Vision
Justice
for
all
crime
victims
Mission
Statement
With
compassion
and
respect
assist
victims
sexual
assanlt
domestic
violence
homicide
and
other
violent
crimes
through
crisis
response
Start
Believing
Start
Public
Awareness
Believing
Campaign
Change
the
Way
Respond
Sexual
Violence
Our
Community
one
response
time
YOUR
REACTION
MAKES
THE
DIFFERENCE
When
someone
tells
you
they
been
raped
there
simple
response
Start
Believing
FAR
TTY
Seyices
afe
funded
rough
Palm
Bedch
County
Board
County
Commissioners
with
grants
from
the
Office
the
General
and
Bofida
Council
Against
Sexual
Violen
WWW
shed
compublcsafeyeimsenicess
SEXUAL
ASSAULT
VIOLENT
CRIME
HELPLINE
HELPLINE
TOLL
FREE
Main
Golirthouse
North
Dixie
Hwy
Suite
West
Palm
Beach
TTY
Victim
Services
SART
Center
North
Australian
AVBy
West
Palm
Beach
option
TTY
North
County
Courthouse
PGA
Blvd
Suite
Palm
Beach
Gardens
option
TTY
South
County
Courthouse
West
Atlantic
Ave
Suite
Delf
Beach
TTY
West
County
Glades
Courthouse
State
Road
Floor
Belle
Glade
irc
option
alm
Beach
Courts
Public
Satety
Department
Servives
Division
EFTA
Victim
Crime
You
Experience
Any
The
Following
Inability
fall
stay
asleep
Feeling
anxious
depressed
Having
outbursts
anger
Inability
concentrate
Feeling
emotionally
numb
Loss
interest
the
things
you
used
enjoy
Painful
memories
the
traumatic
event
Bad
dreams
about
the
traumatic
event
Flashbacks
sense
reliving
the
events
Racing
thoughts
Physiological
stress
response
reminders
the
event
pounding
heart
rapid
breathing
nausea
muscle
tension
sweating
Palm
Beach
County
provides
equality
services
and
care
everyone
regardless
people
age
disability
gender
gender
identity
race
religion
belief
sexual
orientation
Provided
Services
include
for
children
and
adults
and
adult
support
groups
you
are
crime
victim
have
been
victim
crime
the
past
and
are
considering
therapy
welcome
your
call
Therapists
are
available
for
appointments
Monday
through
Friday
excluding
legal
holidays
Therapists
Will
Help
You
Identify
trauma
reactions
Explore
the
impact
that
trauma
has
your
daily
life
Reduce
the
intensity
negative
emotional
responses
and
symptoms
Learn
about
common
trauma
reactions
and
phases
healing
Feel
hopeful
and
positive
regarding
the
future
Develop
coping
mechanisms
utilize
when
thinking
talking
about
the
crime
Experience
reduction
trauma
symptoms
Return
work
school
Explore
the
impact
current
and
future
relationships
Children
Teenagers
Assessment
and
treatment
for
child
victims
crime
Therapeutic
interventions
that
teach
child
safety
Play
Therapy
Assistance
for
parents
during
this
difficult
time
Signs
Trauma
Children
Sadness
The
child
may
feel
despondent
hopeless
The
child
may
cry
easily
withdraw
isolate
from
others
Loss
interest
activities
The
child
may
complain
feeling
bored
reject
offers
participate
activities
they
have
previously
enjoyed
Anxiety
The
child
may
become
anxious
and
tense
and
feel
panic
Turmeil
The
child
may
feel
worried
and
irritable
The
child
may
lash
out
anger
resulting
from
the
distress
she
feeling
Regression
The
child
may
revert
acting
like
baby
bedwetting
clinging
and
demanding
extra
care
EFTA
Vision
Justice
for
all
crime
victims
Mission
Statement
With
compassion
and
respect
assist
victims
sexual
assault
domestic
violence
homicide
and
other
violent
crimes
through
crisis
response
advocacy
therapy
and
community
awareness
Florida
Statute
Provides
Guidelines
For
Fair
Treatment
Specific
Rights
For
Victims
The
Criminal
Justice
System
Some
these
include
the
following
Office
Attorney
General
Crime
Victim
Compensation
when
applicable
informed
present
and
heard
when
relevant
all
crucial
stages
criminal
juvenile
proceedings
the
extent
that
