(09/19)
UNITED STATES CAPITOL POLICE
REPORTS REQUEST FORM
REPORTS PROCESSING SECTION
119 D Street, NE
WASHINGTON, DC 20510
(Please Type or Print Legibly)
Complete as much information as possible *Please note that while requests for information can routinely be
completed 7-10 days from the date of report, in some instances it may take longer.
1. REQUESTOR NAME (Last, First, Middle) 2. DATE OF REQUEST
3. REQUESTOR BUSINESS/ORGANIZATION 4. PHONE NUMBER 5. FAX NUMBER
6. EMAIL ADDRESS (if applicable)
7. CAPITOL FILE NUMBER (CFN) 8. CENTRAL COMPLAINT NUMBER (CCN)
9. TYPE OF REPORT 10. DATE OF REPORT
ACCIDENT OFFENSE INCIDENT
IF CFN OR CCN IS UNKNOWN PLEASE PROVIDE THE FOLLOWING, IF KNOWN, TO ASSIST IN
SEARCHING FOR THIS RECORD
11. NAME OF REPORTING OFFICER 12. PIN NUMBER OF REPORTING OFFICER
13. NAME OF PERSON(S) INVOLVED
14. DATE OF EVENT 15. TIME OF EVENT 16. LOCATION OF EVENT
REPORTS PROCESSING SECTION ONLY
17. NAME OF RPS PROCESSOR
18. INFORMATION
YES NO
19. DATE ACTION
20. ACTION TAKEN
FAXED EMAILED MAILED PICKED UP IN PERSON
NOTIFIED REQUESTOR THAT REQUEST CANNOT BE COMPLETED. REQUESTED
INFORMATION IS NOT PUBLIC INFORMATION AND CANNOT BE RELEASED
