Generally, employees and beneficiaries of agencies or organizations that receive federal funding are protected by civil rights laws. These laws prohibit certain types of discrimination in employment practices and in delivery of services. Please list the contact information of the person responsible for civil rights compliance within your organization.
This form authorizes the release of information to the Georgia Crime Victims Compensation Program (CVCP) from any hospital, physician, medical facility, insurer or any other person that has knowledge relative to a CVCP claim. This information is used for the purpose of making an eligibility determination and the CVCP will preserve the confidentiality of all records received.