right
does
not
interfere
with
the
Constitutional
rights
the
accused
provided
information
concerning
services
available
including
Victim
Compensation
community
treatment
programs
crisis
intervention
services
counseling
and
social
services
prompt
and
timely
disposition
the
case
the
extent
that
this
right
does
not
interfere
with
the
Constitutional
rights
the
accused
have
your
property
returned
you
soon
possible
after
the
investigation
andlor
prosecution
completed
unless
there
compelling
reason
for
its
retention
Have
Victim
Advocate
present
during
depositions
the
victim
Request
for
specific
crimes
exemption
prohibiting
the
disclosure
information
the
public
which
reveals
your
identification
Palm
Beach
County
Public
Safety
Department
Victim
Services
Division
www
pbcgov
com
publicsafety
victimservices
SEXUAL
ASSAULT
VIOLENT
CRIME
HELPLINE
HELPLINE
TOLL
FREE
Main
Courthouse
North
Dixie
Hwy
Suite
West
Palm
Beach
option
TTY
Victim
Services
SART
Center
North
Australian
Ave
West
Palm
Beach
option
TTY
North
County
Courthouse
PGA
Blvd
Suite
Palm
Beach
Gardens
option
TTY
South
County
Courthouse
West
Atlantic
Ave
Suite
Delray
Beach
TTY
West
County
Glades
Courthouse
State
Road
Floor
Belle
Glade
TTY
Services
are
provided
all
crime
victims
Palm
Beach
County
regardless
the
victims
race
sex
color
religion
national
origin
disability
age
sexual
orientation
marital
status
gender
identity
expression
Services
are
funded
through
Palm
Beach
County
Board
County
Commissioners
with
grants
from
the
Office
the
Attorney
General
and
Florida
Council
Against
Sexual
Violence
Palm
Beach
County
Public
Sofety
Department
Victim
Services
Division
Victim
Services
Certified
Rape
Crisis
Center
Serving
Victims
Violent
Crimes
EFTA
Services
Provided
Professional
training
and
community
presentations
are
alse
available
Information
about
Victims
rights
hour
crisis
response
hospitals
law
enforcement
agencies
and
crime
scenes
Sexual
Assault
Nurse
Examiner
SANE
and
Forensic
Exam
site
The
Butterfly
House
Sexual
Assault
Response
Team
SART
provide
Victim
centered
assistance
Criminal
Justice
advocacy
and
court
accompaniment
Assistance
with
filing
State
Crime
Victim
Compensation
applications
and
Restraining
Orders
Individual
therapy
and
support
groups
Information
and
referral
community
resources
including
shelters
and
Legal
Aid
Falm
Beach
County
provides
equality
services
and
care
everyone
regardless
people
age
disability
gender
gender
identity
race
religion
belief
sexual
orientation
Sexual
Assault
Sexual
Assault
violent
crime
including
rape
incest
sexual
harassment
any
other
sexual
contact
without
consent
Per
Florida
Statute
victim
sexual
violence
who
consults
sexual
assault
counselor
rape
crisis
center
has
the
right
confidentiality
information
shared
with
the
counselor
one
except
the
victim
can
compel
the
sexual
assault
counselor
reveal
information
about
their
communications
Only
the
victim
can
waive
the
privilege
and
this
must
done
writing
rape
victims
are
not
sure
whether
report
law
enforcement
victim
advocates
will
assist
them
through
their
decisionmaking
process
respecting
whatever
choices
are
made
Certified
Rape
Crisis
Victim
Advocates
Will
Provide
Crisis
Intervention
and
Personal
Advocacy
Accompaniment
during
forensic
rape
exams
The
Butterfly
House
and
other
medical
facilities
Coordination
follow
medical
care
therapy
and
referrals
Criminal
Justice
advocacy
and
court
accompaniment
Start
Believing
Public
Start
Awareness
Campaign
Change
the
Way
Respond
Sexual
Believing
Violence
Our
Community
One
response
time
YOUR
REACTION
MAKES
THE
DIFFERENCE
When
someone
tells
you
they
been
raped
there
simple
response
Start
Believing
iil
Domestic
Assault
Domestic
