ncvs questionnaire

OMB No. 1121-0111: Approval Expires 7/31/2006

FORM(9-16-2004)

U.S. DEPARTMENT OF COMMERCE

NATIONAL CRIME VICTIMIZATION SURVEY

ITEMS FILLED AT START OF INTERVIEW

10a.

1. Field representative identification

201Code Name

1 Unit in sample the previous enumeration period – Fill 3Unit in sample first time this period – SKIP to 42

2. Unit status202

1 Same household interviewed the previous enumeration3. Household status – Mark first box that applies.203

2 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 (cc item 26a and b)

AFTER INTERVIEW – TRANSCRIBE FROM CONTROL CARD

5. Group Quarters (GQ) type code____________

204

1 Owned or being bought

6. Tenure (cc item 8a)206 2 Rented

for cash3 No cash

rent

1 Urban7. Land use (cc item 9)207 2 Rural

X Item blank8. Farm sales (cc item 10)208 1 $1,000 or more 2 Less than $1,000

9. Type of living quarters (cc items 11c and 11d)Housing unit

1

2

3

4

5

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

209

Mobile home or trailer with no permanent room added

HU not specified above – Describe7

Mobile home or trailer with one or more permanent rooms added6

OTHER unitQuarters not HU in rooming or boarding house8

Unit not permanent in transient hotel, motel, etc.9

Unoccupied site for mobile home, trailer, or tent10

Student quarters in college dormitoryOTHER 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? (cc item 26d)

Fill 10b

210

1 Yes211 2 No 3 Refused to give number

11a. Number of housing units in structure (cc item 27a)1

2

3

1 – SKIP to 11c23

213

4

5

6

45–910+

7 Mobile home/trailer –SKIP to 11c

8 Only OTHER units

11b.

Restricted access (cc item 27c)

1 Yes 3 DK

12a. Household Income (cc item 28)214

8

9

10

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

ITEMS FILLED DURING AND/OR AFTER INTERVIEW

13. Proxy information – Fill for all proxy interviews

a. Proxy inter-view obtained for Line No.

b. Reason(Entercode)

c. Reason(Entercode)

301 303302

Name Line No.

304 306305

307 309308

310 312311

Codes for item 13c

FILL INTER-COMM

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

FILLINTER-COMM

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

6

7

1

2

3

4

5

Less than $5,000$5,000 – 7,499

7,500 – 9,99910,000 – 12,49912,500 – 14,999

12c. Public Housing (cc item 8c)1 Yes (public

housing)219

12d. Manager Verification of Public Housing (cc item 8d)

Unable to verify1

2

Public housing Not public housing

220

3

4

CATI/TelephoneOther – Specify

NCVS-1 BASIC SCREEN QUESTIONNAIRE

12b. College/University (cc item 8b)1 Yes 2 No

Able to verify

218

X

X Item blank

X Item blank

No (not public housing)

2

b. Reason (Enter code)16. Changes in Household Composition (cc item 25a)

a. Line No.324

326

328

330

15,000 – 17,49917,500 – 19,999

11

12

13

14

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

325

327

329

331

Only transcribechanges discoveredduring the currentenumeration

BEFORE INTERVIEW – TRANSCRIBE FROM CONTROL CARD

ACTING AS COLLECTING AGENT FOR THEBUREAU OF JUSTICE STATISTICS

U.S. DEPARTMENT OF JUSTICE

Control numberPSU Segment/Suffix

AFTER INTERVIEW – TRANSCRIBE FROM CONTROL CARD – Cont.

3– TA and won’t return before closeout

American Indian Reservation or American Indian Lands(cc item 8e)

Yes1221 2 No

12e.

Economics and Statistics AdministrationU.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 householdstrictly 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 ofJustice, to collect information using this survey. Title 42, Sections 3789g and 3735, United StatesCode, 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 acollection 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 interview2– 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 (cc item 27b)

U S C E N S U S B U R E A U

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

HOUSEHOLD RESPONDENT’S PERSONAL CHARACTERISTICS

17. NAME (of household respondent)

Last

First

Type of interviewLineNo.

401

1

2

3

4

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

18. 19.

Fill 13 on cover page ________Line No.

