You have ONE YEAR from the date you were administered or used the covered countermeasure alleged to have caused the injury to request benefits.
You can download the PDF forms below or call 1-855-266-CICP (1-855-266-2427) and request a paper copy.
Please read thoroughly:
Please complete thoroughly:
Please make sure:
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.
Last Reviewed: March 2017
Seasonal influenza vaccines are not covered countermeasures under the CICP. If you received the seasonal influenza vaccine or other vaccines covered by the National Vaccine Injury Compensation Program (VICP) such as tetanus or the human papillomavirus vaccine and think that you had an adverse reaction from one or a combination of these covered vaccines, see the VICP.
For your security, please do not send any personal information (Social Security Number, medical, legal, or financial documents, etc.) by email to the Program.
Please call the above number and you will receive information on sending emails safely and securely.