This page includes links to VCF forms and resources to help you complete your claim. If you file your claim using the online system, many of the forms listed below are incorporated into the online form and you will not need to complete them as separate files. Depending on the circumstances of your specific claim, you will not need to complete all the forms listed below. Use our Document Checklist (Personal Injury and Deceased Claim) to ensure you have provided the VCF with all the appropriate documentation in support of your claim.
The documents are provided in PDF format, where possible, to make it easier for you to complete and print. If you type data into a form, please remember to save the file with a different file name in order to save your changes.
Many items are regularly updated so please use the links below to ensure you are using the newest version of each document. Several resources have been translated and can be viewed directly on our Spanish, Polish and Chinese language pages, or by choosing the appropriate version to the right of the document.
Forms
- Signature Page - All Claims
- Exhibit A / Exhibit A Deceased Individual - Authorization for release of medical records.
- Exhibit 1 - Social Security Administration Consent Form
- Exhibit B1 - Authorization for release of pension and health information from HIPAA and non-HIPAA entities - this form can be used for both Personal Injury and Deceased Individuals
- Exhibit E - Notice of Filing for Deceased Individuals
- ACH Payment Information Form and instructions
- ACH International Wire Transfer Form and instructions
- Change of Attorney Form - to add, change or remove an attorney
- Collateral Offset Update Form - Instructions for notifying the VCF of new collateral offsets
- Claim Information Resolution Form - to resolve data discrepancy issues
- Medical Expense Worksheet
- Temporary Past Lost Earnings Worksheet - submit with your claim if the victim is claiming temporary lost earnings due to an eligible condition
- Third Party Verification Form
- Victim Presence Statement - an optional form that may be helpful if you have additional information about your presence that is not already provided as part of the claim form responses or in your supporting documents
- Witness Presence Statement - use this form for any witness who will provide an affidavit in support of your claim
- Claim Form - Hard Copy PDF-Fillable Form available for those who cannot submit via the Online Claims System. The VCF will input your answers into the system on your behalf in order to submit your VCF Claim.
- Appendix A - Additional Information for claims filed for Deceased Individuals
- Private Physician Forms - Including Appendix C & D
Resources
How to Guides and Checklists
- Non-Economic Loss Awards and Certified Conditions Fact Sheet
- Definitive Proof of Presence Documentation
- Required Documents to support Lost Earnings for Certain Unions and Employers
- What to Expect at Your Hearing
- Document Checklist - Personal Injury - use this checklist if you are filing a claim for yourself, or filing for a deceased individual whose death is not believed to be related to a 9/11-related physical condition
- Document Checklist - Deceased Claim - use this checklist if you are filing a claim for an individual who is believed to have died as a result of a 9/11-related physical condition
- Amendments and Appeals Detailed explanation of when to amend and when to appeal, including examples
- How to file an Amendment - instructions on how to file an amendment
- How to claim Medical Expenses - instructions on how to claim past out-of-pocket medical expenses
- WTC Health Program Diagnostic Essentials: Physical Health Conditions guidelines
- WTC Health Program Disability Evaluation Process - also available in Spanish, Polish, and Chinese
When the Claimant is not the Victim
- Information and Instructions: steps to take if a Personal Injury claimant passes away after filing the claim - also available in Spanish, Polish, and Chinese
- Instructions for Letters of Administration with limitations - also available in Spanish, Polish, and Chinese
- Information on appointment of a Personal Representative - also available in Spanish, Polish, and Chinese
- Lead Personal Representative Form to be completed if the court has appointed multiple individuals as co-Personal Representatives
- Documents required when the claimant is not the victim
General Resources
- VCF Overview - a presentation for individuals who are filing a claim with the VCF, or those who are interested in how the VCF operates
- VCF Info Sheet - a general overview of the program, who can apply, and how to apply (Spanish, Polish, Chinese)
- VCF Claim Review Process - an overview of the claim review process
- VCF Just the Facts - a great resource that clarifies some common misconceptions about the VCF
- WTC Health Program Fact Sheet - a great resource highlighting key differences between the two programs
- Claim Filing Deadlines (Spanish, Polish, Chinese)
- VCF New York City Exposure Zone Map
- Using the Claim Management System (CMS)
Online Claims Management System
- Online Claims System Acceptable Use Policy
- Claim Status Definitions - definitions for each claim status in the online system
- All Guides, Enhancements, and Tip Sheets related to the online claims system