FORM CJ-14 (8-8-2007)

U.S. Census Bureau

P.O. Box 5000

Jeffersonville, IN 47199-5000 

GOVS/CJRP

This questionnaire asks about persons who had assigned

beds in this facility on Wednesday, October 24, 2007

OMB No. 1121-0218: Approval Expi

Return the completed form to:

If you have any questions, call Regina Yates or Art Ciampa, 

U.S. Census Bureau, 1–800–352–7229.

PLEASE COMPLETE AND MAIL THIS FORM IN THE ENCLOSED

ENVELOPE BY NOVEMBER 28, 2007

Fax: 1–888–891–2099

EMAIL: govs.CJRP@census.gov

CJ-14, Page 1, Base (Black) CJ-14, Page 1, Tone 20 and 100%, Blue (Pantone 313)

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

PERSON COMPLETING THIS QUESTIONNAIRE

Telephone

Area code Number E

Fax Number

ZIP Code Area code Number

Name

Title

Business address – Number and street/or P.O. Box/Route number

City State

E-mail address

WEBSITE: http://harvester.census.gov/cjr
Page 2 FOR

02

What is the name of this agency?

Does this facility provide ON-SITE

RESIDENTIAL TREATMENT?

01 Yes

02 No

What kind of treatment is provided INSIDE

this facility? Mark (X) those that apply.

01 Mental health treatment

Substance abuse treatment

Sex offender treatment

Treatment for arsonists

Treatment specifically for violent offenders 

Other – Specify

02

03

04

05

06

What type of residential facility is th

listed on the front cover? Mark (X) tho

that apply.

01 Detention center

Training school/Long-term secure facili

Reception or diagnostic center

Group home/Halfway house

Residential treatment center

Boot camp

02

03

04

05

06

Ranch, forestry camp, wilderness or

marine program, or farm

Runaway and homeless shelter

Other type of shelter

Other – Specify

07

08

09

10

➔ SKIP to Question 3

2a.

1b.

2b.

5.

No ➔ SKIP to Question 2

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01 Yes

02 No

On Wednesday, October 24, 2007, d

facility house any overflow detentio

population? "Overflow detention populati

refers to those young persons who, becaus

unavailability of beds in a detention center, 

placed temporarily in a non-detention facilit

If this facility is a detention center, answer N

6.
FORM CJ-14 (8-8-2007)

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Rarely, no set schedule

During shift changes

Whenever they are in their sleeping rooms

At night

Part of each day

Most of each day

All of each day

Other – Specify

03

04

05

06

07

08

09

10

8. Does this facility have any of the

following features intended to confine

young persons within specific areas? 

Mark (X) all that apply.

01 Doors for secure day rooms that are

locked by staff to confine young persons

within specific areas

02 Wing, floor, corridor, or other internal

security doors that are locked by staff to

confine young persons within specific

areas

03 Outside doors that are locked by staff to

confine young persons within specific

buildings

04 External gates in fences or walls

WITHOUT razor wire that are locked by

staff to confine young persons

05 External gates in fences or walls WITH

razor wire that are locked to confine

young persons

06 Other – Specify

07 The facility has NONE of the above

features

9c. WHEN are outside doors to buildin

living/sleeping units in this facility

locked? 

01 Rarely, no set schedule

At night

Part of each day

Most of each day

All of each day

When the facility is unoccupied

Other – Specify

02

03

04

05

02 To keep young persons inside this 

07

Mark (X) all that apply.

06
Page 4 FOR

According to your records, at the end of

the day on October 24, 2007, did ANY

persons have assigned beds in this

facility? Include persons who were temporarily

away, but had assigned beds on October 24. Do

NOT include staff.

10a.

02

According to your records, at the end of

the day on October 24, 2007, how many

persons had assigned beds in this facility?

10b.

Persons

Yes

01

02

Yes

1. those persons under age 21; and

You will then be asked to classify each

person UNDER THE AGE OF 21 into one of

the two following categories:

1. those here because they have been

charged with or court-adjudicated for an

offense. An offense is any behavior that

is illegal in your state for underage

persons alone or for both underage

persons and adults.

2. those here for reasons other than

offenses

Please classify each person under age 21

into just one of these categories. Detailed

descriptions of the above categories are

provided in the questions themselves and

on the Offense Codes on Pages 19 and 20.

Please use your records for October 24,

2007, to answer the following questions.

y 

October 24, 2007, did ANY persons 

AGE 21 have assigned beds in this 

INCLUDE juveniles being tried as adults in 

court. Do NOT include staff.

