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

Notes

FORM

(9-16-2004)

NCVS-2

U.S. DEPARTMENT OF COMMERCE

Economics and Statistics Administration

ACTING AS COLLECTING AGENT FOR THE

BUREAU OF JUSTICE STATISTICS

U.S. DEPARTMENT OF JUSTICE

CRIME INCIDENT REPORT

NATIONAL CRIME VICTIMIZATION SURVEY

N

C

V

S

2

I

N

C

I

D

E

N

T

R

E

P

O

R

T

601

CHECK

ITEM B

1a. LINE NUMBER OF RESPONDENT Line number (ex., 01)

1b. SCREEN QUESTION NUMBER 602

Screen question number (ex., 39)

1c. 603 INCIDENT NUMBER Incident number (ex., 01)

How many incidents?

(Refer to 4.)

1

2

Yes (more than 6 months) – SKIP to 3

No (6 months or less) – Ask 2

606

While living at this address

Before moving to this address

2. You said that during the last 6 months –

(Refer to appropriate screen question for 

description of crime.) Did (this/the first) 

incident happen while you were living here 

or before you moved to this address?

3. (You said that during the last 6 months –

(Refer to appropriate screen question for 

description of crime.)) In what month did 

(this/the first) incident happen? (Show 

calendar if necessary. Encourage respondent to 

give exact month.)

4. If known, mark without asking. If not sure, ASK –

Altogether, how many times did this type of

incident happen during the last 6 months?

CHECK

ITEM D Can you (respondent) recall enough 

details of each incident to distinguish 

them from each other? (If not sure, ASK.)

CHECK

ITEM C Are these incidents similar to each other 

in detail, or are they for different types of

crimes? (If not sure, ASK.)

5. The following questions refer only to the most

recent incident. (ASK item 6.)

6. About what time did (this/the most recent)

incident happen?

Month Year

607

____________ Number of incidents

605

1

2

1–5 incidents (not a "series") – SKIP to 6

6 or more incidents – Fill Check Item C

608

1

2

Similar – Fill Check Item D

Different (not a "series") – SKIP to 6

609

1

2

Yes (not a "series") – SKIP to 6 610

1

2

3

4

After 6 a.m. – 12 noon 612

No (is a "series") – Reduce entry in

screen question if necessary – Read 5

During day

At night

5

6

7

8

After 6 p.m. – 9 p.m.

OR

9 Don’t know whether day or night

CHECK

ITEM A Has the respondent lived at this

address for more than 6 months? 

(If not sure, refer to 33a on the 

NCVS-1 or ASK.)

After 12 noon – 3 p.m.

Don’t know what time of day

After 9 p.m. – 12 midnight

Don’t know what time of night

After 3 p.m. – 6 p.m.

After 12 midnight – 6 a.m.

U.S. CENSUS BUREAU

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.

NCVS-2, Page 1 Black ink NCVS-2, Page 1, 10% Pantone 185 Red

USCENSUSBUREAU

Control number

PSU Segment/Suffix Sample 

designation/Suffix

Serial/

Suffix

HH No. Spinoff

Indicator
1

2

3

4

Outside U.S. – SKIP to 10

Not inside a city/town/village – Ask 8a

SAME city/town/village as present residence – SKIP to 9

7. In what city, town, or village did

this incident occur?

10.

613

⎫

⎬

⎭

Page 2 FORM NCVS-2 (9-16-2004)

Ask 8a

Don’t know – Ask 8a

DIFFERENT city/town/village from

present residence – Specify

5

614

County ________________ State __________

1

2

Yes

No

615

IN RESPONDENT’S HOME OR LODGING

1 In own dwelling, own attached garage, or

enclosed porch (Include illegal entry or attempted 

illegal entry of same) 

616

In detached building on own property, such as 

detached garage, storage shed, etc. (Include illegal

entry or attempted illegal entry of same) 

In vacation home/second home (Include illegal

entry or attempted illegal entry of same)

2

3

In hotel or motel room respondent was staying

in (Include illegal entry or attempted illegal entry

of same)

NEAR OWN HOME

5 Own yard, sidewalk, driveway, carport, unenclosed

porch (does not include apartment yards) 

Apartment hall, storage area, laundry room (does 

not include apartment parking lot/garage) 

On street immediately adjacent to own home

6

7

⎫

⎬

⎭

Ask

11

⎫

⎬

⎭

SKIP

to 18

AT, IN, OR NEAR A FRIEND’S/RELATIVE’S/

NEIGHBOR’S HOME

8 At or in home or other building on their property

Yard, sidewalk, driveway, carport (does not

include apartment yards) 

Apartment hall, storage area, laundry room (does 

not include apartment parking lot/garage) 

9

10

On street immediately adjacent to their home

⎫

⎬

⎭

SKIP

to 18

11

COMMERCIAL PLACES

12

24 Inside bank

25 Inside gas station SKIP

to 17 c

PARKING LOTS/GARAGES

15 Commercial parking lot/garage

16

17

⎫

⎬

⎭

SKIP

to 17 c

SCHOOL

18 Inside school building SKIP to 17a

19 On school property (school parking area,

play area, school bus, etc.) SKIP to 17c

OPEN AREAS, ON STREET OR PUBLIC

TRANSPORTATION

20 In apartment yard, park, field, playground (other 

than school) 

On the street (other than immediately adjacent to

own/friend’s/relative’s/neighbor’s home) 

On public transportation or in station (bus, train,

plane, airport, depot, etc.)

21

22

SKIP

to 18

⎫

⎬

⎭

OTHER

23 Other – Specify ⎫

⎬

⎭

SKIP

to 17 c

8a. In what county and state did it

occur?

8b. Is this the same county and state 

as your present residence?

Where did this incident happen?

Mark (X) only one box.

4

Noncommercial parking lot/garage

Apartment/townhouse parking lot/garage

1

2

Yes

No

9. Did this incident occur on an 633

American Indian Reservation or

on American Indian Lands?

NCVS-2, Page 2 Black ink NCVS-2, Page 2, 10% Pantone 185 Red

26 Inside other commercial building, such as a store

14 Inside office

27 Inside factory or warehouse

Inside restaurant, bar, nightclub ⎫

⎬

⎭
11.

Page 3 FORM NCVS-2 (9-16-2004)

1

2

3

Yes – SKIP to 19 617

Window

1 Damage to window (include frame, glass

broken/removed/cracked)

625

Screen damaged/removed

Lock on window damaged/tampered with

in some way

2

3

Other – Specify ⎫

⎬

⎭

SKIP

to 19

Did the offender live (here/there) or 

have a right to be (here/there), for

instance, as a guest or a repairperson?

Mark (X) all that apply.

⎫

⎬

⎭

No

Don’t know

Ask 12

1

2

3

Yes – SKIP to 14 618

⎫

⎬

⎭

No

Don’t know

Ask 13

1

2

3

Yes – Ask 14 619

No – SKIP to 19

Don’t know – Ask 14

1

2

Yes – Ask 15 

No – SKIP to 16

620

4

Door

5 Damage to door (include frame, glass

panes or door removed)

626

Screen damaged/removed

Lock or door handle damaged/tampered 

with in some way

6

7

8 Other – Specify

Other

9 Other than window or door – Specify

12. Did the offender actually get INSIDE

your (house/apartment /room/garage/

shed/ enclosed porch)?

13. Did the offender TRY to get in your

(house/apartment/room/garage/shed/ 

porch)?

14. Was there any evidence, such as a

broken lock or broken window, that

the offender(s) (got in by force/TRIED

to get in by force)?

15. What was the evidence? Anything

else?

Mark (X) only one box.

2 Offender pushed his/her way in after door

opened

627

Through OPEN DOOR or other opening

Through UNLOCKED door or window

3

4 ⎫

⎬

⎭

SKIP

to 19

1 Let in

5 Through LOCKED door or window – Had

key

6 Through LOCKED door or window – Picked

lock, used credit card, etc., other than key

7 Through LOCKED door or window – Don’t

know how

Don’t know

Other – Specify 

8

9

2 Restricted to certain people (or nobody 

had a right to be there)

630 1 Open to the public

Don’t know 

Other – Specify

3

4

1

2

3

Indoors (inside a building or enclosed space)

Outdoors

Both

631

1 At, in, or near the building containing

the respondent’s home/next door

632

2

3

4

5

6

A mile or less

Five miles or less

Fifty miles or less

More than 50 miles

Don’t know how far

16. How did the offender (get in/TRY to

get in)?

