World Trade Center September 11th Victim Compensation Fund Authorization {WTC-VCF-AUTH}

WTC-VCF-AUTH - WORLD TRADE CENTER SEPTEMBER 11th VICTIM COMPENSATION FUND (VCF) AUTHORIZATION. This form is used for authorizing the Workers' Compensation Board to obtain information related to a claim under the September 11th Victim Compensation Fund (VCF). The claimant provides their personal details, such as name, date of birth, social security number, mailing address, city, state, and zip code. By signing this form, the claimant grants permission for the Workers' Compensation Board to access any necessary information from the U.S. Department of Justice. This information may include medical, government, and financial records relevant to the evaluation of their World Trade Center volunteer claim for compensation. The claimant acknowledges that they have the right to revoke this authorization at any time, except if the Workers' Compensation Board has already taken action based on this authorization. To revoke the authorization, a letter should be sent to the Workers' Compensation Board at the provided address. It is noted that copies of this authorization bearing the claimant's signature are considered as valid as the original release. If the claimant is unable to sign, the form provides space for another individual to fill out their name, signature, relationship to the patient, and the date of signing on the claimant's behalf. www.FormsWorkflow.com