A victim of crime compensation form is the application you file with your state’s compensation program to get reimbursed for medical bills, counseling, lost wages, funeral costs, and other out-of-pocket expenses caused by a violent crime. To complete it successfully, gather your police report information, itemized bills, insurance details, and wage documentation before you open the form; fill in every required field exactly as those documents read; attach supporting records for each expense you claim; and submit it to your state’s compensation board or Attorney General’s office within the state’s filing window.
What to Gather Before You Open the Form
Most applications get sent back for the same reason: missing information. Pulling your paperwork together first prevents that.
- Police report details, including the report number, the name of the investigating law enforcement agency, the date the crime was reported, and the date of the incident. If you don’t have a copy, request one from the responding agency.
- Full legal names and contact information for the victim and, if different, the person filing. Have a Social Security number available; some states ask for one.
- Insurance information — health, auto, or homeowners — including policy numbers and carrier names. Compensation programs are payers of last resort, so the form will ask what your insurance covered.
- Itemized medical bills from hospitals, physicians, dentists, therapists, or pharmacies. Many programs accept standard billing formats such as the CMS-1500, UB-04, or a detailed superbill showing the provider, dates of service, procedure codes, and billed amounts.
- A letter from your employer confirming your job title, pay rate, and the dates you missed work because of the crime, your injuries, or court proceedings. Recent pay stubs help verify the wage amount.
- Itemized funeral or cremation invoices if the crime caused a death.
Organize these by category — medical, mental health, wages, funeral — because the form asks you to break out expenses the same way.
Where to Find Your State’s Form
Each state runs its own program with its own application, so you need the right one. The National Association of Crime Victim Compensation Boards keeps a directory that links to every state program.1National Association of Crime Victim Compensation Boards. State Program Information You can also find the form on your state Attorney General’s website or the compensation board’s site. Many programs offer a secure online portal; if you can’t apply online, most publish a downloadable PDF you can print, complete by hand, and mail or fax.
File in the state where the crime occurred, even if you live somewhere else.2National Association of Crime Victim Compensation Boards. National Association of Crime Victim Compensation Boards Federal law requires state programs to compensate nonresidents using the same criteria they apply to residents.3Office of the Law Revision Counsel. 34 USC 20102 – Crime Victim Compensation Immigration status cannot be used to deny a claim.4Federal Register. Victims of Crime Act (VOCA) Victim Compensation Grant Program
Filling Out Each Section
Law Enforcement Information
The opening section asks for the investigating agency, the police report number, and the incident date. Enter these exactly as they appear on the police report. Mismatched case numbers or dates are one of the most common reasons applications are returned.
Most programs require the crime to have been reported to law enforcement, and many states set a specific window — some as short as 72 hours. Federal law allows exceptions when cooperation could be affected by the victim’s age, physical condition, psychological state, cultural or linguistic barriers, or safety concerns.3Office of the Law Revision Counsel. 34 USC 20102 – Crime Victim Compensation If one of those applies, note it on the form where asked.
Victim and Claimant Information
This section identifies the victim and, if someone else is filing, the claimant. When the victim is a minor, incapacitated, or deceased, a parent, guardian, spouse, or other authorized person can file. Clearly identify your relationship, because the agency needs to know who is legally authorized to receive payments. Complete every required field. Blank mandatory fields trigger an administrative return no matter how strong the rest of the application is.
Insurance and Other Payment Sources
Disclose every insurance policy that might cover the same expenses: health, auto, homeowners, workers’ compensation. Attach any Explanation of Benefits (EOB) statements showing what the insurer paid and what it refused. Be thorough. If the agency discovers unreported coverage later, it can delay or reduce your award.
Expenses
List each cost by category and attach a receipt or bill for every line. The categories federal law requires every state to cover are medical expenses from a physical injury, mental health counseling, lost wages tied to that injury, and funeral costs when the crime caused a death.3Office of the Law Revision Counsel. 34 USC 20102 – Crime Victim Compensation Many states add dental and rehabilitative care, counseling for the victim’s close family members, crime scene cleanup, and relocation costs for safety reasons.
Every state caps what it will pay. Total maximum awards commonly fall somewhere between $25,000 and $75,000, though this varies significantly. Funeral and burial expenses typically carry their own separate cap, often between $6,000 and $12,000 depending on the state. Match every dollar figure on the form to the receipt or invoice behind it, and review the completed form once through before signing to confirm the insurance details align with the expense totals.