17c. ASK OR VERIFY –

18. ASK OR VERIFY –

19. ASK OR VERIFY –

Mark (X) first box that respondent is sure of.

*

*

Did the incident happen in an area

restricted to certain people or was it

open to the public at the time?

Did it happen outdoors, indoors, or

both?

How far away from home did this

happen? 

PROBE –

Was it within a mile, 5 miles, 50 miles

or more?

17b. In what part of the school building did

it happen?

629 1 Classroom

Hallway/Stairwell

Bathroom/Locker room 

Other (library, gym, auditorium, cafeteria)

17a. Was it your school? 628 1 Yes

2 No – SKIP to 17c

2

3

4

NCVS-2, Page 3 Black ink NCVS-2, Page 3, 10% Pantone 185 Red
Page 4

1

2

3

4

5

6

Hand gun (pistol, revolver, etc.)

Other gun (rifle, shotgun, etc.)

Knife

Other sharp object (scissors, ice pick, axe, etc.)

Blunt object (rock, club, blackjack, etc.)

Other – Specify

638

1

2

3

Respondent only

Respondent and other household member(s)

635

Ask 21

Mark (X) all that apply.

642 ⎫

⎬

⎭

SKIP

to 40,

page 6

1

2

3

Something taken without permission

Attempted or threatened to take something

Forcible entry or attempted forcible entry of

house/apartment

Forcible entry or attempted forcible entry of

car

8 Damaged or destroyed property

9

20a. ASK OR VERIFY –

Were you or any other member of this

household present when this incident

occurred?

*

1

2

Yes – Ask 20b

No – SKIP to 56, page 8

634

1

2

3

Yes – Ask 23 637

⎫

⎬

⎭

No

Don’t know

SKIP to 24

Only other household member(s), not

respondent – SKIP to 59, page 8

1

2

Yes

No

636

1

2

Yes – SKIP to 29, page 5

No – Ask 25

639

1

2

Yes – SKIP to 28a

No – Ask 26

640

1

2

Yes – SKIP to 28b

No – Ask 27

641

Other – Specify 

Attempted or threatened to damage or

destroy property

7

10

*

643 ⎫

⎬

⎭

SKIP

to 40,

page 6

1

2

3

4

Verbal threat of rape

Verbal threat to kill

Verbal threat of attack other than to kill or rape

14 Other – Specify 

*

Attempted attack with weapon other than

gun/knife/sharp weapon

Object thrown at person

Followed or surrounded

Tried to hit, slap, knock down, grab, hold,

trip, jump, push, etc.

11

13

12

644

*

645

*

20b. ASK OR VERIFY –

Which household members were

present?

FIELD REPRESENTATIVE – If proxy interview,

"Respondent" refers to the person for whom

the proxy interview is taken, not the proxy

respondent.

21.

Did the offender have a weapon such

as a gun or knife, or something to use

as a weapon, such as a bottle or

wrench?

22.

23. What was the weapon? Anything else?

FIELD REPRESENTATIVE – If proxy

interview, replace "you" with the name of

person for whom the proxy interview is

being taken in 21–115.

24. Did the offender hit you, knock you

down or actually attack you in any

way?

25. Did the offender TRY to attack you?

26. Did the offender THREATEN you with

harm in any way?

27. What actually happened? Anything

else?

Mark (X) all that apply.

28a. How did the offender TRY to attack

you? Any other way?

Mark (X) all that apply.

28b. How were you threatened? Any

other way?

FIELD REPRESENTATIVE – If box 5, ASK –

Do you mean forced or coerced sexual

intercourse including attempts?

If "Yes," change entry in Item 24 to "Yes."

Delete entries in 25–28.

FIELD REPRESENTATIVE – If box 4, ASK –

Do you mean forced or coerced sexual

intercourse including attempts?

If "Yes," change entry in Item 24 to "Yes."

Delete entries in 25–27.

4

6

Unwanted sexual contact without force

(grabbing, fondling, etc.)

Verbal threat of sexual assault other than rape

Unwanted sexual contact with force

(grabbing, fondling, etc.)

Weapon present or threatened with weapon

Shot at (but missed)

Attempted attack with knife/sharp weapon

5

7

8

9

10

Unwanted sexual contact without force

(grabbing, fondling, etc.)

6

Harassed, argument, abusive language

Unwanted sexual contact with force

(grabbing, fondling, etc.)

5

ASK OR VERIFY –

Did you personally see an offender?

NCVS-2, Page 4 Black ink NCVS-2, Page 4, 10% Pantone 185 Red

FORM NCVS-2 (9-16-2004)

}
Page 5

1

2

At the scene 

At home/neighbor’s/friend’s

660

Mark (X) all that apply.

29. How were you attacked? Any other way?

*

1

2

3

Yes

No

Other – Specify

649

1

2

Yes – Ask 33

No – SKIP to 34

657

646 1

2

3

4

5

6

7

8

9

10

11

Raped

Tried to rape

Sexual assault other than rape or attempted rape

Shot

Shot at (but missed)

Hit with gun held in hand

Stabbed/cut with knife/sharp weapon

Attempted attack with knife/sharp weapon

Hit by object (other than gun) held in hand

Hit by thrown object

*

Attempted attack with weapon other than

gun/knife/sharp weapon

Hit, slapped, knocked down

Grabbed, held, tripped, jumped, pushed, etc.

Other – Specify

12

13

14

647

*

648

*

655 1

2

3

4

5

6

7

8

9

10

None – SKIP to 40

Raped

Attempted rape

Sexual assault other than rape or attempted rape

Knife or stab wounds

Gun shot, bullet wounds

Broken bones or teeth knocked out

Internal injuries

Knocked unconscious

*

Bruises, black eye, cuts, scratches,

swelling, chipped teeth

11 Other – Specify

656

*

658

Code Code Code *

1

2

Yes – Ask 35

No – SKIP to 40

659

1

2

Yes – Ask 37

No – SKIP to 38

662

Yes – Ask 36

No – SKIP to 38

Health unit at work/school, first aid station

at a stadium/park, etc.

Doctor’s office/health clinic

Emergency room at hospital/emergency clinic

Hospital (other than emergency room)

Other – Specify

3

4

5

6

7

663

____________ Number of days

FIELD REPRESENTATIVE – If raped, ASK –

Do you mean forced or coerced sexual

intercourse?

Do you mean attempted forced or

coerced sexual intercourse?

If No, ASK – What do you mean?

If tried to rape, ASK –

30. Did the offender THREATEN to hurt you

before you were actually attacked?

Mark (X) all that apply.

31. What were the injuries you suffered, if

any? Anything else?

FIELD REPRESENTATIVE – If raped and box 1 

in item 29 is NOT marked, ASK –

Do you mean forced or coerced sexual

intercourse?

If attempted rape and box 2 in item 29 is NOT

marked, ASK –

32. ASK OR VERIFY –

Were any of the injuries caused by a

weapon other than a gun or knife?

33.

Were you injured to the extent that you

received any medical care, including

self treatment?

34.

Where did you receive this care?

Anywhere else? 35.

Enter code(s) from 31.

Mark (X) all that apply.

CHECK

ITEM E Is (box 6) "Hospital" marked in 35?

36. Did you stay overnight in the hospital?

37. How many days did you stay (in the

hospital)?

If No, ASK – What do you mean?

If No, ASK – What do you mean?

Do you mean attempted forced or

coerced sexual intercourse?

If No, ASK – What do you mean?

Which injuries were caused by a weapon

OTHER than a gun or knife?

NCVS-2, Page 5 Black ink NCVS-2, Page 5, 10% Pantone 185 Red

FORM NCVS-2 (9-16-2004)
Page 6

38. At the time of the incident, were you

covered by any medical insurance, or

were you eligible for benefits from any

other type of health benefits program,

such as medicaid, Veterans

Administration, or Public Welfare?

664

668 1

2

3

4

5

6

Attacked offender with gun; fired gun

Attacked with other weapon

Attacked without weapon (hit, kicked, etc.)

