Do you know
an innocent victim of a crime?
Help May Be Available...
Crime Victim's Reparation Program
Claim Form and Instructions
Q What is
the Crime Victim's Reparations Program?
A The State
of Nebraska has a program to assist innocent victims of crime who
suffer bodily harm and have incurred a financial loss as a direct
result of a criminal act.
Q Who is
A • An
innocent victim who suffers bodily injury from a crime.
• A dependent or legal representative of an
innocent victim who has been killed as a result of a crime.
• A parent or guardian who is responsible for
medical expenses of a minor.
• A person who is injured while aiding a crime
victim or assisting a police officer.
Q Who is
A • Anyone
injured in a motor vehicle accident, unless the injury was
intentionally inflicted by the operator of the motor vehicle or the
charged with D.U.I.
• Anyone whose conduct contributed to his or her
• Anyone who aided and abetted the offender in the
commission of an unlawful act.
• Anyone who is injured or killed while violating a
• Anyone whose economic loss does not exceed ten
percent of his or her net financial resources
Q What may
A • Medical
expenses (hospital, doctor, dental, prescriptions, etc.) incurred as a
direct result of the crime.
• Loss of wages while under a doctor's care as
a direct result of the crime.
• Funeral expenses as a direct result of the crime
(maximum of $5,000).
• Loss of earning power as a direct result of the
• Counseling expenses as a direct result of the
crime (maximum of $2,000).
• Maximum award is $10,000 per incident.
Q What is
A • Loss of
• Payment for PAIN and SUFFERING.
• Expenses not directly related to the crime.
• Expenses paid by a private or group insurance
plan, public funds, the offender or other sources.
must I do to be eligible?
A • You must
report the crime to a law enforcement agency within 3 days of the
• You must file a claim with the CVR program within
2 years of the date
of the crime.
• You must cooperate with criminal justice officials
in the investigation of the crime and the prosecution of the offender.
must I do to apply for compensation?
A • Submit a
completed compensation form.
• Submit a completed Financial Resources Form.
• Submit itemized copies of all medical bills
relating to the incident.
• If requesting loss of wages, submit:
- copies of 3 payroll stubs
covering the period just prior to the incident.
- a statement from your
employer verifying hours of work missed and hourly wages.
- a copy of the doctor's
release stating the exact day you could return to work.
• Submit any other information requested.
Q How will
my claim be considered?
A • After all
the required information is received and an investigation is completed,
your claim will be presented to a Hearing Officer for a decision.
• A copy of the Hearing Officer's decision will be
sent to you.
• If you are dissatisfied with the decision, you
may appeal the decision by writing the CVR program to request a
hearing. The written
request must be made within 30 days.
Q Do I
need an attorney to file a claim?
you do not need an attorney to file a claim. If you do choose
to hire an attorney, the Hearing Officer or Crime Victim's Reparations
Committee may allow reasonable attorney fees not to exceed
5 percent of any compensation awarded.
How and where do I file a claim?
forms are available on the Internet in Adobe PDF format or email:
DOCUMENT (Legal Size Document)
Evaluation : PDF DOCUMENT (Required)
Attestation Form: PDF
or by writing or calling:
Nebraska Crime Commission
301 Centennial Mall South
P.O. Box 94946
Lincoln, Nebraska 68509-4946
Available for Crime Victims
Victims of crime may also
receive assistance (i.e., emergency shelter, crisis intervention,
emotional support, criminal justice information, etc.) by contacting a
Victim/Witness Unit or Domestic Violence/Sexual Assault Center in your
area. Check your telephone book or contact your local law enforcement
agency for more information.
The State of Nebraska does not discriminate on
the basis of sex, handicap, race, color, religion, marital status,
veteran status, or national origin with respect to Crime Victim's
Reparations applications. Inquiries regarding this policy or reasonable
accommodations with respect to such programs may be directed to the
Nebraska Crime Commission (402) 471-2828 (TDD 800-833-7352).