12b. According to your records at the en

day on Wednesday, October 24, 200

many persons UNDER AGE 21 had a

beds in this facility? Include persons w

temporarily away but had assigned beds o

October 24. Do NOT include staff.

Persons under the age of 

NOTE: As a check, the sum of

question 11 (persons 21 and olde

and 12b (persons under age 21)

should equal the sum reported in

question 10b (number of persons

assigned beds in the facility).

2. those persons age 21 and older.

INCLUDE in your count persons UN

AGE 21 here BECAUSE THEY WERE

CHARGED WITH OR ADJUDICATED 

• ANY offense that is illegal for both ad

and underage persons.

13a. At the end of the day on Wednesda

October 24, 2007, did ANY of the pe

UNDER AGE 21 have assigned beds 

facility SPECIFICALLY BECAUSE th

CHARGED WITH OR COURT-ADJUD

FOR AN OFFENSE? An offense is any b

that is illegal in your state for underage pe

alone or for both underage persons and ad

the Offense Codes on Page 19 and 20.

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STOP HERE and mail this form ONLY 

if there were NO PERSONS IN 

YOUR FACILITY OR THE FACILITY 

WAS CLOSED (permanently or

temporarily) on this date. Indicate the

reason in the COMMENTS Section on 

Page 6.

02 ➔

01

No

STOP HERE and mail this for

if there were NO persons unde

your facility on this date. Indica

reason in the COMMENTS Sec

Page 6.

No ➔
FORM CJ-14 (8-8-2007)

Persons under age 21 here because

they were charged with or

court-adjudicated for an offense.

DO NOT INCLUDE here:

• Persons under age 21 who have committed one

or more offenses in the past, BUT HAVE

ASSIGNED BEDS ON OCTOBER 24 FOR

REASONS OTHER THAN OFFENSES such as

neglect, abuse, dependency, abandonment, or

another NON-OFFENSE reason.

• Persons under age 21 assigned beds here

because of mental health problems,

substance abuse problems, etc. UNLESS

THE OFFENSE THEY COMMITTED

REQUIRED TREATMENT AS PART OF THE

COURT ORDER.

• Persons under age 21 who have run away,

been truant or incorrigible, or violated curfew,

IF THESE BEHAVIORS ARE NOT

CONSIDERED ILLEGAL IN YOUR STATE.

These persons will be counted in questions

14a and 14b.

• Those persons who are PINS (Persons in

Need of Services) or CHINS (Children in

Need of Services) who have assigned

beds because of REASONS OTHER

THAN OFFENSES.

13b. According to your records at the end of the

day on Wednesday, October 24, 2007, HOW

MANY PERSONS UNDER AGE 21 had

assigned beds in the facility SPECIFICALLY

BECAUSE they were CHARGED WITH OR

COURT-ADJUDICATED FOR AN OFFENSE,

as defined in question 13a? 

because of mental health problems UNL

OFFENSE THEY COMMITTED REQUIR

TREATMENT AS PART OF THE COUR

• Persons under age 21 who have run aw

truant or incorrigible, or violated curfew, 

THESE BEHAVIORS ARE NOT CONSID

ILLEGAL IN YOUR STATE.

• Persons assigned beds here due to volu

non-offense related admissions.

DO NOT INCLUDE here:

• Persons assigned beds here BECAUSE 

WERE CHARGED WITH OR

COURT-ADJUDICATED FOR AN OFFE

These persons are counted in questions 

and 13b.

SKIP to note below

SKIP to Question 14a

NOTE: As a check, the sum of

questions 13b (persons under 

with offenses) and 14b (perso

under 21 with reasons other t

offenses) should equal 12b (th

number of persons under age 

14b. According to your records at the e

the day on Wednesday, October 24

HOW MANY PERSONS UNDER AGE 

assigned beds in this facility FOR

REASONS OTHER THAN OFFENSES

defined in question 14a?

Include persons who were temporarily awa

had assigned beds on October 24. Do NO

include staff.

Persons under age 21 here 

of non-offense reasons.

Later you will be asked to provide information

about each of these persons. Include persons who

were temporarily away but had assigned beds on

October 24. Do NOT include staff.

01 Yes

02 No ➔

01 Yes

02 No ➔

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Page 6 FOR

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included in Section I, question 13b.