Threatened offender with gun

Threatened offender with other weapon

Threatened to injure, no weapon

Mark (X) all that apply. Then fill Check Item F.

CHECK

ITEM F Was the respondent injured in this

incident? (Is box 2–11 marked in 

31 on page 5?)

43a. Did you take these actions before, after,

or at the same time that you were

injured?

43b. Did (any of) your action(s) help the

situation in any way?

1

2

3

Yes

No

Don’t know

$ ____________ . 665 Total amount 00

0

X

No cost

Don’t know

666 1

2

Yes – SKIP to 42

No/took no action/kept still – Ask 41

667 1

2

Yes – Ask 42

No/took no action/kept still – SKIP to 47

USED PHYSICAL FORCE TOWARD OFFENDER

Yes – Ask 43a

No – SKIP to 43b

672

*

1

2

3

Actions taken before injury

Actions taken after injury

Actions taken at same time as injury

673 1

2

3

Yes –Ask 44

No

Don’t know

*

669 7 Defended self or property (struggled, ducked,

blocked blows, held onto property)

RESISTED OR CAPTURED OFFENDER

* 8 Chased, tried to catch or hold offender

9 Yelled at offender, turned on lights,

threatened to call police, etc.

SCARED OR WARNED OFF OFFENDER

PERSUADED OR APPEASED OFFENDER

670

10 Cooperated, or pretended to (stalled, did 

what they asked)

*

11 Argued, reasoned, pleaded, bargained, etc.

ESCAPED OR GOT AWAY

671

*

12 Ran or drove away, or tried; hid, locked door

GOT HELP OR GAVE ALARM

13

14

Called police or guard

Tried to attract attention or help, warn others

(cried out for help, called children inside)

REACTED TO PAIN OR EMOTION

15 Screamed from pain or fear

Probe – Did your actions help you avoid

injury, protect your property, escape

from the offender – or were they helpful

in some other way?

Mark (X) all that apply.

39. What was the total amount of your

medical expenses resulting from this

incident (INCLUDING anything paid by

insurance)? Include hospital and doctor

bills, medicine, therapy, braces, and any

other injury related expenses.

40. Did you do anything with the idea of

protecting YOURSELF or your PROPERTY

while the incident was going on?

41. Was there anything you did or tried to do

about the incident while it was going on?

FIELD REPRESENTATIVE – Obtain an estimate,

if necessary.

42. What did you do? Anything else?

OTHER

16 Other – Specify

⎫

⎬

⎭

SKIP to 45

NCVS-2, Page 6 Black ink NCVS-2, Page 6, 100% Pantone 185 Red

FORM NCVS-2 (9-16-2004)
NCVS-2, Page 7 Black ink NCVS-2, Page 7, 10% Pantone 185 Red

Page 7

674

* Mark (X) all that apply.

1

2

3

4

5

6

Helped avoid injury or greater injury to respondent

Scared or chased offender off

Helped respondent get away from offender

Protected property

Protected other people

Other – Specify

684 0 None

675 1

2

3

Yes – Ask 46

No

Don’t know

44. How were they helpful? Any other way?

⎫

⎬

⎭

SKIP to 47

45. Did (any of) your action(s) make the

situation worse in any way?

46. How did they make the situation worse?

Any other way?

47. Was anyone present during the

incident besides you and the offender?

(Other than children under age 12.)

48. Did the actions of (this person/any of

these people) help the situation in any

way?

49.

Mark (X) all that apply.

PROBE – Did your actions lead to injury,

greater injury, loss of property, make the

offender angrier, or make the situation

worse in some other way?

How did they help the situation? Any

other way?

Mark (X) all that apply.

50. Did the actions of (this person/any of

these people) make the situation worse 

in any way?

51. How did they make the situation worse?

Any other way?

Mark (X) all that apply.

52. Not counting yourself, were any of the

persons present during the incident harmed

(Pause), threatened with harm (Pause), or

robbed by force or threat of harm? (Do not

include yourself, the offender, or children

under 12 years of age.)

53. How many? (Do not include yourself,

the offender or children under 12 years

of age.)

54. How many of these persons are

members of your household now? (Do

not include yourself, the offender or

children under 12 years of age.)

FIELD REPRESENTATIVE – Enter name(s) or

line number(s) of other household member(s). 

If not sure, ask.

676

*

1

2

3

4

5

6

Led to injury or greater injury to respondent

Caused greater loss of property or damage to property

Other people got hurt (worse)

Offender got away

Made offender angrier, more aggressive, etc.

Other – Specify

677 1

2

3

Yes – Ask 48

No

Don’t know

⎫

⎬

⎭

SKIP to Check Item G

678 1

2

3

Yes – Ask 49

No

Don’t know

⎫

⎬

⎭

SKIP to 50

679

*

1

2

3

4

5

6

Helped avoid injury or greater injury to respondent

Scared or chased offender off

Helped respondent get away from offender

Protected property

Protected other people

Other – Specify

682 1

2

3

Yes – Ask 53

No

Don’t know

⎫

⎬

⎭

SKIP to Check Item G

681

*

1

2

3

4

5

6

680 1

2

3

Yes – Ask 51

No

Don’t know

⎫

⎬

⎭

SKIP to 52

Led to injury or greater injury to respondent

Caused greater loss of property or damage to property

Other people got hurt (worse)

Offender got away

Made offender angrier, more aggressive, etc.

Other – Specify

____________ Number of persons 683

____________ Number of persons

Name(s) OR Line number(s)

FORM NCVS-2 (9-16-2004)
Page 8

SKIP to 60

689 ⎫

⎬

⎭

SKIP

to 88,

page 11

1 Respondent saw or heard offender

From other member of household 

who was eyewitness

From eyewitness(es) other than

household member(s)

From police

Other person (not eyewitness)

Offender(s) admitted it

Offender(s) had threatened to do it

4

5

6

7

Did respondent use or threaten to use

physical force against the offender? 

(Is box 1–6 marked in 42 on page 6?)

1

2

Yes – Ask 55

No – SKIP to 60

685

⎫

⎬

⎭

Other – Specify 

3

10

*

1

2

3

4

Respondent

Offender(s)

Someone else

Don’t know

686

1

2

Yes – Ask 57

No – SKIP to 88, page 11

687

1

2

3

Suspicion

Fairly sure

Certain

688

1

2

3

Something taken without permission

Attempted or threatened to take something

Harassed, argument, abusive language

691

1

2

3

Only one – SKIP to 62

More than one – SKIP to 73

Don’t know – Ask 61

692

1

2

Yes – Ask 62

No – SKIP to 88, page 11

693

*

690

*

2

Stolen property found on offender’s

property or in offender’s possession

8

Figured it out by who had motive,

opportunity, or had done it before

9

Forcible entry or attempted forcible entry

of house/apartment

4

5

6

7

Forcible entry or attempted forcible entry of car

Damaged or destroyed property

Attempted or threatened to damage or

destroy property

8 Other – Specify

55. Who was the first to use or threaten to

use physical force – you, the offender,

or someone else?

56. If household member was present, SKIP to 59.

57. How sure are you of this information?

Do you have a suspicion, are you fairly

sure or are you certain?

58. How did you learn about the offender(s)?

Any other way?

59. What actually happened? Anything else?

60. ASK OR VERIFY –

Was the crime committed by only one or

by more than one offender?

61. Do you know anything about one of the

offenders?

Mark (X) only one box.

CHECK

ITEM G

Notes

Mark (X) all that apply.

Mark (X) all that apply.

Do you know or have you learned

anything about the offender(s) – for

instance, whether there was one or

more than one offender involved,

whether it was someone young or old,

or male or female?

NCVS-2, Page 8 Black ink NCVS-2, Page 8, 10% Pantone 185 Red

FORM NCVS-2 (9-16-2004)
NCVS-2, Page 9 Black ink NCVS-2, Page 9, 10% Pantone 185 Red

Page 9

698 1

2

3

Male

Female

Don’t know

699 1

2

3

4

Under 12

12–14

15–17

18–20

62. Was the offender male or female?

⎫

⎬

⎭

SKIP to 69

63. How old would you say the offender 

was?

64a. Was the offender a member of a street

gang, or don’t you know?

64b. Was the offender drinking or on drugs,

or don’t you know?

