OMB control number
VCF Claim Form
OMB 1105-0092 ยท DOJ/LA.
OMB 1105-0092
Under the James Zadroga September 11 Health and Compensation Act of 2010 (P.L. 111-347), the Department of Justice would request biographical information and limited information regarding eligibility for the September 11th Victim Compensation Fund from potential claimants in order to begin the process of determining whether claimants will be eligible for compensation from the Fund.
The latest form for VCF Claim Form expires 2022-09-30 and is listed under ICR 201907-1105-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form 1105-0092 VCF Claim Form | Form |
 1105-0092 _SS PRA - Revised EC_Form_FINAL_041316_.docx | Supporting Statement A |
| Published 30 Day.pdf | Supplementary Document |
| VCF Updated Claim Form - Summary of Changes_1105-0092.docx | Justification for No Material/Nonsubstantive Change |
| 1105-0092_Claim Form_Signature Page_041316.docx | Supplementary Document |
| 1105-0092_Exhibits_Final Copy_041316.pdf | Supplementary Document |
| 1105-0092 OMB Form 83-I - REVISED_041316.pdf | Supplementary Document |
 VCF Claim Form |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201907-1105-001 | Extension without change of a currently approved collection | 2019-07-24 | Approved without change | |
| 201906-1105-001 | No material or nonsubstantive change to a currently approved collection | 2019-06-21 | Improperly submitted and continue | |
| 201604-1105-001 | Reinstatement with change of a previously approved collection | 2016-04-14 | Approved without change | |
| 201201-1105-003 | Extension without change of a currently approved collection | 2012-04-18 | Approved without change | |
| 201201-1105-002 | Revision of a currently approved collection | 2012-01-12 | Approved with change |