Forms and Publications

Forms and Publications.

Mental Health Service Report (fill-in form for service providers)
Mental Health Service Report (non fill-in form to print - for service providers)
Employer's Certificate (Word)
Funeral Director's Report (Word)
Physicians Report (to be completed by attending physician)
Law Enforcement Victims Rights Notification Pamphlet (eff. 2019)
Sexual Assault Examination Fund Application (Effective February 01, 2025)

2019 Victims Compensation Annual Report Final
Victim Witness Coordinator List (January 2019)
Additional Consideration Transmittal Form (Word fill-in form)
Appeal Transmittal Form (Word fill-in form)
Claim Summary Template (Word fill-in form)
Collateral Source Information Form (Word fill-in form)
Continued Claim Transmittal Form (Word fill-in form)
Eligibility Transmittal Form (Word fill-in form)
Employer's Certificate (Word)
Funeral Director's Report (Word)
Mental Health Service Report (fill-in form for service providers)
Law Enforcement Certificate
Native American Traditional Services Guidelines
Request for Traditional American Indian Services Form
Physicians Report (to be completed by attending physician)
Request for Restitution Form
Sexual Assault Examination Fund Application (4/1/2010)
Victim Notification Request Form
Victim Impact Statement

Contact Information:
Oklahoma District Attorneys Council
Oklahoma Crime Victims Compensation Board
421 NW 13^th, Suite 290
Oklahoma City, OK 73103
405-264-5006
Toll-Free 1-800-745-6098
E-mail: victimsservices@dac.state.ok.us

Last Modified on Feb 06, 2025

Forms and Publications

Service Provider Forms

Crime Victims Compensation Claim Forms

Brochures / Pamphlets

Laws and Rules

Forms for Use by Victim-Witness Services Personnel Only