Application for Benefits - Crime Victims

Application for Benefits - Crime Victims - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Application for Benefits - Crime Victims (A fillable form - 870 KB PDF)

Used by victims of a crime in Washington State to receive benefits for time lost from work, loss of financial support, medical or mental health treatment. The Spanish version of the instructions are online as F800-042-999.

Form number F800-042-000
Online only. See document above to download.
Keywords crime victims compensation, cvc, industrial insurance, worker's compensation, workers compensation, workers' compensation
Languages English , Spanish
Valid dates 12-2010
Contact information
Web pages Help for Crime Victims

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.