Form 1-699 Hate Crime Incident Report

1-699 (Rev. 05-14-2012)

Initial

OMB No. 1110-0015

HATE CRIME INCIDENT REPORT

Adjustment

Date of Incident

ORI

Page

Incident No.

of

Month

/

Day

/

Year

of Same Incident

Offense Information
Enter an offense code and the number of victims for each bias motivated offense.
Offense
Code

Number
of victims

01 Murder

07 Motor Vehicle Theft

Offense #1

02 Rape

08 Arson

Offense #2

03 Robbery

09 Simple Assault

Offense #3

04 Aggravated Assault

10 Intimidation

Offense #4

05 Burglary

11 Destruction/Damage/Vandalism

Offense #5

06 Larceny-Theft

Location Information
Check one location for Offense #1.
01
02
03
04
05
06
07
08
09
10

Air/Bus/Train Terminal
Bank/Savings and Loan
Bar/Night Club
Church/Synagogue/Temple/Mosque
Commercial/Office Building
Construction Site
Convenience Store
Department/Discount Store
Drug Store/Dr.'s Office/Hospital
Field/Woods

24
25
37
38
39
40
41
42
44
45

Specialty Store (TV, Fur, etc.)
Other/Unknown
Abandoned/Condemned Structure
Amusement Park
Arena/Stadium/Fairgrounds/Coliseum
ATM Separate from Bank
Auto Dealership New/Used
Camp/Campground
Daycare Facility
Dock/Wharf/Freight/Modal Terminal

11
12
13
14
15
16
17
18
19
20
21
23

Government/Public Building
Grocery/Supermarket
Highway/Road/Alley/Street
Hotel/Motel/etc.
Jail/Prison
Lake/Waterway
Liquor Store
Parking Lot/Garage
Rental Storage Facility
Residence/Home
Restaurant
Service/Gas Station

46
47
48
49
50
51
52
53
54
55
56
57

Farm Facility
Gambling Facility/Casino/Race Track
Industrial Site
Military Installation
Park/Playground
Rest Area
School-College/University
School-Elementary/Secondary
Shelter-Mission/Homeless
Shopping Mall
Tribal Lands
Community Center

If more than one offense occurred, enter a location code for each additional offense having a different
location than Offense #1.
Offense #2
Offense #3
Offense #4
Offense #5

Location
Code

Bias Motivation Information
Check up to five bias motivations for Offense #1.
Race

Sexual Orientation

11

Anti-White

41

Anti-Gay (Male)

12

Anti-Black or African American

42

Anti-Lesbian

13

Anti-American Indian or Alaska Native

43

Anti-Lesbian, Gay, Bisexual, or Transgender (Mixed Group)

14

Anti-Asian

44

Anti-Heterosexual

15

Anti-Multiple Races, Group

45

Anti-Bisexual

16

Anti-Native Hawaiian or Other Pacific Islander

Religion

Disability

21

Anti-Jewish

51

Anti-Physical Disability

22

Anti-Catholic

52

Anti-Mental Disability

23

Anti-Protestant

24

Anti-Islamic (Muslim)

Gender

25
26

Anti-Other Religion
Anti-Multiple Religions, Group

61
62

27

Anti-Atheism/Agnosticism

Anti-Male
Anti-Female

Ethnicity

Gender Identity

32

Anti-Hispanic or Latino

71

Anti-Transgender

33

Anti-Not Hispanic or Latino

72

Anti-Gender Non-Conforming

If more than one offense occurred, enter up to five bias motivations for each additional offense having a
different bias motivation than Offense #1.

Offense #2
Offense #3
Offense #4
Offense #5

Bias
#1

Bias
#2

Bias
#3

Bias
#4

Bias
#5

Victim Information
Check all applicable victim types for each offense listed above.
Offense Offense Offense Offense Offense
#1
#2
#3
#4
#5
1
2
3
4
5
7
8

Individual*
Business
Financial Institution
Government
Religious Organization
Other
Unknown

*Indicate the number of Individuals (persons) who were victims in the incident.
Total number of victims.
Total number of victims 18 and over.
Total number of victims under 18.

