CHP 190 Form PDF Details

When individuals seek access to information regarding incidents or accidents on California's highways, the Application for Release of Information CHP 190 form proves to be an essential document. Issued by the State of California Department of California Highway Patrol, this form allows various parties, including those directly involved in an incident, family members, legal representatives, insurance company representatives, and others with a vested interest, to formally request and receive pertinent details. It meticulously outlines categories of those eligible to request information, which includes drivers, passengers, property owners, pedestrians, and registered owners among others, and stipulates the need for accurate identification of the requestor's relationship to the incident or the involved party. The form also accommodates special requests, such as inquiries about auto theft or vehicle recovery, and requires the applicant to affirm their statement under penalty of perjury. The design of the CHP 190 form underlines the seriousness with which the California Highway Patrol treats the dissemination of information, reflecting an effort to balance public interest with privacy rights and legal considerations, making it a critical tool for ensuring transparency and facilitating insurance and legal processes following highway incidents.

QuestionAnswer
Form NameCHP 190 Form
Form Length2 pages
Fillable?Yes
Fillable fields1
Avg. time to fill out42 sec
Other nameschp authorization form 190, chp 190 request form, california chp 190 form, california highway patrol form 180

Form Preview Example

STATE OF CALIFORNIA

DEPARTMENT OF CALIFORNIA HIGHWAY PATROL

APPLICATION FOR RELEASE OF INFORMATION

CHP 190 (Rev. 2-90) OPI 083

ACCIDENT / INCIDENT DATE

OFFICE USE ONLY

REPORT NUMBER

ACCIDENT / INCIDENT LOCATION

DRIVER OR OWNER

RECEIPT NUMBER

PARTY OF INTEREST (check and complete one ONLY)

Person involved (indicate whether driver, passenger, property owner, pedestrian, registered owner):

Family member (Indicate relationship):

Other party of interest, specify:

Legal representative (Attorney, guardian, conservator):

Representative of Insurance Company or Insurance Adjusting Agency (Must have been

 

a carrier for involved party at time of accident. Policy or claim number must be presented.)

Policy or Claim No.:

Manufacturer Representative (Must represent insurance carrier/adjuster, attorney

 

handling case, or have a letter from manufacturer certifying authority.)

Manufacturer:

 

 

Self-Insured: Name

Certificate number:

Authorized person (Must have signed authorization). Indicate person represented:

Auto theft or recovery

Vehicle description: Year:

Lic. or VIN No.

 

 

 

PLEASE PRINT NAME AND ADDRESS

APPLICANT

AGENCY / COMPANY

NUMBER AND STREET, CITY, STATE, ZIP CODE

SIGNATURE ( I DECLARE UNDER PENALTY OF PERJURY THAT I AM THE PARTY OF INTEREST

DATE

AS CHECKED ABOVE)

 

 

 

 

Use previous editions until depleted.

ESTADO DE CALIFORNIA

 

 

LA PATRULLA DE CAMINOS DE CALIFORNIA

 

 

 

FECHA DEL ACCIDENTE/ INCIDENTE

 

 

SOLICITUD PARA OBTENER INFORMACION

CHP 190 (Rev. 2-90) OPI 083

c190_400.frp

USO INTERNO SOLAMENTE

NÚMERO DE REPORTE

LUGAR DEL ACCIEENTE / INCIDENTE

CHOFER O PROPIETARIO

NÚMERO DE RECIBO

PARTY OF INTEREST (check and complete one ONLY)

Persona involucrada (indique si es: chofer, pasajero, peatón, propietario):

Miembro de familia (indique parentesco):

Otra parte interesada, especifique:

Representante legal (Abogado, guardián, conservador)

Representante de la Companía Aseguradora o Agencia de Ajustadores (Debe ser la companía que tenia adegurada a la parte interesada cuando occurió el accidente. Debera presentar el númbero de póliza o reclamación. Númbero de Póliza o Reclación:

Representante del Fabricante (Debe representar la aseguriadora/ajustador,

 

ser el abogado de interes, o tener carta poder del fabricante)

Fabricante:

 

 

Asegurado por sí misno: Nombre

Númbero de Certificado:

Persona autorizada (Debe tener firma de autorización) Indique a quién represnta:

 

Robo / recuperacion de vehículo

 

Descricpción: Marca

Modelo

Placas de circulación o númbero de serie (VIN)

NOMBRE Y DOMICILIO (use letra de imprenta)

APLICANTE

AGENCIA / COMPANÍA

NÚMERO Y CALLE, CIUDAD, ESTADO, ZONA POSTAL

FIRMA (DECLARO BAJO PENA DE PERJURIO QUE SOY LA PERSONA INTERESADA COMO ESTA

FECHA

INDICADO ARRIBA)

