Forensic Interview Form printable pdf download

The Georgia Crime Victims Compensation Program can pay for

INSTRUCTIONS

the cost of a forensic interview up to $200.00 per victim, per

To expedite the processing of

victimization for crimes occurring in Georgia on or after July 1, 2014.

your claim, please submit a complete

Please note that the request for payment must comply with the

Forensic Interview Application Packet,

following provisions.

which includes items 1 thru 2 below.

PLEASE NOTE

The Forensic Interview (FI) must be for a person who is less

than 18 years of age or a developmentally disabled adult.

Fill out and sign the attached application.

The FI must be conducted in the context of a multidisciplinary

and diagnostic team, or in a specialized setting such as a Child

Advocacy Center.

The results of the FI must be for identification of the

Collect the required documents and attach to

interviewee’s needs, including social services, personal

your application.

advocacy, case management, substance abuse treatment, and

mental health services. As such, a copy of the referral

information must be submitted with the Application for Payment.

If no referral made, a statement must be provided on the

reason(s) no referrals were given to the victim. The provider

may submit this information on their agency’s form(s) or on the

Mail the complete application packet to

attached Forensic Interview Referral Document (FIRD).

Criminal Justice Coordinating Council,

Forensic Interview Program

The interviewer must have specialized training to conduct FIs

104 Marietta Street NW, Suite 440

appropriate to the developmental age and abilities of children, or

Atlanta, GA 30303

the developmental, cognitive, and physical or communication

disabilities presented by adults.

The victim or their parent/legal guardian may

apply to CVCP to be considered for other

The interviewer must submit a copy of their license or training

benefits (i.e. medical, counseling, or

certificate with the initial Application for Payment.

lost/wages/loss of support). You can visit our

The Agency Executive Director must submit a Forensic

website to get additional information about the

Interviewer Funding Certification Document annually for any

CVCP and download the CVCP application.

forensic interviewer employed by their Agency/Organization

before payment can be disbursed.

Office: (404) 657-2222

All sections of the Application for Payment must be completed.

Toll Free: (800) 547-0060

Incomplete applications will not be processed and a letter will be

TTY: (404) 463-7650

mailed noting the reason the application is incomplete.

Fax: (404) 463)-7652

Incomplete applications will be returned after 30 days.

crimevictimscomp.ga.gov

We must have an eligible application with the original signature

of the person that conducted the FI AND the Agency Executive

Director or their designee on file before we can remit payment.

All charges/services associated with the FI must be itemized

and submitted with the Application for Payment, and only those

expenses for the actual FI will be considered for payment.

Forensic Interview Form

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