Forms

Appeal Request


Billing Tab Guide for the Victims Comp Portal


Civil Rights Requirements


Claims Investigator Contact Roster


CPT CODE/Description of Services Reference Sheet


Crime Victims Compensation Application


Crime Victims Compensation Application in Spanish


Deceased Victims Employment Verification Form


District Attorney Access Form


DUI Memorial Sign Application


DUI Memorial Sign Application (Fillable)


Employment Verification Form for Loss of Support


Employment Verification Form for Lost Wages


FI/FME Victims Compensation Division Designee Form


FME CPT Code Reference Sheet


FME Fee Schedule


FME Itemized Bill Example


Forensic Interview Application for Payment


Forensic Interview DFCS Verification Form


Forensic Interview Itemized Bill Example


Forensic Interview Law Enforcement Verification Form


Forensic Interview Referral Document – FIRD


Forensic Interview Referral Document – FIRD (Fillable)


Forensic Interviewer Funding Certification Document


Forensic Interviewer Funding Certification Document (Fillable)


Forensic Medical Examination Application for Child Advocacy/Rape Crisis/Sexual Assault Centers


Forensic Medical Examination Application for Hospital/Medical Centers


Forensic Medical Examination DFCS Verification Form


Forensic Medical Examination Fee Schedule


Forensic Medical Examination Law Enforcement Verification Form


Forensic Medical Examination Law Enforcement Verification Form (Fillable)


Human Trafficking Reimbursement Form


Itemized Bill Example


Medical Release Form


Minor Beneficiary Form


Minor Beneficiary Form in Spanish


Prosecuting Attorney’s Questionnaire


Serious Mental and Emotional Trauma (SMET) Form


Supplier Change Request Form


Taxpayer Identification Number and Certification Form (W-9)


Unclaimed Restitution Application for Business


Unclaimed Restitution Application for Business (Fillable)


Unclaimed Restitution Application for Individual Victim


Unclaimed Restitution Application for Individual Victim (Fillable)


Victims Bill of Rights


Victims Bill of Rights in Spanish


Victims Comp Portal Offender/Restitution Feature


Victims Comp Portal Rack Card


Victims Comp Portal Resource Guide


Work Release Form