FORMS AND RESOURCES

Updated: September 18, 2017


This page includes links to VCF forms and resources to help you complete your claim. They are provided in PDF format, where possible, to make it easier for you to complete and print the documents. If you type data into a form, please remember to save the file with a different file name in order to save your changes.


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. You should only use the individual forms below if filing in hard copy or responding to a request from the VCF for missing information that is needed in order to process your claim.


Many items are regularly updated so please use the links below to ensure you are using the newest version of each document. Key documents have been translated and can be viewed directly on our Spanish, Polish and Chinese pages.



Forms


  • Claim Form - Hard Copy
  • Signature Page
  • Appendix A - Additional Information for claims filed for Deceased Individuals
  • Appendix B - Presence at the Pentagon and Shanksville, PA Sites
  • Private Physician Forms
  • Exhibit A / Exhibit A Deceased Individual - Authorization for release of medical records. Exhibit A must be mailed to the VCF with original signatures
  • 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
  • Exhibit F - List of Individuals notified of claim filing for Deceased Individuals
  • Employer Verification Form
  • Medical Expense Worksheet
  • ACH Payment Information 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 multiple claim number issues or data discrepancy issues
  • NYCERS and NYSLRS Worksheet - submit with your claim if the victim worked for an agency that is a part of NYCERS or NYSLRS and is claiming loss of pension benefits
  • Union and Defined Benefit Plan Worksheet - submit with your claim if the victim has a defined benefit plan through a union, employer, or other entity
  • Temporary Past Lost Earnings Worksheet - submit with your claim if the victim is claiming temporary lost earnings due to an eligible condition
  • Resources


  • VCF Fact Sheet *NEW* - general overview of the program, who can apply, and how to apply
  • Document Checklist - use this checklist to be sure
    you submit all the appropriate supporting documents for
    your claim
  • Claim Filing Deadlines - also available in Spanish, Polish and Mandarin
  • Guidance for claims started or submitted using the old form - guidelines for what to do next depending on the status of your claim
  • Claim Status Definitions - definitions for each claim status in the online system
  • Navigation Tip Sheet - a short guide to help you navigate the new online claim system
  • 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
  • Presumptively Compensable Expenses - list of conditions with presumptively compensable expenses
  • WTC Health Program Diagnostic Essentials: Physical Health Conditions guidelines
  • WTC Health Program Disability Process
  • Information and Instructions: steps to take if a Personal Injury claimant passes away after filing the claim
  • Instructions for Letters of Administration with limitations
  • Information on appointment of a Personal Representative
  • Map of NYC Exposure Zone
  • Tax Relief for Victims of Terrorist Attacks
  • WTC Health Program Website
  • Online Claims System Acceptable Use Policy



    • POLICIES AND PROCEDURES


      This document outlines the policies and procedures of the September 11th Victim Compensation Fund (“VCF”). The document includes information on eligibility criteria, the methodology used to calculate economic and non-economic loss, payment procedures, appeals and hearings, claims for deceased individuals, and information for claimants who are represented by an attorney for their claim.


      The document is intended to be used as a reference by individuals who are filing a claim, or by those who are interested in how the VCF operates.