29.

33a.

Date of interview 501

If unsure, ASK OR VERIFY –How long have you lived at this address? (Enter number of months OR years.)

____________ Months (1-11) – SKIP to 33b505

OR

____________ Years (Round to nearest whole year) – Fill Check Item A

506

5 years or more – SKIP to 34Less than 5 years – Ask 33b

CHECKITEM A

How many years are entered in 33a?

33b. Altogether, how many times have you moved in the last 5 years, that is, since _________________, 20 ___? ____________ Number of times508

FORM NCVS-1 (9-16-2004)

402


20.Relationship toreferenceperson

21.Age lastbirthday

22a.Marital status THIS survey period

22b.

Maritalstatus LASTsurvey period

23.Sex

24.ArmedForcesmember

25.Educationalattainment

28.Race

27.His-panicorigin

403

01

02

03

04

05

06

07

08

09

10

11

HusbandWifeSonDaughterFatherMotherBrotherSisterOther relativeNonrelativeRef. person

________Age

405

1

2

3

4

5

MarriedWidowedDivorcedSeparatedNevermarried

406

1

2

3

4

5

MarriedWidowedDivorcedSeparatedNevermarriedNot inter-viewedlastsurveyperiod

6

407

1

2

MF

408

1

2

YesNo

413

1

2

YesNo

404

____________Highest level

completed

409 412

1

2

White

AmericanIndian/AlaskaNativeAsian

Other – Specify

4

6

26.Attendingschool

411

1 College/Univer-sityTradeschoolVoca-tionalschool

4 None oftheaboveschools

2

3

(cc 13b) (cc 17) (cc 18) (From previousenumeration)

(cc 19) (cc 20) (cc 21) (cc 22) (cc 24)(cc 23)

Month Day Year

Regular school

0

MOBILITY QUESTIONS

BUSINESS OPERATED FROM SAMPLE ADDRESS

34. Does anyone in this household operate a business fromthis address?

35. Is there a sign on the premises or someother indication to the general public that abusiness is operated from this address?

PERSONAL – Fill by observation.

TELEPHONE – Ask.

1

2

Yes – Go to 35No – SKIP to 36a

530

1

2

Yes (Recognizable business)No (Unrecognizable business)

531

Before we get to the crime questions, I have somequestions that are helpful in studying where and whycrimes occur.

Black/AfricanAmerican

NativeHawaiian/OtherPacific Islander

5

3

*

Mark (X) all thatapply.

HOUSEHOLD RESPONDENT’S SCREEN QUESTIONS

36a. I’m going to read some examples that will give you anidea of the kinds of crimes this study covers.

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 thesehappened to you in the last 6 months, that issince __________ ______, 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 lawn furniture – (f) Things belonging to children in the household –(g) Things from a vehicle, such as a package,

groceries, camera, or CDs –

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

OR

36b. Did any incidents of this type happen to you?MARK OR ASK –

36c. How many times?

37a. (Other than any incidents already mentioned,)has anyone –(a) Broken in or ATTEMPTED to break into your

home by forcing a door or window, pushingpast someone, jimmying a lock, cutting ascreen, or entering through an open door orwindow?

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

(b) Has anyone illegally gotten in or tried to getinto a garage, shed, or storage room?OR



Briefly describe incident(s)

1

Yes – What happened?

532

Number of times (36c)533

No – SKIP to 38

2

Describe above


1534


2

FORM NCVS-1 (9-16-2004)


No – SKIP to 37aDescribe above


39a.

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

During the last 6 months, (other than any incidentsalready mentioned,) (was the vehicle/were any ofthe vehicles) –

(a) Stolen or used without permission?

(Other than any incidents already mentioned,)since __________ ______, 20 ____, were you attackedor threatened OR did you have something stolenfrom 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



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



0

1

2

3

4

None – SKIP to 40a1234 or more

536


1 Yes – What happened?537


No – SKIP to 40a2

Describe above

1 Yes – What happened? 539


No – SKIP to 41a2

Describe above

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

(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 fishingor hunting –


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

FORM NCVS-1 (9-16-2004)


(Other than any incidents already mentioned,)has anyone attacked or threatened you in anyof 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






No – SKIP to 42a2

Describe above

(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 notcertain it was a crime.