65. Which was it? (Drinking or on drugs?)

700 1

2

3

Yes (a member of a street gang)

No (not a member of a street gang)

Don’t know (if a member of a street gang)

701 1

2

3

Yes (drinking or on drugs) – Ask 65

No (not drinking/not on drugs)

Don’t know (if drinking or on drugs)

⎫

⎬

⎭

SKIP to 66

702 Drinking

On drugs

Both (drinking and on drugs)

Drinking or on drugs – could not tell which

5

6

7

21–29

30+

Don’t know

1

2

3

4

66. Was the offender someone you knew

or a stranger you had never seen

before?

703 Knew or had seen before – SKIP to 68

Stranger

Don’t know

1

2

3

67. Would you be able to recognize the

offender if you saw him/her?

704 Yes

Not sure (possibly or probably) 

No – SKIP to 71

1

2

3

⎫

⎬

⎭

SKIP to 70

68. How well did you know the offender –

by sight only, casual acquaintance, or

well known?

705 Sight only – Ask 69

Casual acquaintance

Well known

1

2

3

⎫

⎬

⎭

SKIP to 71

69. Would you have been able to tell the

police how they might find the

offender, for instance, where he/she

lived, worked, went to school, or spent

time?

706 1

2

3

Yes

No

Other – Specify

70. How well did you know the offender?

For example, was the offender a

friend, cousin, etc.? 707 Spouse at time of incident

Ex-spouse at time of incident

Parent or step-parent

Own child or step-child

Brother/sister

Other relative – Specify

1

2

3

4

5

6

RELATIVE

NONRELATIVE

Boyfriend or girlfriend, ex-boyfriend or ex-girlfriend

Friend or ex-friend

Roommate, boarder

Schoolmate

Neighbor

Customer/client

Patient

Supervisor (current or former)

Employee (current or former)

Co-worker (current or former)

Other nonrelative – Specify

7

8

9

10

11

12

14

15

16

17

13

71. Was the offender White, Black, or

some other race?

White

Black

Other – Specify

Don’t know

1

2

3

4

Was this the only time this offender

committed a crime against you or your

household or made threats against

you or your household?

72. ⎫

⎬

⎭

SKIP to 88, page 11

709 Yes (only time)

No (there were other times)

Don’t know

1

2

3

73. How many offenders?

x Don’t know (number of offenders)

710

708

Number of offenders

Mark (X) first box that applies.

Notes

FORM NCVS-2 (9-16-2004)
Boyfriend or girlfriend, ex-boyfriend or ex-girlfriend

Friend or ex-friend

Roommate, boarder

Schoolmate

Neighbor

Customer/client

Patient

Supervisor (current or former)

Employee (current or former)

Co-worker (current or former)

Other nonrelative – Specify

NCVS-2, Page 10 Black ink NCVS-2, Page 10, 10% Pantone 185 Red

Page 10

SKIP to 76

Is "casual acquaintance" or "well

known" marked in 82?

Yes – SKIP to 84

No – Ask 83

⎫

⎬

⎭

1

2

3

4

All male

All female

Don’t know sex of any offenders

Both male and female – Ask 75

711

712

713

74. Were they male or female?

75. If there were only 2 offenders (item 73),

SKIP to 76.

Were they mostly male or mostly female?

76. How old would you say the youngest

was?

77. How old would you say the oldest was?

CHECK

ITEM H

1

2

3

4

Mostly male

Mostly female

Evenly divided

Don’t know

1

2

3

Under 12

12–14

15–17

714

5

6

21–29

30+

78a. Were any of the offenders a member of a

street gang, or don’t you know?

715 1

2

3

Yes (a member of a street gang)

No (not a member of a street gang)

Don’t know (if a member of a street gang)

78b. Were any of the offenders drinking or on

drugs, or don’t you know?

716 1

2

3

Yes (drinking or on drugs) – Ask 79

No (not drinking/not on drugs)

Don’t know (if drinking or on drugs) SKIP to 80 ⎫

⎬

⎭

79. Which was it? (Drinking or on drugs?) 717 1

2

3

4

Drinking

On drugs

Both (drinking and on drugs)

Drinking or on drugs – could not tell which

⎫

⎬

⎭

80. Were any of the offenders known to you, 718

or were they strangers you had never

seen before?

1

2

All known

Some known

81. Would you be able to recognize any of

them if you saw them?

719 1

2

3

Yes

Not sure (possibly or probably)

No – SKIP to 85

82. How well did you know the offender(s) – by

sight only, casual acquaintance, or well

known?

720 1

2

3

Sight only

Casual acquaintance

Well known

⎫

⎬

⎭

SKIP

to 82 Ask 81

⎫

⎬

⎭

83. Would you have been able to tell the 

police how they might find any of them,

for instance, where they lived, worked,

went to school, or spent time?

722 1

2

3

Yes

No

SKIP to 83

SKIP to 85

⎫

⎬

⎭

723

84. How did you know them? For example,

were they friends, cousins, etc.? 

1

2

3

4

5

6

Spouse at time of incident

Ex-spouse at time of incident

Parent or step-parent

Own child or step-child

Brother/sister

NONRELATIVE

Other relative – Specify

RELATIVE

85. Were the offenders White, Black, or 726

some other race?

1

2

3

4

White

Black

Other – Specify

Don’t know race of any/some

724

725

*

*

*

*

Mark (X) all that apply.

Other – Specify 

*

Mark (X) only one box.

Mark (X) all that apply.

Mark (X) all that apply.

Mostly White

Mostly Black

Mostly some other race

Equal number of each race

Don’t know

86. 727 If only one box marked in 85, SKIP to 87. 1

2

3

4

5

What race were most of the offenders?

7

8

9

10

11

12

14

15

16

17

13

3

4

All strangers

Don’t know

4 18–20 7 Don’t know

1

2

3

Under 12

12–14

15–17

5

6

21–29

30+

4 18–20 7 Don’t know

FORM NCVS-2 (9-16-2004)
NCVS-2, Page 11 Black ink NCVS-2, Page 11, 10% Pantone 185 Red

Page 11

SKIP to 92

Besides the respondent, which 

household member(s) owned the

(property/money) the offender tried to

take?

⎫

⎬

⎭

730

1

2

3

Yes – SKIP to 96

No 

Don’t know

731

87. Was this the only time any of these

offenders committed a crime against

you or your household or made threats

against you or your household?

88. ASK OR VERIFY –

Was something stolen or taken without

permission that belonged to you or

others in the household?

CHECK

ITEM J

1

2

3

Yes (only time)

No (there were other times)

Don’t know

89. ASK OR VERIFY –

Did the offender(s) ATTEMPT to take

something that belonged to you or

others in the household?

732 1

2

3

Yes – Ask 90

No

Don’t know

90. What did the offender try to take?

Anything else? 733 1

2

3

4

5

6

Cash

Purse

Wallet

Credit cards, checks, bank cards

Car

738

91. Did the (property/money) the offender

tried to take belong to you personally,

to someone else in the household, or to

both you and other household

members?

1

2

Respondent only – SKIP to 92

739

737

Yes – Ask 93

No – SKIP to 94

*

SKIP to 110, page 14

⎫

⎬

⎭

Other motor vehicle

Part of motor vehicle (tire, hubcap, attached car

stereo or satellite radio, attached CB radio, etc.)

Gasoline or oil

Bicycle or parts

TV, DVD player, VCR, stereo, other household appliances

Silver, china, art objects

Other household furnishings (furniture, rugs, etc.)

Personal effects (clothing, jewelry, toys, etc.)

Handgun (pistol, revolver)

Other firearm (rifle, shotgun)

Other – Specify

Don’t know

7

8

9

10

11

12

13

14

15

16

17

Respondent and other household member(s) –

Fill Check Item J

Other household member(s) only

– Fill Check Item J

Nonhousehold member(s) only

3

4

5 Other – Specify 

If not sure, ask. Do not enter the

respondent’s line number.

OR

40 Household property

92. ASK OR VERIFY –

Was/Were the article(s) IN or

ATTACHED to a motor vehicle when the

attempt was made to take (it/them)?

740 Yes

No

Line number

Line number

Line number

Did the offender try to take cash, a 

purse, or a wallet? (Is box 1, 2, or 3

marked in 90?)

