Fillable Report of Theft or Loss-Explosive Materials (Bureau of Alcohol, Tobacco, Firearms, and Explosives)

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Report of Theft or Loss-Explosive Materials (Bureau of Alcohol, Tobacco, Firearms, and Explosives)

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The Report of Theft or Loss-Explosive Materials (Bureau of Alcohol, Tobacco, Firearms, and Explosives) form is 2 pages long and contains:

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  • 63 check-boxes
  • 45 other fields

Country of origin: US
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Upon discovery of any theft or loss of any of your explosive materials:
- First, contact ATF toll free at 1-800-461-8841 between 8:00 a.m. - 5:00 p.m. EST or after hours and weekends contact ATF at 1-800-800-3855 to
report the theft or loss;
- Second,contactyourlocallawenforcementocetoreportthetheftorlosstoobtainapolicereport;and
- Third, complete this form and attach any additional reports, sheets or invoices necessary to provide the required information, and fax the form with
additional material(s) to the ATF U.S. Bomb Data Center (USBDC) at 866-927-4570 or email to USBDC@atf.gov.
8. NameofLocalLawEnforcementOcertoWhomReported
7. Theft or Loss
a. Discovered
c. Occurred
(Show approximate
if exact not known)
d. ReportedtoATFby
Telephone
e. ReportedtoLocal
Authorities
12. Explosive Materials Lost or Stolen (Attach invoices or additional sheets, if necessary)
9. NameandAddressofLocalAuthoritytoWhomReported
Date Time
a. Manufacturer and/or
Importer
e. Quantity
(Pounds of Explosives,
Number of Dets)
f. Type and Description
(Dynamite, Blasting Agents, Detonators,
etc. Include for each type, size, MS delay
or length of legwire, as applicable)
ATF
E-Form 5400.5
RevisedSeptember2014
OMB No. 1140-0026 (01/31/2022 )
U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives
Report of Theft or Loss-Explosive Materials
For ATF Use Only
DateReceived
Date E-Mailed to JSOC & Field Division
BATS ID
Case Number
To Be Completed By Person Making Report
1. Date
2. TypeofReport(Check one):
Theft
Loss
Supplement
3. FullNameofPersonMakingtheReport(Last, First, Middle)
4a. Licensee or Permittee Name
4b. Federal Explosives License or Permit Number
5a.OceAddress(Street Address, City, State, and Zip Code)
5b. Telephone Number
5c. E-mail Address
6. Actual Location of Theft or Loss (If dierent from item 5a)
b. WhenwastheMagazineLast
Checked
10. Telephone Number
11. PoliceReportNumber
b. Brand Name
c. Date Shift
Code
d. Size
(Length& Diameter)
Attempted Theft/Suspicious
Activity
13. Theft or Loss Occurred from (Check applicable box on each row)
Mobile Truck
Mobile Trailer
Overnight Storage
Day Storage
14. Method of Entry:
Door
Wall(s) Roof Floor/Bottom
a. MagazineType:
1
2
2 Det. Box
3 Day Box 4
5
Outdoor
Indoor
Permanent Portable
Other (Explain)
b. Types of Locks (Check all that apply):
Padlock
Mortise
3-Point
Puck Lock
During Operations
c. Location Description/Type:
Licensed/Permitted
Premises
RemoteStorage
WorkSite In Transit
WasaKeyUsed? Yes No
Suspected Employee-Involved
Theft?
Yes No
Lock(s)Defeated?(If yes, check additional appropriate boxes)
Yes No
Lock Pried, Twisted or Levered
Lock Shackle Cut (How?)
Lock Picked or Shimmed
Lock Left Unlocked
Lock Body Drilled Out or Cut
KeywayDrilledOut
Other (Explain)
Manufacturer and Model of Lock: LocationofMagazineKeys:
Oce
Employee
Other (Address)
AreAllKeysAccountedFor?
Yes
No
15. HoodDefeated?(If yes, check all applicable)
HoodRemoved
Hood Broken
Hood Cut
Other (Explain)
Yes No
HoodWidth(Inches)
Hood Length (Inches)
Hood Depth (Inches)
Hood Thickness (Inches)
16. Cicumstances Pertaining to the Theft, Loss or Suspicious Activity (Any details you can provide)
16a.WasTheftorLossDisclosedDuringanATFInspectionorBeingReportedasaResultofInspection?
Yes No
16b.AdditionalSecurityMeasuresinPlace?
Other (Explain)
Alarm Security System/Service
Fencing
Lighting
ATF
E-Form 5400.5
RevisedSeptember2014
17. SignatureandTitleofPersonMakingReport 18. Date
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signature
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Reporting Instructions
Email or fax this completed form to the ATF address listed below or call if no fax is available:
Bureau of Alcohol, Tobacco, Firearms and Explosives
U.S. Bomb Data Center
99 New York Ave., N.E. 8.S-295
Washington, DC 20226
Toll Free Fax: 1-866-927-4570
Email Address: USBDC@atf.gov
Questions regarding the completion of this form should be referred to the U.S. Bomb Data Center toll free at 1-800-461-8841.
Privacy Act Information
The following information is provided pursuant to section 3 of the Privacy Act of 1974 (5 U.S.C. § 522a(e)(3).
1. Authority.SolicitationofthisinformationismadepursuanttoTitleXIoftheOrganizedCrimeControlActof1970(18U.S.C.Chapter40).
Disclosure of a theft or loss of explosive materials is mandatory pursuant to 18 U.S.C. § 842(k) for any person who has knowledge of such theft or
loss from his stock.
2. Purpose. The purpose for the collection of this information is to give ATF notice of the theft or loss of explosive materials, and to furnish ATF with
thepertinentfactssurroundingsuchtheftorloss.Inaddition,theinformationisusedtoconrmandverifypriornoticationofthistheftorlossof
explosive materials.
3. Routine Uses. The information will be used by ATF to aid in the administration of laws within its jurisdiction concerning the regulation of explosive
materials and other related areas. In addition, the information may be disclosed to other Federal, State, foreign, and local law enforcement of laws
withintheirjurisdiction.SystemofrecordsnoticeJustice/ATF-008RegulatoryEnforcementRecordSystemFRVol.68No.16Page3558dated
January 24, 2003.
4. Eects of not supplying information requested. 18 U.S.C. § 842(k) makes it unlawful for any person, who has knowledge of the theft or loss of
explosive materials from his stock, to fail to report such theft or loss within twenty-four hours of discovery thereof, to the Secretary and to appropriate
localauthorities.Thepenaltyforviolationofthissectionisaneofnotmorethan$1,000orimprisonmentfornotmorethanoneyear,orboth.
18 U.S.C. § 844(b).
Paperwork Reduction Act Notice
ThisrequestinaccordancewiththePaperworkReductionActof1995.Thepurposeofthisinformationcollectionistoreportthetheftorlossofexplosive
materials.TheinformationisusedforinvestigativepurposesbyATFocials.Thisinformationismandatorybystatute.(18U.S.C.§842)
The estimated average burden associated with this collection of information is 1 hour and 48 minutes per respondent or recordkeeper, depending on
individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to
ReportsManagementOcer,DocumentServices,BureauofAlcohol,Tobacco,FirearmsandExplosives,Washington,DC20226.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number.
ATF E-Form 5400.5
RevisedSeptember2014
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Report of Theft or Loss-Explosive Materials (Bureau of Alcohol, Tobacco, Firearms, and Explosives)

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Completed 7 August 2020

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