80 Neb. Admin. Code, ch. 2, § 003

003 Form – The application form, developed by the Committee must be fully completed and mailed with sufficient postage, submitted electronically, or delivered to the Crime Victim’s Reparations program. 003.01 – Incident Information – The claimant is required to provide the following, if known: a brief description of the incident; the date, place, and time of the incident; the date the incident was reported to a law enforcement agency. 003.02 Signatures – The claimant is required to sign a statement authorizing the release of information relating to the incident and to information relating to services rendered to the victim. Information and records received relating to the victim, the criminal incident and treatment shall remain confidential except for that information considered public under Nebraska or U.S. laws.

The claimant is required to submit a signed statement attesting to the validity of the facts included in the claim for compensation.