NHTSA Form 1667 FARS Data Entry Form

Fatality Analysis Reporting System (FARS)

FARS Data Entry Form_ clean

OMB: 2127-0006

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OMB Control No. 2127-0006

Expiration Date XX/XX/XXXX


2021 Fatality Analysis Reporting System

CRASH LEVEL

This collection of information is voluntary and will be used for informative purposes only so that we may develop and evaluate programs designed to reduce the number of motor vehicle-related injuries and deaths. We will not collect any personal information that would allow anyone to identify you. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0006. Public reporting for this collection of information is estimated to be approximately 3 hours per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, W51-316, 1200 New Jersey Ave, S.E., Washington, DC, 20590

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State Number Consecutive Number **Number of Forms Submitted for Persons Not in Motor Vehicles **Number of Vehicle Submitted

**Number of Motor Vehicle Occupant Forms Submitted State Case #

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Crash Date

/ / 2021

Crash Time

:

County

City

Relation To Junction: Within Interchange Area

Relation To Junction: Specific Location







0 - No

01 - Non-Junction

1 - Yes

02 - Intersection

8 - Not Reported

03 - Intersection-Related

9 - Reported as Unknown

04 - Driveway Access


05 - Entrance/Exit Ramp Related

06 - Railway Grade Crossing

07 - Crossover-Related

08 - Driveway Access Related

16 - Shared-Use Path Crossing

17 - Acceleration/Deceleration Lane

18 - Through Roadway

19 - Other location within interchange area

20 - Entrance/Exit Ramp

98 - Not Reported

99 - Reported as Unknown


Type of Intersection

Relation to Trafficway







01 - Not an Intersection

01 - On Roadway

02 - Four-Way Intersection

02 - On Shoulder

03 - T-Intersection

03 - On Median

04 - Y-Intersection

04 - On Roadside

05 - Traffic Circle

05 - Outside Trafficway

06 - Roundabout

06 - Off Roadway-Location Unknown

07 - Five Point, or More

07 - In Parking Lane/Zone

10 - L-Intersection

08 - Gore

11 - Other Intersection Type

10 - Separator

98 - Not Reported

11 - Continuous Left - Turn Lane

99 - Reported as Unknown

12 - Pedestrian Refuge Island or Traffic Island


98 - Not Reported

99 - Reported as Unknown


Work Zone

Light Condition







0 - None

1 - Daylight

1 - Construction

2 - Dark - Not Lighted

2 - Maintenance

3 - Dark - Lighted

3 - Utility

4 - Dawn

4 - Work Zone, Type Unknown

5 - Dusk


6 - Dark - Unknown Lighting

7 - Other

8 - Not Reported

9 - Reported as Unknown


Atmospheric Conditions


01 - Clear

02 - Rain

03 - Sleet or Hail

04 - Snow

05 - Fog, Smog, Smoke

06 - Severe Crosswinds

07 - Blowing Sand, Soil, Dirt

08 - Other

10 - Cloudy

11 - Blowing Snow

12 - Freezing Rain or Drizzle

98 - Not Reported

99 - Reported as Unknown


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Shape13 Shape14 TRAFFICWAY - CRASH LEVEL


Trafficway Identifier (1)

Trafficway Identifier (2)

Route Signing

Land Use







1 - Interstate

1 - Rural

2 - U.S. Highway

2 - Urban

3 - State Highway

6 - Trafficway Not in State Inventory

4 - County Road

8 - Not Reported

5 - Local Street - Township

9 - Unknown

6 - Local Street - Municipality


7 - Local Street - Frontage Road

8 - Other

9 - Unknown


Functional System

Ownership







01 - Interstate

01 - State Highway Agency

02 - Principal Arterial - Other Freeways and Expressways

02 - County Highway Agency

03 - Principal Arterial - Other

03 - Town or Township Highway Agency

04 - Minor Arterial

04 - City or Municipal Highway Agency

05 - Major Collector

11 - State Park, Forest, or Reservation Agency

06 - Minor Collector

12 - Local Park, Forest or Reservation Agency

07 - Local

21 - Other State Agency

96 - Trafficway Not in State Inventory

25 - Other Local Agency

98 - Not Reported

26 - Private (other than Railroad)

99 - Unknown

27 - Railroad


31 - State Toll Road

32 - Local Toll Authority

40 - Other Public Instrumentality (i.e., Airport)

50 - Indian Tribe Nation

60 - Other Federal Agency

62 - Bureau of Indian Affairs

63 - Bureau of Fish and Wildlife

64 - U.S. Forest Service

66 - National Park Service

67 - Tennessee Valley Authority

68 - Bureau of Land Management

69 - Bureau of Reclamation

70 - Corps of Engineers

72 - Air Force

74 - Navy/Marines

80 - Army

96 - Trafficway Not in State Inventory

98 - Not Reported

99 - Unknown


National Highway System

Special Jurisdiction







0 - This section IS NOT on the NHS

0 - No Special Jurisdiction

1 - This section IS ON the NHS

1 - National Park Service

9 - Unknown if this section is on the NHS

2 - Military


3 - Indian Reservation

4 - College/University Campus*

5 - Other Federal Properties*

8 - Other

9 - Unknown



Mile Point


.

Global Position


Latitude: Longitude:



Deg


Min


Sec


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School Bus Related

Rail Grade Crossing Identifier

Notification Time EMS

:

Arrival Time EMS

:

EMS Time at Hospital

:

Crash Related Factors

Additional State Information (1)

Additional State Information (2)


2021 Fatality Analysis Reporting System CRASH LEVEL - CRASH EVENTS


Click here to open Clock Point Diagrams


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First Harmful Event

Manner of Collision of the First Harmful Event

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Shape34 Shape35 2021 Fatality Analysis Reporting System PERSON LEVEL (NOT A MV OCCUPANT)

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State Number Consecutive Number **Person Number


Vehicle Number of Motor Vehicle Striking Non-Motorist

Age

Sex

Person Type







1 - Male

04 - Occupant of a Non-Motor Vehicle Transport Device

2 - Female

05 - Pedestrian

8 - Not Reported

06 - Bicyclist

9 - Reported as Unknown

07 - Other Cyclist


10 - Persons In/On Buildings

11 - Person on Motorized Personal Conveyance

12 - Person on Non-Motorized Personal Conveyance

13 - Person on Personal Conveyance, Unknown if Motorized or Non-

Motorized

19 - Unknown Type of Non-Motorist










Injury Severity

Transported to First Medical Facility By







0 - No Apparent Injury (O)

0 - Not Transported for Treatment

1 - Possible Injury (C)

1 - EMS Air

2 - Suspected Minor Injury (B)

2 - Law Enforcement

3 - Suspected Serious Injury (A)

3 - EMS Unknown Mode

4 - Fatal Injury (K)

4 - Transported Unknown Source

5 - Injured, Severity Unknown

5 - EMS Ground

6 - Died Prior to Crash*

6 - Other

9 - Unknown/Not Reported

8 - Not Reported


9 - Reported as Unknown


Non-Motorist Related Factors

Conditions at Time of Crash

00 - None/Apparently Normal

01 - Ill, Blackout

02 - Asleep or Fatigued

03 - Walking with a Cane or Crutches, etc.