Assault
involves
power
and
control
tactics
such
physical
violence
emotional
abuse
sexual
violence
economic
abuse
and
isolation
Victim
Advocates
Will
Provide
Crisis
Intervention
Safety
Planning
Assistance
with
fling
Restraining
Orders
Safe
Shelter
Referrals
Personal
and
legal
advocacy
during
criminal
justice
proceedings
Homicide
and
Other
Violent
Crimes
Homicide
and
other
violent
crimes
shatter
the
lives
injured
victims
and
survivors
causing
severe
emotional
trauma
and
grief
Victim
Advocates
Will
Provide
Crisis
Intervention
and
emotional
support
for
victims
and
surviving
family
members
Assistance
with
filing
crime
victim
compensation
for
medical
expenses
funeral
costs
and
loss
support
Court
Accompaniment
Referrals
for
individual
therapy
support
groups
and
community
assistance
EFTA
Victims
sexual
crimes
need
compassion
sensitivity
and
empathy
Being
the
victim
crime
can
overwhelming
Your
reactions
are
normal
Local
certified
rape
crisis
centers
have
advocates
who
are
there
help
all
victims
regardless
whether
not
they
report
law
enforcement
Services
are
free
and
confidential
certified
rape
crisis
centers
are
legally
and
ethically
required
protect
your
confidentiality
unless
you
allow
writing
the
release
your
information
Advocates
are
available
Provide
crisis
intervention
Speak
you
the
hour
hotline
Discuss
your
options
Navigate
available
resources
with
you
appointments
Address
safety
concerns
Advocate
your
behalf
Help
you
apply
for
victim
compensation
Sexual
Battery
Crime
Florida
the
legal
term
for
rape
sexual
assault
sexual
battery
Sexual
battery
means
oral
anal
vaginal
penetration
union
with
the
sexual
organ
another
the
anal
vaginal
penetration
another
any
other
object
committed
without
your
consent
Consent
means
intelligent
knowing
and
voluntary
consent
and
does
not
include
coerced
submission
Failure
offer
physical
resistance
the
offender
does
not
imply
consent
person
under
years
age
cannot
legally
consent
sex
Also
person
years
age
older
person
familial
custodial
position
authority
cannot
receive
consent
from
and
year
old
minors
What
forensic
exam
The
forensic
exam
head
toe
exam
collect
evidence
and
check
for
injuries
after
sexual
crime
What
are
rights
with
regard
the
exam
Slop
the
exam
any
time
Have
advocate
from
rape
crisis
center
with
you
informed
about
the
status
the
kit
during
processing
What
evidence
collected
During
the
exam
the
medical
professional
may
collect
blood
urine
saliva
pubic
hair
combings
and
nail
samples
They
may
also
collect
items
your
clothing
They
will
ask
you
questions
about
the
crime
and
your
medical
history
order
help
them
collect
evidence
What
happens
the
evidence
you
make
report
law
enforcement
your
kit
will
sent
the
regional
statewide
lab
within
days
for
tesling
The
lab
required
process
the
kit
within
days
you
don
report
the
crime
law
enforcement
the
time
you
obtain
the
exam
your
kit
will
stored
anonymously
Your
kit
may
stored
for
only
limited
time
depending
your
community
storage
space
The
local
rape
crisis
center
can
advise
you
EFTA
Victim
Bill
Rights
You
have
the
right
Obtain
forensic
exam
whether
not
you
report
law
enforcement
Have
advocate
the
forensic
exam
with
you
Have
the
forensic
exam
sent
for
testing
within
days
reported
law
enforcement
Review
the
law
enforcement
report
prior
final
submission
informed
present
and
heard
all
crucial
stages
the
criminal
juvenile
proceeding
Have
advocate
with
you
during
discovery
deposition
Have
identifying
information
about
the
criminal
investigation
kept
confidential
Have
the
offender
charged
tested
for
HIV
and
hepatitis
Attend
sentencing
disposition
the
offender
Notification
judicial
proceedings
and
scheduling
changes