CHECK

ITEM K

93. ASK OR VERIFY –

Was the (cash/purse/wallet) on your

person, for instance, in a pocket or

being held?

742 1

2

Yes

No

734

735

736

*

*

*

*

*

Mark (X) only one box.

1

2

FIELD REPRESENTATIVE – Include anything

stolen from an unrecognizable business. 

Do not include any items stolen from a

recognizable business operated in the

respondent’s home or in a commercial

establishment.

Mark (X) all that apply?

FORM NCVS-2 (9-16-2004)
NCVS-2, Page 12 Black ink NCVS-2, Page 12, 10% Pantone 185 Red

Page 12

Yes – Ask 95

No – SKIP to 110, page 14

745

746

94. ASK OR VERIFY –

Was there anything (else) the offender(s)

tried to take directly from you, for

instance, from your pocket or hands, or

something that you were wearing?

95. Which items did the offender(s) try to

take directly from you?

96. What was taken that belonged to you or

others in the household? Anything else? 747

2

3

4

Purse

Wallet

Credit cards, check, bank cards

753

22

23

24

25

26

Tools, machines, office equipment

Farm or garden produce, plants, fruit, logs

Animals –pet or livestock

Food or liquor

Other – Specify

750

755

*

1

2

Don’t know

8

9

20

21

27

Code

– SKIP to 110, page 14

Code Code

OR

Tried to take everything marked in 90 directly from

respondent – SKIP to 110, page 14

40

Cash

$ ____________ . Amount of cash taken 00

1 Only cash taken – Enter amount above

Property

PURSE/WALLET/CREDIT CARDS

5 Car

6

7

Ask: Did it contain money?

⎫

⎬

⎭

VEHICLE OR PARTS

Unattached motor vehicle accessories or equipment

(unattached CD player or satellite radio, etc.)

Bicycle or parts

TV, DVD player, VCR, stereo, other household

appliances

Gasoline or oil

Part of motor vehicle (tire, hubcap, attached car

stereo or satellite radio, attached CB radio, etc.)

Other motor vehicle

HOUSEHOLD FURNISHINGS

Portable electronic and photographic gear

(Personal stereo, TV, cellphone, camera, etc.)

11

14

PERSONAL EFFECTS

Handgun (pistol, revolver)

Other firearm (rifle, shotgun)

Clothing, furs, luggage, briefcase

Jewelry, watch, keys

Toys, sports and recreation equipment 

(not listed above)

Collection of stamps, coins, etc.

Other personal and portable objects

15

16

17

18

19

751

FIREARMS

MISCELLANEOUS

754

*

*

752

*

*

*

749

*

748

*

*

10

Exclude property not belonging to 

respondent or other household member.

Enter code(s) from 90.

Do not include cash/purse/wallet. Exclude

property not belonging to respondent or 

other household member.

Mark (X) all that apply.

FIELD REPRESENTATIVE – If purse or wallet

stolen, ASK –

Did it contain any money?

Enter amount of stolen cash where indicated. 

Mark the appropriate box(es) for stolen 

property or the box for only cash taken.

FORM NCVS-2 (9-16-2004)

Respondent only – SKIP to Check Item M1 97. Did the stolen (property/money) belong 760

to you personally, to someone else in

the household, or to both you and other

household members?

1

2 Respondent and other household

member(s) – Fill Check Item L

Other household member(s) only – Fill Check Item L

Nonhousehold member(s) only

Other – Specify

3

4

5 ⎫

⎬

⎭

SKIP to

Check Item

M1

Mark (X) only one box.

Silver, china, art objects

Other household furnishings (furniture, rugs, etc.)

12

13
NCVS-2, Page 13 Black ink NCVS-2, Page 13, 10% Pantone 185 Red

Page 13

Besides the respondent, which

household member(s) owned the 

stolen (property/money)?

CHECK

ITEM L

Yes – Ask 98

No – SKIP to 100

98. Had permission to use the (car/motor

vehicle) ever been given to the 

offender(s)?

763 1

2

3

Yes – Ask 99

No

Don’t know

761

SKIP to Check Item M2

⎫

⎬

⎭

If not sure, ask. Do not enter the

respondent’s line number.

OR

40 Household property

If only cash/checks/credit cards is marked in

item 96, SKIP to 106.

770

40

Line number

Line number

Line number

1

2

3

4

5

6

7

Original cost

Replacement cost

Personal estimate of current value

Insurance report estimate

Police estimate

Don’t know

Other – Specify

Was a car or other motor vehicle taken?

(Is box 5 or 6 marked in 96?)

CHECK

ITEM M1

99. Did the offender return the (car/motor

vehicle) this time?

764 1

2

Yes

No SKIP to Check Item M2

⎫

⎬

⎭

100. ASK OR VERIFY –

Was/Were the article(s) IN or

ATTACHED to a motor vehicle when

(they were/it was) taken?

765 1

2

Yes

No

Yes – Ask 101c

No – SKIP to 102

Was cash, purse, or a wallet taken? 

(Is a cash amount entered or box 1, 2,

or 3 marked in 96?)

CHECK

ITEM N

101c. ASK OR VERIFY –

Was the (cash/purse/wallet) on your

person, for instance, in a pocket or

being held?

767 1

2

Yes

No

102. ASK OR VERIFY –

Was there anything (else) the

offender(s) took directly from you, for

instance, from your pocket or hands, or

something that you were wearing?

768 1

2

Yes – Ask 103

No – SKIP to 104

103. Which items did the offender(s) take

directly from you?

769

Code

OR

Everything marked in 96 was taken

directly from respondent

Code Code

104.

How did you decide the value of the

property that was taken? Any other

way?

771 105.

*

*

*

Mark (X) all that apply.

Exclude property not belonging to 

respondent or other household member.

Enter code(s) from 96.

Do not include cash/purse/wallet. Exclude

property not belonging to respondent or other

household member.

What was the value of the PROPERTY 

that was taken? Include recovered

property. (Exclude any stolen cash/

checks/credit cards. If jointly owned with

a nonhousehold member(s), include only

share owned by household members.)

FORM NCVS-2 (9-16-2004)

Yes – Ask 101a

No – SKIP to Check Item M3

101a. How many handguns were taken? 923

X

_____ Number of handguns

Don’t know (Number of handguns taken)

Did the offender(s) take a handgun?

(Is box 20 marked in 96?)

CHECK

ITEM M2

Yes – Ask 101b

No – SKIP to Check Item N

Did the offender(s) take some other

type of firearm?

(Is box 21 marked in 96?)

CHECK

ITEM M3

101b. How many other types of firearms 

were taken?

924 _____ Number of firearms

X Don’t know (Number of firearms taken)

$ ____________ . Value of property taken 00
NCVS-2, Page 14 Black ink NCVS-2, Page 14, 10% Pantone 185 Red

Page 14

Was PROPERTY other than cash,

checks, or credit cards recovered? (If

not sure, ask.)

1

2

Yes – Ask 108

No – SKIP to 109

775

What was recovered? Anything else?

CHECK

ITEM O

Purse

Wallet

Credit cards, checks, bank cards

Car or other motor vehicle

Property other than the above

108. Considering any damage, what was

the value of the property after it was

recovered? (Do not include recovered

cash, checks, or credit cards.)

778

779

Was the theft reported to an insurance

company? 1

2

3

4

Yes

No 

Don’t have insurance

Don’t know

Was/Were the damaged item(s) repaired

or replaced? 781 1

2

3

Yes, all

Yes, part

No, none – Ask 112

How much would it cost to repair or

replace the damaged item(s)? 782

⎫

⎬

⎭

1

2

3

4

5

6

Items will not be repaired or replaced

Household member

Landlord or landlord’s insurance

Victim’s (or household’s) insurance

Offender

Other – Specify

SKIP to 113

Cash

Property

1 Only cash recovered

2

3

4

5

6

⎫

⎬

⎭

Ask: Did it contain any money?

Value of property recovered

109.

777

780

(Other than any stolen property) was

anything that belonged to you or other

members of the household damaged in

this incident?

1

2

Yes – Ask 111

No – SKIP to 115

110.

111.

112.

113. How much was the repair or

replacement cost?

