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Click ‘Get Form’ to open the CRME DISCLOSURE in the editor.
Begin by entering the date of birth in the specified format (mm/dd/yyyy) and fill in the name of the victim, including first, middle, and last names.
Input the claim number and provide the name of the claimant or person filing on behalf of the victim.
Indicate whether the victim disclosed being a crime victim in Connecticut by selecting 'Yes' or 'No'. If 'Yes', proceed to question 2.
Check all applicable types of crimes from the list provided, such as sexual assault, domestic violence, or human trafficking.
Answer questions regarding physical and emotional injuries by selecting 'Yes', 'No', or 'Don't know' as appropriate.
Describe the incident and any injuries sustained in detail. Include dates for both the incident and when it was disclosed.
Select your profession from the list provided to confirm eligibility for victim compensation.
Complete your details at the bottom of the form, including your name, agency information, telephone number, and signature before submitting.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (27 Votes)
2018	4.2 Satisfied (68 Votes)
2014	4.4 Satisfied (181 Votes)

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