People often don’t think of incidents committedby someone they know. (Other than any incidentsalready mentioned,) did you have somethingstolen from you OR were you attacked orthreatened by (Exclude telephone threats) –

42a.

(a) Someone at work or school –

(c) A relative or family member –(b) A neighbor or friend –






No – SKIP to 43a2

Describe above

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

Incidents involving forced or unwanted sexualacts are often difficult to talk about. (Other thanany incidents already mentioned,) have you beenforced or coerced to engage in unwanted sexualactivity by –

43a.

(a) Someone you didn’t know before –

(c) Someone you know well?

(b) A casual acquaintance –






No – SKIP to 44a2

Describe above

OR

FORM NCVS-1 (9-16-2004)


During the last 6 months, (other than anyincidents already mentioned,) did you call thepolice to report something that happened to YOUwhich you thought was a crime?

44a. Briefly describe incident(s)


No – SKIP to 45a2

Describe above

44b. How many times?

548

*OFFICE USE ONLY

CHECKITEM B

Look at 44a. If unsure, ASK, otherwise, mark withoutasking. Were you (was the respondent) attacked orthreatened, or was something stolen or anattempt made to steal something thatbelonged to you (the respondent) or anotherhousehold member?

1

2

Yes – Ask 44b No – SKIP to 45a

549

Number of times (44b)550

During the last 6 months, (other than anyincidents already mentioned,) did anything whichyou thought was a crime happen to YOU, but youdid NOT report to the police?



No – SKIP to INTRO 1 at top ofpage 7

2

Describe above


552

*OFFICE USE ONLY

CHECKITEM C

Look at 45a. If unsure, ASK, otherwise, mark withoutasking. Were you (was the respondent) attacked orthreatened, or was something stolen or anattempt made to steal something thatbelonged to you (the respondent) or anotherhousehold member?

1

2

Yes – Ask 45b 553

NOTES

554

Number of times (45b)

No – SKIP to INTRO 1 at top ofpage 7

FORM NCVS-1 (9-16-2004)

HOUSEHOLD RESPONDENT’S IDENTITY THEFT QUESTIONS

FIELD REPRESENTATIVE – Read introduction.

Did these episodes of identify theft occur separatelyor at the same time?

45e.

INTRO 1: The next few questions are related to identity theft. They refer to episodes of identity theft discovered by you oranyone in your household during the last 6 months.

FORM NCVS-1 (9-16-2004)

45c. Since , 20 , have youor anyone in your household discovered thatsomeone –

(a) Used or attempted to use any existing creditcards or credit card numbers without permissionto place charges on an account? . . . . . . . . . .

Yes1 2 No 3 Don’t know107

(b) Used or attempted to use any existing accountsother than a credit card account – for example, awireless telephone account, bank account ordebit/check cards – without the account holder’spermission to run up charges or to take moneyfrom accounts? . . . . . . . . . . . . . . . . . . . . . .

(c) Used or attempted to use personal informationwithout permission to obtain NEW credit cards orloans, run up debts, open other accounts, orotherwise commit theft, fraud, or some othercrime? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .



CHECKITEM C1 Look at 45c. How many times is box 1 (Yes)

marked in 45c?1

2

None (no entries of Yes) – SKIP to Check Item DOne or more times – Ask 45d

INTRO 2: The following questions refer only to the most recent discovery of identity theft by you or anyone in yourhousehold.

Was the misuse of – (the credit card account(s)/anyexisting account(s) other than credit cards/personalinformation or new account(s)) one episode or morethan one episode of identity theft?

45d.

1

2

3

Existing credit cards Existing accounts other than a credit cardPersonal information to obtain new accounts

110

Mark (X) all that apply.

1

2

One – SKIP to 45gMore than one

111 1

2

SeparatelyAt the same time – SKIP to 45g

45f. Which episode of identity theft was most recentlydiscovered?