04 - Paraplegic or in a Wheelchair

05 - Impaired Due to Previous Injury

06 - Deaf/Hard of Hearing

07 - Blind/Low Vision

08 - Emotional (depressed, angry, disturbed, etc.)

09 - Under the Influence of Alcohol, Drugs or Medication

10 - Physical Impairment - No Details

96 - Other Physical Impairment

98 - Not Reported

99 - Reported as Unknown if Impaired



Shape42 Shape41 2021 Fatality Analysis Reporting System PERSON LEVEL (NOT A MV OCCUPANT - PEDESTRIAN)

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State Number Consecutive Number **Vehicle Number **Person Number


School Zone


Marked Crosswalk







0 - None Noted

0 - None Noted

1 - Yes

1 - Yes

9 - Unknown

9 - Unknown



Sidewalk Presence

Crash Type Number




0 - None Noted

1 - Yes

9 - Unknown


Crash Group Number


Crash Location







100 - Unusual Circumstances

1 - At Intersection

200 - Backing Vehicle

2 - Intersection-Related

310 - Working or Playing in Roadway

3 - Not At Intersection

340 - Bus Stop-Related

4 - Non-Trafficway Location

350 - Unique Midblock

9 - Unknown / Insufficient Information

400 - Walking/Running Along Roadway


460 - Driveway Access/Driveway Access Related

500 - Waiting to Cross

600 - Pedestrian in Roadway - Circumstances Unknown

720 - Multiple Threat / Trapped

740 - Dash Run, No Visual Obstruction Noted / Dart-Out Visual

Obstruction Noted

750 - Crossing Roadway - Vehicle Not Turning

790 - Crossing Roadway - Vehicle Turning

800 - Non-Trafficway

910 - Crossing Expressway

990 - Other / Unknown - Insufficient Details


Pedestrian Position


Pedestrian Initial Direction of Travel







1 - Intersection Area

1 - Northbound

2 - Crosswalk Area

2 - Eastbound

3 - Travel Lane

3 - Southbound

4 - Paved Shoulder / Bicycle Lane / Parking Lane

4 - Westbound

5 - Sidewalk / Shared-Use Path / Driveway Access

9 - Not Derived/Unknown Initial Direction of Travel

6 - Unpaved Right-of-Way


7 - Non-Trafficway - Driveway

8 - Non-Trafficway - Parking Lot/Other

9 - Other/Unknown


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1 - Northbound

1 - Left Turn

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2 - Eastbound

2 - Right Turn

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3 - Southbound

3 - Straight through

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9 - Unknown Initial Direction of Travel

4 - Westbound

9 - Unknown Motorist Maneuver


Leg Intersection Scenario

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1 - Nearside


2 - Farside

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9 - Unknown/None of the Above

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Crash Type Expanded

Shape56 2021 Fatality Analysis Reporting System

Shape57 Shape58 NON-MOTORIST ACTIONS (NOT A MV OCCUPANT)


NM. Location at Time of Crash

NM. Action/Circumstances

NM. Contributing Circumstances

NM. Distracted By

Shape59 Shape60 Shape61 Non-Motorist Safety Equipment


Protective

Helmet

Pads







1 - No

1 - No

2 - Yes

2 - Yes

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown



Other





1 - No

2 - Yes

8 - Not Reported

9 - Reported as Unknown



Preventive

Clothing

Lighting







1 - No

1 - No

2 - Yes

2 - Yes

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown



Other





1 - No

2 - Yes

8 - Not Reported

9 - Reported as Unknown


Shape62 2021 Fatality Analysis Reporting System ALCOHOL (NOT A MV OCCUPANT)


Police-Reported Alcohol Involvement


Alcohol Test Status







0 - No (Alcohol Not Involved)

0 - Test Not Given

1 - Yes (Alcohol Involved)

2 - Test Given

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown if Tested



Alcohol Test Type

Alcohol Test Result




00 - Test Not Given

01 - Blood

02 - Breath Test (AC)

03 - Urine

04 - Vitreous

05 - Blood Plasma/Serum

06 - Blood Clot

07 - Liver

08 - Other Test Type

10 - Preliminary Breath Test (PBT)

11 - Breath Test, Unknown Type

95 - Not Reported

98 - Unknown Test Type

99 - Reported as Unknown if Tested



Shape63 Shape64 Shape65 Shape66 DRUG (NOT A MV OCCUPANT)


Police Reported Drug Involvement

Method of Drug Determination by Police

Drug Test Status


Drug Toxicology Results

Drug Specimen Drug Test Results






Shape67 Shape68 Shape69 Shape70 Shape71 2021 Fatality Analysis Reporting System RACE (NOT A MV OCCUPANT)

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SUPPLEMENTAL (NOT A MV OCCUPANT)


Died at Scene/En Route

Death Date

/ /




0 - Not Applicable

7 - Died at Scene

8 - Died En Route

9 - Unknown


Death Time

:


Shape73 Shape74 2021 Fatality Analysis Reporting System PERSON LEVEL (NOT A MV OCCUPANT)

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State Number Consecutive Number **Person Number


Vehicle Number of Motor Vehicle Striking Non-Motorist

Age

Sex

Person Type







1 - Male

04 - Occupant of a Non-Motor Vehicle Transport Device

2 - Female

05 - Pedestrian

8 - Not Reported

06 - Bicyclist

9 - Reported as Unknown

07 - Other Cyclist


10 - Persons In/On Buildings

11 - Person on Motorized Personal Conveyance

12 - Person on Non-Motorized Personal Conveyance

13 - Person on Personal Conveyance, Unknown if Motorized or Non-

Motorized

19 - Unknown Type of Non-Motorist










Injury Severity

Transported to First Medical Facility By







0 - No Apparent Injury (O)

0 - Not Transported for Treatment

1 - Possible Injury (C)

1 - EMS Air

2 - Suspected Minor Injury (B)

2 - Law Enforcement

3 - Suspected Serious Injury (A)

3 - EMS Unknown Mode

4 - Fatal Injury (K)

4 - Transported Unknown Source

5 - Injured, Severity Unknown

5 - EMS Ground

6 - Died Prior to Crash*

6 - Other

9 - Unknown/Not Reported

8 - Not Reported


9 - Reported as Unknown


Non-Motorist Related Factors

Conditions at Time of Crash

00 - None/Apparently Normal

01 - Ill, Blackout

02 - Asleep or Fatigued

03 - Walking with a Cane or Crutches, etc.

