Apply for Crime Victim Benefits

Attention Please

Apply online or use PDF form

Complete the Application for Benefits online. You will have a chance to save or print a copy of the completed application for your records before you submit the claim. The application ID appears after you submit the claim and you do not need to send a copy of the paper application to us.

If you experience difficulties using the online portal, or if you prefer you can use the application method below.

Complete the Application for Benefits — Crime Victims (F800-042-000) form. This form is also available from victim witness advocates at your local county prosecutor's office and from health-care providers. This form may be directly faxed to 360-902-5333 or emailed to CrimeVictimsProgramM@Lni.wa.gov.
For homicide victims, use the Application for Benefits — Homicide Crime Victims (F800-120-000). This form may be directly faxed to 360-902-5333 or emailed to CrimeVictimsProgramM@Lni.wa.gov.
- Note: Be sure to sign and date the form. Incomplete information could delay the decision on your claim.

You will hear from us within 5-7 days regarding receipt of your application and in most cases within 15-18 days regarding the outcome of your application. Call 800-762-3716 to check the status of your application.

Address change

Victims who have filed Crime Victims Compensation claims with the Crime Victims Compensation Program need to submit in an address change request when they have a change in their mailing address.

Your address change must be submitted in writing by mail, fax or email.

All address change requests must include:

Date
Claim number
Claimant name
New address
The claimant's authorizing signature

Please provide an updated telephone number if appropriate.

Mail

Mail the address change request to your claim manager:

Crime Victims Compensation Program
Department of Labor & Industries
P.O. Box 44520
Olympia, WA 98504-4520

Fax

Fax the address change request to your claim manager. The claim manager should be advised before the fax is sent.

Fax: 360‑902‑5333

Email

Email: CrimeVictimsProgramM@Lni.wa.gov

Always include the claim number on every fax page.

Questions crime victim applicants have

Print your completed application and send it to the Crime Victims Compensation Program.
Yes, complete the form Crime Victim's Application for Benefits - Injury Claims (F800‑042‑000). Once you print out the application, follow the instructions to send it to us by mail or fax.
The little red * indicates it is a required field. The online application cannot be submitted without completing all required fields.
When you file online, an electronic copy of the application should automatically download to your device.
Submit your claim online and write down your claim number. Next, write your claim number on the top of each page of the documents you want to submit and fax them to 360-902-5333. You can also email the documents to: CrimeVictimsProgramM@Lni.wa.gov
Please call us right away at 1-800-762-3716, and provide updated and current information to avoid claim delays. Any address changes must be submitted in writing by mail, fax or email.

Attention Please

Apply online or use PDF form

Address change

Mail

Fax

Email

Questions crime victim applicants have

Contact Crime Victims:

Mailing Address