This program may be able to help by paying you back for money you had to pay or lost because of a crime. Compensation may be paid to you or others for medical costs, counseling, loss of earnings, loss of support, funeral costs, travel costs, childcare, stolen cash, relocation, the costs to cleanup a crime scene and other costs.

To Receive Compensation, You Have To:

1. Be a victim of a crime that happened in Pennsylvania.
2. Report the crime or file a Protection From Abuse Order (PFA) within three days.
3. Cooperate with the police, courts and the Victim Compensation Assistance Program.
4. File the claim within 2 years of the crime.
5. Not be involved in illegal activity that caused the crime to happen.
6. Lose at least $100 because of the crime (if you are less than 60 years old).

There are exceptions to the above requirements (especially if the victim is younger than 18 years old).

This program will not reimburse you for:

1. Pain and suffering.
2. Stolen or damaged property (except some medical things).

What You Need to Complete this Online Claim:

• A printer to print the Signature Page documents.

Your Responsibility:

• Keep the Program informed if you change your address or phone number. In order to process your claim, we must be able to contact you.

Filing a claim is only one service that is available to victims of crime in Pennsylvania. Local victim advocates are available in each county to support victims and can assist you in filing a claim. You may also file a claim directly using this site by pressing the "Continue" button below. The overall maximum award shall not exceed $35,000, however monetary limits apply to most benefits. Your cooperation with the Program and the submission of complete and accurate information will assist us in processing your claim in a timely manner.

Note: Making a false statement in this claim form with an intent to mislead the Program, is a criminal offense punishable as a misdemeanor under 18 Pa. C.S. §4904.