04 - Paraplegic or in a Wheelchair

05 - Impaired Due to Previous Injury

06 - Deaf/Hard of Hearing

07 - Blind/Low Vision

08 - Emotional (depressed, angry, disturbed, etc.)

09 - Under the Influence of Alcohol, Drugs or Medication

10 - Physical Impairment - No Details

96 - Other Physical Impairment

98 - Not Reported

99 - Reported as Unknown if Impaired



2021 Fatality Analysis Reporting System PERSON LEVEL (NOT A MV OCCUPANT - BIKE)

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State Number Consecutive Number **Vehicle Number **Person Number


School Zone

Marked Crosswalk


0 - None Noted

1 - Yes

9 - Unknown Sidewalk Presence

0 - None Noted

1 - Yes

9 - Unknown


0 - None Noted

1 - Yes

9 - Unknown

Crash Type Number




Crash Group Number






















Crash Location

110 - Loss of Control / Turning Error

140 - Motorist Failed to Yield - Sign-Controlled Intersection 145 - Bicyclist Failed to Yield - Sign-Controlled Intersection 150 - Motorist Failed to Yield - Signalized Intersection

158 - Bicyclist Failed to Yield - Signalized Intersection 190 - Crossing Paths - Other Circumstances

210 - Motorist Left Turn / Merge 215 - Motorist Right Turn / Merge

219 - Parking / Bus-Related

220 - Bicyclist Left Turn / Merge 225 - Bicyclist Right Turn / Merge 230 - Motorist Overtaking Bicyclist 240 - Bicyclist Overtaking Motorist 258 - Wrong-Way / Wrong-Side

290 - Parallel Paths - Other Circumstances 310 - Bicyclist Failed to Yield - Midblock 320 - Motorist Failed to Yield - Midblock 600 - Backing Vehicle

850 - Other / Unusual Circumstances 910 - Non-Trafficway

990 - Other / Unknown - Insufficient Details Bicyclist Position


1 - At Intersection

2 - Intersection-Related

3 - Not At Intersection

4 - Non-Trafficway Location

9 - Unknown / Insufficient Information




Bicyclist Direction

  1. - Travel Lane

  2. - Bicycle Lane / Paved Shoulder / Parking Lane

  3. - Sidewalk / Crosswalk / Driveway Access

  4. - Shared-Use Path

  5. - Non-Trafficway - Driveway

  6. - Non-Trafficway - Parking Lot/Other

  1. - Other

  2. - Unknown

Crash Type Expanded

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  1. - With Traffic

  2. - Facing Traffic

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3 - Not applicable


9 - Unknown

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Shape88 2021 Fatality Analysis Reporting System

Shape89 Shape90 NON-MOTORIST ACTIONS (NOT A MV OCCUPANT)


NM. Location at Time of Crash

NM. Action/Circumstances

NM. Contributing Circumstances

NM. Distracted By

Shape91 Shape92 Shape93 Non-Motorist Safety Equipment


Protective

Helmet

Pads







1 - No

1 - No

2 - Yes

2 - Yes

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown



Other





1 - No

2 - Yes

8 - Not Reported

9 - Reported as Unknown



Preventive

Clothing

Lighting







1 - No

1 - No

2 - Yes

2 - Yes

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown



Other





1 - No

2 - Yes

8 - Not Reported

9 - Reported as Unknown


Shape94 2021 Fatality Analysis Reporting System ALCOHOL (NOT A MV OCCUPANT)


Police-Reported Alcohol Involvement


Alcohol Test Status







0 - No (Alcohol Not Involved)

0 - Test Not Given

1 - Yes (Alcohol Involved)

2 - Test Given

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown if Tested



Alcohol Test Type

Alcohol Test Result




00 - Test Not Given

01 - Blood

02 - Breath Test (AC)

03 - Urine

04 - Vitreous

05 - Blood Plasma/Serum

06 - Blood Clot

07 - Liver

08 - Other Test Type

10 - Preliminary Breath Test (PBT)

11 - Breath Test, Unknown Type

95 - Not Reported

98 - Unknown Test Type

99 - Reported as Unknown if Tested



Shape95 Shape96 Shape97 Shape98 DRUG (NOT A MV OCCUPANT)


Police Reported Drug Involvement

Method of Drug Determination by Police

Drug Test Status


Drug Toxicology Results

Drug Specimen Drug Test Results






Shape99 Shape100 Shape101 Shape102 Shape103 2021 Fatality Analysis Reporting System RACE (NOT A MV OCCUPANT)

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SUPPLEMENTAL (NOT A MV OCCUPANT)


Died at Scene/En Route

Death Date

/ /




0 - Not Applicable

7 - Died at Scene

8 - Died En Route

9 - Unknown


Death Time

:


Shape105 Shape106 Shape107 2021 Fatality Analysis Reporting System VEHICLE LEVEL # 1

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State Number Consecutive Number **Vehicle Number **Number Of Occupants


Number of Occupants


Unit Type




1 - Motor Vehicle In-Transport (Inside or Outside the Trafficway)

2 - Motor Vehicle Not In-Transport Within the Trafficway

3 - Motor Vehicle Not In-Transport Outside the Trafficway

4 - Working Motor Vehicle (Highway Construction, Maintenance,

Utility only)


Hit and Run

Registration State




0 - No

1 - Yes


Registered Vehicle Owner

Travel Speed




0 - Not Applicable, Vehicle Not Registered

1 - Driver (in this crash) was Registered Owner

2 - Driver (in this crash) Not Registered Owner (Other Private Owner

Listed)

