California Code of Regulations › Title 2 - Administration › Division 2 - Financial Operations › Chapter 1 - California Victim Compensation Board (Calvcb) Regulations › Article 5.6 - Indemnification of Victims of Crime › Section 649.7 - Complete Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Pursuant to Government Code section
					 13952,
					 applications for assistance will be deemed to be complete within the meaning of
					 Section 13952, subdivision (c) only if:
(a) The applicant provides all the
				  information requested on the application and in the instructions for completing
				  the application. As part of the application the applicant must provide the
				  following information:
(1) The applicant
				  seeking compensation must provide their name, residential address, date of
				  birth and telephone number. If the applicant uses an address that is different
				  from their residential address to receive mail, then the mailing address must
				  also be provided.
(2) A designation
				  on the application as to whether the applicant is a victim, a derivative
				  victim, or a person who legally assumed the obligation to pay for a deceased
				  victim's medical or funeral and burial expenses.
(3) If the person who signs the application
				  as the applicant is someone other than the direct victim or derivative victim
				  seeking assistance, the application must include some designation and
				  supporting documentation as to the person's legal authority to apply for
				  benefits on behalf of the victim or derivative victim (for example, a minor's
				  parent or legal guardian, or a court appointed conservator for an adult who has
				  been determined to be incompetent.)
(4) A description of the date, nature,
				  location, and circumstances of the qualifying crime.
(5) Except in the case where the applicant
				  has no pecuniary loss, a complete statement of the losses incurred and
				  reimbursements received that are directly related to the qualifying crime. This
				  statement must include the date or dates that medical, mental health or other
				  professional services were provided to the victim or derivative victim, a
				  description of the services provided affirmation that the services were in fact
				  received, and affirmation that such services were required as a direct result
				  of the qualifying crime and for no other reason. If mental health counseling or
				  psychotherapy services were provided, the statement must indicate whether they
				  occurred in an individual, family or group setting.
(6) The application must be signed under
				  penalty of perjury by the victim, derivative victim, or other eligible
				  applicant, attesting that the information provided in the application is true
				  and correct to the best of their knowledge. Applications signed by an
				  authorized representative must be signed under information and
				  belief.
(7) A signed authorization
				  permitting the Board staff or a joint powers victim witness center employee, or
				  both, to verify the contents of the application.
(8) The Board may accept electronically
				  signed applications and communications if the signature meets the following
				  criteria:
(A) It is unique to the person
				  using it;
(B) It is capable of
				  verification; and
(C) It is under
				  the sole control of the person using it.
(9) If the applicant is represented by an
				  attorney or other authorized person, the application must include the name,
				  address and telephone number of the representative. If the representative is an
				  attorney, the application must include the attorney's California State Bar
				  license number and the tax payer identification number.
(10) A statement indicating whether the
				  victim, the victim's survivors, or the derivative victim have commenced or
				  intend to commence a civil action to recover monetary damages from the
				  perpetrator or perpetrators of the qualifying crime. If the applicant indicates
				  that they have commenced or intend to commence a civil action for damages, they
				  must include, if represented, their attorney's name, telephone number and
				  address.
(11) A promise to contact
				  and repay the Board if the applicant receives any payments from the offender, a
				  civil suit, an insurance policy, or any other governmental or private agency to
				  cover expenses that the Board has already paid.
(12) A statement disclosing all collateral
				  benefits for which the victim, the victim's survivors, or the derivative victim
				  have applied or for which they may be eligible. Collateral benefits include,
				  but are not limited to, any private or public insurance or benefits, any form
				  of public or private assistance, any salary or bereavement leave, and any
				  restitution paid by the perpetrator(s) of the qualifying crime.