Form » NYS Department of Corrections and Community Supervision

Request for Victim Notification

Complete this form if you would like to receive notifications from the New York State Department of Corrections and Community Supervision Office of Victim Assistance (DOCCS OVA) on an incarcerated individual currently housed in a state prison facility. Notifications include release from custody, change in release status, upcoming parole interview dates and victim impact statement options.

Fields marked with an asterisk (*) are required.

*Name of Person Requesting Information: Please enter a valid Full Name.

NOTE: "Person Requesting Information" refers to an adult party who is capable of receiving conmmunication. DO NOT complete this form with the name of a deceased person, minor or otherwise compromised person.

*Street Address: (Please include apartment number) Please enter a valid Street Address.

*City Please enter a valid City Name.

*State

*Zip Code: Please enter a valid Zip Code.

*Best Daytime Phone Number:(Format:222-222-2222) Please enter a valid Phone Number.

*Email Address: Please enter a valid e-mail address.

I prefer notifications in: English Spanish

Name of Victim: (if different from above) Please enter a valid Full Name.

*Relationship to Victim:

Is the victim a minor (under 18 years of age)? Yes No

Incarcerated Individual Information:

Please work with your district attorney's office to provide as much information as possible. NOTE: You must submit a separate registration form for each incarcerated individual for which you are requesting notifications.

*Incarcerated Individual Name: Please enter a valid Incaracerated Individual Full Name.

Date of Birth: (Format:MM-DD-YYYY)

County of Conviction: Please enter a valid County of Conviction Number.

Indictment Number:

Sentence Date: (Format:MM-DD-YYYY)

DIN: (Format:99-A-9999) Please enter a valid DIN Number.

NYSID: (Format:99949998A) Please enter a valid NYSID Number.

For Release Notifications ONLY, please choose your preferred delivery method:

Certified Mail Regular Mail Electronic Notification*

*Electronic notification is handled through the third-party VINE service. If you choose electronic notification, you MUST register at vinelink.com as well.

I understand that any information I give to the NYS DOCCS and the NYS Board of Parole will be kept strictly confidential. I understand that it is my responsibility to notify DOCCS of any changes in the contact information I provided above, OR any changes in my request for information, by completing a new "Request for Victim Notification" registration form.

Office of Victim Assistance - Request for Victim Notification Form