Please specify the job not covered in answer categories 11-16 in 76a.Specify -SKIP to 77

    11

    12

    13

    14

    15

    16

    Specify - SKIP to 77

    Employed in the Medical Profession: As a -- .

    Read each category

    Employed in the Mental Health Services Field:

    Please specify employed in the medical profession as a -

    Are YOUR duties - Read each category.

    Please specify duties in the mental health services field.

    Specify - SKIP to 77

    Employed in the Teaching Profession:

    WERE YOU employed in a -

    Read each category.

    Please specify employed in the teaching profession as a -

    76h.

    76i.

    Employed in the Law Enforcement or Security Field:

    WERE YOU employed as a -

    Read each category.

    Specify - SKIP to 7776j. Please specify employed in the law enforcement or security field as a -

    17

    Transportation Field? - SKIP to 76m

    - SKIP to 77

    - SKIP to 77

    Other teaching profession? - Specify - ASK 76h

    - SKIP to 77

    - SKIP to 77

    74.

    76b.

    76c.

    12

    13

    14

    76d.

    76e.

    16

    17

    76f.

    76g.

    19

    20

    21

    22

    23

    24

    25

  • Page 11

    RESPONDENT'S EMPLOYMENT QUESTIONS CONTINUED

    CHECKITEM I

    Is this the last household member to be interviewed? Yes - If Household Respondent finish collecting income and telephone information, then END interview. Otherwise end

    interview.

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

    Is your job with - Read each category.

    77.

    Ask OR Verify -

    1 A private company, business, or individual for wages?5802

    3

    4

    The Federal government? A State, county, or local government?

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

    79. 1234

    A city?Suburban area?

    Rural area?Combination of any of these?

    582

    78. 581 12

    YesNoAre you employed by a college or university?

    Retail Sales -

    Transportation Field -

    Convenience or liquor store clerk? Gas station attendant?

    Bartender?Other retail sales profession? Specify - ASK 76l

    30

    31

    32

    33

    Bus driver?Taxi cab driver?Other transportation FIeld profession? Specify - ASK 76n

    34

    35

    36

    76k. Employed in Retail Sales:

    WERE YOU employed as a -

    Read each category.

    Specify - SKIP to 77 76l.

    Please specify employed in retail sales as a -

    76m.

    Employed in the Transportation Field:

    WERE YOU employed as a -

    Read each category.

    76n. Specify

    Please specify employed in the transportation field as a -

    - SKIP to 77

    - SKIP to 77

    Yourself (Self-employed) in your own business, professional practice, or farm?

    80.

    FIELD REPRESENTATIVE --

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

    If TEACHINGJOB = 22 SKIP to 79, else ASK 78.