How to File Requests for Benefits

Individuals who would like to file Preparedness Countermeasures Injury Compensation (PCIC) Requests for Benefits may send a letter of their intent to file. Request for benefits forms are not available yet, but will be sent later to those who send a letter of intent to file. Postmarking the letter of intent to file within the one (1) year filing deadline of receiving the covered countermeasure will ensure that an individual is considered to have a timely filed request for benefits.

Although it is not required, requestors may engage the services of an attorney or other representative to render services in connection with the request for benefits. However, the payment of fees and/or costs of an attorney or other representative are not permitted under the Public Readiness and Emergency Response Act, which is the law that created the PCIC Request for Benefits.

The letter of intent to file should include:

• the name, current address, and phone number of the requestor of benefits;
• the name, address, and phone number of the requestor’s attorney of record or other representative for the request for benefits, if any;
• the covered countermeasure received, the date it was received, the circumstances under which the covered countermeasure was received (e.g., clinical trial sponsored by the National Institutes of Health), and the name of the vaccine recipient if the requestor is filing a death claim.

Send the letter to:

• Health Resources and Services Administration
  Preparedness Countermeasures Injury Compensation Request for Benefits
  5600 Fishers Lane, Room 11C-26
  Rockville, MD 20857

Letters of intent must be postmarked by the U.S. Postal Service, a commercial carrier, or a private courier service. HRSA will not accept request packages electronically or by hand-delivery. The postmark date will be used to determine whether the filing deadline of one year from receipt of the countermeasure has been met. Because request forms are not yet available, HRSA will accept letters of intent as described on this website, for purposes of meeting the one-year filing deadline if postmarked as described above.

After receiving the letter of intent to file a request for benefits, an acknowledgment will be sent to the requestor or the requestor’s attorney of record or other representative for the request for benefits with a case number assigned to the filing. Sending this acknowledgment in no way implies that the requestor has been determined eligible for benefits. If and when funds are appropriated to provide compensation, the processing and review of requests for benefits will occur after the appropriate forms have been filed by or on behalf of the requestor.

The requestor must notify the PCIC Request for Benefits of any change of address, phone number, or attorney of record or other representative. The letter of intent to file will not be further processed if the requestor or his/her attorney or representative cannot be contacted in the future because of a change in such information of which the PCIC Request for Benefits was not informed. New name, address, phone number(s) or attorney or other representative information should be sent to the same address as the letter of intent to file.