Victims Compensation Forms

Claims Investigator Roster Rev 8.31.21

DUI Memorial Sign Application

Forensic Interview Application for Payment

Forensic Interviewer Funding Certification Document

Forensic Interview Referral Document - FIRD

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

Forensic Medical Examination Application for Hospital/Medical Centers

FME Fee Schedule

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.

Minor Beneficiary Form

Minor Beneficiary Form in Spanish

This form should be completed by a licensed mental health professional to verify a victim suffered serious mental or emotional trauma relating to a crime that did not result in a physical injury.

Taxpayer Identification Number and Certification Form (W-9)

Unclaimed Restitution Application for Business

Unclaimed Restitution Application for Individual Victim

Victims Compensation Application

Victims Compensation Application in Spanish

Victims Comp Portal Resource Guide

Victims Comp Portal Restitution Resource Guide

Providers and Claimants should only fill out sections one and two of this form for ACH/Direct Deposit.

Work Release Form