Cost to repair/replace – SKIP 

to 114

No cost – SKIP to 115

Don’t know – SKIP to 114

0

x

776

*

783

*

Cost to repair/replace – Ask 114

No cost – SKIP to 115

Don’t know – Ask 114

0

x

114. Who (paid/will pay) for the repairs or

replacement? Anyone else? 784

Notes

PROBE – For example, was (a lock or

window broken/clothing damaged/

damage done to a car), or something

else?

Mark (X) all that apply.

Did it contain any money?

Enter amount of recovered cash where 

indicated. Mark the appropriate box(es) for

recovered property or the box for only cash

recovered.

FIELD REPRESENTATIVE – If purse or wallet

recovered, ASK –

Mark (X) all that apply.

FORM NCVS-2 (9-16-2004)

107.

772

Was all or part of the stolen (money/

property) recovered, not counting 

anything received from insurance?

1

2

3

All – SKIP to Check Item O

Part – Ask 107

None – SKIP to 109

106.

$ ____________ . Amount of cash recovered 00

$ ____________ . 00

$ ____________ . 00

$ ____________ . 00
NCVS-2, Page 15 Black ink NCVS-2, Page 15, 10% Pantone 185 Red

Page 15

Is more than one reason marked in 117? 1

2

Yes – Ask 118

No – SKIP to 130, page 17

1

2

3

Yes – Ask 116

No – SKIP to 117

Don’t know – SKIP to 130, page 17

800

115. Were the police informed or did they

find out about this incident in any way?

116.

CHECK

ITEM P

1

2

3

Respondent – SKIP to 119

Other household member

117. What was the reason it was not

reported to the police? (Can you tell me

a little more?) Any other reason?

802

4

5

6

7

808

801

*

118. Which of these would you say was the

most important reason why the incident

was not reported to the police?

806

Notes

Someone official called police (guard, apt.

manager, school official, etc.)

Someone else

Police were at scene – SKIP to 123

Offender was a police officer

Some other way – Specify 

⎫

⎬

⎭

SKIP

to 121

⎫

⎬

⎭

SKIP to 124

DEALT WITH ANOTHER WAY

1 Reported to another official (guard, apt. manager,

school official, etc.)

Private or personal matter or took care of it myself or

informally; told offender’s parent

2

NOT IMPORTANT ENOUGH TO RESPONDENT

Minor or unsuccessful crime, small or no loss,

recovered property

INSURANCE WOULDN’T COVER

Child offender(s), "kid stuff"

Not clear it was a crime or that harm was intended

No insurance, loss less than deductible, etc.

POLICE COULDN’T DO ANYTHING

Didn’t find out until too late

Could not recover or identify property

Could not find or identify offender, lack of proof

POLICE WOULDN’T HELP

Police wouldn’t think it was important enough, 

wouldn’t want to be bothered or get involved

Police would be inefficient, ineffective (they’d arrive 

late or not at all, wouldn’t do a good job, etc.)

Police would be biased, would harass/insult 

respondent, cause respondent trouble, etc.)

Offender was police officer

OTHER REASON

Did not want to get offender in trouble with the law

Was advised not to report to police

Afraid of reprisal by offender or others

Did not want to or could not take time – too 

inconvenient

Other – Specify

*

805

*

804

803

Respondent not present or doesn’t know why it

wasn’t reported

30

Code – SKIP to 130, page 17

No one reason more important – SKIP to 130, page 17

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

*

*

Mark (X) all that apply.

STRUCTURED PROBE –

Was the reason because you dealt with

it another way, it wasn’t important

enough to you, insurance wouldn’t

cover it, police couldn’t do anything,

police wouldn’t help, or was there some

other reason?

Enter code from 117.

How did the police find out about it?

Mark (X) first box that applies.

FIELD REPRESENTATIVE – If proxy interview,

we want the proxy respondent to answer

questions 116–134 for herself/himself, not for 

the person for whom the proxy interview is 

being taken.

FORM NCVS-2 (9-16-2004)
NCVS-2, Page 16 Black ink NCVS-2, Page 16, 10% Pantone 185 Red

Page 16

Is more than one reason marked in 119? Yes – Ask 120

No – SKIP to 121

CHECK

ITEM Q

119. Besides the fact that it was a crime, did

YOU have any other reason for 

reporting this incident to the police? 809

120. Which of these would you say was the 813 most important reason why the incident

was reported to the police?

⎫

⎬

⎭

SKIP to 128

TO GET HELP WITH THIS INCIDENT

1

2

Stop or prevent THIS incident from happening

Needed help after incident due to injury, etc.

TO RECOVER LOSS

To recover property

To collect insurance

TO GET OFFENDER

To prevent further crimes against respondent/

respondent’s household by this offender

TO LET POLICE KNOW

To improve police surveillance of respondent’s home,

area, etc.

OTHER

Other reason – Specify

No other reason – SKIP to 121

21

Code

No one reason more important

Because it was a crime was most important

3

4

6

7

8

9

11

12

*

To stop this offender from committing other 

crimes against anyone

To punish offender

Duty to let police know about crime

5

10

22

121. Did the police come when they found 814 out about the incident?

1

2

3

4

Yes – Ask 122

No

Don’t know

Respondent went to police – SKIP to 123

122. How soon after the police found out did 815 they respond? Was it within 5 minutes,

within 10 minutes, an hour, a day, or

longer?

1

2

3

4

5

6

Within 5 minutes

Within 10 minutes

Within an hour

Within a day

Longer than a day

Don’t know how soon

123. What did they do while they were 816 (there/here)? Anything else?

1

2

3

4

5

6

7

8

9

Took report

Searched/looked around

Took evidence (fingerprints, inventory, etc.)

Questioned witnesses or suspects

Promised surveillance

Promised to investigate

Made arrest

Other – Specify

Don’t know

124. Did you (or anyone in your household) 818 have any later contact with the police

about the incident?

1

2

3

Yes – Ask 125

No

Don’t know

125. Did the police get in touch with you or 819 did you get in touch with them?

1

2

3

4

5

Police contacted respondent or other HHLD member

Respondent (or other HHLD member) contacted police

Both

Don’t know

Other – Specify

126. Was that in person, by phone, or some 820 other way?

1

2

3

4

In person

Not in person (by phone, mail, etc.)

Both in person and not in person

Don’t know

810

*

811

*

817

*

*

Catch or find offender – other reason or no

reason given

⎫

⎬

⎭

SKIP to 124

Any other reason?

Mark (X) all that apply.

STRUCTURED PROBE –

Did you report it to get help with this

incident, to recover your loss, to stop or

punish the offender, to let police know

about it, or was there some other

reason?

Enter code from 119.

Mark (X) first category respondent is sure of.

Mark (X) all that apply.

127. What did the police do in following up

this incident? Anything else? 821 1

2

3

4

5

6

7

Took report

Questioned witnesses or suspects

Did or promised surveillance/investigation

Recovered property

Made arrest

Stayed in touch with respondent/household

Other – Specify

Nothing (to respondent’s knowledge)

Don’t know

8

9

*

822

*

Mark (X) all that apply.

FORM NCVS-2 (9-16-2004)
NCVS-2, Page 17 Black ink NCVS-2, Page 17, 10% Pantone 185 Red

Page 17

Were the police informed? (Is "Yes"

marked in 115 on page 15?)

Yes – Ask 132

No – SKIP to 135

CHECK

ITEM R

829

132. Have you (or someone in your

household) had contact with any other

authorities about this incident (such as

a prosecutor, court, or juvenile officer)?

830

133. Which authorities? Any others?

1

2

3

4

5

Prosecutor, district attorney

Magistrate

Court

Juvenile, probation or parole officer

Other – Specify

831

134. Do you expect the police, courts, or

other authorities will be doing anything

further in connection with this incident?

1 Yes – Specify

832

135.

FIELD REPRESENTATIVE – If proxy interview,

replace "you" with the name of the person for

whom the proxy interview is being taken in

135–173.

1

2

3

4

5

6

7

8

9

10

Working or on duty – SKIP to 138a

On the way to or from work – SKIP to Check Item S

On the way to or from school

On the way to or from other place

Shopping, errands

Attending school

Leisure activity away from home

Sleeping

Other activities at home

Other – Specify

840

136. ASK OR VERIFY –

Did you have a job at the time of the

incident?

