CALIFORNIA VICTIM COMPENSATION BOARD
P.O. Box 3036 • Sacramento, CA 95812 • Phone: 800.777.9229 • www.victims.ca.gov
VCB-30-19231a
DRS Code - 19231, Relo Instructions Worksheet
Rev. 5/2024
Page 1/3
STATE OF CALIFORNIA
HOW TO APPLY FOR
RELOCATION BENEFITS
VCB-30-19231a (Rev 05/2024)
CalVCB may reimburse a claimant up to $3,418 per household for expenses incurred in relocating.
Although your claim may have been found eligible, not all claimants qualify for relocation benefits. The
need for the relocation must be verified and required as a direct result of the qualifying crime. To
determine this, certain documentation is required.
Please read the instructions carefully and provide requested information including receipts or
proof of expenses to assist CalVCB staff in verifying your request.
Required Documentation:
1. Determination that the need to move was:
Necessary for Safety Reasons OR
*Law Enforcement Verification Form or a letter
from law enforcement on the agency’s
letterhead containing the same information
requested on the Law Enforcement Relocation
Verification Form.
Necessary for Emotional Reasons
*Mental Health Provider Verification Form or
a letter from your licensed treatment
provider on their letterhead containing the
same information requested on the Mental
Health Provider Verification Form.
*For a listing of acceptable Law Enforcement Agencies and Mental Health Providers please see the
other side of this form.
2. Verification of the cost for moving into the new apartment, house or room:
When you are requesting the cost for moving into the new residence (deposit, rent), please
submit the following:
Apartment or House Rental
Lease/Rental Agreement must be completed
by the Apartment Manager, Leasing Agent or
Landlord. If a Lease/Rental Agreement is not
available, the CalVCB Rental Verification Form
must be completed.
Room Rental or Renting from Family/Friend
CalVCB Rental Verification Form must be
completed by the Landlord or the individual
that is renting the house/room to you.
► When you are requesting that CalVCB pay the Apartment or Landlord directly, the W-9 Form must
be completed by the Apartment Manager, Leasing Agent or Landlord in addition to the
Lease/Rental Agreement.
► The remaining security deposit balance must be returned to CalVCB upon termination of the rental
agreement. The check must be sent to CalVCB Accounting, P.O. Box 1348, Sacramento CA 95812-1348,
indicate on the check “RELOCATION REFUND,” the renter’s Full Name and Application ID.
CALIFORNIA VICTIM COMPENSATION BOARD
P.O. Box 3036 • Sacramento, CA 95812 • Phone: 800.777.9229 • www.victims.ca.gov
VCB-30-19231a
DRS Code - 19231, Relo Instructions Worksheet
Rev. 5/2024
Page 2/3
3. Verification of Other Expenses and Completion of the Relocation Expense
Verification Worksheet:
Necessary for Safety Reasons OR
Necessary for Emotional Reasons
► When requesting other moving costs; please submit copies of contracts, receipts, billing statements,
etc. that substantiate your losses.
► Before CalVCB can consider payment of any expenses associated with relocation; the *Relocation
Expense Verification Worksheet must be completed with your signature acknowledging that all of the
information is correct and that you agree not to inform the offender of the location of your new residence.
*If you have received this relocation information by mail, the required forms should be included in your
packet. If not, the forms can be obtained at our website at: www.victims.ca.gov.
Mail the completed documents to:
California Victim Compensation Board
P.O. Box 3036 Sacramento, CA 95812-3036
Or by Fax:
1-866-902-8669
If you have any questions or need assistance, please feel free to contact us at 800.777.9229.
Law Enforcement Agencies that can Provide
the Documentation for Relocation:
• Police Department
• Sheriff’s Department
• District Attorney
• County Probation Department
• Social Services Agency (Child Protective
Services – CPS)
• Department of Justice
• Department of Corrections
• Department of Youth Authority
• Highway Patrol
• Police Department of any campus of the
University of California
• California State University or community
college
• Every agency of the State of California
expressly authorized by statute to investigate
or prosecute violators
• Federal agencies authorized by statute to
investigate or prosecute violators
Mental Health Providers that can provide the
documentation for Relocation based on
Emotional Well Being:
• Clinical Nurse Specialist
• Licensed Clinical Social Worker (LCSW)
• Licensed Marriage and Family Therapist
(LMFT)
• Licensed Professional Clinical Counselor
(LPCC)
• Licensed Psychiatrist
• Psychiatric Mental Health Nurse
• Psychologist
• Registered Psychologist
A signature from the licensed supervising therapist
is required for the following:
• Associate Social Worker
• Associate Professional Clinical Counselor
(APCC)
• Associate Marriage and Family Therapist
(AMFT)
• Psychiatric Resident
• Certified Child Life Specialist
