Florida HSMV Form 94010ADA Sworn Statement Crash Report – If you need to obtain an official Florida traffic crash report during the first 60 days after it is filed, you must complete and submit the Florida HSMV Form 94010ADA – Sworn Statement for Crash Report (Accessible). This is the ADA-compliant version of Form HSMV 94010 issued by the Florida Department of Highway Safety and Motor Vehicles (FLHSMV). It allows eligible parties to legally request confidential crash report information while certifying that the report will not be used for commercial solicitation.
What Is Florida HSMV Form 94010ADA?
HSMV Form 94010ADA is the accessible (ADA-compliant) version of the standard Sworn Statement for Crash Report. Florida law makes most crash reports confidential for 60 days after filing under Section 316.066(2), Florida Statutes. During this period, only specific authorized individuals or entities may obtain the report.
The form serves two main purposes:
- It documents the requester’s legal eligibility to receive the crash report within the 60-day confidentiality window.
- It includes a sworn statement (under penalty of perjury) that the information will not be used for commercial solicitation of crash victims or knowingly disclosed to third parties for that purpose.
The ADA version ensures the form is usable by individuals with disabilities and meets accessibility standards while containing the same legal content as the standard Form 94010 (revised March 2023).
Who Is Eligible to Use Form 94010ADA?
Under Florida Statute § 316.066(2)(b), a crash report may be released within 60 days of filing only to the following persons or entities:
- A party involved in the crash (driver, passenger, injured pedestrian, or cyclist)
- The legal representative of a party involved in the crash (attorney with Florida Bar number)
- A licensed insurance agent of a party involved, or an insurer to which a party has applied for coverage
- A person under contract with a qualifying insurer to provide claims or underwriting information
- Victim services programs
- Local, state, or federal agencies, or private entities acting on their behalf
- Prosecuting authorities
- Radio or television stations licensed by the FCC, or newspapers qualified to publish legal notices (under limited circumstances)
Persons who qualify during the 60-day period remain eligible after the confidentiality period expires. After 60 days, crash reports generally become public records, subject to Driver’s Privacy Protection Act (DPPA) requirements.
Key Sections of HSMV Form 94010ADA
The current form (Rev. 03/2023) contains the following main sections:
Requester and Crash Information
- Requester’s full name, address, telephone, fax, email, and date of request
- Crash date, crash report number (if known), location of crash, county, and law enforcement agency case number (FHP or other)
- Names of parties involved
Section One – Sworn Statement for Obtaining Crash Report Within 60 Days
The requester selects the single option that best describes their eligibility and provides any required identifying information (such as Florida Bar number or insurance license number). The requester then signs under penalty of perjury, affirming the information is true and that the report will not be used for commercial solicitation.
Notarization
The form must be sworn to (or affirmed) and subscribed before a notary public. Online notarization is permitted. The notary section records whether the signer was personally known or produced identification, the type of identification, and the notary’s commission details.
Section Two – DPPA Certification (for Requests 60 Days or Later)
When requesting a report 60 or more days after filing, the requester certifies one or more permissible uses under the federal Driver’s Privacy Protection Act (18 U.S.C. § 2721(b)) and agrees to comply with resale and redisclosure restrictions.
A notice on the form warns that knowingly obtaining confidential crash reports without entitlement, or using them in violation of the sworn statement, is a third-degree felony under Florida law.
How to Complete and Submit Florida HSMV Form 94010ADA?
- Download the official form from the Florida Department of Highway Safety and Motor Vehicles website (link below).
- Fill in all required fields accurately. Use black or blue ink if completing by hand, or type the information if using a fillable PDF.
- Select the correct eligibility category in Section One.
- Sign the sworn statement under penalty of perjury.
- Have the form notarized (in person or via online notarization).
- Submit the completed, notarized form along with a valid photo ID (or proof of status) to the law enforcement agency that investigated the crash or to the appropriate FLHSMV Crash Records office. Fees typically apply ($10 per report plus any convenience fees for online or mail requests).
Many local police and sheriff’s departments accept the form in person at their records division. For larger requests or mail submissions, follow the instructions on the FLHSMV Traffic Crash Reports page.
Download Florida HSMV Form 94010ADA (Official PDF)
Download the official, current accessible version of the form directly from the Florida Department of Highway Safety and Motor Vehicles:
Download HSMV Form 94010ADA – Sworn Statement for Crash Report (Accessible) (PDF)
Always use the form hosted on the official flhsmv.gov domain to ensure you have the most recent revision. The standard (non-ADA) version is Form 94010, also available on the FLHSMV forms page.
Important Legal Warnings
- Obtaining a confidential crash report when not entitled to do so is a felony.
- Using confidential information in violation of the sworn statement (including for commercial solicitation) is a third-degree felony punishable under Florida Statutes §§ 775.082, 775.083, or 775.084.
- Each crash report request generally requires its own sworn statement.
- False statements on the form are made under penalty of perjury.
Additional Resources from Official Sources
- FLHSMV Official Forms Page – Complete list of Highway Safety and Motor Vehicles forms, including both 94010 and 94010-ADA.
- Florida Traffic Crash Reports Information – How to request reports online, by mail, or in person.
- Florida Statute § 316.066 – Written Reports of Crashes – Full text of the governing law.
- Florida Crash Portal – Official online portal for purchasing crash reports (subject to the 60-day rule).
Frequently Asked Questions
Is the ADA version different from the regular Form 94010?
The content and legal requirements are the same. The 94010ADA version is formatted for greater accessibility while remaining an official FLHSMV form.
Do I need the form after 60 days?
After the 60-day confidentiality period, most requesters no longer need the sworn statement for eligibility under § 316.066(2)(b), but DPPA certifications and other agency requirements may still apply.
Can the form be notarized online?
Yes. The form explicitly allows online notarization in addition to physical presence.
Where should I submit the completed form?
Submit it to the law enforcement agency that handled the crash or to FLHSMV Crash Records, following the agency’s specific instructions for in-person, mail, or electronic requests.