Victims Compensation Forms

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.

Appeal Request Form

Application for Trafficking Victims with Court-Ordered Reimbursement of Fines and Fees

Claims Investigator Contact Roster updated 3.14.22

District Attorney Release Form

DUI Memorial Sign Application

Forensic Interview Application for Payment

Forensic Interview DFCS Verification Form

Forensic Interviewer Funding Certification Document

Forensic Interview Law Enforcement Verification Form

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

Forensic Medical Examination LE DFCS Verification Form for Minors and Developmentally Disabled Adults Form

Georgia Victims Bill of Rights

Georgia Victims Bill of Rights in Spanish

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

Updated Payment in Full Provider Agreement Form

Taxpayer Identification Number and Certification Form (W-9)

Taxpayer Identification Number and Certification Form (W-9) in Spanish

Unclaimed Restitution Application for Business

Unclaimed Restitution Application for Individual Victim

Vendor Management Form

Victims Compensation Application

Victims Compensation Application in Spanish

Victims Compensation Flyer

Victims Comp Portal Resource Guide

Victims Comp Portal Restitution Resource Guide

Victims Comp Portal Service Provider Resource Guide

Victims Comp Portal Victim Resource Guide

Work Release Form