Form R-84 Final Disposition Report

R-84 (Rev. 09-15-2017)
OMB-1110-0051

DISPOSITION REPORT
State Bureau Requirements must be met.
Forward completed form to FBI, CJIS Division, Clarksburg, WV 26306, Email [email protected], or Fax: (304) 625-9896. See instructions on reverse side.

FBI Number (UCN)
*Name on fingerprint card submitted to FBI
(Last, First, Middle)
*Date of Arrest
Social Security No.

State Bureau No. (SID)

Offense(s) Charged at Arrest
*Submitting
Agency ORI

Disposition Maintenance Required (see reverse for explanation):
Court
Charge
#

*Court Offense Literal (COL)
Charge at time of Disposition

*Date of Birth
Contributing/Arresting
Agency ORI

Add

Felony
*Court Provision Literal (CPL)
or
Misd
Disposition

*Mandatory Field
Additional Court Charges and Dispositions can be added on reverse side of form.

*Submitting Agency,
City, State
Replace

Append (CPL only)

Delete

Relationship
to Victim

Is the
offense
drug
related?

INSTRUCTIONS
1. The purpose of this report is to capture the disposition of an arrest to complete an individual’s criminal history record information. The FBI number
(UCN) should be indicated, if known. Asterisk indicates mandatory field, but all known data should be provided.
2. If the arrest is disposed of by the arresting agency, as where the arrestee is released without charge, the arresting agency must complete this form. Of
course, if the disposition is known when the arrest is submitted, it should be noted on the fingerprint submission and this form is then unnecessary. In the
event the case goes to the prosecutor this form should be forwarded to the prosecutor with arrestee’s case file.
3. The prosecutor should complete the form to show disposition at the prosecution level if the matter is not being referred for court action. If court action is
required, the prosecutor must forward form with case file to court having jurisdiction.
4. The court should complete this form as to final court disposition such as when the arrested person is acquitted, case is dismissed, conviction/sentence
imposed or suspended, or person placed on probation.
5. When the arrested person is convicted or pleads guilty to a lesser or different offense than when originally arrested, this information should be clearly
indicated.
6. Disposition Maintenance Requested explanation:
a. Add:
Add new court charge number.
b. Replace: Replace existing court charge number and associated COL and CPL.
c. Append: Append to the Court Provision Literal only for the specified court charge number.
d. Delete: Delete existing court charge number (if exact match).
Court
Charge
#

*Court Offense Literal (COL)
Charge at time of Disposition

Felony
or
*Court Provision Literal (CPL)
Misd
Disposition

Relationship
to Victim

Is the
offense
drug
related?

Paperwork Reduction Act Notice: According to the Paperwork Reduction Act of 1995, no persons are required to provide the information requested unless a valid
OMB control number is displayed. The valid OMB control number for this information collected is 1110-0051. The time required to complete this information
collected is estimated to be five minutes, including time reviewing instructions, gathering, completing, reviewing and submitting the information collection. If you
have any comments concerning the accuracy of this time estimate or suggestions for reducing this burden, please send to: Department Clearance Officer, United States
Department of Justice, Justice Management Division, Policy and Planning Staff, Washington, DC 20530