Forms and Resources

This page includes links to VCF forms and resources to help you complete your claim. 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 Victim Claim) to ensure you have provided the VCF with all the appropriate documentation in support of your claim.

Resources with an asterisk (*) are translated and can be viewed directly on our Spanish, Polish and Chinese language pages.

Links in the Topic column will open related VCF Policies and Procedures.

Topic	Resources	Forms
Claim Submission	Before you Begin Checklist 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. Instructions for Accessing Pre-Populated Forms	The following forms must be downloaded from your online claim. The forms will be available to download after you submit your Registration: Claim Form Signature Page Exhibit A – Authorization for Release of Information and Medical Records
Eligibility Criteria and Deadlines	Registration and Claim Filing Deadlines* How to Prove Presence	Third Party Verification Form Witness Presence Statement - use this form for any witness who will provide an affidavit in support of your claim Victim Presence Statement - An optional form to provide any additional details about your presence that aren’t already covered in the claim form or your supporting documents
Eligible Conditions	WTC Health Program website Review this factsheet for additional information about the differences between the VCF and the WTC Health Program. WTC Health Program Disability Evaluation Process* Diagnostic Essentials: Physical Health Conditions guidelines.	Private Physician Forms
Calculation of Loss (Compensation)	Non-Economic Loss Awards and Certified Conditions Fact Sheet Non-Economic Loss Impact Statement for Prostate Cancer How to claim Medical Expenses - instructions on how to claim past out-of-pocket medical expenses.	Exhibit 1 - Social Security Administration Consent Form Exhibit B1 - Authorization for release of pension and health information from HIPAA and non-HIPAA entities 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.
Awards and Payment		ACH Payment Information Form and instructions* ACH International Wire Transfer Form
Appeals and Hearings	What to Expect at Your Hearing
Amendments	You should amend if you are seeking a new determination based on new information. Instructions for Amending a Claim Amendments and Appeals - Detailed explanation of when to amend and when to appeal, including examples
Deceased Victim Claims	Document Checklist – Deceased Victim 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 Information and Instructions: Steps to Take When a Claimant Dies After Filing a Personal Injury Claim * Instructions for Letters of Administration with limitations* Information on appointment of a Personal Representative* Documents required when the claimant is not the victim	Exhibit A Deceased Individual - Authorization for Release of Information and Medical Records. Note: This form must be downloaded from the online claim. The form will be available to download after you submit the Registration. Exhibit E – Notice of filing for deceased individuals Lead Personal Representative Form to be completed if the court has appointed multiple individuals as co-Personal Representatives Appendix A – Additional questions for hard copy claim forms submitted for deceased individuals
Information for Individuals with Attorneys	Under the VCF Act, attorneys may not charge any individual more than 10% of the amount of the individual’s VCF award. If you are working with an attorney, they will receive your payment directly.	Change of Attorney Form - to add, change or remove an attorney
Expedite Process	You can request that the VCF expedite processing your claim or amendment if you are terminally ill or facing imminent financial hardship. The VCF Expedited Claim Process and Expedited Request Checklist explains how the process works, the steps you must take to submit your request to expedite processing your claim or amendment, and the documents and information you must submit to support the request.
General	VCF Info Sheet* - a general overview of the program, who can apply, and how to apply VCF Just the Facts - a resource that clarifies some common misconceptions about the VCF VCF Claim Review Process - an overview of the claim review process VCF New York City Exposure Zone Map Tax Relief for Victims of Terrorist Attacks	Claim Form - hard copy PDF-fillable form available for those who cannot submit using the Online Claims System Appendix B - for presence at the Pentagon or Shanksville, PA site, if using the hard copy Claim Form Claim Information Resolution Form – to resolve data discrepancy issues, such as an incorrect name, SSN, or date of birth Collateral Offset Update Form - Instructions for notifying the VCF of new collateral offsets
Claims System	Using the Claim Management System (CMS). CMS Acceptable Use Policy Claim Status Definitions - definitions for each claim status in the online system Instructions for Accessing Pre-Populated Forms Document Upload Guide	Access the online system to create a new account or Login to an existing account

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Forms and Resources