3 - Vehicle Registered as Commercial/Business/Company/Government

Vehicle

4 - Vehicle Registered as Rental Vehicle

5 - Vehicle was Stolen (reported by police)

6 - Driverless/Motor Vehicle Parked/Stopped Off Roadway

9 - Unknown


Vehicle Underride/Override


Rollover







0 - No Underride or Override

0 - No Rollover

1 - Underride

1 - Rollover, Tripped by Object/Vehicle

2 - Override

2 - Rollover, Untripped

7 - Not Applicable

9 - Rollover, Unknown Type

8 - Not Reported


9 - Reported as Unknown











Location of Rollover


Areas of Impact-Initial







0 - No Rollover

00 - Non-Collision

1 - On Roadway

01 - 1 Clock Point

2 - On Shoulder

02 - 2 Clock Point

3 - On Median/Separator

03 - 3 Clock Point

4 - In Gore

04 - 4 Clock Point

5 - On Roadside

05 - 5 Clock Point

6 - Outside of Trafficway


06 - 6 Clock Point

7 - In Parking Lane/Zone

07 - 7 Clock Point

9 - Unknown

08 - 8 Clock Point


09 - 9 Clock Point

10 - 10 Clock Point

11 - 11 Clock Point

12 - 12 Clock Point

13 - Top

14 - Undercarriage

18 - Cargo/Vehicle Parts Set-In-Motion

19 - Other Objects or Person Set-In-Motion

20 - Object Set in Motion, Unknown if Cargo/Vehicle Parts or Other

61 - Left

62 - Left-Front Side

63 - Left-Back Side

81 - Right

82 - Right-Front Side

83 - Right-Back Side

98 - Not Reported

99 - Reported as Unknown


Extent of Damage


Vehicle Removal







0 - No Damage

2 - Towed Due to Disabling Damage

2 - Minor Damage

3 - Towed But Not Due to Disabling Damage

4 - Functional Damage

5 - Not Towed

6 - Disabling Damage

7 - Towed, Unknown Reason

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown



Vehicle Sequence of Events

Most Harmful Event

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Shape117 Shape121 Shape122 Shape123 Shape124 Shape125 Shape126 Shape127 Shape128 Shape129 DAMAGED AREAS FOR VEHICLE# 1

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VIN INFORMATION FOR VEHICLE# 1


Vehicle Model Year

VIN

Shape131

00000000000000000 - No VIN Required, Not a Vehicle for Road Use 88888888888888888 - Not Reported

99999999999999999 - Reported as Unknown

vPIC Make

vPIC Model

vPIC Body Class

NCSA Make

NCSA Model

NCSA Body Type

Power Unit GVWR From

Power Unit GVWR To

Automation System(s) in Vehicle

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Highest Automation System Level Present in Vehicle

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Highest Automation System Level Engaged at Time of Crash


Shape134 DETAILS FOR VEHICLE# 1


Motor Carrier ID Issuing Authority

Shape135

Motor Carrier Identification Number


Vehicle Configuration




00 - Not Applicable

01 - Single-Unit Truck (2- axle and GVWR more than 10,000 lbs)

02 - Single-Unit Truck (3 or more axles)

04 - Truck Pulling Trailer(s)

05 - Truck Tractor (Bobtail)

06 - Truck Tractor/Semi-Trailer

07 - Truck Tractor/Double

08 - Truck Tractor/Triple

10 - Vehicle 10,000 pounds or less placarded for hazardous materials

19 - Vehicle More Than 10,000 lbs., Other

20 - Bus/Large Van (seats for 9-15 occupants, including driver)

21 - Bus (seats for more than 15 occupants, including driver)

88 - Qualifying Vehicle, Unknown Configuration

99 - Unknown



Cargo Body Type


HM1: Hazardous Material Involvement







00 - Not Applicable (N/A)

1 - No

01 - Van/Enclosed Box

2 - Yes

02 - Cargo Tank

HM2: Placard

03 - Flatbed




04 - Dump

05 - Concrete Mixer

0 - Not Applicable

06 - Auto Transporter

1 - No

07 - Garbage/Refuse

2 - Yes

08 - Grain/ Chips/ Gravel

8 - Not Reported

09 - Pole-Trailer

HM3: Hazardous Material ID Number

10 - Log




11 - Intermodal Container Chassis

0000 - Not Applicable

12 - Vehicle Towing Another Motor Vehicle

8888 - Not Reported

22 - Bus

HM4: Hazardous Material Class Number

96 - No Cargo Body Type

97 - Other




98 - Unknown Cargo Body Type

00 - Not Applicable

99 - Unknown

01 - 01


02 - 02

03 - 03

04 - 04

05 - 05

06 - 06

07 - 07

08 - 08

09 - 09

88 - Not Reported

HM5: Release of Hazardous Material from the Cargo Compartment




0 - Not Applicable

1 - No

2 - Yes

8 - Not Reported


Shape136 OTHER INFORMATION FOR VEHICLE# 1


Vehicle Trailing


Jackknife







0 - No Trailing Units

0 - Not an Articulated Vehicle

1 - One Trailing Unit

1 - No

2 - Two Trailing Units

2 - Yes - First Event

3 - Three or More Trailing Units

3 - Yes - Subsequent Event

4 - Yes, Number of Trailing Units Unknown


5 - Vehicle Towing Another Motor Vehicle - Fixed Linkage

6 - Vehicle Towing Another Motor Vehicle - Non-Fixed Linkage

9 - Unknown


Bus Use


Special Use







00 - Not a Bus

00 - No Special Use Noted

01 - School

01 - Taxi

04 - Intercity

02 - Vehicle Used for School Transport

05 - Charter/Tour

03 - Vehicle Used as Other Bus

06 - Transit/ Commuter

04 - Military

07 - Shuttle

05 - Police

08 - Modified for Personal/Private Use

06 - Ambulance

98 - Not Reported

07 - Fire Truck

99 - Reported as Unknown

08 - Non-Transport Emergency Services Vehicle


10 - Safety Service Patrols Incident Response

11 - Other Incident Response

12 - Towing – Incident Response

19 - Motor Vehicle Used for Vehicle Sharing Mobility

20 - Motor Vehicle Used for Electronic Ride-hailing

21 - Mail Carrier

22 - Public Utility

23 - Rental Truck over 10,000 lbs.