112

45g. How did you become aware of the identity theft? 113 Block was placed on a credit card or other existing account1

6

7

8

9

Money missing from account or charges placed on anaccountContacted by a credit bureau, collection agency, credit cardcompany or other company about late/unpaid bills Contacted by a bankNoticed that a credit card, check book, etc. was missingNotified by a law enforcement agencyDenied credit or a loanNoticed an error in a credit reportOther – Specify

3

4

5

2

45h. What was the total dollar amount of the credit,loans, cash, services, and anything else the personobtained while misusing (the credit cardaccount(s)/any existing accounts other than creditcards/personal information or new account(s))?

$ .00 Amount taken

X Don’t know0 None

Yes NoDon’t know

115

114

Has the misuse of – (the credit card account(s)/anyexisting accounts other than credit cards/personalinformation or new account(s)) stopped (e.g. you ora household member closed a checking account)?

45i.

Is the misuse of – (the credit card account(s)/anyexisting accounts other than credit cards/personalinformation or new account(s)) still causingproblems for you or any other household member?For example, are you still spending time clearing upcredit accounts or your credit report?

45j. Yes – SKIP to 45lNoDon’t know

116

1

2

3

1

2

3

*

HOUSEHOLD RESPONDENT’S IDENTITY THEFT QUESTIONS

FORM NCVS-1 (9-16-2004)

CHECK ITEM E

HOUSEHOLD RESPONDENT’S CHECK ITEMS D AND E

1

2

3

1

Yes No Person for whom interview taken not present

2

3

4

5

6

7

8

Telephone interview – SKIP to 46a Personal interview – Mark all that apply.

If self-response interview, SKIP to 46a

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

CHECK ITEM D Who besides the respondent was present when the

screen questions were asked? (If telephoneinterview, mark box 1 only.) *

556

11 No problems

45l. As a result of (any of) the misuse of (the credit cardaccount(s)/any existing account(s) other than creditcards/personal information or new account(s))discovered in the last 6 months, have you or anyonein your household . . .

(Read answer categories 1–10)

Mark (X) all that apply.

119

*

1

2

3

4

Been turned down for a loan? Had banking problems? Had problems with credit card accounts? Had phone or utilities cut off or been denied newservice?

Been turned down for insurance or had to payhigher rates? Been contacted by a debt collector or creditor? Been the subject of a civil suit or judgment? Been the subject of a criminal investigation,warrant, proceeding, or conviction? Had some other problems?– Specify

6

7

8

9

10

CHECK ITEM C2 Briefly summarize the identity theft that occurred

against the respondent or another household member.

X Don’t know days or months

Less than one month:

____________ Days117

OR

____________ Months118

1 – 6 Months:

45k. How much time did it take to resolve ALL PROBLEMSassociated with the misuse of – (the credit cardaccount(s)/any existing account(s) other than creditcards/personal information or new account(s)) afterthe misuse was discovered?

Had to pay higher interest rates on credit cards,loans, etc.

5

HOUSEHOLD RESPONDENT’S VANDALISM SCREEN QUESTIONS

46a.

1

2

3

4

5

6

7

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 monthsagainst YOUR household. Vandalism is the deliberate, intentional damage to or destruction of householdproperty. Examples are breaking windows, slashing tires, and painting graffiti on walls.

46b. What kind of property was damaged or destroyedin this/these act(s) of vandalism? Anything else?

Since __________ ______, 20 ____, has anyone intentionallydamaged or destroyed property owned by you orsomeone else in your household? 1

2

Yes557

8

9 Other – Specify

*

Mark (X) all property that was damaged or destroyed byvandalism during reference period.

Continue asking "Anything else?" until you get a "No" response.

(EXCLUDE any damage done in conjunction withincidents already mentioned.)

No – SKIP to Check Item G on page 11

Did the person for whom this interview was takenhelp the proxy respondent answer any screenquestions?

HOUSEHOLD RESPONDENT’S VANDALISM SCREEN QUESTIONS

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

55946c. What kind of damage was done in this/theseact(s) of vandalism? Anything else?

2

3

4

5

6

Defaced: marred, graffiti, dirtiedBurned: use of fire, heat or explosivesDrove into or ran over with vehicleOther breaking or tearingInjured or killed animals

7 Other – Specify

*

46d. What was the total dollar amount of the damagecaused by this/these act(s) of vandalism during thelast 6 months? (Use repair costs if the property wasrepaired.)

