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International Terrorism Victim Expense Reimbursement Program (ITVERP)

Application Checklist

For every application submitted to ITVERP requesting reimbursement of expenses linked to a designated international terrorist incident, supporting documentation must be provided. This checklist is intended to provide you with information about various acceptable forms of documentation related to your claim.

Required Proof of Identification

  1. Did you include a copy of the victim’s identification such as a passport, driver’s license, or birth certificate? (Must be a valid government issued photo I.D.)
  2. Did you include a copy of the claimant’s identification such as a passport, driver’s license, or birth certificate? (Must be a valid government issued photo I.D.)
  3. If you are not the direct victim, but are applying based on your relationship to the victim, did you include proof of the relationship between you and the victim, such as a birth certificate or marriage certificate?

Required Expense Documentation

  1. Did you include copies of receipts for each expense?
  2. If you don’t have receipts, did you explain why?
  3. If you don’t have receipts, did you include a detailed itemized statement describing each expense and how it is linked to the terrorist incident?
  4. Did you sign and date the itemized statement?
  5. Do you have any other types of documentation for the expenses such as credit card or bank statements, statements from medical or mental health providers? Insurance reports? If so, make sure to include them and a statement that links the expenses to the terrorist incident.

Required Collateral Source Documentation

  1. Did you include copies of insurance coverage (medical, property, homeowners, disability, etc.) for each expense?
  2. Did you include copies of any other types of support available to you at the time of the incident such as Workers Compensation benefits, Medicare or Medicaid, Social Security, or other victim assistance/emergency assistance programs that would have covered some of your expenses?

Required Signatures

  1. Did you sign and upload the HIPAA release form?
  2. If you have a legal representative, did you fill out and upload the Legal Representative Form?
  3. If you have a third party payer, did you have them sign the Third Party Payer form and upload a copy of their government issued identification?

Online Application

Begin the application process online, add supporting documentation as you find it, and complete your application when you are ready.  If you need help, please contact an ITVERP Case Manager at 1-800-363-0441 to assist you in completing the application.

Date Created: November 12, 2021