24 - Truck Operating with Crash Attenuator Equipment

99 - Reported as Unknown


Emergency Motor Vehicle Use

Vehicle Related Factors




0 - Not Applicable

2 - Non-Emergency, Non-Transport

3 - Non-Emergency Transport

4 - Emergency Operation, Emergency Warning Equipment Not in Use

5 - Emergency Operation, Emergency Warning Equipment in Use

6 - Emergency Operation, Emergency Warning Equipment in Use

Unknown

8 - Not Reported

9 - Reported as Unknown


Fire Occurrence




0 - No or Not Reported

1 - Yes


Shape139 Shape143 Shape146 TRAILER INFORMATION FOR VEHICLE# 1


Trailer VIN (1)


vPIC Make

vPIC Body Class

vPIC Trailer Body Type vPIC Model

vPIC Model Year




00000000000000000 - No VIN Required, Not a Vehicle for Road Use

77777777777777777 - No Trailing Units

88888888888888888 - Not Reported

99999999999999999 - Reported as Unknown

Trailer GVWR



Trailer VIN (2)


vPIC Make

vPIC Body Class vPIC Body Type vPIC Model vPIC Year




00000000000000000 - No VIN Required, Not a Vehicle for Road Use

77777777777777777 - No Trailing Units

88888888888888888 - Not Reported

99999999999999999 - Reported as Unknown

Trailer GVWR



Trailer VIN (3)


vPIC Make

vPIC Body Class

vPIC Trailer Body Type vPIC Model

vPIC Year




00000000000000000 - No VIN Required, Not a Vehicle for Road Use

77777777777777777 - No Trailing Units

88888888888888888 - Not Reported

99999999999999999 - Reported as Unknown

Trailer GVWR

Shape152 2021 Fatality Analysis Reporting System PRECRASH LEVEL (VEHICLE/DRIVER) FOR VEHICLE# 1

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State Number Consecutive Number **Vehicle Number


Contributing Circumstances, Motor Vehicle


Trafficway Description




00 - None Noted

0 - Non-Trafficway or Driveway Access

1 - Two-Way, Not Divided

01 - Tires

2 - Two-Way, Divided, Unprotected Median

02 - Brake System

3 - Two-Way, Divided, Positive Median Barrier

03 - Steering

4 - One-Way Trafficway

5 - Two-Way, Not Divided With a Continuous Left-Turn Lane

04 - Suspension

6 - Entrance/Exit Ramp

05 - Power Train

8 - Not Reported

9 - Reported as Unknown

06 - Exhaust System


07 - Head Lights

08 - Signal Lights

09 - Other Lights

10 - Wipers

11 - Wheels

12 - Mirrors

13 - Windows/Windshield

14 - Body, Doors

15 - Truck Coupling/Trailer Hitch/Safety Chains

16 - Safety Systems

17 - Vehicle Contributing Factors - No Details

97 - Other

99 - Reported as Unknown


Total Lanes in Roadway

Speed Limit




0 - Non-Trafficway or Driveway Access

1 - One lane

2 - Two lanes

3 - Three lanes

4 - Four lanes

5 - Five lanes

6 - Six lanes

7 - Seven or more lanes

8 - Not Reported

9 - Reported as Unknown


Roadway Alignment


Roadway Grade







0 - Non-Trafficway or Driveway Access

0 - Non-Trafficway or Driveway Access

1 - Straight

1 - Level

2 - Curve Right

2 - Grade, Unknown Slope

3 - Curve Left

3 - Hillcrest

4 - Curve - Unknown Direction

4 - Sag (Bottom)

8 - Not Reported

5 - Uphill

9 - Reported as Unknown

6 - Downhill


8 - Not Reported

9 - Reported as Unknown


Roadway Surface Type


Roadway Surface Conditions







0 - Non-Trafficway or Driveway Access

00 - Non-Trafficway or Driveway Access

1 - Concrete

01 - Dry

2 - Blacktop, Bituminous, or Asphalt

02 - Wet

3 - Brick or Block

03 - Snow

4 - Slag, Gravel or Stone

04 - Ice/Frost

5 - Dirt

05 - Sand

7 - Other

06 - Water (Standing or Moving)

8 - Not Reported

07 - Oil

9 - Reported as Unknown

08 - Other


10 - Slush

11 - Mud, Dirt or Gravel

98 - Not Reported

99 - Reported as Unknown


Traffic Control Device


Device Functioning







00 - No Controls

0 - No Controls

01 - Traffic control signal (on colors) without Pedestrian Signal

1 - Device Not Functioning

02 - Traffic control signal (on colors) with Pedestrian Signal

2 - Device Functioning-Functioning Improperly

03 - Traffic control signal(on colors) not known whether or not

Pedestrian Signal

3 - Device Functioning Properly

4 - Device Not Functioning or Device Functioning Improperly, Specifics

Unknown

04 - Flashing Traffic Control Signal

07 - Lane Use Control Signal

8 - Not Reported

08 - Other Highway Traffic Signal

9 - Reported as Unknown

09 - Unknown Highway Traffic Signal


20 - Stop Sign

21 - Yield Sign

23 - School Zone Sign/Device

28 - Other Regulatory Sign

29 - Unknown Regulatory Sign

40 - Warning Sign

50 - Person

65 - Railway Crossing Device

97 - Not Reported

98 - Other

99 - Reported as Unknown


Shape157 Shape158 Shape159 Shape160

Driver's Vision Obscured By

Driver Maneuvered to Avoid

Driver Distracted By

Pre-Event Movement(Prior to Recognition of Critical Event)


Shape161 Shape162

Critical Event-Precrash (Category)

Critical Event -Precrash (Event)




1 - This Vehicle Loss of Control Due To:

2 - This Vehicle Traveling

3 - Other Motor Vehicle in Lane

4 - Other Motor Vehicle Encroaching into Lane

5 - Pedestrian or Pedalcyclist or Other Non-Motorist

6 - Object or Animal

7 - Other

9 - Unknown


Attempted Avoidance Maneuver


Pre-Impact Stability







00 - No Driver Present / Unknown if Driver Present

0 - No Driver Present / Unknown if Driver Present

01 - No Avoidance Maneuver

1 - Tracking

05 - Releasing brakes

2 - Skidding longitudinally rotation less than 30 degrees

06 - Steering left

3 - Skidding laterally clockwise rotation

07 - Steering right

4 - Skidding laterally counterclockwise rotation

08 - Braking and steering left

5 - Skidding Laterally, Rotation Direction Unknown

09 - Braking and steering right

7 - Other vehicle loss-of-control (specify:)

