Get Cicb Application

Completing the Cicb application online is a vital step in seeking compensation for crime-related expenses. This guide will provide you with detailed, step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the application with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the victim information in Section 1. Provide the victim's full name, date of birth, gender, primary language, social security number, marital status, safe telephone number, current address, email address, and county.
3. Proceed to Section 2 for claimant information. If the claimant is the same as the victim, write 'SELF.' Fill out the claimant's full name, social security number, relationship to the victim, gender, date of birth, primary language, marital status, safe telephone number, current address, and county.
4. In Section 3, provide details about the crime. Include the date and time of the crime, when it was reported to authorities, location, names of individuals involved, a description of the crime, the police report number, and court information.
5. Move to Section 4 if you are requesting reimbursement for medical expenses. Describe any injuries, and list all hospitals and treatment providers. Attach all itemized medical bills and insurance statements.
6. For counseling expenses in Section 5, indicate whether they are for the victim. Attach necessary itemized bills and insurance statements.
7. In Section 6, provide information regarding any loss of earnings due to the crime. Include dates absent from work, employer information, and supporting documentation.
8. Complete Section 7 if claiming disability compensation. Describe the disability and indicate if you have applied for Social Security Disability benefits.
9. If claiming loss of support in Section 8, provide necessary details about the dependent and include supporting documents as listed.
10. For funeral expenses in Section 9, provide the name of the funeral home, decedent's name, total expenses, and supporting documents.
11. Section 10 allows for claims about other incurred expenses related to the crime scene cleanup. Provide receipts if applicable.
12. In Section 11, fill out the voluntary statistical information regarding race, disability, and referral source.
13. If represented by others in Section 12, provide details of the attorney or victim service provider assisting with the claim.
14. In Sections 13 and 14, read and sign the authorization to obtain information and the acknowledgment and reimbursement agreement.
15. After completing all sections, review your responses for accuracy. Save changes, download, print, or share the form as needed.

Begin your application process online today to ensure you receive the compensation you deserve.