DL 921 is the Notice of Non-Compliance Ignition Interlock, the California Department of Motor Vehicles (DMV) form on which an ignition interlock device (IID) installer reports that a driver has missed service or has tried to bypass, tamper with or remove the device. The form carries an installer certification in Section 6, and the DMV instructions on it are addressed to the installer. On FillingPDF you can fill out the form online and download or print the completed PDF; the DMV receives it only by mail or fax, as described below.
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What is DL 921?
Form DL 921, Notice of Non-Compliance Ignition Interlock, is the California DMV form an ignition interlock device (IID) installer uses to report to the DMV that a driver with an IID has not complied with the device's service requirements or has tampered with it.
The form has six sections: driver information, manufacturer and installer information, device information, vehicle information, the non-compliance details and an installer-only certification. Section 5 records the type of non-compliance and its dates. The DMV instructions printed on the back state that all non-compliance must be reported. They list bypass, tampering, a removal attempt, three or more missed appointments and failure to service the device within a sixty-day interval.
The DMV instructions warn that non-compliance by a driver may result in suspension or revocation of the driving privilege, and/or a pause in the IID restriction term. The form does not decide any of that: it is the installer's report. The DMV Mandatory Actions Unit is the office the form is sent to, and the DMV phone number printed on the form answers questions about what counts as non-compliance.
Installers must check on the form whether they are licensed through the Bureau of Automotive Repair (BAR) or the Bureau of Household Goods and Services (BHGS) and give the license number.
Who needs to file DL 921?
The installer of the ignition interlock device completes and sends Form DL 921. The instructions on the form are headed "Instructions to Installer," and Section 6 is marked "Installer Use Only" with a certification under penalty of perjury under the laws of the State of California.
The installer reports one of these situations, all of which the DMV says must be reported:
- bypass of the device;
- tampering with the device;
- an attempt to remove the device;
- three or more missed appointments;
- failure to service the device within a sixty-day interval.
Section 1 identifies the driver, so the driver's name, license number, addresses and telephone numbers must be known to the installer. Sections 2 to 4 identify the manufacturer, the installer, the device and the vehicle.
The form tells the installer to provide a copy to the driver, installer, manufacturer or manufacturer's agent. A driver who has an IID is the person the notice is about; the form does not give the driver a section to complete.
When to file DL 921
Mail Form DL 921 to the DMV within three working days after the non-compliance is noted. The form's instructions give that deadline to the installer, and they allow a faxed copy as well.
The triggering event is any reportable non-compliance: bypass, tampering, a removal attempt, three or more missed appointments, or failure to service the device within a sixty-day interval. The DMV instructions say that all such non-compliance must be reported, not only some of it.
For a failure to service, Section 5 asks for the date of the customer's last appointment and the current date. For repeated missed appointments, the instructions say to enter the date of the third missed appointment. For bypass, tampering or removal attempts, you enter the date recorded by the device's data recorder. If the tampering was noticed during a vehicle check but was not recorded, use the date you saw the evidence.
Documents you need
- A printout of the non-compliance incidents recorded by the ignition interlock device, only when you report non-compliance based on information recorded on the device. Attach it to your copy of the form and keep it for your records.
- Your Bureau of Automotive Repair (BAR) or Bureau of Household Goods and Services (BHGS) license number, entered in Section 2 with the matching box checked.
How to fill out DL 921
Enter the driver license number
At the top of the form, write the driver's license number in the box marked DRIVER LICENSE NUMBER.
Complete Section 1, Driver Information
Enter the driver's name (first, middle, last) and any suffix, the mailing address, the residence address if it differs, the birth date and the home and work telephone numbers.
Complete Section 2, Manufacturer/Installer
Enter the device manufacturer, the installer name and address, and the installer's license number. Check the box for BAR or BHGS and give the matching number.
Complete Section 3, Device Information
Enter the device name, the model or serial number and the date of installation of the device that was in non-compliance.
Complete Section 4, Vehicle Information
Enter the vehicle make, year, license plate number and vehicle identification number of the vehicle that had the device.