 

 

 

Use previous editions until depleted.

c190_400.frp

RECORD OF INTERVIEW

INTERVIEWER

REPRESENTING

 

DATE / TIME OF INTERVIEW

 

 

 

 

 

 

DATE:

 

 

 

 

 

 

 

 

FROM

 

TO

 

HOURS

 

 

 

 

 

 

 

 

 

LOCATION OF INTERVIEW

 

REGARDING (PURPOSE OF INTERVIEW)

 

 

 

 

 

MEMBER TO BE INTERVIEWED

ID NUMBER

APPROVED BY

DATE APPROVED

RECORD OF INTERVIEW

INTERVIEWER

REPRESENTING

 

DATE / TIME OF INTERVIEW

 

 

 

 

 

 

DATE:

 

 

 

 

 

 

 

 

FROM

 

TO

 

HOURS

 

 

 

 

 

 

 

 

 

LOCATION OF INTERVIEW

 

REGARDING (PURPOSE OF INTERVIEW)

 

 

 

 

 

MEMBER TO BE INTERVIEWED

ID NUMBER

APPROVED BY

DATE APPROVED

RECORD OF INTERVIEW

INTERVIEWER

REPRESENTING

 

DATE / TIME OF INTERVIEW

 

 

 

 

 

 

DATE:

 

 

 

 

 

 

 

 

FROM

 

TO

 

HOURS

 

 

 

 

 

 

 

 

 

LOCATION OF INTERVIEW

 

REGARDING (PURPOSE OF INTERVIEW)

 

 

 

 

 

MEMBER TO BE INTERVIEWED

ID NUMBER

APPROVED BY

DATE APPROVED

RECORD OF INTERVIEW

INTERVIEWER

REPRESENTING

 

DATE / TIME OF INTERVIEW

 

 

 

 

 

 

DATE:

 

 

 

 

 

 

 

 

FROM

 

TO

 

HOURS

 

 

 

 

 

 

 

 

 

LOCATION OF INTERVIEW

 

REGARDING (PURPOSE OF INTERVIEW)

 

 

 

 

 

MEMBER TO BE INTERVIEWED

ID NUMBER

APPROVED BY

DATE APPROVED

How to Edit CHP 190 Form Online for Free

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As for the fields of this specific form, here is what you want to do:

1. To start with, while filling in the chp 190 request form, start out with the section that contains the subsequent blanks:

Stage number 1 in submitting form chp 190

2. Once your current task is complete, take the next step – fill out all of these fields - AGENCY COMPANY, SIGNATURE I DECLARE UNDER PENALTY, DATE, ESTADO DE CALIFORNIA LA PATRULLA, CHOFER O PROPIETARIO, FECHA DEL ACCIDENTE INCIDENTE, USO INTERNO SOLAMENTE, NÚMERO DE REPORTE, NÚMERO DE RECIBO, Use previous editions until, cfrp, Persona involucrada indique si es, PARTY OF INTEREST check and, Miembro de familia indique, and Otra parte interesada especifique with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Writing section 2 of form chp 190

It's very easy to get it wrong when completing your DATE, and so make sure that you look again before you decide to send it in.

3. This next step is usually easy - complete all of the fields in APLICANTE, AGENCIA COMPANÍA, NOMBRE Y DOMICILIO use letra de, NÚMERO Y CALLE CIUDAD ESTADO ZONA, FIRMA DECLARO BAJO PENA DE, FECHA, Use previous editions until, and cfrp to complete this segment.

Filling out part 3 in form chp 190

4. The subsequent paragraph comes next with all of the following empty form fields to fill out: INTERVIEWER, REPRESENTING, DATE TIME OF INTERVIEW, RECORD OF INTERVIEW, LOCATION OF INTERVIEW, REGARDING PURPOSE OF INTERVIEW, DATE, FROM, HOURS, MEMBER TO BE INTERVIEWED, ID NUMBER, APPROVED BY, DATE APPROVED, INTERVIEWER, and REPRESENTING.

Step no. 4 of submitting form chp 190

5. When you come close to the end of this document, you'll notice a few more requirements that must be satisfied. Notably, MEMBER TO BE INTERVIEWED, ID NUMBER, APPROVED BY, DATE APPROVED, INTERVIEWER, REPRESENTING, DATE TIME OF INTERVIEW, RECORD OF INTERVIEW, LOCATION OF INTERVIEW, REGARDING PURPOSE OF INTERVIEW, DATE, FROM, HOURS, MEMBER TO BE INTERVIEWED, and ID NUMBER must all be done.

Completing section 5 of form chp 190

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