46f. How many times?

560 $ .– SKIP to Check

Item F1

X

0

Don’t knowNo cost – SKIP to Check Item F1

46e. Was the damage under $100 or $100 or more? 1

2

3

Under $100$100 or moreDon’t know

561

Look at 46a. If unsure, ASK, otherwise, mark withoutasking. In the vandalism just mentioned, wereyou (was the respondent) attacked or threatened,or was something stolen or an attempt madeto steal something that belonged to you (therespondent) or another household member?(other than any incident(s) alreadymentioned)



No – SKIP to 46g2

Describe above

Number of times (46f)563

CHECKITEM F1

00

Mark (X) all kinds of damage by vandals that occurredduring reference period.

Continue asking "Anything else?" until you get a "No" response.

(INCLUDE total amount for all incidents ofvandalism during the last 6 months.)

(EXCLUDE any damage done in incidents alreadymentioned.)

NOTES

FORM NCVS-1 (9-16-2004)

CHECKITEM F2 Are one or more boxes marked "Yes" in 46h

OR 46i?Yes – Ask 46jNo – SKIP to Check Item G

46g.

Yes1 2 No

1 2 No587

3 Don’t know

3 Don’t know

HOUSEHOLD RESPONDENT’S HATE CRIME SCREEN QUESTIONS

Hate crimes or crimes of prejudice or bigotry occurwhen (an offender/offenders) target(s) people becauseof one or more of their characteristics or religiousbeliefs.

Do you have any reason to suspect the vandalism justdiscussed was a hate crime or crime of prejudice orbigotry?

Yes – Ask 46hNo . . . . . . .Don’t know . .

1

2

3

586

46h. An offender/Offenders can target people for a variety ofreasons, but we are only going to ask you about a fewtoday. Do you suspect the offender(s) targeted youbecause of...

(a) Your race? . . . . . . . . . . . . . . . . . . . . . . . . . . .(b) Your religion? . . . . . . . . . . . . . . . . . . . . . . . . .(c) Your ethnic background or national origin (for

example, people of Hispanic origin)? . . . . . . . .

(e) Your gender? . . . . . . . . . . . . . . . . . . . . . . . . .(f) Your sexual orientation? . . . . . . . . . . . . . . . . .

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

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

Yes1 2 No 3 Don’t know





564

565

566

567

568

569

46i. Some offenders target people because theyassociate with certain people or the (offenderperceives/offenders perceive) them as havingcertain characteristics or religious beliefs.

Do you suspect you were targeted because of...

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

(b) 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 – Specify

1 2 No589 3 Don’t knowYes – Specify

46j. Do you have any evidence that this vandalism was ahate crime or crime of prejudice or bigotry?

If "No" or "Don’t know," ASK –

1

2

3

591

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

SKIP to Check Item G

Yes – Ask 46k No . . . . . . . .Don’t know . . . SKIP to Check Item G

588

590

FORM NCVS-1 (9-16-2004)

CHECK ITEM G Transcribe "number of times" entry for each

of the following:

____________ Number of times (36c)(a)

(h)

(i)

No entries transcribed below – Go to CheckItem H

____________ Number of times (37c)






____________ Number of times (44b)


____________ Number of times (46f)

(f)

(g)

(j)

(b)

(c)

(d)

(e)

Screen Question, Item 36c, page 3






Screen Question, Item 44b, page 6



Vandalism Screen Question, Item 46f, page 9

HOUSEHOLD RESPONDENT’S CHECK ITEM G

FIELD REPRESENTATIVE – After completing Check Item G, fill a separate crime incident report for each screenquestion that has an entry of 1 or more. Do this before marking Check Item H.

HOUSEHOLD RESPONDENT’S HATE CRIME SCREEN QUESTIONS

46k. The next questions ask about the evidence you havethat makes you suspect this vandalism was a hatecrime or a crime of prejudice or bigotry. As I readthe following questions, please tell me if any of thefollowing happened:

(a) Did the offender(s) make fun of you, makenegative comments, use slang, hurtful words, orabusive language? . . . . . . . . . . . . . . . . . . . .

