Get Dss-aa-694 09/15

The DSS-AA-694 09/15 form is critical for individuals seeking assistance through the South Dakota Crime Victims’ Compensation Program. This guide provides clear and supportive instructions on how to complete the form online, ensuring that all necessary information is submitted accurately.

Follow the steps to successfully complete the DSS-AA-694 09/15 form online.

1. Click the ‘Get Form’ button to access the DSS-AA-694 09/15 form and open it in your online editor.
2. Begin with Section I, which asks for victim information. Clearly enter the victim’s name, social security number, date of birth, marital status, age, and contact details. Ensure accuracy to avoid processing delays.
3. Complete Section II, providing additional information about the victim, including their race and national origin. Answer questions regarding any disabilities the victim may have had prior to or resulting from the crime.
4. If someone other than the victim is filing the claim, complete Section III with the claimant's details, including their relationship to the victim and contact information.
5. In Section IV, indicate how you learned about the Crime Victims’ Compensation Program by checking all applicable sources.
6. Fill out Section V with crime information, including the location, date, reported law enforcement agency, and case numbers. Provide brief details about the incident and any injuries sustained.
7. If applicable, provide details in Section VI regarding lost wages due to the crime. Include the period of absence from work and any relevant employer information.
8. Section VII collects information on any insurance or benefits received related to the crime. Note all relevant policies and detail your contact with each entity.
9. In Section VIII, list medical bills incurred as a result of the crime. Attach copies of all related bills and receipts.
10. Section IX allows you to outline other expenses. Attach any receipts or estimates for expenses incurred due to the crime.
11. If the victim died due to the crime, complete Section X with details regarding life and burial insurance, as well as associated costs.
12. In Section XI, provide information about any dependents and their relationship to the victim.
13. Review your completed form to ensure that all required sections are filled out correctly and attach any necessary documentation as specified in the instructions.
14. Finally, save your changes and choose to download, print, or share your completed DSS-AA-694 09/15 form as needed.

Complete your application online today to ensure you receive the support you need.