UNITED STATES DISTRICT COURT


for the Western District of Michigan

Paul L. Maloney

Chief Judge

Tracey Cordes

Clerk of Court


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Frequently Asked Qualification Questionnaire Questions

1. I received a qualification questionnaire, how do I know it’s a legitimate federal form?
2. Where did you get my name?
3. I have a question regarding one of the questions on the form, I’m not sure how to answer
4. Why must I fill out the form if I don’t live in (Grand Rapids, Lansing, Kalamazoo or Marquette)?
5. Why does the questionnaire ask about my race and gender?
6. Jury duty will create a hardship for me, do I still need to fill out the questionnaire?
7. There are ten “bubbles” on the questionnaire under question #15 but only four excuses listed.
8. I need to be excused, but my reasons do not fit the four excuse categories listed under question #15.
9. Should I call the court if I need to be excused from jury service?
10. What if I have a planned vacation or other important event scheduled? Should I let the court know at the qualification stage?
11. I received a questionnaire for someone who has moved out of state, is deceased, or is in the military. What should I do.
12. A qualification questionnaire came to my house for my son/daughter and they are in the military or are out of state. What do I do?
13. I can not serve during a certain time during the year. Can I be sure I won’t receive a summons for that time period?
14. I received a questionnaire addressed to John Smith. My son and I are John Smith, Sr. and John Smith, Jr. -who fills out the form?
15. I received a questionnaire and have lost it or it has been destroyed, can you send another?
16. The form states I have only 5 days to return the form and the time has gone by, should I still send it in?
17. What if I don’t send the questionnaire back?
18. I sent in my form but now I’ve received another!
19. When will I be summoned?

1. I received a qualification questionnaire, how do I know it’s a legitimate federal form?

2. Where did you get my name?

The United States District Court randomly selects the names of our jurors from the voter registration lists for all counties located in our district. We supplement this list with 50% of our names coming from the Drivers license lists and registered I.D. holders.

3. I have a question regarding one of the questions on the form, I’m not sure how to answer:

The following are instructions for answering each question on the questionnaire form.

Name & address: Please make corrections to name and/or address on the front of the form.

Home, work telephone numbers: Occasionally, we have questions about information your have provided on your questionnaire. Without a telephone number the form must be returned to you for completion.

County you live in: In this district jurors report to the divisional office closest to their home.  It is helpful to know which county you live in so that you can be placed in the appropriate jury “wheel”.

Section A -question#1: You must be a natural born citizen or be a naturalized citizen of the United States to serve as a juror in federal court.

Question #2: Please provide the month, day and year of your birth. You may be excused if you are over 70 years old and you request to be excused. If you are asking to be excused because you are over 70 years old, please indicate your age and the year of your birth and then fill in the number 1 circle under section 14.

Question #3: If you answered “no” that your primary residence was not in Michigan for the last year, name the other states and/or counties of primary residence and give dates.

Question #4: Are you able to read and write with a reasonable amount of proficiency?

Question #5 & 6: Are there pending charges against you at this time? Have you ever been convicted of a crime where you could have been sentenced to one year in jail? If you answer yes to either of these questions please give more specific information regarding the offense and sentence under “remarks” on the back of the questionnaire form.

Question #7: Were your civil rights restored? That is, can you vote and hold public office?

Question #8 -Health: If you claim a mental or physical disability, please explain under “remarks” and/or enclose proof of your condition in a separate document. Please make it clear that you are asking to be excused because of your health concerns. Do not ask the court to call your doctor. Any doctor’s statement you obtain regarding your physical condition must be sent to the court by you rather than by the doctor. If you have a physical handicap or disability that would affect, but not prevent, your serving as a juror, and you are willing to serve if reasonable accommodation can be provided, please advise and explain by enclosing a separate, unattached letter.

Question #9 -Exemptions: Are you employed on a full time basis as a public official, police officer, firefighter, or are you a member of the armed forces of the United States?

Questions 10 & 11 -Race, gender: Federal law requires you, as a prospective juror, to indicate your race. Ths answer is required solely to avoid discrimination in jury selection and has absolutely no bearing on qualifications for jury service. By answering these questions you help the federal court check and observe the juror selection process so that discrimination cannot occur. In this way, the federal court can fulfill the policy of the United States, which is to provide jurors who have been randomly selected from a fair cross section of the community.

Question 12 -Occupation: Federal law requires that you answer the questions about your occupation so that the federal courts may determine promptly whether you fall within an excuse or exemption category.

Question 14 - Grounds for requesting excuse Although there are circles numbered 1 through 10, this court allows only 4 possible categories of people who may be excused. These categories are:

1) Persons over 70 years of age, who request to be excused.

2) Volunteer safety personnel (must be specified)

3) Persons who have served on a federal petit or grand jury within the last two years.  Serving in your county court is NOT a category of excuse.

4) Health

Question #15: Marital status

Question 16: Your signature, Social Security number and date: Be sure you have signed the form. If you fail to sign the form it will be returned to you for a signature. If another person had to fill out the questionnaire for you, that person must indicate his/her name, address and reason why, under “Remarks” on the back of the form.

Social security numbers are requested on a voluntary basis under authority of sections 6041 and 6109 of the Internal Revenue Code. If you earn more than $600.00 in compensation as a juror, the court must inform the IRS using your social security number, and it is helpful to get your number now. Failure to provide your social security number at this time will not disqualify you from serving as a juror, but it may delay jury service payments to which you become entitled. This court uses an automated system which utilizes social security numbers for payments. Failure to provide your social security number will delay your payment.