Notification
about
the
release
incarcerated
offender
Request
restitution
Give
victim
impact
statement
Not
subjected
polygraph
Take
days
leave
from
work
with
eligible
employer
Apply
for
injunction
you
fear
for
your
safely
offender
nearing
release
Victim
Compensation
You
may
eligible
for
financial
assistance
for
Medical
Care
Lost
Income
Mental
health
services
Relocation
Other
expenses
related
injuries
result
the
crime
Contact
your
local
certified
rape
crisis
center
for
more
information
This
project
was
supported
Grant
awarded
the
Office
Violence
Against
Women
Department
Justice
The
opinions
findings
conclusions
and
recommendations
expressed
this
publication
are
those
the
author
and
not
necessarily
reflect
the
views
the
Department
Justice
Office
Violence
Against
Women
Besourcas
Florida
Council
Against
Sexual
Violence
www
fcasv
org
Victim
Compensation
www
myfloridalegal
com
Florida
Department
Law
Enforcement
Sexual
Offender
Predator
Unit
For
TTY
Accessibility
mail
sexpred
fdie
state
Florida
Department
Corrections
Victim
Information
and
Notification
Everyday
VINE
VINE
www
state
oth
victasst
index
html
Florida
Abuse
Hotline
Local
Rape
Crisis
Center
Palm
Beach
County
Victim
Services
Certified
Rape
Crisis
Center
Victim
Services
SART
Center
North
Australian
Avenue
West
Palm
Beach
Office
Helpline
RAPE
www
pbcgov
com
publicsafety
victimservices
March
EFTA
Center
for
Trauma
Counseling
Vithere
Your
Emotional
Healing
Can
Eegin
non
profit
Community
Counseling
Center
Serving
Palm
Beach
County
and
beyond
Individual
Couples
Family
Group
Therapy
Services
for
Children
Adults
offer
affordable
counseling
services
those
that
are
insured
and
not
insured
Insurance
accepted
Cigna
Humana
Commercial
Magellan
Beacon
Humana
Medicaid
Coventry
Sliding
Scale
Reduced
fees
based
income
for
those
who
qualify
Languages
Spoken
English
Spanish
and
Farsi
Evidence
Based
Models
Play
Sand
Tray
therapy
EMDR
Trauma
Focused
Cognitive
Behavioral
Therapy
Hours
Monday
Friday
Saturdays
and
evening
appointments
available
Referral
Process
Call
Office
email
info
palmbeachmentalhealth
org
Center
for
Trauma
Counseling
Inc
Lake
Worth
Road
Suite
Greenacres
Office
www
palmbeachmentalhealth
org
EFTA
Office
the
Attorney
General
The
Capitol
Tallahassee
Office
Fax
Bill
Status
Information
for
Providers
TDD
users
may
call
through
Florida
Relay
Service
Website
myfloridalegal
com
Email
address
veintake
myfloridalegal
com
BUREAU
VICTIM
COMPENSATION
CLAIM
FORM
Instructions
Please
read
the
Eligibility
Requirements
see
you
qualify
for
this
program
Fill
out
this
form
completely
please
print
attach
all
required
documentation
and
submit
the
above
address
you
move
change
your
addrass
you
are
required
notify
this
office
CHECK
THE
TYPE
VICTIM
COMPENSATION
BENEFITS
YOU
ARE
REQUESTING
DISABILITY
compensation
for
the
victim
who
suffered
permanent
disability
EXPENSES
payment
reimbursement
behalf
the
victm
for
crime
relaed
Attach
documentation
outlined
Section
funeralfburial
medicalidenta
treatment
and
mental
health
counseling
expanses
WAGE
LOSS
compensation
for
the
victm
who
bst
wages
due
crime
related
robe
ale
nhl
physical
injuries
Attach
documentation
cullined
Section
Attach
femizad
bills
and
recei
Wuneral
providers
SUPPORT
compensation
for
the
dependent
deceased
victim
FUNERAL
EURIAL
DICALIDENTAL
HEALTH
GRIEF
who
was
employed
the
time
the
crime
Aftach
documentation
oulined
TREATMENT
COUNSELING
Section
EMERGENCY
ASSISTANCE
reimbursement
for
documented
wage
loss
and
out
pocket
expenses
relaled
the
crime
Attach
receipts
CHECK
ALL
OTHER
TYPES
BENEFITS
YOU
ARE
REQUESTING
Separate
claim
numbes
wil
assigned
PROPERTY
LOSS
for
adult
over
the
age
disabled
adult
attach
pomssmc
VIOLENCE