10 - Accelerating

9 - Precrash stability unknown

11 - Accelerating and steering left


12 - Accelerating and steering right

15 - Braking and Unknown Steering Direction

16 - Braking

98 - Other actions (specify:)

99 - Unknown/Not Reported


Pre-Impact Location

Crash Type




0 - No Driver Present / Unknown if Driver Present

1 - Stayed in original travel lane

2 - Stayed on roadway, but left original travel lane

3 - Stayed on roadway, not known if left original travel lane

4 - Departed roadway

5 - Remained off roadway

6 - Returned to roadway

7 - Entered roadway

9 - Unknown


Shape163 Shape164 2021 Fatality Analysis Reporting System DRIVER LEVEL FOR VEHICLE# 1

Shape168 Shape165
Shape166
Shape167
State Number Consecutive Number **Vehicle Number


Driver Presence

Drivers License State




0 - No Driver Present/Not Applicable

1 - Yes

9 - Unknown


Driver Zip Code

Violations Charged




00000 - Not resident of U.S. or Territories

99998 - Not Reported

99999 - Reported as Unknown


Speeding Related


Condition (Impairment) At Time of Crash




0 - No

00 - None/Apparently Normal

2 - Yes, Racing

3 - Yes, Exceeded Speed Limit

01 - Ill, Blackout

4 - Yes, Too Fast for Conditions

02 - Asleep or Fatigued

5 - Yes, Specifics Unknown

03 - Walking with a Cane or Crutches, etc.

9 - Reported as Unknown


04 - Paraplegic or in a Wheelchair

05 - Impaired Due to Previous Injury

06 - Deaf/Hard of Hearing

07 - Blind/Low Vision

08 - Emotional (depressed, angry, disturbed, etc.)

09 - Under the Influence of Alcohol, Drugs or Medication

10 - Physical Impairment - No Details

96 - Other Physical Impairment

98 - Not Reported

99 - Reported as Unknown if Impaired


Driver Related Factors

Shape169 DRIVER LICENSE FOR VEHICLE# 1


Non-CDL License Type


Non-CDL License Status







0 - Not Licensed

0 - Not licensed

1 - Full Driver License

1 - Suspended

2 - Intermediate Driver License

2 - Revoked

7 - Learner's Permit

3 - Expired

8 - Temporary License

4 - Canceled or denied

9 - Unknown License Type

6 - Valid


9 - Unknown License Status


Commercial Motor Vehicle License Status


Compliance With CDL Endorsements







00 - No (CDL)

0 - No Endorsements required for this vehicle

01 - Suspended

1 - Endorsement(s) Required, Complied with

02 - Revoked

2 - Endorsement(s) Required, Not Complied with

03 - Expired

3 - Endorsement(s) Required, Compliance Unknown

04 - Cancelled or Denied

9 - Unknown, if required

05 - Disqualified


06 - Valid

07 - Commercial Learner’s Permit (CLP)

08 - Other Not-Valid

99 - Unknown License Status


License Compliance with Class of Vehicle


Compliance with license Restrictions







0 - Not licensed

0 - No Restrictions or Not Applicable

1 - No license required for this class vehicle

1 - Restrictions Complied With

2 - No valid license for this class vehicle

2 - Restrictions Not Complied With

3 - Valid license for this class vehicle

3 - Restrictions, Compliance Unknown

8 - Unknown If CDL and/or CDL endorsement required for this vehicle

9 - Unknown

9 - Unknown



Driver Height(Feet)

Driver Height(Inches)

Driver Weight


Shape170 Shape171 Shape172 Shape173 Shape174 Shape175 Shape176 Shape177 Shape178 Shape179 Shape180 Shape181 DRIVER COUNTERS FOR VEHICLE# 1



Previous Rec. Crashes

Previous Rec. Susp.,Revoc. and Withdrawals

Previous Underage Admin. Per Se for BAC

Shape182

Previous Admin. Per Se for BAC (Not Underage)

Shape183

Previous Recorded Other Susp/Revoc/Withdrawals

Previous DWI Convictions

Previous Recorded Speeding Convictions

Previous Other Moving Violation Convictions

Date of Oldest Crash, Suspension, Convictions

/

Date of Most Recent Crash, Susp., Convictions

/



2021 Fatality Analysis Reporting System

PERSON LEVEL (MV OCCUPANT) FOR VEHICLE# 1 AND PERSON# 1


Shape188 Shape184
Shape185
Shape186
Shape187
State Number Consecutive Number **Vehicle Number **Person Number


Age


Sex




1 - Male

2 - Female

8 - Not Reported

9 - Reported as Unknown


Person Type


Injury Severity







01 - Driver of a Motor Vehicle In-Transport

0 - No Apparent Injury (O)

02 - Passenger of a Motor Vehicle In-Transport

1 - Possible Injury (C)

03 - Occupant of a Motor Vehicle Not In- Transport

2 - Suspected Minor Injury (B)

09 - Unknown Occupant Type in a Motor Vehicle In- Transport

3 - Suspected Serious Injury (A)


4 - Fatal Injury (K)

5 - Injured, Severity Unknown

6 - Died Prior to Crash*

9 - Unknown/Not Reported


Seating Position


Transported to First Medical Facility By







11 - Front Seat, Left Side

0 - Not Transported for Treatment

12 - Front Seat, Middle

1 - EMS Air

13 - Front Seat, Right Side

2 - Law Enforcement

18 - Front Seat, Other

3 - EMS Unknown Mode

19 - Front Seat, Unknown

4 - Transported Unknown Source

21 - Second Seat, Left Side

5 - EMS Ground

22 - Second Seat, Middle

6 - Other

23 - Second Seat, Right Side

8 - Not Reported

28 - Second Seat, Other

9 - Reported as Unknown

29 - Second Seat, Unknown


31 - Third Seat, Left Side

32 - Third Seat, Middle

33 - Third Seat, Right Side

38 - Third Seat, Other

39 - Third Seat, Unknown

41 - Fourth Seat, Left Side

42 - Fourth Seat, Middle

43 - Fourth Seat, Right Side

48 - Fourth Seat, Other

49 - Fourth Seat, Unknown

50 - Sleeper Section of Cab (Truck)

51 - Other Passenger in enclosed passenger or cargo area

52 - Other Passenger in unenclosed passenger or cargo area

53 - Other Passenger in passenger or cargo area, unknown whether or

not enclosed

54 - Trailing Unit

55 - Riding on Exterior of Vehicle

56 - Appended to a Motor Vehicle for Motion

98 - Not Reported

99 - Reported as Unknown


Shape189

SAFETY DEVICES FOR VEHICLE# 1 AND PERSON# 1


Restraint System Use

Type of Restraint System in Use


Helmet Use

Helmet Use







01 - Shoulder Belt Only Used

05 - DOT-Compliant Motorcycle Helmet

02 - Lap Belt Only Used

16 - Helmet, Other than DOT-Compliant Motorcycle Helmet

03 - Shoulder and Lap Belt Used

17 - No Helmet

04 - Child Restraint Type Unknown

19 - Helmet, Unknown if DOT-Compliant

06 - Racing-Style Harness Used

20 - Not Applicable

08 - Restraint Used - Type Unknown

98 - Not Reported

10 - Child Restraint System - Forward Facing

99 - Reported as Unknown if Helmet Worn

11 - Child Restraint System - Rear Facing

Indication of Helmet Misuse?