4. Why must I fill out the form if I don’t live in (Grand Rapids, Lansing, Kalamazoo or Marquette)?

The state of Michigan is divided into two Districts, the Western District and the Eastern District.  Each district is divided into “divisions” with designated counties in each “division”. This, the Western District, is comprised of the following counties:

Southern Division at Grand RapidsAntrim, Barry, Benzie, Charlevoix, Emmet, Grand Traverse, Ionia, Kalkaska, Kent, Lake, Leelanau, Manistee, Mason, Mecosta, Missaukee, Montcalm, Muskegon, Newaygo, Oceana, Osceola, Ottawa, Wexford

Southern Division at Kalamazoo:  Allegan, Berrien, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren

Southern Division at Lansing:  Branch, Clinton, Eaton, Hillsdale, Ingham

Northern Division at Marquette (includes entire Upper Peninsula):  Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keweenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft.

You must complete the form and return it even if you DO NOT live in one of the counties listed above. If you have moved from our district you will be excused upon receipt of the completed form.

5. Why does the questionnaire ask about my race and gender?

Federal law requires you, as a prospective juror, to indicate your race. This answer is required solely to avoid discrimination in jury selection and has absolutely no bearing on qualifications for jury service. By answering these questions you help the federal court check and observe the juror selection process so that discrimination cannot occur. In this way, the federal court can fulfill the policy of the United States, which is to provide jurors who have been randomly selected from a fair cross section of the community.

6. Jury duty will create a hardship for me, do I still need to fill out the questionnaire?

The only requests for excuse that will be considered at the qualification stage are the four listed under question #15 of the questionnaire. When/if you should receive a summons you may request to be excused at that time. Requests to be excused which are either written on the back of the form or attached to the questionnaire, will not be considered at the qualification stage.

7. There are ten “bubbles” on the questionnaire under question #15 but only four excuses listed.

Although there are circles numbered 1 through 10, this court allows only 4 possible categories of people who may be excused. These categories are: 

1. Persons over 70 years of age, who request to be excused.

2. Volunteer safety personnel (must be specified)

3. Persons who have served on a federal petit or grand jury within the last two years.  Serving in your county court is NOT a category of excuse.

4. Health (with proof)  This form is a standard, nationally used form. Some courts may allow more excuse categories based on the needs of their geographical area. We utilize only the first four.

8. I need to be excused, but my reasons do not fit the four excuse categories listed under question #15.

The only requests for excuse that will be considered at the qualification stage are the four listed under question #15 of the questionnaire. When/if you should receive a summons you may request to be excused at that time. Requests to be excused which are either written on the back of the form or attached to the questionnaire, will not be considered at the qualification stage.

9. Should I call the court if I need to be excused from jury service?

No. Jury personnel are unable to excuse you over the phone. You will be advised to complete and return the questionnaire. Written requests to be excused will be accepted at the summons stage.

10. What if I have a planned vacation or other important event scheduled? Should I let the court know at the qualification stage?

At the qualification stage, it is not necessary to inform the court of scheduled vacations or other significant events. Because names are drawn randomly from qualified candidates the court has no control over when, or if, you will be summoned. If you receive a summons for a time when you can not serve you can request a deferral at that time.

11. I received a questionnaire for someone who has moved out of state, is deceased, or is in the military. What should I do?

Please write this information on the questionnaire, sign your name and return the questionnaire to us.

12. A qualification questionnaire came to my house for my son/daughter and they are in the military or are out of state. What do I do?

Please write this information on the questionnaire, sign your name and return the questionnaire to us.

13. I can not serve during a certain time during the year. Can I be sure I won’t receive a summons for that time period?

Because names are drawn randomly from qualified candidates the court has no control over when, or if, you will be summoned. If you receive a summons for a time when you can not serve you can request a deferral at that time.

14. I received a questionnaire addressed to John Smith. My son and I are John Smith, Sr. and John Smith, Jr. -who fills out the form?

Because names are randomly drawn from both voter registration and driver’s license lists we have no way of knowing who the questionnaire is intended for. The court is provided a list which contains only name and address. If both Jr. and Sr. are of voting/driving age then they may choose who will complete and return the form.

15. I received a questionnaire and have lost it or it has been destroyed, can you send another?

You may call the divisional office to request a second form.

16. The form states I have only 5 days to return the form and the time has gone by, should I still send it in?

You should return the form even if the time limit has elapsed. This may help avoid an order demanding your personal appearance to complete the form.

17. What if I don’t send the questionnaire back?

If we do not receive your completed form a court order will be entered directing you to appear, at your expense, to the court for the purpose of completing the form. Any person failing to show good cause for non-compliance may be fined not more than $100.00 or imprisoned not more than three (3) days, or both, pursuant to Title 28, USC Section 1866.

18. I sent in my form but now I’ve received another!

The court processes thousands of questionnaires at one time. Every effort is made to scan and process each form. Because forms are put through a machine sometimes forms stick together or get lost in the mail between your house and the court. Please complete the subsequent form and mail it back to the court.

19. When will I be summoned?

Names are randomly drawn from lists of persons found to be qualified. Due to the random nature of this draw the court has no way of telling when/if a qualified person will be summoned.

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