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Appendix B

Summary Data Component Data Collection Form

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These forms and instructions and a glossary were sent to all States, the District of Columbia, the territories, and the Armed Services in the spring of 1997.

Cover Page

Notice to Respondents

Section I - General Information

Section II - Report Data

1. Number of Reports Alleging Maltreatment

2. Number of Children Who Were the Subject of a Report

3. Number of Reports by Source

Section 3 - Disposition Data

4. Number of Completed Investigation or Assessments by Disposition

5. Number of Children and Families Who Were The Subject of a Completed Investigation

6. Number of Children by Disposition

Section IV - Victim Data

7. Number of Victims by Maltreatment Type

8. Age of Victims

9. Sex of Victims

10. Race/Ethnicity of Victims

11. Number of Victims Removed From the Home

12. Number of Victims For Whom Court Action Was Initiated

13. Number of Victims and Families Receiving Additional Services

14. Number of Victims Who Died as a Result of Child Abuse and Neglect

Section V - Perpetrator Data