How to Fill Out and Submit a Victim Restitution Request Form

A victim restitution request form, usually called a victim loss affidavit, is the sworn document you submit to the court to list the financial losses a crime caused you so the judge can order the defendant to reimburse them at sentencing. Federal law requires the probation officer assigned to the case to give you the affidavit and notify you of your chance to submit loss information.¹ Fill it out accurately, attach documentation for every dollar, and get it in well before sentencing. Miss the window and your losses may never make it into the order.

Who Gives You the Form

In federal cases, the U.S. Probation Office handles restitution paperwork as part of the presentence investigation. The probation officer assigned to the defendant’s case is required by statute to provide you with the affidavit and explain how to submit it.¹ In some jurisdictions, the victim-witness coordinator in the prosecutor’s office sends the form instead.

If sentencing is approaching and no one has contacted you, call the U.S. Probation Office in the district where the case was prosecuted, or reach out to the prosecutor’s victim-witness liaison. Don’t wait for the form to arrive on its own.

Losses You Can List

Federal restitution is strictly compensatory. It covers money you spent or income you lost, documented with records. It does not cover pain and suffering, emotional distress, state or federal taxes, interest, fines or penalties, private attorney fees, tax advisors, or the cost of pursuing a civil lawsuit.² If you want those categories, you would need to file a separate civil case.

Within those limits, the statute requires the court to order reimbursement for:

Medical, psychiatric, psychological, physical and occupational therapy, rehabilitation, prescription medications, and medical devices.
Property that was damaged, destroyed, or stolen and not recovered. For stolen property, you can claim the greater of its value on the date of the crime or on the date of sentencing, minus any salvage value.
Wages or income lost because of injuries the crime caused.
Funeral and burial costs if the crime resulted in a death.
Lost income, childcare, and transportation incurred while attending court proceedings, cooperating with investigators, or transporting a family member for related medical care.

Each category must be supported by documentation the probation officer can verify.³

Documents to Gather Before You Start

The probation officer matches every line item on the form against supporting records. Unsupported numbers get flagged or removed. Pull everything together first.

Medical Expenses

Request itemized billing statements from every provider that treated crime-related injuries: hospitals, clinics, therapists, pharmacies, and equipment suppliers. Insurance explanation-of-benefits statements show what the insurer covered and what you paid out of pocket, which is what the restitution order should reflect. If treatment is ongoing, ask your doctor for a written prognosis and projected cost estimate; courts can order restitution for necessary future medical care when documentation supports it.

Property Damage or Theft

For stolen items not recovered, establish fair market value using comparable sales listings, original purchase receipts, or professional appraisals. For damaged property, get written repair estimates from licensed contractors or mechanics and photograph the damage. Because the statute entitles you to the greater of the value on the date of the crime or on the date of sentencing, update your valuations if prices have shifted.³

Lost Wages

Ask your employer for a letter on company letterhead stating your pay rate, the specific dates you missed, and the total income lost. Pay stubs from before and after the crime corroborate the figure. If you are self-employed, use prior-year tax returns and bank statements showing a drop in deposits. Include lost income from days spent attending hearings or cooperating with investigators; the statute specifically covers that time.³

Travel and Childcare

Keep receipts for mileage, gas, parking, public transit fares, and childcare costs incurred while traveling to court proceedings, investigator meetings, or related medical appointments. Victims regularly lose this money by not tracking it.

Filling Out the Affidavit

The top of the form asks for your legal name, current address, and contact information. The court uses this address to direct restitution payments, so give an address where you reliably receive mail. If disclosing your address to the defendant raises safety concerns, ask the victim-witness coordinator about filing under a protected address.

The main section is an itemized list of your losses by category. Keep medical expenses, property losses, lost income, and participation costs in separate groups. Enter exact dollar amounts that match your records; rounded or estimated figures invite scrutiny and slow the review. Behind each section, attach the corresponding receipts, invoices, estimates, and letters. If what you wrote on the form doesn’t line up with what the documents show, the probation officer will come back with questions.

The form is an affidavit, so you sign it under penalty of perjury affirming that the information is true and correct. Some jurisdictions require a notary; others accept an unsworn declaration without one. Confirm the requirement with the probation officer or victim-witness coordinator before you sign.

Where and When to Submit

Send the completed affidavit and all supporting documents to the U.S. Probation Office handling the case, or to the prosecutor’s office if that’s where you were directed. The probation officer needs your submission in time to fold it into the presentence investigation report the judge reads before sentencing.¹

Federal law requires the prosecutor to provide loss information to the probation officer no later than 60 days before the initial sentencing date. Your submission should land well before that deadline so the officer has time to verify your figures. If sentencing is near and the affidavit hasn’t reached you, call the probation office right away. Missing the window can mean your losses aren’t in the initial order.

If your total losses are still being calculated at sentencing because treatment is ongoing or bills haven’t finished arriving, the court can set a final determination date up to 90 days after sentencing to lock in the amount. If you discover additional losses after the order is entered, you have 60 days from the discovery to petition for an amended order, and you’ll need to show good cause for why those losses weren’t included originally.¹

What Happens After You Submit

The probation officer reviews the affidavit and documents to confirm each expense is tied to the defendant’s criminal conduct. Expect a call or email if anything is unclear or if additional proof would help a specific line item. The officer then summarizes your verified losses, along with a recommended total, in the presentence investigation report.¹

At the sentencing hearing, the judge issues the restitution order based on that verified information. The defendant can dispute the amounts, which may trigger a separate hearing where you could need to testify or produce more documentation. Once entered, the order is a binding legal judgment, enforceable with the same tools as any civil money judgment. You also have the right under the Crime Victims’ Rights Act to speak at the sentencing hearing.⁴

If There Is More Than One Defendant

When multiple defendants contributed to your losses, the court can make all of them jointly and severally liable for the full amount, meaning you can collect from any one of them until the balance is paid. The judge can also apportion liability so each defendant owes only an assigned share based on their involvement and finances. The practical difference matters for collection: if one co-defendant has no assets under an apportioned order, you may never see that share.¹

When Restitution Won’t Pay the Bills

A restitution order depends on the defendant actually paying, and many defendants cannot, especially while incarcerated. Every state operates a victim compensation fund that can reimburse crime-related expenses independently of the defendant’s finances, typically covering medical costs, mental health treatment, lost wages, and funeral expenses. Maximum benefits vary by state but average around $25,000. Filing a compensation claim doesn’t block a restitution award, though you generally can’t be paid twice for the same expense. Your state’s victim compensation board, or the prosecutor’s victim-witness coordinator, can provide the application.

1
Office of the Law Revision Counsel. 18 USC 3664 – Procedure for Issuance and Enforcement of Order of Restitution
2
Department of Justice. Restitution Process
3
Office of the Law Revision Counsel. 18 USC 3663A – Mandatory Restitution to Victims of Certain Crimes
4
Office of the Law Revision Counsel. 18 USC 3771 – Crime Victims Rights