(b) An application for compensation under this chapter must be verified and contain:

(1) the date on which the criminally injurious conduct occurred;

(2) a description of the nature and circumstances of the criminally injurious conduct;

(3) a complete financial statement, including:

(A) the cost of medical care or burial expenses and the loss of wages or support the claimant or victim has incurred or will incur; and

(B) the extent to which the claimant or victim has been indemnified for the expenses under Paragraph (A) from a collateral source;

(4) a statement indicating the extent of any disability resulting from the injury incurred;

(5) an authorization permitting the attorney general to verify the contents of the application; and

(6) any other information the attorney general requires.

Added by Acts 2019, 86th Leg., R.S., Ch. 469 (H.B. 4173), Sec. 1.06, eff. January 1, 2021.

Text of article effective on January 01, 2021