Form 1-699 Hate Crime Incident Report

OMB No. 1110-0015
Expires 8-31-12

1-699 (Rev. 05-07-09)

HATE CRIME INCIDENT REPORT
Initial

ORI

Adjustment

Date of Incident

/
Month

/
Day

Year

Incident No.
Page
of
of Same Incident
Offense (Enter an offense code and number of victims for each bias-motivated offense.)
# of victims
Offense
Offense
# of victims
01 Murder
07 Motor Vehicle Theft
02
Forcible
Rape
08 Arson
#1
#3
03 Robbery
09 Simple Assault
Offense
# of victims
Offense
# of victims
04 Aggravated Assault
10 Intimidation
05
Burglary
11 Destruction/Damage/
#2
#4
Vandalism
06 Larceny-Theft
Location (Check one for Offense #1.)
01
Air/Bus/Train Terminal
14
Hotel/Motel/etc.
Bank/Savings and Loan
02
15
Jail/Prison
Bar/Night Club
16
03
Lake/Waterway
04
Church/Synagogue/Temple
17
Liquor Store
18
Parking Lot/Garage
05
Commercial/Office Building
Enter a Location for
19
06
Construction Site
Rental Storage Facility
each offense having a
20
Residence/Home
07
Convenience Store
different location than
21
Restaurant
Offense #1:
08
Department/Discount Store
Drug Store/Dr.'s Office/Hospital 22
09
School/College
23
Field/Woods
Service/Gas Station
10
#2
11
Government/Public Building
24
Specialty Store (TV, Fur, etc.)
#3
12
Grocery/Supermarket
25
Other/Unknown
13
Highway/Road/Alley/Street
#4
Bias Motivation (Check one for Offense #1.)
Race
Religion
Disability
11
Anti-White
21
51
Anti-Jewish
Anti-Physical Disability
12
Anti-Black
22
Anti-Catholic
52
Anti-Mental Disability
Anti-American Indian/
23
13
Anti-Protestant
24
Alaskan Native
Anti-Islamic (Muslim)
14
Anti-Asian/Pacific Islander 25
Anti-Other Religion
15
Anti-Multiple Races, Group 26
Anti-Multiple Religions, Group
Enter a Bias Motivation
for each offense having a
27
Anti-Atheism/Agnosticism
different bias motivation
Sexual Orientation
Ethnicity/National Origin
than Offense #1:
Anti-Hispanic
41
Anti-Male Homosexual (Gay)
32
33
Anti-Other Ethnicity/
42
Anti-Female Homosexual (Lesbian)
#2
National Origin
43
Anti-Homosexual (Gay & Lesbian)
#3
44
Anti-Heterosexual
45
Anti-Bisexual
#4
Victim Type (Check all applicable victim types for each offense listed above.)
Offense
#1

1
2
3
4

Individual*
Business
Financial Institution
Government

Offense
#2

Offense
#3

Offense
#4

Offense
#1

5
6
7
8

Offense
#2

Offense
#3

Religious Organization
Society/Public
Other
Unknown
Total # of Victims

*Indicate the total number of individuals (persons) who were victims in the incident.
(Use "00" for Unknown Offender.)
Number of Offenders
Race of Offender(s) as an individual or group (Check one.)
1
2

White
Black

3
4

American Indian/Alaskan Native
Asian/Pacific Islander

5
6

Multiple Races (group only)
Unknown

Offense
#4

INSTRUCTIONS FOR PREPARING QUARTERLY HATE CRIME REPORT AND HATE CRIME INCIDENT REPORT
This report is authorized by Title 28, Section 534, U.S. Code, and the Hate Crime Statistics Act of 1990. Even though you are not required to respond, your cooperation
in using this form to report hate crimes known to law enforcement during the quarter will assist the FBI in compiling timely, comprehensive, and accurate data regarding the
incidence and prevalence of hate crime throughout the Nation. Please submit this report quarterly, by the 15th day after the close of the quarter, and any questions to the
FBI, Criminal Justice Information Services Division, Attention: Uniform Crime Reports/Module E-3, 1000 Custer Hollow Road, Clarksburg, West Virginia 26306;
telephone 304-625-4830, facsimile 304-625-3566. Under the Paperwork Reduction Act, you are not required to complete this form unless it contains a valid OMB
control number. The form takes approximately 7 minutes to complete. Instructions for preparing the form appear below.

GENERAL
This report is separate from and in addition to the routine Summary UCR submission. In hate crime reporting, there
is no Hierarchy Rule. Offense data (not just arrest data) for Intimidation and Destruction/Damage/Vandalism of
Property should be reported. On this form, all reportable bias-motivated offenses should be included regardless of
whether arrests have taken place. Please refer to the publication Hate Crime Data Collection Guidelines for
additional information.
QUARTERLY HATE CRIME REPORT
At the end of each calendar quarter, each reporting agency should submit a single Quarterly Hate Crime Report ,
together with an individual Incident Report for each bias-motivated incident identified during the quarter (if any).
If no hate crimes occurred during the quarter, the agency should submit only the Quarterly Hate Crime Report .
The Quarterly Hate Crime Report should be used to identify your agency, to state the number of bias-motivated
incidents being reported for the calendar quarter, and to delete any incidents previously reported that have been
determined during the reporting period not to have been motivated by bias.
HATE CRIME INCIDENT REPORT
The Incident Report should be used to report a bias-motivated incident or to adjust information in a previously
reported incident. Include additional information on separate paper if you feel it will add clarity to the report.
Indicate the type of report as Initial or Adjustment. Provide the Originating Agency Identifier (ORI) and Date of
Incident.
INCIDENT NUMBER: Provide an identifying incident number, preferably your case or file number.
UCR OFFENSE: Provide codes for all offenses within the incident determined to be bias motivated and the number
of victims for each offense. In multiple offense incidents, report only those offenses determined to be bias
motivated. Should more than four bias-motivated offenses be involved in one incident, use additional Incident
Reports and make an appropriate entry in the Page □ of □ portion of each form.
LOCATION: Provide the most appropriate location of each bias-motivated offense.
BIAS MOTIVATION: Provide the nature of the bias motivation for each bias-motivated offense.
VICTIM TYPE: Provide the type of victim(s) identified within the incident. Where the type of victim is Individual,
indicate the total number of individuals (persons) who were victims in the incident. Society/Public is applicable only
in the National Incident-Based Reporting System (NIBRS).
NUMBER OF OFFENDERS: Provide the number of offenders. Incidents involving multiple offenders must not
be coded as Unknown Offender. Indicate an Unknown Offender when nothing is known about the offender
including the offender's race. When the Race of Offender(s) has been identified, indicate at least one offender.
RACE OF OFFENDER(S): Provide the race of the offender(s), if known. If there was more than one offender,
provide the race of the group as a whole. If the number of offenders is entered as Unknown Offender, then the
offender's race must also be indicated as Unknown.