Form CRB-2 is a document that is used to request or ask for criminal history information about an individual. The form is also used to disclose any arrests and convictions the individual may have. This form must be completed by individuals who are requesting this information on behalf of someone else, such as an employer. Completing the form correctly is important in order to ensure that the correct information is received. For more information on how to complete Form CRB-2, please visit our website. Thank you!
| Question | Answer |
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| Form Name | Form Crb 2 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | texas crb driver, crb2 driver crash report, dps crb form, tx crb2 crash |
DRIVER'S CRASH REPORT
PLEASE READ INSTRUCTIONS ON REVERSE SIDE
FORM |
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* INDICATES REQUIRED FIELDS |
TEXAS DEPARTMENT OF PUBLIC SAFETY |
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PLACE WHERE |
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* CITY OR TOWN _____________________________________________ |
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CRASH OCCURRED |
COUNTY _________________________________ |
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IF CRASH WAS OUTSIDE CITY LIMITS, |
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LOCATION |
INDICATE DISTANCE FROM NEAREST TOWN_______________________ MILES |
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OF _________________________________________________________________ |
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NORTH |
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W |
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CITY OR TOWN |
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ROAD ON WHICH |
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CONSTR. |
YES |
SPEED |
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CRASH OCCURRED ________________________ _________________________________________________________________________________ |
ZONE |
NO |
LIMIT |
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BLOCK NUMBER |
STREET OR ROAD NAME |
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ROUTE NUMBER |
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CONSTR. |
YES |
SPEED |
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INTERSECTING STREET ___________________ |
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ZONE |
NO |
LIMIT |
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COMPLETE ONE |
BLOCK NUMBER |
STREET OR ROAD NAME |
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ROUTE NUMBER |
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NOT AT INTERSECTION ___________________ |
FEET |
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OF |
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NORTH |
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SHOW NEAREST INTERSECTING NUMBERED HIGHWAY. IF URBAN, |
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SHOW NEAREST INTERSECTING STREET |
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DATE
*DATE OF CRASH _____________________ 20_________ DAY OF WEEK __________________________ |
HOUR ___________________ |
A.M. |
IF EXACTLY NOON OR |
P.M. |
MIDNIGHT, SO STATE |
VEHICLES
FOR
ADDITIONAL VEHICLES USE ANOTHER FORM
#1 - YOUR VEHICLE |
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VEHICLE IDENT. NO. |
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TYPE OF |
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YEAR |
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MAKE / |
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LICENSE |
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MODEL |
___________________ |
MODEL |
____________________________ |
VEHICLE ___________________________ |
PLATE________________________________________________________ |
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CHEVY, FORD, ETC. |
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SEDAN, TRUCK, VAN, ETC. |
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YEAR |
STATE |
NUMBER |
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DRIVER _____________________________________________________ |
_____________________________________________________________________________________________________ |
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LAST |
FIRST |
MI |
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MAIL ADDRESS |
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CITY AND STATE |
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ZIP |
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DRIVER'S LICENSE _____________________________________ DATE OF BIRTH __________________________ SEX ______________ |
RACE __________________ |
APPROX. COST TO REPAIR |
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STATE |
NUMBER |
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YOUR VEHICLE |
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OWNER _______________________________________________________ |
______________________________________________________________________________ |
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LAST |
FIRST |
MI |
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MAIL ADDRESS |
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CITY |
STATE |
ZIP |
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$_____________________ |
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INSURANCE INFORMATION ______________________________________________________________________________________________________ |
_______________________________________ |
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INSURANCE COMPANY NAME (NOT THE AGENT) |
ADDRESS |
CITY |
STATE |
ZIP |
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POLICY NUMBER |
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#2- OTHER VEHICLE |
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MOTOR VEHICLE |
TRAIN |
PEDESTRIAN |
BICYCLIST |
OTHER |
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(COMPLETE INFORMATION YOU HAVE AVAILABLE - IF UNKNOWN, MARK "NOT KNOWN") |
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YEAR |
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MAKE / |
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TYPE OF |
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LICENSE |
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MODEL |
___________________ |
MODEL |
____________________________ |
VEHICLE ___________________________ |
PLATE________________________________________________________ |
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CHEVY, FORD, ETC. |
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SEDAN, TRUCK, VAN, ETC. |
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YEAR |
STATE |
NUMBER |
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DRIVER _____________________________________________________________ |
_____________________________________________________________________________________________________ |
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LAST |