(b) Were any hate symbols present at the crimescene to indicate the offender(s) targeted you fora 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 certaincharacteristics or religious beliefs)? . . . . . . .

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

(e) Did the vandalism occur on or near a holiday,event, location, gathering place, or buildingcommonly associated with a specific group (forexample, at the Gay Pride March or at asynagogue, Korean church, or gay bar)? . . . . .

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

(g) Do your feelings, instincts, or perception lead youto suspect this vandalism was a hate crime orcrime of prejudice or bigotry, but you do not haveenough evidence to know for sure? . . . . . . . .








FORM NCVS-1 (9-16-2004)

1

2

3

4

PhysicianNurseTechnicianOther – Specify

579

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

47a.576 1

2

Yes – SKIP to 48a No – Ask 47b

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

47b.ASK OR VERIFY – 577

578 1

2

1

2

Yes – Ask 47cNo – SKIP to Check Item I

Yes – Ask 48aNo – SKIP to Check Item I

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

47c.

Which of the following best describes your job?48a.ASK OR VERIFY – Medical Profession – As a –

Mental Health Services Field – Are your duties –

Teaching Profession – Were you employed in a –

Law Enforcement or Security Field – Were youemployed as a –

Retail Sales – Were you employed as a –

Transportation Field – Were you employed as a –

Something else – Specify

5

6

7

Professional (Social worker/psychiatrist)Custodial careOther – Specify

8

9

PreschoolElementaryJunior high or middle schoolHigh schoolCollege or universityTechnical or industrial schoolSpecial education facility Other – Specify

10

11

12

13

14

15

Law enforcement officerPrison or jail guardSecurity guardOther – Specify

16

17

18

19

Convenience or liquor store clerkGas station attendantBartenderOther – Specify

20

21

22

23

Bus driverTaxi cab driverOther – Specify

24

25

26

27

OR

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

PERSONAL INTERVIEW (Show flashcard)

TELEPHONE INTERVIEW – Were you employedin the (Read main headings until you get a yes.Then read answer categories) –

Mark (X) only one category.

CHECKITEM H Is the respondent 16 years or older?

1

2


HOUSEHOLD RESPONDENT’S EMPLOYMENT QUESTIONS

CHECKITEM I

Is this the last household member to beinterviewed?

Yes – Ask or verify Control Card items.Then END interview.

No – Ask or verify Control Card items. See note below beforeinterviewing next household member.

FIELD REPRESENTATIVE – If the next household member to be interviewed is under 18, tell the household respondentthat you will be asking the same questions you just asked him/her.

Is your job with (Read answer categories) –48b.ASK OR VERIFY – 1 A private company, business, or individual for wages?580

2

3

4

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

While working at your job, do you work mostly in(Read answer categories) –

48d. 1

2

3

4

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

582

If box 12 is marked in 48a, mark without asking.48c.

581 1

2

YesNoAre you employed by a college or university?

Be sure to fill any incident reports before marking Check Item H.

FORM NCVS-1 (9-16-2004)

INDIVIDUAL’S PERSONAL CHARACTERISTICS

Noninterview – Fill 19 – 28 on this page. Alsofill 14 and adjust item 15c on cover page.

5

17. NAME

Last

First


401

1

2

3

4

Per. – Self-respondent Tel. – Self-respondent Per. – Proxy Tel. – Proxy

18. 19.


402


29.

33a.



____________ Months (1-11) – SKIP to 33b505

OR


506

5 years or more – SKIP to 36aLess than 5 years –Ask 33b

CHECKITEM A



Month Day Year

MOBILITY QUESTIONSBefore we get to the crime questions, I have one or twoquestions that are helpful in studying where and whycrimes occur.


21.Age lastbirthday


22b.


23.Sex



28.Race

27.His-panicorigin

01

02

03

04

05

06

07

08

09

10

11


________Age

1

2

3

4

5


1

2

3

4

5


6

1

2

MF

1

2

YesNo

1

2

YesNo


completed

1

2

White


Other – Specify

4

6

26.Attendingschool



2

3


(cc 19) (cc 20) (cc 21) (cc 22) (cc 24)(cc 23)

Regular school

0



5

3

403 405 406 407 408 413404 409 412411

*


FORM NCVS-1 (9-16-2004)

INDIVIDUAL’S SCREEN QUESTIONS


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 thesehappened 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 from a vehicle, such as a package, groceries,camera, or CDs –

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

OR



40a.


