Victims of Crime Program Forms

Overview

The VOCP has developed a series of forms to assist the victim, or a vendor or service provider, file a claim with the VOCP. Use of the appropriate form will help expedite processing and payment of the claim or bill. All forms are in PDF format and can be downloaded by clicking on the form name:

VOCP Information and Application

• Information for Victims of Violent Crime - English
• Information for Victims of Violent Crime - en espanol
• Application - English
• Application - en espanol

Police Report Verification

• Police Report Verification (for use by Law Enforcement only)
• Police Report Verification - DUI (for use by Law Enforcement only)

Authorization for Employer to Release Information

• English - Authorization for Employer to Release Information
• en espanol - Authorization for Employer to Release Information

Patient Release for Medical Information

• English - Patient Release for Medical Information
• en espanol - Patient Release for Medical Information

Other Forms

• Doctor’s Certificate of Crime Related Disability (to be completed by Physician only)
• Employers Verification of Employment (to be completed by Employer only)
• IRS Form W-9
• Request for Pre-Authorization for Payment

Appeal Information

• English - Appeal Information
• en espanol - Appeal Information