FORM CJ-14 (8-8-2007)

BE SURE TO KEEP COPIES OF THE

DATA YOU SUBMIT.

You may choose one of the following ways to

record this information:

2.

a. Continue to write information on this form.

or

Provide a data file which conforms to the

CJRP record layout. The acceptable formats

are text file, spreadsheet, or data base file.

b.

U.S. Census Bureau

P.O. Box 5000

Jeffersonville, IN 47199-5000 

GOVS/CJRP

Download an excel spreadsheet by going to

our website at http://harvester.census.gov/cjrp

Do not type "www" as a prefix.

Additional information is also available on this

website by clicking on General Guidelines. The

spreadsheet can be submitted by e-mail to the

following: govs.CJRP@census.gov

3.

CJ-14, Page 7, Base (Black) CJ-14, Page 7, Tone 20, 40, and 100%, Blue (Pantone 313)

Please send to:

c.

E-mail: govs.CJRP@census.gov
FOR

Line number

Mo. Day Yr.Code

01

02

03

04

06

07

08

09

10

11

IF MORE PERSONS MEET REQUIREMENTS A THROUGH D ABOVE

initial for all

persons meeting

ALL 4 requirements

above. Use an

identifier that will

allow YOU to

reidentify each

person 6 months

from now, if a

callback is needed.

sex?

1 – Male

2 – Female

date of

birth?

1 White, not of Hispanic origin

the line.

2 – Black or African American,

not of Hispanic origin

Code Specify Other on

1 – Court, probation agency, o

law enforcement agency

Enter the

code on

the line.

Specify Other only

12

Page 8

Code

05

2 – Corrections or other justice

agency not included in 1

3 – Social services agency

4 – School official, parent or

guardian, or young person

him/herself

5 – Other – Specify

3 – Hispanic or Latino 

(i.e., Mexican, Puerto Rican, 

Cuban, Central or South American, 

or other Spanish culture or origin),

regardless of race

4 – American Indian/Alaska Native, 

not of Hispanic origin

5 – Asian, not of Hispanic origin

7 – Two or More Races, not of

Hispanic origin – Specify

EX 

6 – Native Hawaiian or other Pacific 

Islander, not of Hispanic origin

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For definitions of these categories,

please refer to Page 18.

2071 1 02 14 1992 3 1
Code

FORM CJ-14 (8-8-2007) Line number

Mo. Day 

01

02

03

04

06

07

08

09

10

11

CONTINUE ON NEXT PAGE

Code

referred to in question 5

at the federal, tribal,

state, county, or

municipal level?

1 – Federal

2 – A Native American

Tribal Government

3 – State

4 – County

5 – Municipal (includes

Washington, DC)

6 – Other – Specify

this person was

assigned a bed

here on 

October 24? 

Enter the code for 

the most serious

offense resulting in

this placement. 

person

commit

the

offense?

State name

may be

abbreviated.

court process which determines whether or not

the person committed the offense.

admitte

to this

facility 

the offe

listed i

questio

If more t

one date

applies, 

enter the

earliest o

for the

offense 

in questi

Code

99 – Don’t know

If state is not

known, enter

code 99 in

the box

below.

02 – Awaiting adjudication hearing in 

juvenile court

03 – Adjudicated, awaiting disposition by

juvenile court

04 – Adjudicated and disposed in juvenile court

and awaiting placement elsewhere

08 – Convicted in adult criminal court

06 – Awaiting transfer hearing to adult criminal

court

07 – Awaiting hearing or trial in adult

criminal court

10 – Other – Specify

Specify Other only Specify Other only

12

See Offense

Codes on 

Page 19 and 20.

State

05

05 – Adjudicated and disposed in juvenile

court, in placement here

01 – Agreement not to adjudicate (diversion)

EX 

If this person was

assigned a bed for

reasons other than

offenses, ENTER

code 00 below and

SKIP to next line for

next person.

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4 25 Vt. 04 01 15 
FOR

Line num

Mo. Day Yr.CodeCode Specify Other onlSpecify Other only

Page 10

Code

CJ-14, Page 10, Base (Black) CJ-14, Page 10, Tone 10, 20 and 100%, Blue (Pantone 313)

30

13

14

15

16

18

19

20

21

22

23

24

25

26

27

28

29

17

Hispanic origin  Specify

For definitions of these categories,

please refer to Page 18.
Code

FORM CJ-14 (8-8-2007) Line num

Mo. Day CodeCode

99 – Don’t know

08 – Convicted in adult criminal court

10 – Other – Specify

Specify Other only Specify Other only

See Offense

Codes on 

Page 19 and 20.

