Accident Report (SR 1-21) – Arkansas

Accident Report (SR 1-21) is the Arkansas DFA form, headed Arkansas Motor Vehicle Accident Report (SR-1), for reporting a motor vehicle accident involving bodily injury, death or property damage above the amount printed on it.

The Arkansas Department of Finance and Administration (DFA) issues it, and the form carries the heading of its Safety Responsibility Section, which lists a P.O. box, a phone number and a fax number for the section. The SR-1 part collects the driver and owner of your vehicle, the vehicle itself, where and when the accident happened, the cost of repairing each vehicle or property, a description of the accident, the names of anyone injured or killed in your vehicle, and the driver, owner and vehicle of the other party. The driver then certifies that the information is true and correct to the best of their knowledge and belief.

The second part of the same sheet is the Verification of Liability Insurance (SR-21). It identifies the vehicle, owner and operator, names the insurance company and agent, states whether limited liability insurance was in place at the time of the accident, whether the liability limits equal or exceed Arkansas requirements, whether the coverage applies to the owner or the operator, and carries the SR case number and the date of the accident. An authorized representative signs it.

The form does not state any other purpose, and it prints no revision date.

The form is written for people involved in a motor vehicle accident that resulted in bodily injury to or the death of any one person, or in damage to the property of any one person above the amount printed at the top of the form. The SR-1 is completed from the point of view of one driver: it has one block for "your vehicle" and one for the "other vehicle", so the person filling it out reports their own driver, owner and vehicle details first and then the other party's.

Groups that appear on the form:

• The driver of your vehicle, who gives name, driver's license number and state, and address, and signs and dates the certification.
• The owner of your vehicle, when different from the driver, whose name and address are entered separately.
• The liability insurance side, for the SR-21 section: the form asks for the insurance company, the agent, the policy number and the signature of an authorized representative.

The form does not describe who may sign for someone else, and it does not list accidents that are exempt. If you are unsure whether your accident meets the damage or injury threshold, call the Safety Responsibility Section at (501) 682-7100.

The triggering event is a motor vehicle accident that results in bodily injury to or the death of any one person, or in damage to the property of any one person above the amount printed on the form. The form prints a filing period counted in days from the date of the accident next to the Safety Responsibility Section address; read the exact number on the PDF or confirm it with the section at (501) 682-7100 before you rely on a date.

The SR-21 Verification of Liability Insurance is printed on the same form as the SR-1, and no separate due date is printed for it. It asks for the SR case number and the date of the accident, so have both ready when you complete it.

The form is returned to the Safety Responsibility Section of the Arkansas Department of Finance and Administration, using the contact details printed at the top of the PDF.

• By mail: use the address printed on the form: P.O. Box 1272, Rm. 1120, Little Rock, AR 72203.
• By fax or phone contact: the form also prints a fax number, (501) 682-2100, and a phone number, (501) 682-7100. Call the section to confirm whether it accepts a faxed report before you send one.

Send the completed and signed SR-1, the completed SR-21 section, and any extra pages on which you continued the description of the accident. The form names no fee and no online portal. FillingPDF lets you fill out and download the PDF; submission follows the channels above.