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1121-0292: Approval Expires 08 31 2024

1121-0292: Approval Expires 08 31 2024-2025

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The document is a form from the U.S. Department of Justice, specifically the Bureau of Justice Statistics, designed to collect data on incidents of sexual victimization within correctional facilities for the year 2021. It includes sections for reporting details about the incident, victims, perpetrators, and any injuries sustained. The form aims to gather comprehensive information regarding the nature and circumstances of sexual violence in these settings.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the incident number at the top of the form. This is crucial for tracking and reference.
Fill in the date of the incident in the designated fields, ensuring accuracy for reporting purposes.
Indicate how many victims were involved. If there are more than two, provide additional details in the notes section.
Complete the facility name and location where the incident occurred, marking all applicable areas where it took place.
For each victim, specify their sex or gender identity, age, and race/ethnic origin as required by the form.
Document any physical injuries sustained by victims and whether they received medical treatment post-incident.
Finally, review all entries for completeness and accuracy before submitting your form through our platform.

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Versions	Form popularity	Fillable & printable
2021	4.3 Satisfied (40 Votes)
2017	4.6 Satisfied (192 Votes)

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