New Hampshire Code of Administrative Rules
Jus - Attorney General, Department of Justice
Chapter Jus 600 - VICTIMS' COMPENSATION
Part Jus 604 - FORMS
Section Jus 604.01 - Claim Application Form
Universal Citation: NH Admin Rules Jus 604.01
Current through Register No. 40, October 3, 2024
(a) Each claimant seeking compensation from the fund shall complete and submit a "New Hampshire Victim's Compensation Program Application Form," revised 8/23/19 and available from the unit.
(b) In addition to submitting the "New Hampshire Victims' Compensation Program Form," the claimant shall provide:
(1) Documentation of expenses for
the compensation of expenses and losses being sought;
(2) A certification, under the penalties of
RSA 641:2, as to
whether the expenses and losses listed have not, will not, and cannot be
covered by any other resource, private or public assistance program, and if
they might be, a full description of such resources;
(3) Copies of all documentation of denials or
applications made to other resources, private or public assistance programs for
payment or compensation of expenses and losses listed;
(4) A statement by the claimant acknowledging
and agreeing that recovery of any expenses listed through legal action shall
entitle the State of New Hampshire to seek compensation to the fund to the
extent of any award of compensation made under this chapter; and
(5) A certification, under the penalties of
RSA 641:2, that
the claimant has provided information on or with the application that is true,
complete, and accurate to the best of the claimant's knowledge and
belief.
#4864, eff 7-13-90; ss by #6052, eff 7-1-95, EXPIRED: 7-1-03
New. #9553, eff 9-25-09
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