FIRST |
MI |
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MAIL ADDRESS |
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CITY |
STATE |
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ZIP |
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OWNER _____________________________________________________________ |
_____________________________________________________________________________________________________ |
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LAST |
FIRST |
MI |
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MAIL ADDRESS |
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CITY |
STATE |
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ZIP |
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INSURANCE INFORMATION ______________________________________________________________________________________________________ |
_______________________________________ |
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INSURANCE COMPANY NAME (NOT THE AGENT) |
ADDRESS |
CITY |
STATE |
ZIP |
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POLICY NUMBER |
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DAMAGE TO PROPERTY OTHER |
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APPROX. COST TO REPAIR |
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THAN VEHICLES |
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NAME OBJECT, SHOW OWNERSHIP AND STATE NATURE OF DAMAGE |
$__________________ |
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#1 |
INJURED PERSON |
DRIVER |
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PASSENGER |
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PEDESTRIAN |
OTHER |
__________________________ |
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NAME_______________________________________________________________ |
ADDRESS__________________________________________________________________________________________ |
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INJURIES |
AGE________________ |
SEX_____________ |
RACE_________________ |
WAS PERSON KILLED______________ DATE OF DEATH ______________________________ |
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SEAT BELT |
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DESCRIBE INJURY_________________________________________________________________________________________________________________________________ |
USED |
NOT USED |
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# 2 |
INJURED PERSON |
DRIVER |
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PASSENGER |
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PEDESTRIAN |
OTHER |
__________________________ |
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NAME_______________________________________________________________ |
ADDRESS___________________________________________________________________________________________ |
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AGE________________ |
SEX_____________ |
RACE_________________ |
WAS PERSON KILLED______________ DATE OF DEATH ______________________________ |
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SEAT BELT |
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DESCRIBE INJURY_________________________________________________________________________________________________________________________________ |
USED |
NOT USED |
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STATE BRIEFLY WHAT HAPPENED |
PLEASE DO NOT SEND PHOTOGRAPHS |
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(IF SPACE IS INSUFFICIENT CONTINUE ON ANOTHER PAGE) |
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DATE OF
DRIVER'S SIGNATURE
(Please use blue or black ink only)
REPORT
When completed, mail this form to:
CRASH RECORDS BUREAU
TEXAS DEPARTMENT OF PUBLIC SAFETY
PO BOX 4087
AUSTIN TEXAS
PLEASE READ ALL INSTRUCTIONS CAREFULLY
The driver of a motor vehicle involved in a crash not investigated by a law enforcement officer and resulting in injury to or death of any person, or damage to the property of any one person, including himself, to any apparent extent of at least One Thousand Dollars ($1,000), shall within ten (10) days after such crash complete and forward this report in
accordance with the instructions below. This report is not required when a crash is investigated by a law enforcement officer unless specifically requested by authority of Section 4, Texas Motor Vehicle
WHO SHOULD
COMPLETE A
LOCATION |
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DATE |
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VEHICLES |
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PROPERTY |
DAMAGE |
INJURIES |
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DRIVER'S |
STATEMENT |
SIGNATURE |
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1.The information on the reverse side of the
2.All data fields should be completed to the best of your knowledge; however, fields marked with an
asterisk (*) are required data fields and should include sufficient information for DPS to process the report. This information is an important element in locating reports and maintaining an accurate filing system. *CITY OR TOWN in the Location section is a required field; if it is left blank the report will be returned to you.
3.*DATE OF CRASH is a required data field and must include the specific month, day and year the crash occurred. Please provide the time of the crash if known. If the date of the crash is not provided, the report will be returned to you.
4.In the section titled #1 YOUR VEHICLE, the name of the *DRIVER involved in the crash is a required data field . All remaining information should be completed to the best of your knowledge. In the section titled #2 OTHER VEHICLE, please specify if the crash involved another motor vehicle, a train, a pedestrian, etc. and provide the name of the other involved party on the line labeled DRIVER. Please complete the remaining information to the best of your knowledge.
5.If the crash involved "PROPERTY DAMAGE" please provide all available information. (Description of property, location, owner, etc.)
6.In the section titled #1 INJURED PERSON, select the position of the occupant in your vehicle that was injured as a result of the crash and complete all data fields on that person. In the section titled #2 INJURED PERSON , select the position of the other person involved in the crash that was injured and complete all data fields to the best of your knowledge. If known, please indicate if the injured person wore a seatbelt.
7.“STATE BRIEFLY WHAT HAPPENED” In this section please provide a narrative description of the facts regarding this crash. If space is insufficient, attach a FULL SIZE sheet of paper for continuation. PLEASE DO NOT SEND PHOTOGRAPHS! Photographs cannot be returned.
8.Please review the report to insure accuracy and completeness as this will expedite the processing of the report and avoid having the report returned for insufficient information. Once you are satisfied with the completeness of the report, sign in black or blue ink and mail to the address at the top of the page.