The following forms can be viewed and printed using Adobe Acrobat Reader version 4.0 or later. If you do not have a copy of the Acrobat Reader, download a free copy from the Adobe web site and follow the instructions for installation. Personal Injury Compensation Form and Instructions PDF

An award can be issued via check or through an Electronic Funds Transfer (EFT) into a checking or savings account. EFTs are performed via an Automated Clearing House (ACH) payment. In general, an ACH payment is quicker and more secure than a check. If you would like to receive your award via ACH payment, complete the Automated Clearing House (ACH) Payment Information Form found here. Note: Have a bank representative confirm that your account can receive an ACH payment, verify ALL information on the form, and sign the form. Also, submit the form by either the date provided to you by the Fund or May 1, 2004, whichever is earlier.

Automated Clearing House (ACH) Payment Information Form PDF

Periodic Payment Agreement Template

If the Special Master has approved a claimant's periodic payment election, the claimant should download one of the following sample periodic payment agreements and use the exact payment stream to draft an appropriate periodic payment agreement. Please note: claimants and their representatives SHOULD NOT ALTER the terms, conditions, rights, obligations, liabilities and guarantees contained in paragraphs two through eleven of the sample periodic payment agreement. The claimant should submit the proposed periodic payment agreement to the Special Master for review and comments. Please send one copy by mail to By regular mail: Victim Compensation Fund P.O. Box 18698 Washington, DC 20036-8698 By overnight mail: Victim Compensation Fund 1900 K Street, NW Suite 900 Washington, DC 20006 [removed] and a copy by electronic mail to the following address: [removed] Sample Periodic Payment Agreement (Microsoft Word) DOC Sample Periodic Payment Agreement (WordPerfect) WPD Helpful Hints PDF For more information, please refer to FAQ Section 11.

Freedom of Information Act (FOIA) / Privacy Act (PA) Requests

If you wish to request copies of anything contained in a Victim Compensation Fund claim file, you must submit a request in writing, and your request must include a completed and signed U.S. Department of Justice Certification of Identity. Before making a request, please review the Freedom of Information Act (FOIA) Request Guidelines. You may obtain copies of the Guildines and the Certification of Identity by clicking on the links below. Freedom of Information Act (FOIA) Request Guidelines PDF U.S. Department of Justice Certification of Identity PDF

Electronic Claim Forms

The electronic fillable forms will allow you to work on the forms at different times and save your information as you proceed. Before you use the electronic claim forms, please be sure you have Adobe Acrobat Approval 5 software*. If you do not have this software, it can be downloaded from the Adobe website for a price of $39 (US). Please click on the link below to purchase and download this software: Adobe Acrobat Approval 5 *If you have the full Adobe Acrobat Suite 5.0 or higher, the Approval software and its capabilities are included, therefore, you will not need to download Approval 5. For Adobe Acrobat Technical Support, please call 1-800-685-3652, Monday – Friday, 6 am to 5 pm PST. Using the Electronic Claim Forms To use the electronic forms, you can "right click" the form and then "Save Link/Target As" to download the form to a location of your choosing on your computer's hard drive. You can also launch the form onto your web browser by clicking on the form, but please be sure to download/save it to your hard drive as this is only a temporary version that will not be saved if you do not "Save Link/Target As". Once saved, you can launch Adobe Acrobat Approval 5, open your saved electronic claim form file, and work on the form at your leisure, saving your work as you progress until completion of the form. Finally, once complete, you will still need to print and mail back the electronic form to the VCF with original initials, signatures and notarization. Form Download Options We have two options for form download. You can either download a complete form with both instructions and form pages or you can just download the form itself without the instructions. This option may be quicker and more efficient if you already have the instructions or if you are processing multiple claim forms. The electronic claim form options for download are listed below: Electronic Compensation Form and Instructions for Personal Injury Victims PDF Electronic Compensation Form for Personal Injury Victims PDF If you have questions about the electronic claim form, please call [removed] for assistance.

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