RELOCATION
ASSISTANCE
for
the
victim
proof
disability
prio
the
date
crime
from
physician
the
Social
Security
domestic
vislence
seeking
assistance
relocate
safe
environment
Administration
who
suflered
the
loss
tangible
personal
property
the
result
certified
domestic
violence
certifcation
form
and
application
must
receved
criminal
dedinquent
act
Attach
receipt
writin
estimate
from
vendor
within
days
from
the
date
crime
mercharit
identifying
the
comparable
replacement
value
Com
nsable
lems
must
identified
the
law
enforcement
report
HUMAN
TRAFFICKING
RELOCATION
ASSISTANCE
for
the
victim
sexual
trafficking
with
urgent
need
relocate
rapa
crisis
domestic
viclence
baflery
seeking
assistance
relocate
due
reasonable
fear
certified
rape
las
identifiable
threat
crisis
canter
certification
form
must
received
with
the
application
Section
Victim
and
Applicant
Information
VICTIM
MAME
last
first
middle
SOCIAL
YOU
LIKE
ALL
CORRESPONDENCE
SECURITY
EMAILT
CITY
STATE
Norn
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ALTERNATE
OCCUPATION
PHONE
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THIS
INFORMATION
COLLECTED
FOR
FEDERAL
REPORTING
PURPOSES
AND
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LATING
wire
MON
LATING
CAUCASIAN
MULTIPLE
RACES
GENDER
NATIONAL
ORIGIN
WAS
VICTIM
DISABLED
BEFORE
THE
GRIME
OCCURRED
ves
The
applicant
fling
behalf
victim
required
provide
claimant
information
below
When
requesting
compensation
behalf
incompetent
aduft
vielam
proof
legal
guardianship
must
attached
and
the
applicant
signature
claim
form
must
witnessed
Notary
Public
THE
VICTIM
jcheck
one
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muuren
mor
MINOR
WITNESS
INCOMPETENT
NOT
INJURED
APPLICANT
NAME
DATE
last
first
icicle
BIRTH
SOCIAL
EMAL
WOULD
YOU
LIKE
ALL
CORRESPONDENCE
SECURITY
ADDRESS
SENT
EMAIL
Cvs
ADDRESS
city
STATE
CODE
TELEPHONE
ALTERNATE
RELATIONSHIP
OCCUPATION
nar
PHONE
NUMBER
TOVICTIM
BVC
THE
The
Office
the
Attorney
General
Bureau
Victim
Compensation
equal
opportunity
provider
and
employer
Page
EFTA
Section
Referral
Source
Information
ndividuats
who
assisted
with
flied
out
any
sections
this
application
are
required
provide
referral
information
below
signing
this
application
the
vicim
applicant
affirms
that
all
information
provided
true
and
correct
and
thus
all
sections
should
reviewed
before
the
application
signed
Treatment
providers
can
request
training
the
Victim
Compensation
Program
which
recommandad
prior
becoming
referral
source
NAME
PERSON
ASSISTING
WITH
APPLICATION
MAIL
last
first
middle
ADDRESS
NAME
AGENCY
ORGANIZATION
AGENCYIORGANZATIONS
ADDRESS
TELEPHONE
address
city
state
zip
pode
HUMBER
Section
Disability
Lost
Wages
Information
Tre
rosie
comeemaion
wages
ach
copy
your
pay
sub
earings
saement
which
dete
your
entpoyment
siais
and
wages
ime
rie
sek
employed
work
for
family
member
attach
copy
your
latest
income
tax
eum
and
applicable
IRS
schedule
forms
more
than
work
days
were
missed
result
the
crime
attach
doctor
lefier
which
axrused
you
for
fis
absence
When
requesing
dsabiity
compensation
altach
doctor
letier
which
specifies
each
cme
related
panmanent
disability
rating
according
American
Medical
Lssoriaicn
Guidelines
Florida
Impainment
Rating
Guidelines
and
forward
Social
Security
Administration
award
lefiers
NAME
COMPANYBUSINESS
more
one
employer
please
atiach
additiaal
shee
COMPANY
ADDRESS
city
stale
Zip
code
WAGE
LOSS
COVERED
INSURANCE
YES
VICTIM
DISABLED
RESULT
THE
CRIME
YES
WAGE
LOSS
COVERED
WORKER
COMPENSATION
YES
Section
Loss
Support
Information
Grief
Counseling
Information
indicate
the
name
and
date
birth
the
deceased
vichim
surviving
spouse
parent
sibling
child
For
bes
