Late Filing Consideration
Your Name: Application ID:
Victim’s Name (if different than above):
Unfortunately, Government Code section 13953 states that an application for compensation must
be filed within seven years of: the date of the crime, after the victim turns 21, or the victim had
reasonable knowledge of the crime.
While the law stipulates that applications should be filed within this timeframe, it also allows for
CalVCB to review and consider applications that are submitted late. The information you provide
will help us determine if we may accept your application for demonstrated good cause. Please
complete and return this form and any supporting documentation or crime-related bills to the
address below:
CalVCB, P.O. Box 3036, Sacramento, CA
95812
Did you testify during the prosecution or punishment of the person accused or convicted of
the crime resulting in emotional harm or a crime-related expense?
Yes No
Please provide a detailed explanation:
Did you incur emotional harm or any crime-related expenses because the person convicted
of the crime for which you are filing is scheduled for a parole hearing or is released from
incarceration?
Yes No
Please provide a detailed explanation:
If the questions above do not apply, please explain the reason you were unable to apply for
compensation within the filing period:
If the above information resolves the late filing issue for your application, the crime
circumstances
will be reviewed to determine if your application meets the eligibility criteria for CalVCB benefits.
Please sign and date the statement below:
I declare under penalty of perjury (Penal Code, Section 72), that I have read all of the above
questions and, to the best of my knowledge and belief, all of my answers are true, correct and
complete.
Signature: Date:
Printed Name:
If you have any questions, please call our Customer Service Unit toll-free at 1-800-777-9229.
CALIFORNIA VICTIM COMPENSATION BOARD
PO Box 3036 Sacramento, CA 95812 Phone: 800.777.9229 www.victims.ca.gov
Late Filing Consideration Form
DRS Code – 09059
Rev. 12/2019
*09059*