1

2

Yes – SKIP to Check Item S

No

841

137. What was your major activity the week

of the incident — were you looking for

work, keeping house, going to school, or

doing something else?

1

2

3

4

5

6

Looking for work

Keeping house

Going to school

Unable to work

Retired

Other – Specify 

825

Did you (or someone in your household)

sign a complaint against the offender(s) to

the police department or the authorities?

1

2

Yes

No

128.

826

ASK OR VERIFY –

As far as you know, was anyone arrested

or were charges brought against anyone in

connection with this incident?

1

2

3

Yes

No

Don’t know

129.

⎫

⎬

⎭

SKIP to Check Item R

827

130. Did you (or someone in your household)

receive any help or advice from any office

or agency —other than the police — that

deals with victims of crime?

1

2

3

Yes – Ask 131

No

Don’t know

828

Was that a government or private

agency? 1

2

3

Government

Private

Don’t know

131.

⎫

⎬

⎭

SKIP to 134

1

2

3

Yes – Ask 133

No

Don’t know

No

Don’t know

2

3

11 Don’t know

⎫

⎬

⎭

SKIP to 151, page 19

* Mark (X) all that apply.

Mark (X) only one box.

Mark (X) only one box.

Notes

ASK OR VERIFY –

What were you doing when this incident

(happened/started)?

FORM NCVS-2 (9-16-2004)
What kind of work did you do, that is,

what was your occupation at the time 

of the incident?

Page 18

Was the respondent injured in this incident?

(Is box 2–11 marked in 31 on page 5?) Yes (injury marked in 31) – Ask 143

No (blank or None marked in 31) – SKIP to 147

CHECK

ITEM S

138a. Now I have a few questions about the 843

job at which you worked during the 

time of the incident. 

Were you employed by (Read answer 

categories) –

1 A private company, business, or

individual for wages? – Ask 138b

2

140. While working at this job, did you work 844

mostly in (Read answer categories) –

1

2

3

4

A city?

Suburban area?

Rural area?

Combination of any of these?

845 141a.

ASK OR VERIFY –

Did this incident happen at your work

site?

1

2

3

4

Yes

No

Don’t know

Other – Specify

870

The Federal government?

A State, county, or local

government?

Yourself (Self-employed) in your own

business, professional practice, or

farm? – Ask 138b

3

4

141b. Did you usually work days or nights? 846 1

2

3

Days

Nights

Both days and nights/rotating shifts

871

143. Did YOU lose time from work because

of the injuries you suffered in this

incident?

1

2

Yes – Ask 144

No – SKIP to 147

872

144. How much time did you lose

because of injuries?

0

x

Less than one day – SKIP to 147

Don’t know – Ask 145

Number of days – Ask 145

145. During these days, did you lose any

pay that was not covered by

unemployment insurance, sick

leave, or some other source?

1

2

Yes – Ask 146

No – SKIP to 147

146. About how much pay did you lose? 873

x Don’t know

Amount of pay lost

955

956 1

2

3

4

Manufacturing?

Retail trade?

Wholesale trade?

Something else?

957

958

138d. What kind of business or industry is

this?

138e. Is this mainly ... (Read answer

categories) –

138f.

139. What were your usual activities or

duties at this job?

142. Is this your current job? 959 Yes

No

1

2

Mark (X) only one box.

(For example: plumber, typist, farmer)

5 A private, not-for-profit, tax-exempt, or

charitable organization? – Ask 138b

⎫

⎬

⎭

SKIP to 138c

138b. Is this business incorporated? 953 Yes

No

Don’t know

1

2

3

138c. What is the name of the (company/ 954

government agency/business/

non-profit organization) for which you

worked at the time of the incident?

Read if necessary: What do they make or do

where you worked at the time of the

incident?

NCVS-2, Page 18 Black ink NCVS-2, Page 18, 10% Pantone 185 Red

FORM NCVS-2 (9-16-2004)

$ ____________ . 00
NCVS-2, Page 19 Black ink NCVS-2, Page 19, 10% Pantone 185 Red

Page 19

Was the respondent on the way to or from

work, school, or some other place when the

incident (happened/started)? (Is box 2, 3, or

4 marked in 135 on page 17?)

1

2

Yes – Ask 150

No – SKIP to 151

CHECK

ITEM T

153. ASK OR VERIFY –

You told me earlier you were on the way

(to/from) (work/school/some place) when

the incident happened.

881 1

2

3

4

5

6

7

8

9

10

Car, truck or van

Motorcycle

Bicycle

On foot

School bus (private or public)

Bus or trolley

Subway or rapid transit

Train

Taxi

Other – Specify

874

Did YOU lose any (other) time from

work because of this incident for such

things as cooperating with a police

investigation, testifying in court, or

repairing or replacing damaged or

stolen property?

1

2

3

4

5

Police related activities

Court related activities

Repairing damaged property

Replacing stolen items

Other – Specify

147.

875

How much time did you lose altogether

because of (name all reasons marked in

147)?

0

x

148.

876

149. During these days, did you lose any pay

that was not covered by unemployment

insurance, paid leave, or some other

source?

Yes – Ask 153

No – SKIP to Check Item U

877

150. About how much pay did you lose?

None (did not lose time from work for any of these

reasons) – SKIP to 151

⎫

⎬

⎭

Ask 148

Number of days – Ask 149

Less than one day – SKIP to 151

Don’t know – Ask 149

x Don’t know

Amount of pay lost

Were there any (other) household

members 16 years or older who lost time

from work because of this incident?

151.

1

2

Yes – Ask 152

No – SKIP to Check Item T

878

879

How much time did they lose

altogether?

0

x

152.

Number of days

Less than one day 

Don’t know

Is this incident part of a series 

of crimes? (Is box 2 (is a "series") 

marked in Check Item D on page 1?)

CHECK

ITEM U Yes – Ask 154

No – SKIP to 161, page 21

883

You have told me about the most recent

incident. How many times did this kind

of thing happen to you during the last 6

months?

1

2

3

154.

Number of incidents – Ask 155

Is that because there is no way of

knowing, or because it happened too

many times, or is there some other

reason?

OR

Don’t know –

No way of knowing

Happened too many times

Some other reason – Specify

6

*

884

Mark (X) all that apply. If no time was lost for

any of these reasons, mark None (box 6).

What means of transportation were you

using?

Mark (X) only one box.

155. In what month or months did these

incidents take place? Number of incidents per quarter

Jan., Feb.,

or March

(Qtr. 1)

April, May,

or June 

(Qtr. 2)

July, Aug.,

or Sept.

(Qtr. 3)

Oct., Nov.,

or Dec. 

(Qtr. 4)

885 886 887 888

If more than one quarter involved, ASK

How many in (name months)?

FIELD REPRESENTATIVE – Enter number for

each quarter as appropriate.

FORM NCVS-2 (9-16-2004)

$ ____________ . 00
NCVS-2, Page 20 Black ink NCVS-2, Page 20, 10% Pantone 185 Red

Page 20

Mark the ONE category that best 

describes this series of crimes.

Friend or ex-friend

Neighbor

Schoolmate

Roommate, boarder

Customer/client

Patient

Supervisor (current or former)

Employee (current or former)

Co-worker (current or former)

Stranger

CHECK

ITEM V1

156. Did all, some, or none of these incidents

occur in the same place?

889 All in the same place

Some in the same place

None in the same place

1

2

3

Were all, some, or none of these 890

incidents done by the same person(s)?

1

2

3

4

All by same person

Some by same person

None by same person

Don’t know – SKIP to 159

157.

891

What (was/were) the relationship(s) of

the offender(s) to you? For example,

friend, spouse, schoolmate, etc. 1

2

3

4

158.

1 Completed or threatened violence in the course of 

the victim’s job (police officer, security guard,

psychiatric social worker, etc.)

Spouse at time of incident

Ex-spouse at time of incident

Parent or step-parent

Other relative – Specify

159. Did the same thing happen each time? 1

2

Yes

No – How did the incidents differ?

893

894 160. Is the trouble still going on?

Relative

Nonrelative

1

2

Yes

No – What ended it?

Completed or threatened violence between spouses,

other relatives, friends, neighbors, etc.