State

CJ-14, Page 11, Base (Black) CJ-14, Page 11, Tone 10, 20 and 100%, Blue (Pantone 313)

30

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29
FOR

Line num

Mo. Day Yr.CodeCode Specify Other onlSpecify Other only

Page 12

Code

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48

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

Hispanic origin  Specify

For definitions of these categories,

please refer to Page 18.
Code

FORM CJ-14 (8-8-2007) Line num

Mo. Day CodeCode

99 – Don’t know

08 – Convicted in adult criminal court

10 – Other – Specify

Specify Other only Specify Other only

See Offense

Codes on 

Page 19 and 20.

State

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48

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47
FOR

Line num

Mo. Day Yr.CodeCode Specify Other onlSpecify Other only

Page 14

Code

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66

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

Hispanic origin  Specify

For definitions of these categories,

please refer to Page 18.
Code

FORM CJ-14 (8-8-2007) Line num

Mo. Day CodeCode

99 – Don’t know

08 – Convicted in adult criminal court

10 – Other – Specify

Specify Other only Specify Other only

See Offense

Codes on 

Page 19 and 20.

State

CJ-14, Page 15, Base (Black) CJ-14, Page 15, Tone 10, 20 and 100%, Blue (Pantone 313)

66

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65
FOR

Line num

Mo. Day Yr.CodeCode Specify Other onlySpecify Other only

Page 16

Code

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Hispanic origin  Specify

For definitions of these categories,

please refer to Page 18.
Code

FORM CJ-14 (8-8-2007) Line num

Mo. Day CodeCode

99 – Don’t know

08 – Convicted in adult criminal court

10 – Other – Specify

Specify Other only Specify Other only

See Offense

Codes on 

Page 19 and 20.

State

CJ-14, Page 17, Base (Black) CJ-14, Page 17, Tone 10, 20 and 100%, Blue (Pantone 313)
the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Mala

Pakistan, the Philippine Islands, Thailand, and Vietnam. 

Native Hawaiian or other Pacific Islander – A person having origins in any of the or

peoples of Hawaii, Guam, Samoa or other Pacific Islands. 

Two or More Races, not of Hispanic origin – Refers to combinations of two or more 

following race categories: White, Black or African American, American Indian/Alaska Native, 

Native Hawaiian or other Pacific Islander. In cases of Hispanic origin, regardless of race(s), m

"Hispanic or Latino".

Page 18 FOR

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U.S. Census Bureau

P.O. Box 5000

Jeffersonville, IN 47199-5000 

GOVS/CJRP

Thank you for completing this questionnaire. If you would like to give us any comments on this

form, please write them on Page 6.

Please make copies for your own records of this completed questionnaire, so that if we need t

call you about an answer, you will be able to refer to your copies.

Please mail the completed form in the enclosed envelope to:
FORM CJ-14 (8-8-2007)

CJ-14, Page 19, Base (Black) CJ-14, Page 19, Tone 100%, Blue (Pantone 313)

coded as 20 (assault, aggravated).

Definitions of the offenses are provided on Page 20.

OFFENSES FOR BOTH UNDERAGE PERSONS AND ADULTS

OFFENSES AGAINST PROPERTY

10

11

12

Arson

Auto theft, unauthorized use of auto, joyriding

Burglary, breaking and entering, household

larceny

13

14

19

Theft, non-household larceny

Property damage, vandalism

Other property offense

OFFENSES AGAINST PERSONS

20 Assault, aggravated

(include attempted murder)

21

22

23

24

Assault, simple

Kidnapping

Murder, manslaughter, negligent homicide

25 

29

Violent sexual assault including forcible

rape

Robbery 

Other person offense

DRUG-RELATED OFFENSES

30

31 

39

Drugs or narcotics, trafficking

Drugs or narcotics, possession 

Other drug-related offense

OFFENSES AGAINST THE PUBLIC ORDE

40 Alcohol or drugs, driving under the

influence of

41

42

43

49

Obstruction of justice

Non-violent sex offense, statutory rape

Weapons-related offenses 

Other public order offense

PROBATION OR PAROLE VIOLATION

50 Probation or parole violation,

violation of a valid court order

POSSIBLE OFFENSES FOR UNDERAGE PERSONS ONLY

UNKNOWN OFFENSES

The behaviors identified below are considered offenses in this census ONLY IF THEY ARE ILLEGAL in your sta

for underage persons:

60

61

62

Curfew violation

Incorrigible, ungovernable

Running away

63

64

69

Truancy

Alcohol: underage use, possession or consumption 

Other offense that is illegal for underage persons on

97

98

99

Unknown offense for both underage persons and adults

Unknown offense for underage persons only

Unknown offense
Page 20 FOR

than serious harm and without use of a weapon – See

Assault, simple.