OR




1

532


2

Describe above539



(b) At or near a friend’s, relative’s, or neighbor’shome –



(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 fishingor hunting –

(h) Did anyone ATTEMPT to attack or ATTEMPT tosteal anything belonging to you from any ofthese places?


▼▼

No – SKIP to 41a


1

2

Describe aboveNo – SKIP to 40a


FORM NCVS-1 (9-16-2004)


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

41a.



(b) With anything like a baseball bat, frying pan,scissors, or stick –

OR






No – SKIP to 42a2

Describe above





42a.








No – SKIP to 43a2

Describe above



43a.









No – SKIP to 44a2

Describe above

OR

▼▼

▼

FORM NCVS-1 (9-16-2004)



No – SKIP to 45a2

Describe above


548

*OFFICE USE ONLY

CHECKITEM B

Look at 44a. If unsure, ASK, otherwise, mark without asking.Were you (was the respondent) attacked orthreatened, or was something stolen or anattempt made to steal something that belonged toyou (the respondent) or another household member?

1

2


549




No – SKIP to Check Item D below2

Describe above

How many times?

552

*OFFICE USE ONLY

CHECKITEM C

Look at 45a. If unsure, ASK, otherwise, mark withoutasking. Were you (was the respondent) attacked orthreatened, or was something stolen or anattempt made to steal something that belongedto you (the respondent) or another householdmember?

1

2

553





45b.

FORM NCVS-1 (9-16-2004)

CHECK ITEM E

INDIVIDUAL’S CHECK ITEMS D, E, AND G

1

2

3

1


2

3

4

5

6

7

8

Telephone interview – SKIP to Check Item GPersonal interview – Mark all that apply.

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

555


CHECK ITEM D

If self-response interview, SKIP to Check Item G

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

CHECKITEM G








Transcribe "number of times" entry for each of the following:

(a)

(f)

(g)

(b)

(c)

(d)

(e)








No entries transcribed below – Go to Check Item H

FIELD REPRESENTATIVE – After completing Check Item G, fill a separate crime incident report for each screen question that has an entryof 1 or more. Do this before marking Check Item H.

556

Yes – Ask 45b No – SKIP to Check Item D below

INDIVIDUAL’S EMPLOYMENT QUESTIONS


1

2

3

4


579

1

2



47a.576 1

2



47b.ASK OR VERIFY –

577

578 1

2

1

2



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

47c.

Which of the following best describes your job?48a.ASK OR VERIFY –

Medical Profession – As a –







5

6

7


8

9


10

11

12

13

14

15


16

17

18

19


20

21

22

23


24

25

26

27

OR



TELEPHONE INTERVIEW –Were you employed in the (Read main headings until you get a yes. Then read answer categories) –



CHECKITEM I


Is your job with (Read answer categories) –48b.ASK OR VERIFY –

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

3

4

The Federal government?A State, county, or local government?Yourself (Self-employed) in your ownbusiness, professional practice, or farm?

While working at your job, do you work mostly in(Read answer categories) –

48d.1

2

3

4


582

Yes – END interview.

If box 12 is marked in 48a, mark without asking.Are you employed by a college or university?48c. Yes

No581 1

2

FIELD REPRESENTATIVE – If the current respondent is a parent or legal guardian and the next household member to be interviewed isunder 18, tell the current respondent that you will be asking the same questions you just asked him/her.

No – See note below before interviewing next household member.

FORM NCVS-1 (9-16-2004)


17. NAME

Last

First


401

1

2

3

4


18. 19.


402


29.

33a.



____________ Months (1-11) – SKIP to 33b505

OR


506


CHECKITEM A



Month Day Year



21.Age lastbirthday


22b.