Submitting the Application
Online portals let you upload the completed form along with scanned bills, and they typically generate an immediate confirmation number. If you mail a paper application, send it by certified mail or with delivery confirmation so you have proof of receipt. Paper applications can take several weeks to be logged into the system.
Once the agency receives your application, it assigns a claim number. Keep that number somewhere accessible. You’ll need it every time you call, email, or check your claim status.
Filing Deadlines
Every state sets its own filing deadline. Some require applications within one year of the crime; others allow three, five, or seven. Most programs grant extensions for good cause, and many waive the deadline entirely for child victims until several years after they turn 18. If a delayed DNA match from a sexual assault forensic exam later identifies the crime, federal law requires states to waive the filing deadline.3Office of the Law Revision Counsel. 34 USC 20102 – Crime Victim Compensation File as soon as you’re able; letting months pass makes both the paperwork and the eligibility determination harder.
After You File
The agency reviews your application, verifies the crime with law enforcement, and compares your documented expenses against any insurance or other payments. Initial review commonly runs around 90 days, though the timeline varies by state and by claim complexity. During the review the agency may ask for updated bills, additional proof of lost wages, or clarification on insurance. Respond within the timeframe stated in the notice. Failing to respond can get your claim closed.
Some states offer emergency or interim awards for victims facing immediate financial hardship. If you can’t wait for the standard timeline, contact your state program directly and ask whether expedited or partial payments are available.
When the review is complete, you’ll get a written decision with the approved amounts or the reason for denial. Approved payments go either directly to the provider or to you as a reimbursement, depending on the state and the type of expense.
Common Reasons Claims Get Denied
- Missing your state’s filing deadline without requesting an extension or showing good cause.
- No police report, or an inability to provide a report number.
- Required fields left blank, missing signatures, or supporting documentation not attached.
- Contributory conduct. If the state finds you were engaged in criminal activity that contributed to your own injury, your award can be reduced or denied. Federal guidelines allow this only in exceptional cases, and states must publish a written policy explaining the standard and the appeal process.4Federal Register. Victims of Crime Act (VOCA) Victim Compensation Grant Program
- Refusing to cooperate with the investigation or prosecution without a qualifying reason such as safety concerns or psychological barriers.
- Insurance, restitution, or a civil settlement has already paid the full amount of the claimed expense. The compensation program will not duplicate those payments.
Federal guidelines prohibit states from denying compensation based solely on a victim’s criminal history, incarceration status, or prior convictions.4Federal Register. Victims of Crime Act (VOCA) Victim Compensation Grant Program A denial on one of those grounds alone is grounds to challenge.
Appealing a Denial
Every state compensation program provides an appeal process, and the denial letter will spell out how to request reconsideration. Appeal deadlines are strict, often 30 days from the date of the decision, though the exact window depends on the state. Read the denial letter as soon as it arrives.
Most appeals start with an internal reconsideration by the agency, where a different reviewer looks at the same evidence or any new documentation you submit. If that reconsideration upholds the denial, the next step is usually a formal hearing before an independent panel or administrative law judge. Some states offer a final level of judicial review in state court. Submit every appeal in writing, signed and dated, and keep copies of everything you send.
If You Receive Other Compensation Later
If a civil lawsuit settlement, a court judgment, or offender restitution later pays for expenses the program already covered, you will likely need to repay the program for the overlap. This is called subrogation, and most states require it.
Notify the compensation program before finalizing any settlement. Programs usually deduct reasonable attorney fees and legal costs from the repayment calculation, and payments for non-economic damages like pain and suffering generally aren’t subject to repayment because the program never covered those categories in the first place. If a settlement doesn’t break out economic and non-economic damages separately, some programs treat the whole amount as economic damages subject to repayment. Make sure your settlement agreement specifies what each portion covers.
Taxes
Payments from a state crime victim compensation fund aren’t taxable federal income. The IRS treats these awards as welfare-type payments excluded from gross income, so you don’t report them on your federal return.5Internal Revenue Service. Publication 525 – Taxable and Nontaxable Income Check your state’s income tax rules as well; most follow the federal treatment. Keep your award letter and payment records in case you ever need to document the source of the funds.