support
attach
copy
the
deceased
victim
latest
income
tax
return
and
individual
eamings
statement
reemployment
assistance
benefit
statement
court
order
for
support
birth
certficate
which
identifies
dependent
relationship
marriage
certificate
legal
documentabon
proving
principal
support
DEPENDANT
MINCR
CLAIMANT
NAME
DATE
BIRTH
RELATIONSHIP
WCTIM
Section
Insurance
Information
Samants
who
are
determined
eligible
for
the
Vichm
Compensalion
and
Property
Loss
Programs
may
exempt
from
insurance
deductible
payment
provisions
INSURANCE
MEDICAID
AVAILABLE
ASSIST
WITH
THESE
EXPENSES
Yes
MEDICAID
NUMBER
yes
provid
the
following
for
all
insurance
policies
including
Wedicesd
Medicare
homeowner
automabila
major
medical
Atach
related
insurance
Explanation
Benefits
statement
POPPIN
Less
ive
Sad
EEO
ADDRESS
CITY
COMPANY
NAME
POLICY
NUMEER
ail
NUMBER
ADDRESS
CITY
STATE
Fao
Section
Other
Compensation
Settlement
and
Attorney
Information
You
must
notify
this
office
you
have
received
you
anticipate
receiving
compensation
any
benefits
from
any
other
source
result
this
incident
You
must
also
nofify
this
office
you
have
are
planning
hire
atiomey
represent
you
result
the
incident
STATE
THE
SOURCE
AND
ARE
YOU
REPRESENTED
DATE
RECEIVED
grapruciny
LEGAL
COUNSEL
ADDRESS
MAIL
ADDRESS
CITY
STATE
ZIP
TELEPHONE
CODE
NUMBER
BVC
THY
The
Office
the
Attorney
General
Bureau
Victim
Compensation
equal
opportunity
provider
and
employe
Page
EFTA
Section
Crime
Information
THis
sodlion
must
completed
and
proof
crime
such
law
enforcement
report
charging
affidavil
must
attached
Failure
submit
proof
crime
will
result
your
application
not
being
processed
your
claim
being
denied
NAME
LAW
DATE
DATE
REPORTED
LAW
ENFORCEMENT
AGENCY
CRIME
ENFORCEMENT
AGENCY
WAS
THE
CRIME
REPORTED
LAW
ENFORCEMENT
WITHIN
HOURS
YES
please
explain
failure
provide
acceptable
explanation
this
section
will
result
denial
benefits
THE
APPLICATION
AND
LAW
ENFORCEMENT
REPORT
BEING
SUBMITTED
WITHIN
ONE
YEAR
FROM
THE
DATE
criMe
YES
LINO
please
explain
Please
advised
that
most
benefits
apply
treatment
losses
suffered
within
one
year
from
the
date
crime
with
some
excaplions
for
minor
victims
failure
provide
acceptable
explanation
this
section
will
result
denial
benefits
TYPE
CRIME
SPECIFIED
LAW
ENFORCEMENT
THE
LAW
ENFORCEMENT
REPORT
REPORT
NUMBER
NAME
LAW
NAME
OFFENDER
ENFORCEMENT
OFFICER
rawr
NAME
ASSISTANT
STATE
ATTORNEY
ihe
ATTORNEY
HANDLING
THE
CASE
applicable
CLERK
COURT
GASE
NUMBER
applicable
Section
Eligibility
Requirements
Additional
qualification
criteria
deadlines
and
exceptions
not
listed
may
apply
Victim
Compensation
The
victim
must
cooperate
fully
with
law
enforcement
officials
State
Attorney
Office
and
the
Attorney
General
Office
The
crime
must
reported
law
enforcement
within
hours
unless
there
good
cause
for
delayed
reporting
The
claim
must
fled
witin
one
year
after
fhe
dae
the
crime
within
two
years
when
there
good
reason
for
not
ling
within
one
year
Exceptions
for
fling
time
requirements
apply
victims
who
are
FEIOfS
The
victim
must
not
have
engaged
unlawful
activity
contributed
the
situation
that
brought
about
his
her
own
injury
death
The
victim
must
have
suffered
physical
psychiatric
psychological
injury
death
result
the
crime
Property
Loss
The
victim
must
have
suffered
substantial
diminution
their
quality
life
from
the
loss
tangible
personal
property
the
result
criminal
delinquent
act
Property
loss
reimbursement
available
any
one
claim
and
lifetime
maximum
all
claims
Domestic
Violence
Relocation
Assistance
The
victin
must
need
immediate
assistance
escape
domestic
violence
environment
The
application
must
filed
within
days
afer
the
domestic
violence
crime
