This report should be submitted immediately upon completion,
DO NOT wait for the end of the month to forward.
UCR-BI1 (Rev. 04/20)
STATE OF NEW JERSEY • DEPARTMENT OF LAW & PUBLIC SAFETY
Supplementary Bias Incident Offense Report
• All information shall be entered into the UCR System within 24 HOURS of the Reporting Time.
• DO NOT: Email, Fax, or Mail a paper copy of this form to the New Jersey State Police, County Prosecutor, or New Jersey
Division of Criminal Justice, unless otherwise directed by County Prosecutor.
1. Case Number
Original
Update
26. Location of Occurrence (Check One)
27. Relationship of Victim to Offender
1. Acquaintance
2. Neighbor 5. Unknown3. Employee
4. Stranger
24. Sexual Orientation (Check One) ANTI-
41 = Gay (Male)
42 = Lesbian 45 = Bisexual
43 = Lesbian, Gay, Bisexual, or Transgender (Mixed Group)
44 = Heterosexual
12. Victim's Race (Check One)
11. Type of Incident (Check One)
3. Mun. Code
8. Incident Target (Check One) 9. Organized Group (Check One)
NJ 00
2. Municipality 6. Code5. State Police Station (NJSP Use Only)
7. Date of Bias Incident
4. ORI Number
Yes No
Unk.
10. Gang (Check One) If Yes, complete a
Gang Form
(S.P. 153)
Yes No
Unk.
VICTIM/OFFENDER INFORMATION:
COMPLETE ONE FORM FOR EACH VICTIM.
13. Victim's Age
16. Offender's Age
Individual Business
Financial Inst.
Other (Specify in Remarks)
Government
Religious Org.
Unknown
Swastika
Cross Burning
In-Person
Personal Injury
Property Damage
Graffiti
Letters
Telephone
Other (Specify in Remarks)
14. Victim's Sex (Check One)
M F
Unk.
W = White
B = Black/African American
I = American Indian/Alaska Native
U = Unk.
A = Asian
P = Native Hawaiian/Other Pacific Islander
M = Group of Multiple Races
15. Offender's Race (Check One)
W = White
B = Black/African American
I = American Indian/Alaska Native
U = Unknown
A = Asian
P = Native Hawaiian/Other Pacific Islander
M = Group of Multiple Races
17. Offender's Sex (Check One)
Male Female Unknown
18. Offender's Ethnicity (Check One)
Hispanic Non-Hispanic Unknown
BIAS MOTIVATION: Select up to Five Bias Motivations per Offense.
INCIDENT DETAILS:
28. Total # Victims 29. Total # Offenders
30. Disposition
*
If Arrested or Exceptional Clearance is selected, you must enter information in Fields 15-18.
Adult Juvenile Arrested*
Exceptional Clearance*
Unfounded
31. Est. Damaged Prop. Value
37. Reviewed By36. Date CompletedBadge Number35 Prepared by (Print Rank/Name)
34. Telephone and Extension33. Department Reporting
32. Remarks. List additional offender(s). Brief Synopsis of Incident is Required
19. Race/Ethnicity/Ancestry (Check One) ANTI-
11 = White
12 = Black/African American
13 = Amer. Indian/Alaska Native
32 = Hispanic/Latino
14 = Asian
16 = Nat. Hawaiian/Other Pacific Isldr.
15 = Multiple Races, Group
31 = Arab 33 = Other Race/Ethnicity/Ancestry
20. Religion (Check One) ANTI-
21 = Jewish
22 = Catholic
24 = Islamic (Muslim)
83 = Buddhist
25 = Other Religion
28 = Mormon
27 = Atheism/Agnosticism
29 = Jehovah's Witness 84 = Hindu
82 = Other Christian
23 = Protestant 26 = Multiple Religions, Group 81 = Eastern Orthodox (Russian, Greek, Other) 85 = Sikh
22. Disability (Check One) ANTI-
51 = Physical Disability
52 = Mental Disability
23. Gender (Check One) ANTI-
61 = Male
62 = Female
21. Gender Nonconforming (Check One) ANTI-
71 = Transgender
72 = Gender Nonconforming
25. Type of Bias Crime Committed (Check One)
Murder
Manslaughter
Burglary
Trespass
Larceny-Theft
Destruction/Damage/Vandalism
Intimidation
Human Trafficking, Commercial Sex Acts
Disorderly Conduct
Terroristic Threats
Rape
Motor Vehicle Theft
Human Trafficking, Involuntary Servitude
Harassment
All Other Bias Incidents
Sex Offense (Except Rape)
Simple AssaultAggravated Assault
Desecration of Venerated Objects
Fear of Bodily Violence
Arson
Robbery
Weapon Offense, Illegal Activity
01 Air/Bus/Train Terminal
02 Bank/Savings & Loan
09 Drug Store/Dr's. Office/Hospital
44 Daycare Facility
10 Field/Woods
20 Residence/Home
19 Rental Storage Facility
21 Restaurant
45 Dock/Wharf/Freight/Modal Terminal
42 Camp/Campground
03 Bar/Nightclub
11 Government/Public Building
23 Service/Gas Station
46 Farm Facility
41 Auto Dealer New/Used
13 Highway/Rd./Alley/Street
05 Commercial/Office Bldg.
47 Gambling Facility/Casino
24 Specialty Store (TV, Fur, etc.)
12 Grocery/Supermarket
04 Church/Synagogue/Temple
25 Other/Unknown
54 Shelter - Mission/Homeless
08 Department/Discount Store
07 Convenience Store
06 Construction Site
14 Hotel/Motel
15 Jail/Prison
16 Lake/Waterway
55 Shopping Mall
56 Tribal Lands
39 Arena/Stadium/Fairgrounds/Coliseum
38 Amusement Park
37 Abandoned/Condemned Structure 48 Industrial Site
49 Military Installation
57 Community Center
40 ATM Separate from Bank
50 Park/Playground
51 Rest Area
52 School - College/University
53 School - Elementary/Secondary
17 Liquor Store
18 Parking Lot/Garage
25C Cemetery
25B Motor Vehicle
