According to year 2011 statistics compiled by the U.S Department of Health and Human Services, almost six million children were referred to the various state children protective services in the United States. Approximately half of that number was reported to state authorities more than once. Of the total number of referrals, about 681,000 children were found to have been the direct victims of abuse and/or neglect. The remainder of the referrals included those who were not the direct victim, e.g. a sibling, a relatively few being false reports, and another large group where evidence of actual abuse could not be conclusively determined. The total of 681,000 includes 1570 fatalities. Of the six million referrals, approximately 225,000 resulted in new foster care placements, and another 900,000 children received some form of home protective oversight. As of September 2011, there were nearly 401,000 children in foster care, with slightly less than half being placed with non-relatives, another quarter being placed with relatives, and the remainder residing in such places as group homes, shelters and other institutions. Of the total cases: 78% involved neglect, 18% were physically abused, 9% sexually abused, and 8% psychologically abused. Some children suffered multiple forms of abuse. Typically, abuse is at the hands of someone the victim knows, with a biological parent being involved at least 75% of the time. Except for the 401,000 total children in foster care, these statistics are only a single year representation. It is believed that thousands of other cases of abuse and neglect go unreported every year.