Form FD-1114 FBI Expungement Form

FD-1114 FBI EXPUNGEMENT/SEALING FORM OMB: 1110-0064 Rev. 12/31/2021

This form is used to delete/expunge or seal arrest information in the III/NGI System. If there are multiple arrests* for the same date, provide the Event Identifier (EVI) or the State Identification Number (SID), the Originating Agency Case Number (OCA), the Originating Agency Identifier (ORI), and the Date of Arrest (DOA) Suffix.

Email completed form. State users, email to: [email protected] Federal users, email to: [email protected]

SUBMITTING AGENCY INFORMATION

ORI: Submitter’s First and Last Name: Agency Email Address:

SELECT ACTION: (Action selection applies to all listed below)

Delete/Expunge ☐ Seal ☐

UCN FBI Number	EVI Event Identifier	Name Last,First,Middle	DOB YYYY/MM/DD	Entire Record X	DOA YYYY/MM/DD	Full X	Partial X	Partial DOA (not available for sealing) List Charges to be removed; Otherwise Leave Blank.	SID/OCA/ORI/DOA Suffix* Use to distinguish between multiple arrests on the same date

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 1110-0064. 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.