Application Forms & Documents

These materials describe the International Terrorism Victim Expense Reimbursement Program (ITVERP) program, general requirements, implementation efforts, and the steps to apply for this benefit.

• The International Terrorism Victim Expense Reimbursement Program Brochure:
  • English
  • Arabic
  • French
  • Hebrew
• The International Terrorism Victim Expense Reimbursement Program Fact Sheet

Forms & Checklists

You will need the following forms and instructions to prepare your application.

• ITVERP Application (OMB Number 1121-0309; form expires 3/31/2021)
• ITVERP Supplemental Sheet (OMB Number 1121-0309; form expires 3/31/2021)
• ITVERP Application Checklist
• ITVERP HIPAA Release
• Sample Property Loss Affidavit
• Automated Clearinghouse Form (for direct deposit of claim payment)
• Authorization for Legal Representative Affidavit
• Third Party Payer Authorization

Regulations

• ITVERP Final Regulations (Federal Register Volume 71, Issue 172; September 6, 2006).
• ITVERP Final Rule (Federal Register Volume 76, Issue 69; April 11, 2011).

Reports to Congress

• 2015 – Reporting Period October 2014 – September 2015
• 2014 – Reporting Period October 2013 – September 2014
• 2013 – Reporting Period October 2012 – September 2013
• 2012 – Reporting Period September 2011 – September 2012
• 2011 – Reporting Period September 2010 – August 2011
• 2010 – Reporting Period September 2009 – August 2010
• 2009 – Reporting Period September 2008 – August 2009
• 2009 – Reporting Period June 2007 – August 2008
• 2008 – Reporting Period October 2006 – May 2007

Resource List

These Federal government resources and programs may be of assistance to you.

Office of Overseas Citizens Services, Bureau of Consular Affairs, U.S. Department of State
Assists American citizens who become victims of crime while traveling, working, or residing abroad. Consular duty personnel are available for emergency assistance 24 hours a day, 7 days a week, at embassies, consulates, and consular agencies overseas and in Washington, D.C.

Contact information for U.S. Embassies and Consulates overseas can be found at www.usembassy.gov.

Victim Services Division, Federal Bureau of Investigation, U.S. Department of Justice
Manages the FBI’s operational victim assistance response to terrorist attacks outside the United States, criminal transportation disasters, and other mass casualty crimes.

Office of Justice for Victims of Overseas Terrorism, National Security Division, U.S. Department of Justice
Responsible for ensuring that the investigation and prosecution of a terrorist attack remains a high priority within the Department of Justice and providing information and support to victims and their families during the criminal justice process.

More information on this office and available services can be found in the Assistance for U.S. Victims of Overseas Terrorism and Their Families brochure.

More information is available from the Help for Victims section of the OVC website.