United States Victims of State Sponsored Terrorism Fund Application

OMB 1123-0013

The United States Victims of State Sponsored Terrorism Fund (Fund) provides compensation to certain individuals who were injured as a result of an international act of terrorism by a state sponsor of terrorism. The Justice for United Victims of State Sponsored Terrorism Act sets forth criteria for eligibility under the Fund, such as a final judgment issued against a state sponsor of terrorism. The Fund Application From requests information to determine eligibility and amount of compensation.

The latest form for United States Victims of State Sponsored Terrorism Fund Application expires 2022-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form Notice of Filing C USVSST Application Form and Instruction
Nonmaterial Change Justification 1123-0013.docx Justification for No Material/Nonsubstantive Change
Memo 1123-0013.docx Supplementary Document
Published 30-Day Notice.pdf Supplementary Document
VSST ACH Form 9.20.16.pdf Supplementary Document
PR's Acknowledgment of Attorney's Compliance with Limitation on Attorney.pdf Supplementary Document
Notice of Filing Claim 10.5.16.pdf Supplementary Document
Hearing Request Form.pdf Supplementary Document
Draft List of Individuals (for Notice of Filing Claim) 10.6.16 1115am.pdf Supplementary Document
Draft Distribution Plan 10.07.16.pdf Supplementary Document
Consent to Distribution_10.5.16 v2.pdf Supplementary Document
Authorization for Communication Correspondence PR_10.5.16.pdf Supplementary Document
Authorization for Communication Correspondence nonPR 10.5.16.pdf Supplementary Document
Attorney Change or Removal Form.pdf Supplementary Document
Attorney Certification for Fee Limitation_PR.pdf Supplementary Document
Attorney Certification for Fee Limitation nonPR 10.5.16.pdf Supplementary Document
Applicant's Acknowledgment of Attorney's Compliance with Limitation on A.10.5.16.pdf Supplementary Document
supporting statement 10-12-16.doc Supporting Statement A
42 USC 10609.pdf Supplementary Document
USVSST Application Form and Instruction

All Historical Document Collections

202304-1123-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-04-17
202210-1123-001 Approved without change	Revision of a currently approved collection	2022-11-03
201910-1123-001 Approved without change	Extension without change of a currently approved collection	2019-10-16
201610-1123-001 Approved without change	Revision of a currently approved collection	2016-10-24
201607-1123-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-07-29
201607-1123-001 Approved with change	New collection (Request for a new OMB Control Number)	2016-07-08