23.Sex



28.Race

27.His-panicorigin

01

02

03

04

05

06

07

08

09

10

11


________Age

1

2

3

4

5


1

2

3

4

5


6

1

2

MF

1

2

YesNo

1

2

YesNo


completed

1

2

White


Other – Specify

4

6

26.Attendingschool



2

3


(cc 19) (cc 20) (cc 21) (cc 22) (cc 24)(cc 23)

Regular school

0



5

3

403 405 406 407 408 413404 409 412411

*


FORM NCVS-1 (9-16-2004)


5











OR



40a.


OR




1

532


2

Describe above539











▼▼

No – SKIP to 41a


1

2



FORM NCVS-1 (9-16-2004)



41a.




OR






No – SKIP to 42a2

Describe above





42a.








No – SKIP to 43a2

Describe above



43a.









No – SKIP to 44a2

Describe above

OR

▼▼

▼

FFORM NCVS-1 (9-16-2004)



No – SKIP to 45a2

Describe above


548

*OFFICE USE ONLY

CHECKITEM B


1

2


549





Describe above

How many times?

552

*OFFICE USE ONLY

CHECKITEM C


1

2

553





45b.

FORM NCVS-1 (9-16-2004)

CHECK ITEM E


1

2

3

1


2

3

4

5

6

7

8



555


CHECK ITEM D



CHECKITEM G









(a)

(f)

(g)

(b)

(c)

(d)

(e)










556

Yes – Ask 45b No – SKIP to Check Item D below



1

2

3

4


579

1

2



47a.576 1

2




577

578 1

2

1

2



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

47c.









5

6

7


8

9


10

11

12

13

14

15


16

17

18

19


20

21

22

23


24

25

26

27

OR



TELEPHONE INTERVIEW – Were you employed in the (Read main headings until you get a yes. Then read answer categories) –



CHECKITEM I




3

4


While working at your job, do you work mostly in (Readanswer categories) –

48d.1

2

3

4


582



No581 1

2



FORM NCVS-1 (9-16-2004)


17. NAME

Last

First


401

1

2

3

4


18. 19.


402


29.

33a.



____________ Months (1-11) – SKIP to 33b505

OR


506


CHECKITEM A



Month Day Year



21.Age lastbirthday


22b.


23.Sex



28.Race

27.His-panicorigin

01

02

03

04

05

06

07

08

09

10

11


________Age

1

2

3

4

5


1

2

3

4

5


6

1

2

MF

1

2

YesNo

1

2

YesNo


completed

1

2

White


Other – Specify

4

6

26.Attendingschool



2

3


(cc 19) (cc 20) (cc 21) (cc 22) (cc 24)(cc 23)

Regular school

0



5

3

403 405 406 407 408 413404 409 412411

*


FORM NCVS-1 (9-16-2004)


5











OR



40a.


OR




1

532


2

Describe above539











▼▼

No – SKIP to 41a


1

2



FORM NCVS-1 (9-16-2004)



41a.




OR






No – SKIP to 42a2

Describe above





42a.








No – SKIP to 43a2

Describe above



43a.









No – SKIP to 44a2

Describe above

OR

▼▼

▼

FORM NCVS-1 (9-16-2004)



No – SKIP to 45a2

Describe above


548

*OFFICE USE ONLY

CHECKITEM B


1

2


549





Describe above

How many times?

552

*OFFICE USE ONLY

CHECKITEM C


1

2

Yes – Ask 45b 553





45b.

FORM NCVS-1 (9-16-2004)

CHECK ITEM E


1

2

3

1


2

3

4

5

6

7

8



555


CHECK ITEM D



CHECKITEM G









(a)

(f)

(g)

(b)

(c)

(d)

(e)










556

No – SKIP to Check Item D below



1

2

3

4


579

1

2



47a.576 1

2




577

578 1

2

1

2



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

47c.









5

6

7


8

9


10

11

12

13

14

15


16

17

18

19


20

21

22

23


24

25

26

27

OR



TELEPHONE INTERVIEW – Were you employed in the (Read main headings until you get a yes. Then read answer categories) –



CHECKITEM I




3

4


While working at your job, do you work mostly in (Readanswer categories) –

48d.1

2

3

4


582



No581 1

2



FORM NCVS-1 (9-16-2004)

NOTES

FORM NCVS-1 (9-16-2004)

ncvs questionnaire

Economy & Finance