(1) FILING DEADLINE. A claim must be filed by
the applicant within the time limits specified in s.
Jus 11.07(1).
(2) APPLICATION FORM. A claim shall be filed
on the application form prescribed by the department and shall contain at least
the following information:
(a) The name and
address of the victim of the crime.
(b) The name and address of the applicant and
the relationship of the applicant to the victim.
(c) An accurate description of the crime and
the date on which the crime occurred.
(d) The law enforcement agency to which the
crime was reported and the date on which the crime was reported.
(e) The nature and extent of the injuries the
victim sustained from the crime; the name and address of any person who gave
medical treatment to the victim for these injuries; the name and address of any
hospital or similar institution where the victim received medical treatment for
the injuries and the costs of such treatment.
(f) The work loss the victim sustained as a
result of the crime.
(g) The source
and amount of benefit the victim, dependent or applicant has received, or is to
receive, from any collateral source for economic loss that resulted from the
crime and the name of the collateral source.
(h) Whether the claimant knows the offender,
and the nature of the relationship, if any.
(i) A release authorizing the department to
obtain any report, document or other information it needs in its determination
of the claim.
(j) Any additional
information or material the department determines is reasonably related to the
application.
Note: A copy of the application form may be
obtained at the Wisconsin department of justice at no charge.
(3) INCOMPLETE APPLICATIONS.
Whenever an application is not complete or the department otherwise lacks
information required under sub. (2), the department shall request the applicant
to provide the required information. If the applicant fails within 30 days to
provide the information or to indicate why the information is unavailable, the
applicant shall be denied an award under s.
Jus 11.07(7).
