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The Claim Form serves as the application to the Virginia Victims Fund. With this application, you may apply for one or more of the following assistance programs: • Auxiliary Grants (AG).This claim form should be submitted within one year of the crime. Complete the Application for Benefits — Crime Victims (F800-042-000) form. You need to enable JavaScript to run this app. Complete the "Application For Crime Victim Compensation" and return it to the Victim Compensation and Assistance Division for verification. After receiving an application, it will be given a claim number. Expenses qualify for compensation? ; Medical, dental, and prescriptions. The program provides compensation to victims of crimes, survivors or homicide victims, and dependent family members.