Assault, simple – An actual, attempted, or threatened

physical attack on a person that causes less than serious

physical harm and without a weapon. Include non-physical

attacks causing the fear of an attack.

Code 21.

Auto theft, unauthorized use of auto, joyriding –

Actual or attempted unauthorized taking or use of a motor 

vehicle, intending to deprive the owner of it temporarily or 

permanently. Include joyriding and grand theft auto. 

Code 11.

Burglary, breaking and entering, household

larceny – Actual or attempted unlawful entry of a building,

structure, or vehicle with intent to commit larceny or

another crime. Code 12.

Curfew violation – Violation of an ordinance forbidding

persons below a certain age from being in public places

during set hours. Code 60.

Drugs or narcotics, possession – Actual or attempted

purchase, possession or use of any illegal drug or

substance, excluding alcohol. Code 31.

Drugs or narcotics, trafficking – Actual or attempted

making, selling, or distributing of a controlled or illegal drug

or substance. Code 30.

Incorrigible, ungovernable – Being beyond the control

of parents, guardians, or custodians. Code only if this is

considered an offense in your state. Code 61.

Kidnapping – Actual or attempted unlawful

transportation or confinement of a person without his/her

consent (or, if a minor, consent of a guardian). 

Code 22.

Murder/manslaughter/negligent homicide –

Causing the death of a person without legal justification.

Code 23. For attempted murder/manslaughter – See 

Assault, aggravated.

Non-violent sex offense, statutory rape – Actual

or attempted offenses with a sexual element, without

violence. Include consensual sex with an underaged

person, prostitution, solicitation, indecent exposure,

pornography, and obscenity. Code 42. For sexual abuse

by a minor against another minor – See Violent sexual

assault.

Obstruction of justice – Any act that intentionally

impedes the enforcement of a law or court order.

Examples: Escape from confinement, contempt of court,

perjury, failing to report a crime, nonviolently resisting

arrest, and bribery. Code 41. See Probation/parole

violation.

Other property offense – Use this code if the pr

offense is not specifically listed on the offense codes 

definitions. Examples include: trespassing, selling s

property, possession of burglar’s tools, fraud, etc. Co

Other public order offense – Use this code if th

order offense is not specifically listed on the offense 

or definitions. Examples include: cruelty to animals

disorderly conduct, traffic offenses, etc. Code 49.

Probation or parole violation, violation of v

court order – Acts that disobey or go against the

conditions of probation or parole. Examples: failure 

participate in a specific program, failure to appear fo

drug tests or meetings, and failure to pay restitution.

Code 50.

Property damage, vandalism – Actual or attem

damaging or destroying of property of a person or pu

property. Code 14. For destroying or damaging by f

explosion – See Arson.

Robbery – Actual or attempted unlawful taking of p

in the direct possession of a person by force or threa

force. Include purse snatching with force and carjack

Code 25. For purse snatching without force – See

Theft/non-household larceny.

Running away – Leaving the custody and home o

parents or guardians without permission and failing t

within a reasonable length of time. Code only if this 

considered an offense in the state in which it occurre

Code 62. For running away from a facility – See Ob

of justice.

Theft, non-household larceny – Actual or attem

taking of property (other than an auto) from a person 

force or deceit. Include shoplifting, pickpocketing, an

snatching without force. Code 13.

• For purse snatching with force – See Robbery.

• For theft using deceit – See Other property offense

• For household larceny – See Burglary, breaking an

entering, household larceny.

Truancy – Violation of a compulsory school attend

law. Code only if this is considered an offense in you

Code 63.

Violent sexual assault including forcible ra

Actual or attempted sexual intercourse or sexual ass

against a person against her/his will by force or thre

force. Includes incest, sodomy, and sexual abuse by 

against another minor. Code 24. See also Non-viole

offense, statutory rape.

Weapons-related offenses – Actual or attempte

sale, distribution, manufacture, alteration, transporta

possession, or use of a deadly or dangerous weapon 

accessory. Code 43.

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