Certifying Agency Reporting Form 2024

Certifying Agency Reporting Form 2024

RCW 7.98.020 (6)(c) requires each certifying agency identified in RCW 7.98 to: "Keep written documentation regarding the number of victims who requested certifications, the number of certification forms that were signed, the number of certification forms that were denied, and the number of certification forms that were withdrawn, which must be reported to the Office of Crime Victims Advocacy on an annual basis."

This form is for July 1, 2023 through June 30, 2024. The data is due BY AUGUST 15, 2024.

If no U&T Visas were received, please enter "0" and submit.

Agency Name*

Type of Agency

Select

Are you filing for multiple agencies?

If yes, check the box.

Additional Agencies you are reporting for

If your agency reports for more than one agency, please list the agencies you are reporting for (i.e. Prosecuting Attorney's Office reporting for a Sheriff's Office)

City*

Please select the city that your agency is located in. You can type ahead to filter the list.

Select

Zip Code*

Please enter the zip code that your agency is located in.

County*

Please select the county that your agency is located in. You can type ahead to filter the list.

Select

Name of Person Completing Report*

Title of Person Completing Report*

Date of Report Completion*

Number of victims who requested certifications*

Please enter the number of certification requests received during the reporting period,

Signed Certification Requests*

Please enter the number of certification requests that were signed during the reporting period,

Denied Certification Requests*

Please enter the number of certification requests that were denied during the reporting period,

Withdrawn Certifications*

Please enter the number of certification requests that were withdrawn during the reporting period,

Certification Requests Pending

This is not a required field. However, if your agency tracks the number of requests that are pending determination, please enter that information here.

Certification Referred to another agency

Addtl. Comments

If you have any additional comments on the information provided, please provide that here. Although not required, you could indicate the reasons for denied and/or withdrawn requests as an example.

Email Address*

Please enter your email address for any follow up questions.

Submitted By Name (if different)

Submitted By Title (if different)

Thank you for providing this information. It provide important data regarding U and T visa certifications in the state of Washington.

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