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For waiver ct 2026

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The document is an application form from the State of Connecticut's Office of Victim Services, allowing individuals to request a waiver for the two-year filing requirement for victim compensation claims. It outlines the necessary steps for completion, including information about the victim and claimant, reasons for late filing, and compliance with ADA regulations.

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Click ‘Get Form’ to open the for waiver ct in the editor.
Begin by entering the 'Name of Victim' and 'Claim Number' in the designated fields. Ensure that all information is accurate.
Next, fill in the 'Name of Claimant or Person Filing for Claimant' and 'Claims Examiner'. This identifies who is submitting the application.
Select the appropriate box regarding the claimant's status at the time of the criminal incident. Provide a detailed description of any physical, emotional, or psychological injuries that prevented timely filing if applicable.
Print your name and provide a signature. If the claimant is a minor, ensure a parent or guardian signs on their behalf.
Finally, review all entries for accuracy before saving your completed form. You can then print it or send it via email or fax as instructed.

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