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Bureau of Transportation Data and Support

Self Reporting Crash Form -- SUPPLIMENTAL

ATTENTION: You DO NOT have to fill out this form unless you are adding to or changing information submitted in a prior report.

User Instructions

• NOTE: To navigate this form you can use the tabs across the top as well as blue navigation button at the bottom of the page.
• Please provide as much information as you can accurately remember. 
• IMPORTANT: Fields marked with * are required.  The form will not submit if any of these fields are blank.
• For YOUR FULL NAME, please enter your first and last name. 
• For YOUR EMAIL ADDRESS, please enter email address where you can best be contacted with notificatons from this process.
  • IMPORTANT: When checking for responses from this process, be sure to check both your regular INBOX and any JUNK or SPAM folders you have set up.
• For all entered DRIVER and/or OWNER ADDRESSES:
  • If an address lays within the US, you should provide a state and a zip in the standard manner.
  • If an address lays outside the US, you should enter any additional address details for the selected country if a space for them is present.
• For all calendar entries: clicking the Month/Year (between the left/right arrows) will allow you to select a month in the current year; clicking again will allow you to use the left/right arrows to scroll through a decade range in which to select a year.
• For all dollar amounts: rounding to the nearest dollar is acceptable.
• For each additional vehicle (after the second) click the GREEN BAR on the ADDITIONAL VEHICLES tab to fill in the information for that vehicle.
• For each injured individual click the GREEN BAR on the INJURY INFO tab to fill in their information.
• Conditions-at-the-scene statistics for each additional vehicle (after the second) can be entered on the CONDITIONS INFO tab, by clicking the GREEN BAR at the bottom.
• Please make certain your insurance policy from date is BEFORE your insurance policy to date.
• Please click the SUBMIT button to finish the form.
• If your form fails to submit or stays on the last screen, it is likely one or more fields have NOT been properly filled out. Please check over all fields in this form to insure they have been correcly entered; paying special attention to those marked as required.