Current through Register No. 40, October 3, 2024
(a) Upon receipt of a complete "New Hampshire
Victims' Compensation Program Application Form" by the unit, it shall send an
"Acknowledgment of Receipt of Claim and Request for More Information letter" to
acknowledge the receipt of the claim and shall identify any specific types of
additional information required to process the claim. Determination of such
types of additional information shall be made on a case-by-case basis, pursuant
to (b) below.
(b) The types of
additional information that the unit identified pursuant to (a) above shall
include:
(1) Information regarding collateral
financial sources, as described in
Jus
604.03, if collateral financial sources might
exist;
(2) Photocopies of all
crime-related medical bills;
(3)
Photocopies of all crime-related mental health counseling bills;
(4) If copies of medical bills, mental health
counseling bills, or both are not available but expenses have been incurred, a
complete list of each such provider's:
a.Name;
b.Complete mailing address;
c.Telephone number; and
d. Services actually rendered;
(5) The name of the victim's
employer, supervisor, mailing address, and telephone number at the time the
eligible crime occurred, if the victim was employed;
(6) Photocopies of the victim's paycheck
stubs for the month prior to the eligible crime if the victim was employed, or,
if the victim was self-employed, a copy of the previous year's federal income
tax return;
(7) A letter to be
provided directly from the victim's physician or mental health professional to
the commission, which sets forth the following in support of a claim for more
than 14 consecutive workdays' lost wages:
a.A
description of the disabling injuries suffered by the victim;
b.The period of time the disabling injuries
prevented the victim from working; and
c.The date on which the victim returned to
work, or if the victim has not returned to work, the anticipated date of return
to work;
(8) A photocopy
of the final funeral bill, including burial and all related expenses but not
including expenses for the reception, wake, or purchase of clothing;
(9) A photocopy of the receipt, deed, or
both, for the purchase of a cemetery plot;
(10) A photocopy of the bill for the monument
and engraving; and
(11) Any other
information related to the claim but not covered by (1) - (10) above, and
unique to the circumstances of the claim.
(c) If needed, the unit shall provide a
self-addressed envelope for the claimant to use in submitting the information
and documents identified pursuant to (b) above. Postage shall not be provided
by the unit.
(d) The unit shall
provide information to the claimant concerning debt collection delay for
crime-related expenses, pursuant to New Hampshire RSA 21-M:8-h (a)-(b), X in
the form.
