Countermeasures Injury Compensation Program (CICP) Filing Process

The Countermeasures Injury Compensation Program (CICP) provides compensation for covered injuries or deaths that occur as a result of the administration or use of certain countermeasures. A countermeasure is a vaccine, medication, device, or other item used to prevent, diagnose, or treat a public health emergency or a security threat.

Compensation may include unreimbursed medical expenses (e.g., expenses that health insurance did not cover), lost employment income, and the survivor death benefit. Learn more about the types of benefits to eligible requesters.

What Are the Filing Deadlines?

You have one year from the date you were administered or used the covered countermeasure alleged to have caused the injury to request benefits.

In the event that the Secretary issues a new Covered Countermeasure Injury Table, or amends a previously published Table, certain requesters will have an extended filing deadline based on the effective date of the Table amendment. However, this extended filing deadline will only apply to requesters if the Table amendment enables a person who could not establish a Table injury before the amendment to establish such an injury. The alternative filing deadline is one year from the effective date of the Table change to file a Request Form.

What Is the Process for Filing a Claim for Benefits?

Below is a brief summary of the CICP claims process. For more detailed information regarding how the CICP works and its requirements, see the CICP Administrative Implementation Interim Final Rule and Final Rule.

The CICP reviews and resolves claims through an administrative process.

Review

CICP medical staff will review your Request for Benefits Package to decide whether you are eligible for program benefits.

Medical staff provide a thorough, individualized review of each claim to determine if a covered injury occurred and your eligibility for program benefits. The time it takes for the CICP to review your package depends partly on the complexity of your case.

If You Are Eligible:

• CICP will contact you to submit additional documentation to determine the type and amount of compensation.
• You will receive a notification in writing and a payment will be issued.

If You Are Ineligible:

• CICP will inform you in writing of the disapproval.
• If you do not agree with a CICP decision, you can ask for reconsideration.

How Do I File a Request for Benefits Package Electronically?

On the HRSA Injury Compensation Programs website, follow the step-by-step instructions on the How to Create an Account page, and then log in with your username and password. After login, select the "Submit" button under Submit a Request Package to CICP on the homepage. Fill out the required fields to submit your Request for Benefits.

Please read thoroughly:

• Instructions for Completing the HRSA Authorization for Use or Disclosure of Health Information form (PDF - 226 KB) / Instrucciones para llenar la autorización para usar o divulgar información médica de HRSA (PDF - 122 KB)

You can complete and upload the following form at the time of your submission or add it to your "Submitted" request at a later date:

• Authorization for Use or Disclosure of Health Information form (PDF - 536 KB) / Autorización para usar o divulgar información médica (PDF - 246 KB)
  Please note that you must fill out a separate form for each health care provider who treated you.

Health care providers can also submit and upload medical records electronically. They must include the patient’s name in the filename of each medical record.

For more information about CICP, contact 1-855-266-2427 or cicp@hrsa.gov.

How Do I File a Request for Benefits Package by Mail?

Please read thoroughly:

• Instructions for Completing the Request of Benefits form (PDF - 64 KB) / Instrucciones para llenar el formulario de solicitud de beneficios (PDF - 223 KB)
• Instructions for Completing the HRSA Authorization for Use or Disclosure of Health Information form (PDF - 226 KB) / Instrucciones para llenar la autorización para usar o divulgar información médica de HRSA (PDF - 122 KB)

Please complete thoroughly:

• Request for Benefits form (PDF - 903 KB) / Formulario de solicitud de beneficios (PDF - 181 KB)
• Authorization for Use or Disclosure of Health Information form (PDF - 536 KB) / Autorización para usar o divulgar información médica (PDF - 246 KB).
  Please note that you need to fill out a separate form for each health care provider who treated you.

Please make sure:

• Your Request for Benefits forms are sent to the CICP via U.S. Postal Service mail or a private courier (e.g., FedEx or UPS). CICP does not accept Request for Benefits forms via fax or email.
• CICP receives all medical records from each health care provider who treated you. These are generally all of the medical records from one year before the administration or use of the covered countermeasure to the present time. The records also need to be sent to the CICP by U.S. Postal Service mail or private courier service.

You can download the PDF forms or call 1-855-266-2427 and request a paper copy.

The CICP is not authorized to provide reimbursement for attorneys’ fees. You may elect to use an attorney; however, you are responsible for any costs incurred from using one.

How Do I File a Letter of Intent?

A Letter of Intent to file a Request for Benefits Form may be submitted to ensure that you meet the one-year filing deadline. However, if you submit a Letter of Intent, you must still file Request for Benefits Forms as soon as possible.

Please make sure:

• Letters of Intent include your full name and a statement that demonstrates your intent to submit a Request for Benefits. Please do not include any additional personal identifiable information (Social Security Number, medical, legal, or financial documents) in this letter.
• Your Letter of Intent is submitted to the CICP via U.S. Postal Service mail, a private courier, or the HRSA Injury Compensation Programs website. CICP does not accept Request for Benefits forms via fax or email.

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