The State Institution Claims Program Form, known as BVC402SI, serves as a vital tool for individuals seeking restitution for property damages or direct medical expenses resulting from incidents involving those under the care or supervision of specific Florida state departments. This includes shelter and foster children, escapees, inmates, or patients of state institutions or developmental disabilities centers. Managed by the office located in Tallahassee, Florida, the form requires detailed claimant information, specifies restitution information, and must be submitted within a strict 120-day timeframe post-incident to be considered. Failure to meet this deadline will lead to claim rejection. Furthermore, the form necessitates verification by a state agency delegate, who must certify the authenticity and accuracy of the information provided, under penalty of perjury or fraud. The specific departments authorized to delegate a representative include the Department of Children and Family Services, the Department of Health, the Department of Juvenile Justice, the Department of Corrections, and the Agency for Persons with Disabilities. It also outlines maximum award amounts, depending on the individual responsible for the loss, and stipulates the need for attaching supporting documentation for the claimed damages or expenses. For those seeking restitution, understanding the procedural requirements and the importance of accurate and timely submission is essential for navigating the claims process successfully.
| Question | Answer |
|---|---|
| Form Name | Form Bvc402Si |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | TDD, CLAIMANT, myfloridalegal, Fla |