Completed or threatened violence at school or on

school property

Other contact crimes (other violence, pocket picking,

purse snatching, etc.) – Specify

3

2

4

Contact crimes

5 Theft or attempted theft of motor vehicles

Theft or attempted theft of motor vehicle parts (tire,

hubcap, battery, attached car stereo, etc.)

Theft or attempted theft of contents of motor 

vehicle, including unattached parts

Theft or attempted theft at school or on school 

property

7

6

8

Noncontact crimes

Illegal entry of, or attempt to enter, victim’s home, 

other building on property, second home, hotel, 

motel

Theft or attempted theft from victim’s home or 

vicinity by person(s) known to victim (roommate,

babysitter, etc.)

Theft or attempted theft from victim’s home or

vicinity by person(s) unknown to victim

11

9

10

Other theft or attempted theft (at work, while 

shopping, etc.) – Specify

12

5

6

7

8

11

12

13

14

15

9

895

892

*

*

Mark (X) only one box.

Mark (X) only one box.

Mark (X) all that apply.

If more than one category describes 

this series, mark the box with the 

lowest number.

10 Other nonrelative – Specify

FORM NCVS-2 (9-16-2004)
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Page 21

CHECK

ITEM V2 Are one or more boxes marked "Yes" in

162 OR 163?

Yes – Ask 164

No – SKIP to Check Item V3

161.

1 Yes 2 No

911 1 2 No

3 Don’t know

3 Don’t know

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

incident just discussed was a hate crime or

crime of prejudice or bigotry?

Yes – Ask 162

No

Don’t know

1

2

3

910

162. 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...

(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, or developmental disabilities) 

you may have?

1 2 No 3 Don’t know

1 Yes 2 No 3 Don’t know

1 Yes 2 No 3 Don’t know

1 Yes 2 No 3 Don’t know

1 Yes 2 No 3 Don’t know

896

897

898

899

900

901

163. 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...

(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

913 1 2 Yes –Specify No 3 Don’t know

164. Do you have any evidence that this

incident was a hate crime or crime of

prejudice or bigotry?

If "No" or "Don’t know," ASK – 

1

2

3

915

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 Check Item V3

Yes – Ask 165

No

Don’t know SKIP to Check Item V3

Yes

161.

914

912

FORM NCVS-2 (9-16-2004)

}

}
NCVS-2, Page 22 Black ink NCVS-2, Page 22, 10% Pantone 185 Red

Page 22

165. The next questions ask about the evidence

you have that makes you suspect this

incident 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:

(a) 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 incident 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 incident was a

hate crime or crime of prejudice or

bigotry, but you do not have enough

evidence to know for sure?

916 1 Yes 2 No 3 Don’t know

917 1 Yes 2 No 3 Don’t know

918 1 Yes 2 No 3 Don’t know

919 1 Yes 2 No 3 Don’t know

920 1 Yes 2 No 3 Don’t know

921 1 Yes 2 No 3 Don’t know

922 1 Yes 2 No 3 Don’t know

166. At any time, did you tell the police that you

believed the incident was a hate crime or

crime of prejudice or bigotry?

1 Yes

2 No

908

Notes

FORM NCVS-2 (9-16-2004)
NCVS-2, Page 23 Black ink NCVS-2, Page 23, 10% Pantone 185 Red

Page 23

CHECK

ITEM V3 Is this the first incident reported for this

respondent?

(a) An intellectual disability such as

mental retardation or Down

Syndrome? 928 1 Yes 2 No 3 Don’t know

170.

Yes – SKIP to INTRO

No – Fill Check Item V4

Have you ever suffered a stroke, brain

tumor, or any type of brain injury that

causes you to have difficulty thinking,

concentrating, or making decisions?

FIELD REPRESENTATIVE – Read Introduction.

INTRO:

1 Yes – Specify

925

9

934

935

(First Condition)

(Second Condition)

(Third Condition)

CHECK

ITEM V5

Is box 1 marked in any of 167 through 170?

(That is, has the respondent indicated that

he/she has a health condition or disability?)

Yes – Ask 172

No – SKIP to Check Item W

172. During the incident you just told me

about, do you have reason to suspect

you were victimized because of your

health condition(s), impairment(s), or

disability(ies)?

1

2

3

Yes – Ask 173

No

Don’t know SKIP to Check Item W

944

926

FORM NCVS-2 (9-16-2004)

CHECK

ITEM V4

Is Check Item V5 marked "Yes" for ANY

incidents already reported for this respondent?

(That is, has the respondent indicated that

he/she has a health condition or disability?)

Yes – SKIP to 172

No – SKIP to Check Item W

Research has shown that people with disabilities may be more vulnerable to crime 

victimization. The next questions ask about any health conditions, impairments, or disabilities

you may have.

167. Does a mental health condition currently

keep you from participating fully in work,

school, or other activities?

Yes 

No

Don’t know

927 1

2

3

168. Do you have any of the following: (Read

categories a–c below.)

(b) Autism?

(c) Cerebral Palsy?

1 Yes 2 No 3 Don’t know

1 Yes 2 No 3 Don’t know

169.

Other than anything you’ve already

mentioned, do you have any SERIOUS

disabling conditions? Anything else?

FIELD REPRESENTATIVE – If "Yes" list up to 

3 different conditions reported by the respondent.

Do not repeat conditions.

No 

Don’t know

2

3

Yes 

No

Don’t know

931 1

2

3

(a) Taking care of yourself, such as

bathing, dressing, or eating? 1 2 3

171. I’m going to read you a list of activities. As 

I read each activity, please tell me if you 

have difficulty or need help none of the 

time, some of the time, most of the time, or

all of the time:

933

936 1 2 3

(b) Communicating, such as talking with

or listening to other people? 1 2 3 937

(c) Learning any new skills or activities? 1 2 3 938

(d) With mobility such as bending,

walking, or climbing stairs?

1

939

(e) Making important decisions for

yourself about your health care,

education, or career?

1 2 3

940

(f) Living independently, such as

preparing meals, doing housework, or

shopping for groceries and personal

items? 1 941

(g) Managing your finances, such as

keeping track of your money and

paying bills? 1 942

None 

of the

time

Some 

of the 

time

Most 

of the 

time

All of

the

time

4

4

4

4

2 3 4

2 3 4

2 3 4

943

929

930

932

}
NCVS-2, Page 24 Black ink NCVS-2, Page 24, 10% Pantone 185 Red

Page 24

173. Which of your health conditions,

impairments, or disabilities do you 

believe caused you to be targeted for this

incident?

FORM NCVS-2 (9-16-2004)

Summarize this incident or series of

incidents. Include what was taken, how entry

was gained, how victim was

threatened/attacked, what weapons were

present and how they were used, any

injuries, what victim was doing at time of

attack/threat, whether the incident was

reported to the police or whether only

nonhousehold property was stolen.

CHECK

ITEM W

Yes – Fill Check Item Z

No – Go to next Crime Incident Report

CHECK

ITEM Y Is this the last Incident Report to be filled for

this screen question?

Yes – FILL NCVS-1, Check Item H

No – Go to next Crime Incident Report

CHECK

ITEM Z Is this the last Incident Report to be filled for

this respondent?

FIELD REPRESENTATIVE –

Check BOUNDING INFORMATION on the

back of the control card.

ALSO INCLUDE DETAILS ABOUT THE

INCIDENT THAT ARE NOT PROVIDED IN

THE ANSWER CATEGORIES AND THAT

WILL HELP CLARIFY THE INCIDENT.

Yes – Be sure you fill or have filled an Incident

Report for each interviewed household

member 12 years of age or over who was

harmed, threatened with harm, or had

something taken from him/her by force or

threat in this incident. 

CHECK

ITEM X Is there an entry for "Number of persons"?

(Refer to 54 on page 7.)

No

CHECK BOUNDING INFORMATION

909

947

948

(First Condition)

(Second Condition)

(Third Condition)

946
NCVS-2, Page 25 Black ink NCVS-2, Page 25, 10% Pantone 185 Red

Page 25

Notes

FORM NCVS-2 (9-16-2004)
NCVS-2, Page 26 Black ink NCVS-2, Page 26, 10% Pantone 185 Red

Page 26

Notes

FORM NCVS-2 (9-16-2004)