Lead PR Designation Form

Lead Personal Representative Designation Instructions

Released: November 2022 1 www.vcf.gov / VCF Helpline 1-855-885-1555

Who needs to submit this form?

You must complete and submit this form if the court has appointed multiple individuals as co-Personal

Representatives (“PRs”) for the victim’s estate. The co-PRs must designate which individual will serve as the Lead

Personal Representative (“Lead PR”) for purposes of the claim filed on the decedent’s behalf with the September

11th Victim Compensation Fund (“VCF”). The Lead PR is the individual the VCF will primarily communicate with

regarding the claim, and the individual to whom the VCF will issue any payment on the claim.

Why does the VCF require this form?

We can only direct correspondence to, and pay, one person per claim. Since the court appointed more than one

Personal Representative for the victim, we need you to tell us who to communicate with and who will receive payment

of any VCF award.

When should this form be submitted?

This form should be submitted when you file the claim on the victim’s behalf. However, if you are submitting this form

in response to a Missing Information letter sent to you by the VCF, you should return this form based upon the

deadlines included in that letter.

How do we choose the Lead PR?

The person you identify as the Lead PR must be listed on the court order appointing the representatives of the victim’s

estate. To help you choose the Lead PR, the table below provides a summary of the rights and responsibilities of

the Lead PR and the other co-Personal Representatives. The Lead PR designation does not provide the named

individual with any additional authority over the claim or it’s processing.

Lead PR

All co-PRs and Lead PR

• Receives all correspondence from the VCF and

is the primary point of contact for the claim.

• Provides direction to the VCF regarding any

payment on the claim, either by providing a

completed ACH Payment Information Form, or

by signing a Client Authorization Form provided

by their attorney (if applicable).

• Must distribute any payment based on

applicable laws and court orders. The Lead PR

may not keep the payment unless the law or a

court order allows them to do so.

• Receives notification by mail when the VCF

validates the co-Personal Representative(s)

and designates the Lead PR.

• Can request access to the decedent’s claim in

the online claims system, including uploading

documents in support of the claim, viewing

correspondence sent by the VCF, and

checking claim status.

• Can call the VCF Helpline to receive status

updates about the claim.

What documents need to be submitted with this form?

• Completed and signed Lead PR Form. The co-PRs may submit one form that includes the initials and

signatures of all the PRs appointed by the court, or each PR may submit their own individual form with their

own signature. If the PRs elect to submit individual Lead PR Designation Forms, the same Lead PR must

be listed on all the submitted forms.

• A copy of the court order appointing the multiple Personal Representatives.

• A Claim Form Signature Page initialed and signed by each co-PR. Co-PRs can initial and sign the same

Signature Page (one document with initials and signatures from all the PRs), or each PR can submit their

own Signature Page.

Any other forms that are required to be submitted with the claim (such as Exhibit A, Exhibit B1, etc.) should be

signed by the Lead PR. These documents do not require the signatures of all PRs. You only need to submit

one copy of each form and it will be considered sufficient to continue processing the claim as long as it is

completed correctly and properly signed and/or initialed by the Lead PR.

How do we submit the completed Lead PR Designation Form?

The completed form(s) should be uploaded to the online claim. Uploading documents will speed the processing of

your claim. If you do not have online access to your claim, you can go to www.vcf.gov/getting-started for instructions

on how to get online access. If you are not able to get online access to your claim, mail the completed form(s) to:

September 11th Victim Compensation Fund

P.O. Box 34500

Washington, D.C. 20043

Lead Personal Representative Designation Form

Released: November 2022 2 www.vcf.gov / VCF Helpline 1-855-885-1555

Lead Personal Representative (“Lead PR”) Designation Form

Read the instructions on the first page before completing this form. Each co-Personal Representative

(“PR”), including the Lead PR, must print their name and sign and date this form. You can choose to

have all co-PRs sign the same copy of the form or have each co-PR sign and submit their own copy to the

VCF. If individual Lead PR Designation Forms are submitted, the same Lead PR must be listed on each

of the submitted forms.

Decedent VCF Claim Number: VCF __ __ __ __ __ __ __ (input the 7 numbers after “VCF”)

Decedent Name: _______________________ ________________ ____________________________

First Middle Last

I declare the following under penalty of perjury:

• I agree that _____________________________________ will be the Lead PR for our claim to

(print Lead PR full legal name as listed on the court order)

the VCF on behalf of the decedent.

• I understand that the Lead PR will be the primary point of contact for the VCF and will receive all

correspondence on the claim.

• I understand that the Lead PR will provide the VCF with direction as to the bank account to which

any payment on the claim will be made. I understand that the Lead PR must distribute any

payment according to applicable laws and court orders.

• I understand that all co-Personal Representatives, including the Lead PR, are entitled to the

following: notification from the VCF that it has validated the co-Personal Representatives and

accepted the Lead PR designation; access to the claim in the VCF’s online claims system; status

updates regarding the claim; and ability to submit documentation in support of the claim.

Personal Representative Signatures. The Lead PR and each Co-PR must print their names and

sign and date below. If there are more than two co-PRs, add lines as necessary.

The VCF does not accept electronic signatures. You must sign this form with an original signature.

By signing below, I authorize the VCF to make the necessary updates to my claim.

____________________________________________________________

Print Lead Personal Representative Full Legal Name

________________________________________________ ________________________

Lead Personal Representative Signature Date Signed

___________________________________________________________

Print First Co-Personal Representative Full Legal Name

________________________________________________ ________________________

Co-Personal Representative Signature Date Signed

____________________________________________________________

Print Second Co-Personal Representative Full Legal Name (if applicable)

________________________________________________ ________________________

Second Co-Personal Representative Signature Date Signed