Certification
certified
domestic
violence
center
the
State
Florida
required
The
victim
must
submit
estimates
invoices
receipts
for
interim
lodging
housing
utility
deposits
new
cellular
phone
service
transportation
moving
company
expenses
emergency
food
clothing
Relocation
for
Victims
Sexual
Battery
The
victim
must
need
relocate
due
reasonable
fear
for
his
her
safety
Certification
certified
rape
ists
center
the
State
Florida
required
The
victim
must
submit
estimates
invoices
receipts
for
interim
lodging
housing
uly
deposits
new
cellar
phone
service
transportation
moving
company
expenses
emergency
food
clothing
Human
Trafficking
Relocation
Assistance
The
victim
must
have
urgent
need
escape
from
unsafe
environment
directly
related
sexual
human
trafficking
offense
Application
must
received
within
days
the
last
identifiable
threat
human
trafficking
offender
The
identifiable
threat
must
have
heen
communicated
with
the
proper
authorities
Certification
from
certified
rape
crisis
domestic
violence
center
the
State
Florida
required
The
victim
must
submit
estimates
invoices
receipts
from
interim
lodging
housing
utity
deposits
new
cellular
phone
service
iransportation
moving
company
Expenses
emergency
food
clothing
Criminal
History
Record
Check
order
for
compensation
considered
the
victim
applicant
must
not
have
been
confined
custody
county
municipal
facility
state
federal
comedtional
facility
juvenile
detention
commilment
assessment
facility
adjudicated
habitual
felony
offence
habitual
violent
offender
violent
career
criminal
adjudicated
forcible
felony
offense
Notice
Payment
Limitations
The
Bureau
Victim
Compensation
may
provide
financial
assistance
for
eligible
persons
but
only
afte
all
other
sources
payment
have
been
exhausted
Payments
accepted
state
behalf
victims
are
considered
payment
full
per
Florida
Statute
Total
victim
Fompensation
benefits
cannot
exceed
the
maximum
award
amount
determined
the
current
benefit
payment
schedule
Limits
below
the
maximum
may
specific
benefits
which
may
reduced
without
prior
notice
the
award
recipient
based
the
availability
funding
Acceptable
Proof
Crime
The
Bureau
Victim
Compensation
does
not
make
independent
judgment
whether
compensable
crime
occurred
but
instead
relies
proof
crime
from
the
proper
authorities
Failure
provide
acceptable
documentation
proving
that
compensable
crime
occurred
shall
result
your
application
not
being
processed
your
claim
being
denied
Acceptable
documentation
includes
law
enforcement
report
charging
affidavit
from
child
tection
team
law
enforcement
agency
stat
prosecuting
attomey
the
Department
Children
and
Families
that
affims
compensable
crime
occurred
indictment
grand
jury
indictment
prosecutor
from
court
competent
jurisdiction
report
from
the
United
States
Federal
Bureau
investigation
Florida
Department
Law
Enforcement
cybercrime
investigator
ceriication
crime
for
purposes
Section
Complete
Application
Package
your
responsibilty
provide
complete
application
package
which
includes
acceptable
documentation
proving
ocoumsd
the
department
receives
report
which
insufficient
proving
that
compensable
crime
occurred
the
application
will
assigned
claim
number
and
denied
Claim
numbers
assigned
are
not
indicative
eligibility
denial
For
assistance
with
collecting
acceptable
documentation
please
contact
your
local
law
enforcement
agency
the
agency
where
the
crime
was
reported
the
referral
source
your
local
State
Atiomey
Office
BVC
The
Office
the
Attorney
General
Bureau
Victim
Compensation
equal
opportunity
provider
and
employer
Pagelofd
EFTA
PLEASE
READ
CAREFULLY
AND
SIGN
THE
FOLLOWING
CERTIFICATIONS
Section
CONFIDENTIALITY
you
are
the
victim
sexual