Offender Information
Indicate the number of Individuals (persons) who were offenders in the incident.
Total number of offenders. If unknown, enter 00.
Total number of offenders 18 and over. If unknown, enter 00.
Total number of offenders under 18. If unknown, enter 00.

Race and Ethnicity of Offender or Offender Group
Check one race and one ethnicity.
Race
1

White

2

Black or African American

3

American Indian or Alaska Native

4

Asian

5

Group of Multiple Races

6

Unknown

7

Native Hawaiian or Other Pacific Islander

Ethnicity
H

Hispanic or Latino

N

Not Hispanic or Latino

M

Group of Multiple Ethnicities

U

Unknown

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 traditional Summary Reporting System 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 and Training Manual 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 Hate Crime 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.

Instructions for preparing the Hate Crime Incident Report
Administrative Information
Report Type: (Required.) Indicate the type of report as Initial or Adjustment.
Initial-To report a hate crime incident.
Adjustment-To update a hate crime incident previously reported. (Note: This will delete the information already on
file and insert the information provided in this report.)
ORI Number: (Required.) Enter the nine-character Originating Agency Identifier assigned to your agency.
Date of Incident: (Required for Initial or Adjustment Reports.) Provide the date of the hate crime incident in the
format of MMDDYYYY.

Incident Number: (Required for Initial or Adjustment Reports.) Provide an identifying incident number, preferably
your case or file number. The number can be up to 12 characters in length. Valid characters include: A through Z, 0
through 9, hyphens, and/or blanks.
Page

of

of same incident: If additional Incident Reports are used, make an appropriate entry into this portion.

Offense Information
Offense Code: Enter the two-digit offense code for each bias motivated offense. The offense codes that are specific to
hate crime are: 01 Murder, 02 Rape, 03 Robbery, 04 Aggravated Assault, 05 Burglary, 06 Larceny-theft, 07 Motor
Vehicle Theft, 08 Arson, 09 Simple Assault, 10 Intimidation, and 11 Destruction/Damage/Vandalism.
Number of Victims: Enter the number of victims for each bias motivated offense. The field allows for up to a three-digit
number to be entered. Number of victims are inclusive of Individual, Business, Financial Institution, Government,
Religious Organization, Other, and Unknown.
Location Information
Offense #1 Location: Check one location for Offense #1.
Additional Offense Locations: Enter a two-digit location code for each additional offense that has a different location
than Offense #1.
Bias Motivation Information
Offense #1 Bias Motivation: Check up to five bias motivations for Offense #1.
Additional Offense Bias Motivations: Enter up to five two-digit bias motivation codes for each additional offense that
has a different bias motivation than Offense #1.
Victim Information
Victim Type: Check all applicable victim types identified within the incident.
Number of Victims: When victim type is individual enter the total number of individuals (persons) who were victims in
the incident. Enter the total number of individuals (persons) who were victims in the incident that are 18 and over. Enter
the total number of individuals (persons) who were victims in the incident that are under the age of 18.

Offender Information
Number of Offenders: Enter the total number of individuals (persons) who were offenders in the incident. If unknown,
enter 00 in the two-digit field. Enter the total number of individuals (persons) who were offenders in the incident that
were 18 and over. If unknown, enter 00 in the two-digit field. Enter the total number of individuals (persons) who were
offenders in the incident that were under the age of 18. If unknown, enter 00 in the two-digit field. 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 and Ethnicity of Offender or Offender Group
Race: Check one race for the offender. 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.
Ethnicity: Check one ethnicity for the offender. If there was more than one offender, provide the ethnicity of the group
as a whole. If the number of offenders is entered as Unknown Offender, then the offender's ethnicity must also be
indicated as Unknown.