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Filing For Benefits

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.

Summary of CICP Claims Process

The CICP reviews and resolves claims through an administrative process. 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.

  1. An individual submits a Request Package to the CICP.
  2. The Package is reviewed by CICP medical staff to determine whether the requester is eligible for program benefits, including whether a covered injury was sustained.
  3. If the requester is determined to be eligible for program benefits, the requester is asked to submit additional documentation to determine the type and amount of compensation the requester may be entitled to receive. If the requester is found ineligible for program benefits, the requester is informed in writing of the disapproval.
  4. If the requester is found entitled to program benefits, the requester is notified in writing and payment is issued to the requester.
  5. The requester may ask the Associate Administrator of the Healthcare Systems Bureau of HRSA to reconsider the program’s eligibility or benefits determination. When a request for reconsideration is received, a qualified panel, independent of the program, is convened to review the program’s determination.
  6. The panel makes its recommendation to the Associate Administrator who makes a final determination with regard to the specific issue(s) identified in the reconsideration request. Requesters may not seek review of a decision made on reconsideration.

Types of Eligible Requesters

Below is the list of the types of eligible requesters.

  • Person who is administered or used a covered countermeasure (injured countermeasure recipient)
  • Representative of an injured countermeasure recipient
  • Administrator of the estate of a deceased injured countermeasure recipient
  • Survivor of a deceased injured countermeasure recipient

Filing a Request for Benefits Electronically

Note: If you are submitting electronically, do not also submit by mail.

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 home page. Fill out the required fields to submit your Request for Benefits.

The following forms can be completed and uploaded at the time of your submission or added to your In Progress request at a later date:

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

Filing a Request for Benefits by Mail

Note: If you are submitting by mail, do not also submit electronically.

Please read thoroughly:

Please complete thoroughly:

Please make sure:

  • Your Request for Benefits forms are sent to the CICP via U.S. Postal Service mail or a private courier. 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-CICP (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.

Filing 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 our online portal. CICP does not accept Request for Benefits forms via fax or email.

Criteria to Demonstrate that a Covered Injury Occurred

To be eligible for benefits under the program, a requester must demonstrate that a covered injury occurred.

Types of Benefits

The CICP provides various types of benefits to eligible requesters.

CICP Fact Sheet

Download the CICP fact sheet (PDF - 156 KB)

Frequently Asked Questions CICP

Seasonal Flu

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.

Countermeasures Injury Tables

Smallpox Countermeasures Injury Table

Smallpox Countermeasures Injury Table Final Rule

Pandemic Influenza Countermeasure Injury Table (XML)

Pandemic Influenza Countermeasure Injury Table Final Rule (PDF)

Contact Us - CICP

Health Resources and Services Administration, Countermeasures Injury Compensation Program, 5600 Fishers Lane, 08N146B, Rockville, MD 20857

cicp@hrsa.gov
1-855-266-2427 (1-855-266-CICP)

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.

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