battery
aggravated
child
abuse
aggravated
stalking
harassment
aggravated
battery
domastic
violence
you
have
the
right
have
information
about
your
home
address
and
telephone
number
employment
address
and
telephone
number
and
your
personal
assets
kept
confidential
for
pericd
five
years
you
are
the
victim
any
these
crimes
please
mark
one
the
following
statements
Your
response
will
not
the
processing
your
claim
want
the
information
confidential
NOT
want
the
information
confidential
SERIOUS
FINANCIAL
HARDSHIP
certify
that
have
serious
financial
hardship
because
crime
related
expenses
that
cannot
paid
any
other
source
PROPERTY
LOSS
CERTIFICATION
certify
that
the
property
question
belonged
the
victim
that
this
loss
adversely
affects
the
victim
quality
life
that
there
other
source
reimbursement
for
this
loss
and
that
replacement
the
propaty
would
cause
the
claimant
serious
financial
hardship
RELEASE
INFORMATION
give
permission
any
hospital
doctor
dentist
mental
health
counselor
other
treatment
provider
banking
institution
social
sarvice
agency
law
enforcement
agency
comections
agency
state
atiomey
office
insurance
carrier
attorney
employer
give
out
information
that
requested
conceming
any
treatment
rendered
employment
insurance
third
party
payer
law
enforcoment
investigative
information
the
Department
Legal
Affairs
for
use
processing
claim
give
permission
the
Department
release
information
about
the
status
daim
any
treatment
provider
law
enforcement
agency
state
attomey
office
SOCIAL
SECURITY
NUMBER
DISCLOSURE
The
Bureau
Victim
Compensation
collects
and
uses
Social
Security
numbers
for
the
purpose
performing
imperative
duties
and
responsibilities
which
may
include
the
following
searching
criminal
history
records
identity
management
billing
and
payments
banefit
processing
and
reporiing
authorized
state
and
federal
govemment
agencies
Failure
provide
this
optional
information
may
delay
the
processing
your
application
benefits
Federal
and
State
laws
require
the
Bureau
protect
Social
Security
numbers
from
disclosure
unauthorized
parties
Absent
waiver
from
you
your
legal
representative
Social
Security
numbers
will
redacted
unless
the
agancy
receives
court
onder
urn
over
non
redacted
file
REPAYMENT
REQUIREMENT
understand
that
payment
the
victim
compensation
program
payment
last
resort
and
that
must
repay
the
Crimes
Compensation
Trust
Fund
receive
victim
compensation
award
and
also
recaive
payment
from
another
source
result
the
same
criminal
incident
Other
sources
include
but
are
not
limited
any
payment
from
the
offender
insurance
policy
settlement
judgment
award
third
party
lawsuit
further
understand
that
must
repay
any
emergency
award
from
the
Crimes
Compensation
Trust
Fund
claim
determined
inedigible
also
understand
that
eligibility
withdrawn
must
repay
any
amount
recaived
from
the
Crimes
Compensation
Trust
Fund
VICTIM
Must
signed
and
dated
the
victim
filing
competent
adult
Printed
Nama
and
correct
the
best
knowledge
Signature
APPLICANT
Applicant
signature
required
filing
the
parent
legal
guardian
individual
authorized
administer
victim
estate
Printed
Name
Signature
Date
Under
penalty
perjury
fraud
the
information
have
provided
rue
and
correct
the
best
knowledge
NOTARIZATION
REQUIREMENT
Persons
submitting
application
behalf
incompetent
adult
must
submit
proof
legal
guardianship
and
have
their
signature
witnessed
Notary
Fublic
Swom
and
subscribed
before
this
day
personaly
known
identification
produced
Notary
Public
Signature
Stamp
Seal
BVC
THE
The
Office
the
Attarney
General
Bureau
Victim
Compensation
equal
opportunity
provider
and
employer
Page
dof
EFTA
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