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Resources

Forms
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.
Forms
Exhibit 1
Social Security Administration Consent Form
Forms
Exhibit A - Deceased Individuals
Authorization for release of medical records. Exhibit A must be mailed to the VCF with original signatures.
Forms
Exhibit A
Authorization for release of medical records. Exhibit A must be mailed to the VCF with original signatures.
Forms
NYCERS and NYSLRS Pension 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.
Forms
ACH Payment Information Form
Change Log: November 25, 2022: Added text stating that form can be uploaded.
Forms
Claim Information Resolution Form
Form used to resolve data discrepancy issues.
Forms
Collateral Offset Update Form
Updated form including instructions for notifying the VCF of new collateral offsets.
Forms
Third Party Verification Form
Updated form used to verify third parties, such as employers or volunteer organizations.
Forms
VCF Hard Copy Claim Form
Updated hard copy claim form for those without the ability to submit their claim via our online claims management system.