Application and Additional Forms
Update – January 11, 2023
All claimants should use the new and updated forms linked on this page, which list an expiration date of January 31, 2026. Please do not submit earlier versions of these forms to the USVSST Fund.
USVSST Fund Application FormAdditional Forms
- Change of Attorney Form
- Applicant’s Acknowledgment of Statutory Limitation on Attorneys’ Fees
- Attorney’s Certification of Compliance with Statutory Limitation on Attorneys’ Fees
- Authorization for Communication
- Hearing Request Form
- Informer Information and Acknowledgement
Forms for Personal Representatives of Deceased Individuals
- Certification of Personal Representative
- Notice of Filing Claim - The Personal Representative must notify everyone specified in Part VII.2 of the Notice published in the Federal Register. Use of this particular Notice of Filing Claim form is not required; however, any other notification must meet all of the requirements in Part VII.2.
These documents are in PDF format. Acrobat Reader is required to view PDFs. You may already have the Adobe Acrobat Reader on your computer or on disks that came with your computer. If you do, you do not need to download Adobe Acrobat. If you do not have Acrobat, you may download the Free Adobe Acrobat Reader.