Required Proof of Identification

A claim will not be processed unless you include a valid form of identification and proof of citizenship for the victim and the individual submitting the claim.

• Acceptable forms of a valid government-issued photo identification include a passport, driver’s license, or state non-driver identification card.
• Acceptable forms of proof of citizenship include a passport, birth certificate, certificate of naturalization, certificate of citizenship, or consular report of birth abroad. A driver’s license is not proof of citizenship.

The victim and the claimant can be the same person. If they are not, you must also include proof of the relationship between the claimant and the victim, such as a birth certificate or marriage certificate.

Required Expense Documentation

• Receipts for each expense.
• If you don’t have receipts, explain why you don’t have receipts and include a detailed itemized statement describing each expense and how it is linked to the terrorist incident. Sign and date the itemized statement. See the Sample Property Loss Affidavit form for more information.  
• Include any available documentation for the expenses, such as credit card or bank statements, statements from medical or mental health providers, insurance reports, etc. Include a statement that links the expenses to the terrorist incident.

Required Collateral Source Documentation

• Include copies of insurance coverage (medical, property, homeowners, disability, etc.) for each expense.
• 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

• Sign and upload the HIPAA release form.
• If you have a legal representative, fill out and upload the Authorization for Legal Representative Affidavit form.
• If you have a third-party payer, have them sign the Third-Party Payer Authorization form and upload a copy of their government issued identification.