Report a missed service in Section 5
If the driver failed to service the device within 60 days, check that box and enter the date of the last appointment and the current date. For repeated missed appointments, enter the date of the third missed appointment.
Report bypass, tampering or removal
Under the evidence list, enter the date next to each that applies: attempt(s) to bypass, tampering or attempt(s) to remove. Use the data recorder's dates, or the date you saw the evidence if it was not recorded.
Complete Section 6, Installer Use Only
Enter the installer's printed name and daytime telephone number, sign, and enter the date sent to DMV and the date signed. The signature certifies the information under penalty of perjury.
Review, download and keep copies
Check every section, then download or print the completed PDF from FillingPDF. Keep a copy with any device printout, give copies as the instructions direct and send the form as described under How to submit.
How to submit DL 921
The installer sends Form DL 921 to the DMV by mail or by fax, within three working days after non-compliance is noted.
- By mail: Department of Motor Vehicles, Mandatory Actions Unit, M/S J233, PO Box 942890, Sacramento, CA 94290-0001.
- By fax: a copy of the form may be faxed to (916) 657-8513.
Give a copy of the form to the driver, installer, manufacturer or manufacturer's agent, as the instructions direct. When the report is based on information recorded on the device, print out the recorded non-compliance incidents, attach the printout to your copy of the form and keep it for your records; the instructions say these documents could be subpoenaed in a court case and the DMV could request copies.
Questions about completing the form, including what constitutes non-compliance, go to the DMV at (916) 657-6525. The form states no fee. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Mailing the form to the DMV later than three working days after the non-compliance was noted.
- Leaving unchecked the box that shows whether you are licensed through the Bureau of Automotive Repair (BAR) or the Bureau of Household Goods and Services (BHGS).
- Entering the date you completed the form instead of the date the bypass, tampering or removal attempt was recorded by the data recorder.
- Using the recorder date for tampering you noticed during a vehicle check that was not recorded; the instructions say to use the date you saw the evidence.
- Reporting three or more missed appointments without entering the date of the third missed appointment.
- Checking the sixty-day box without giving the date of the customer's last appointment and the current date in Section 5.
- Not printing the recorded non-compliance incidents from the device and keeping them with your copy of the form.
- Not giving a copy of the form to the driver, installer, manufacturer or manufacturer's agent.
Frequently asked questions
What is DL 921?
DL 921 is the California DMV Notice of Non-Compliance Ignition Interlock. An ignition interlock device installer completes it to report a driver's bypass, tampering, removal attempt, three or more missed appointments, or failure to service the device within a sixty-day interval.
Who fills out the DL 921 form?
The installer. The instructions on the form are addressed to the installer, and Section 6 is marked Installer Use Only with a certification under penalty of perjury. The form identifies the driver in Section 1 but gives the driver nothing to complete.
How long does the installer have to send DL 921 to the DMV?
Within three working days after the non-compliance is noted. The instructions say the form must be mailed to the DMV within that time, and that a copy may also be faxed to (916) 657-8513.
Where do I mail the DL 921?
Mail it to Department of Motor Vehicles, Mandatory Actions Unit, M/S J233, PO Box 942890, Sacramento, CA 94290-0001. You may also fax a copy to (916) 657-8513. Questions about completing the form go to (916) 657-6525.
What counts as non-compliance on DL 921?
The DMV instructions list bypass, tampering, a removal attempt, three or more missed appointments, and failure to service the device within a sixty-day interval. All of these must be reported. For other questions, call the DMV at (916) 657-6525.
What happens to the driver after a DL 921 is filed?
The DMV instructions say non-compliance by a driver may result in suspension or revocation of the driving privilege, and/or a pause in the IID restriction term. The form itself is only the installer's report to the DMV.
Do I need to keep anything with the DL 921?
Yes, when the report is based on information recorded on the device. Print the recorded non-compliance incidents, attach the printout to your copy of the form and keep it; the instructions say these documents could be subpoenaed and the DMV could request copies.
Can I fill out DL 921 online on FillingPDF?
Yes. You can fill out the fillable PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not send the form to the DMV; you mail or fax it yourself.
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