12 - Booster Seat




20 - None Used/Not Applicable

97 - Other

0 - No Indication of Misuse

98 - Not Reported

1 - Yes, Indication of Misuse

99 - Reported as Unknown

7 - None Used/Not Applicable

Indication of Restraint System Misuse?





0 - No Indication of Misuse

1 - Yes, Indication of Misuse

7 - None Used/Not Applicable


Air Bag Deployed


Ejection







0 - Not Ejected

01 - Deployed- Front

1 - Totally Ejected

02 - Deployed- Side (door, seatback)

2 - Partially Ejected

03 - Deployed- Curtain (roof)

3 - Ejected - Unknown Degree

07 - Deployed- Other (Knee, air belt, etc.)

7 - Not Reported

08 - Deployed- Combination

8 - Not Applicable

09 - Deployment- Unknown Location

9 - Reported as Unknown if Ejected

20 - Not Deployed


98 - Not Reported

99 - Reported as Deployment Unknown


Ejection Path


Extrication







0 - Ejection Path Not Applicable

0 - Not Extricated or Not Applicable

1 - Through Side Door Opening

1 - Extricated

2 - Through Side Window

9 - Unknown

3 - Through Windshield


4 - Through Back Window

5 - Through Back Door/Tailgate Opening

6 - Through Roof Opening (sun-roof, convertible top down)

7 - Through roof (convertible top up)

8 - Other Path (e.g., back of pick-up truck)

9 - Ejection Path Unknown


Shape190 2021 Fatality Analysis Reporting System ALCOHOL FOR VEHICLE# 1 AND PERSON# 1


Police-Reported Alcohol Involvement


Alcohol Test Status







0 - No (Alcohol Not Involved)

0 - Test Not Given

1 - Yes (Alcohol Involved)

2 - Test Given

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown if Tested



Alcohol Test Type

Alcohol Test Result




00 - Test Not Given

01 - Blood

02 - Breath Test (AC)

03 - Urine

04 - Vitreous

05 - Blood Plasma/Serum

06 - Blood Clot

07 - Liver

08 - Other Test Type

10 - Preliminary Breath Test (PBT)

11 - Breath Test, Unknown Type

95 - Not Reported

98 - Unknown Test Type

99 - Reported as Unknown if Tested


DRUG FOR VEHICLE# 1 AND PERSON# 1


Police Reported Drug Involvement


Method of Drug Determination by Police







0 - No (Drugs Not Involved)

1 - Evidential Test (Blood, Urine)

1 - Yes (Drugs Involved)

2 - Drug Recognition Expert (or Evaluator) (DRE)

8 - Not Reported

3 - Observed Behavior or SFST

9 - Reported as Unknown

7 - Other


8 - Not Reported


Drug Test Status





0 - Test Not Given

2 - Test Given

8 - Not Reported

9 - Reported as Unknown if Tested


Shape191

2021 Fatality Analysis Reporting System RACE FOR VEHICLE# 1 AND PERSON# 1


Race


Hispanic Origin







00 - Not a Fatality (not applicable)

00 - Not A Fatality (not Applicable)

01 - White

01 - Mexican

02 - Black or African American

02 - Puerto Rican

03 - North American Indian or Alaska Native

03 - Cuban

04 - Chinese

04 - Central or South American

05 - Japanese

05 - European Spanish

06 - Native Hawaiian

06 - Hispanic, Origin Not Specified or Other Origin

07 - Filipino

07 - Non-Hispanic

18 - Asian Indian

99 - Unknown

19 - Other Indian (includes South and Central America, any others,

except North American or Asian Indians)


28 - Korean

38 - Samoan

48 - Vietnamese

58 - Guamanian or Chamorro

68 - Other Asian or Pacific Islander

78 - Asian or Pacific Islander, No Specific (individual) Race

97 - Multiple Races Unspecified

98 - Other Race

99 - Unknown


Shape192 Shape193 Shape194 Shape195 Shape196 Shape197 Shape198 Shape199 Shape200 SUPPLEMENTAL FOR VEHICLE# 1 AND PERSON# 1


Died at Scene/En Route

Death Date

/ /




0 - Not Applicable

7 - Died at Scene

8 - Died En Route

9 - Unknown


Death Time

:

Death Certificate Number

Fatal Injury At Work


2021 Fatality Analysis Reporting System

PERSON LEVEL (MV OCCUPANT) FOR VEHICLE# 1 AND PERSON# 2


Shape205 Shape201
Shape202
Shape203
Shape204
State Number Consecutive Number **Vehicle Number **Person Number


Age


Sex




1 - Male

2 - Female

8 - Not Reported

9 - Reported as Unknown


Person Type


Injury Severity







01 - Driver of a Motor Vehicle In-Transport

0 - No Apparent Injury (O)

02 - Passenger of a Motor Vehicle In-Transport

1 - Possible Injury (C)

03 - Occupant of a Motor Vehicle Not In- Transport

2 - Suspected Minor Injury (B)

09 - Unknown Occupant Type in a Motor Vehicle In- Transport

3 - Suspected Serious Injury (A)


4 - Fatal Injury (K)

