Section Jus 604.02 - Acknowledgment of Receipt of Claim and Request for More Information Letter(a) Upon receipt of a complete "New Hampshire Victims' Compensation Program Application Form" by the unit, it shall send an "Acknowledgment of Receipt of Claim and Request for More Information letter" to acknowledge the receipt of the claim and shall identify any specific types of additional information required to process the claim. Determination of such types of additional information shall be made on a case-by-case basis, pursuant to (b) below.(b) The types of additional information that the unit identified pursuant to (a) above shall include: (1) Information regarding collateral financial sources, as described in Jus 604.03, if collateral financial sources might exist;(2) Photocopies of all crime-related medical bills;(3) Photocopies of all crime-related mental health counseling bills;(4) If copies of medical bills, mental health counseling bills, or both are not available but expenses have been incurred, a complete list of each such provider's: b.Complete mailing address;d. Services actually rendered;(5) The name of the victim's employer, supervisor, mailing address, and telephone number at the time the eligible crime occurred, if the victim was employed;(6) Photocopies of the victim's paycheck stubs for the month prior to the eligible crime if the victim was employed, or, if the victim was self-employed, a copy of the previous year's federal income tax return;(7) A letter to be provided directly from the victim's physician or mental health professional to the commission, which sets forth the following in support of a claim for more than 14 consecutive workdays' lost wages:a.A description of the disabling injuries suffered by the victim;b.The period of time the disabling injuries prevented the victim from working; andc.The date on which the victim returned to work, or if the victim has not returned to work, the anticipated date of return to work;(8) A photocopy of the final funeral bill, including burial and all related expenses but not including expenses for the reception, wake, or purchase of clothing;(9) A photocopy of the receipt, deed, or both, for the purchase of a cemetery plot;(10) A photocopy of the bill for the monument and engraving; and(11) Any other information related to the claim but not covered by (1) - (10) above, and unique to the circumstances of the claim.(c) If needed, the unit shall provide a self-addressed envelope for the claimant to use in submitting the information and documents identified pursuant to (b) above. Postage shall not be provided by the unit.(d) The unit shall provide information to the claimant concerning debt collection delay for crime-related expenses, pursuant to New Hampshire RSA 21-M:8-h (a)-(b), X in the form.N.H. Admin. Code § Jus 604.02
#4864, eff 7-13-90, EXPIRED: 7-13-96
New. #7117, eff 10-8-99, EXPIRED: 10-8-07
New. #9553, eff 9-25-09
Amended by Volume XL Number 2, Filed January 9, 2020, Proposed by #12938, Effective 12/9/2019, Expires 12/9/2029.