Please use this form to request the status of applications or bills that have been submitted to the Victim Compensation and Government Claims Board, Victim Compensation Program.

Please provide the following information for staff to research the status of an application or bill. Feel free to submit additional requests as necessary.

Provider Information Provider Name: Name of Requester: Job Title: Telephone Number: Email Address: Application Number Claimant Name Date of Service Bill Amount

Information on this form is intended for the single requestor listed above. All claims filed with the California Victim Compensation Program (VCP) are confidential. Except as required by law, information such as the identity of an applicant, the existence of a claim, the status of a claim or other details regarding the claim can only be disclosed with the written permission of the applicant. Disclosure of confidential VCP information to unauthorized parties is a violation of California law.