5 - Injured, Severity Unknown

6 - Died Prior to Crash*

9 - Unknown/Not Reported


Seating Position


Transported to First Medical Facility By







11 - Front Seat, Left Side

0 - Not Transported for Treatment

12 - Front Seat, Middle

1 - EMS Air

13 - Front Seat, Right Side

2 - Law Enforcement

18 - Front Seat, Other

3 - EMS Unknown Mode

19 - Front Seat, Unknown

4 - Transported Unknown Source

21 - Second Seat, Left Side

5 - EMS Ground

22 - Second Seat, Middle

6 - Other

23 - Second Seat, Right Side

8 - Not Reported

28 - Second Seat, Other

9 - Reported as Unknown

29 - Second Seat, Unknown


31 - Third Seat, Left Side

32 - Third Seat, Middle

33 - Third Seat, Right Side

38 - Third Seat, Other

39 - Third Seat, Unknown

41 - Fourth Seat, Left Side

42 - Fourth Seat, Middle

43 - Fourth Seat, Right Side

48 - Fourth Seat, Other

49 - Fourth Seat, Unknown

50 - Sleeper Section of Cab (Truck)

51 - Other Passenger in enclosed passenger or cargo area

52 - Other Passenger in unenclosed passenger or cargo area

53 - Other Passenger in passenger or cargo area, unknown whether or

not enclosed

54 - Trailing Unit

55 - Riding on Exterior of Vehicle

56 - Appended to a Motor Vehicle for Motion

98 - Not Reported

99 - Reported as Unknown


Shape206

SAFETY DEVICES FOR VEHICLE# 1 AND PERSON# 2


Restraint System Use

Type of Restraint System in Use


Helmet Use

Helmet Use







01 - Shoulder Belt Only Used

05 - DOT-Compliant Motorcycle Helmet

02 - Lap Belt Only Used

16 - Helmet, Other than DOT-Compliant Motorcycle Helmet

03 - Shoulder and Lap Belt Used

17 - No Helmet

04 - Child Restraint Type Unknown

19 - Helmet, Unknown if DOT-Compliant

06 - Racing-Style Harness Used

20 - Not Applicable

08 - Restraint Used - Type Unknown

98 - Not Reported

10 - Child Restraint System - Forward Facing

99 - Reported as Unknown if Helmet Worn

11 - Child Restraint System - Rear Facing

Indication of Helmet Misuse?

12 - Booster Seat




20 - None Used/Not Applicable

97 - Other

0 - No Indication of Misuse

98 - Not Reported

1 - Yes, Indication of Misuse

99 - Reported as Unknown

7 - None Used/Not Applicable

Indication of Restraint System Misuse?





0 - No Indication of Misuse

1 - Yes, Indication of Misuse

7 - None Used/Not Applicable


Air Bag Deployed


Ejection







0 - Not Ejected

01 - Deployed- Front

1 - Totally Ejected

02 - Deployed- Side (door, seatback)

2 - Partially Ejected

03 - Deployed- Curtain (roof)

3 - Ejected - Unknown Degree

07 - Deployed- Other (Knee, air belt, etc.)

7 - Not Reported

08 - Deployed- Combination

8 - Not Applicable

09 - Deployment- Unknown Location

9 - Reported as Unknown if Ejected

20 - Not Deployed


98 - Not Reported

99 - Reported as Deployment Unknown


Ejection Path


Extrication







0 - Ejection Path Not Applicable

0 - Not Extricated or Not Applicable

1 - Through Side Door Opening

1 - Extricated

2 - Through Side Window

9 - Unknown

3 - Through Windshield


4 - Through Back Window

5 - Through Back Door/Tailgate Opening

6 - Through Roof Opening (sun-roof, convertible top down)

7 - Through roof (convertible top up)

8 - Other Path (e.g., back of pick-up truck)

9 - Ejection Path Unknown


Shape207 2021 Fatality Analysis Reporting System ALCOHOL FOR VEHICLE# 1 AND PERSON# 2


Police-Reported Alcohol Involvement


Alcohol Test Status







0 - No (Alcohol Not Involved)

0 - Test Not Given

1 - Yes (Alcohol Involved)

2 - Test Given

8 - Not Reported

8 - Not Reported

9 - Reported as Unknown

9 - Reported as Unknown if Tested



Alcohol Test Type

Alcohol Test Result




00 - Test Not Given

01 - Blood

02 - Breath Test (AC)

03 - Urine

04 - Vitreous

05 - Blood Plasma/Serum

06 - Blood Clot

07 - Liver

08 - Other Test Type

10 - Preliminary Breath Test (PBT)

11 - Breath Test, Unknown Type

95 - Not Reported

98 - Unknown Test Type

99 - Reported as Unknown if Tested


DRUG FOR VEHICLE# 1 AND PERSON# 2


Police Reported Drug Involvement


Method of Drug Determination by Police







0 - No (Drugs Not Involved)

1 - Evidential Test (Blood, Urine)

1 - Yes (Drugs Involved)

2 - Drug Recognition Expert (or Evaluator) (DRE)

8 - Not Reported

3 - Observed Behavior or SFST

9 - Reported as Unknown

7 - Other


8 - Not Reported


Drug Test Status





0 - Test Not Given

2 - Test Given

8 - Not Reported

9 - Reported as Unknown if Tested


Shape208

2021 Fatality Analysis Reporting System RACE FOR VEHICLE# 1 AND PERSON# 2


Race


Hispanic Origin







00 - Not a Fatality (not applicable)

00 - Not A Fatality (not Applicable)

01 - White

01 - Mexican

02 - Black or African American

02 - Puerto Rican

03 - North American Indian or Alaska Native

03 - Cuban

04 - Chinese

04 - Central or South American

05 - Japanese

05 - European Spanish

06 - Native Hawaiian

06 - Hispanic, Origin Not Specified or Other Origin

07 - Filipino

07 - Non-Hispanic

18 - Asian Indian

99 - Unknown

19 - Other Indian (includes South and Central America, any others,

except North American or Asian Indians)


28 - Korean

38 - Samoan

48 - Vietnamese

58 - Guamanian or Chamorro

68 - Other Asian or Pacific Islander

78 - Asian or Pacific Islander, No Specific (individual) Race

97 - Multiple Races Unspecified

98 - Other Race

99 - Unknown


Shape209 Shape210 Shape211 Shape212 Shape213 Shape214 Shape215 Shape216 Shape217 SUPPLEMENTAL FOR VEHICLE# 1 AND PERSON# 2


Died at Scene/En Route

Death Date

/ /




0 - Not Applicable

7 - Died at Scene

8 - Died En Route

9 - Unknown


Death Time

:

Death Certificate Number

Fatal Injury At Work



NHTSA Form 1667

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCulbreath, Walter (NHTSA)
File Modified0000-00-00
File Created2023-09-03

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