(740 ILCS 45/7.1) (from Ch. 70, par. 77.1)
    Sec. 7.1. (a) The application shall set out:
        (1) the name and address of the victim;
        (2) if the victim is deceased, the name and address
    
of the applicant and his relationship to the victim, the names and addresses of other persons dependent on the victim for their support and the extent to which each is so dependent, and other persons who may be entitled to compensation for a pecuniary loss;
        (3) the date and nature of the crime on which the
    
application for compensation is based;
        (4) the date and place where and the law enforcement
    
officials to whom notification of the crime was given;
        (5) the nature and extent of the injuries sustained
    
by the victim, and the names and addresses of those giving medical and hospitalization treatment to the victim;
        (6) the pecuniary loss to the applicant and to such
    
other persons as are specified under item (2) resulting from the injury or death;
        (7) the amount of benefits, payments, or awards, if
    
any, payable under:
            (a) the Workers' Compensation Act,
            (b) the Dram Shop Act,
            (c) any claim, demand, or cause of action based
        
upon the crime-related injury or death,
            (d) the Federal Medicare program,
            (e) the State Public Aid program,
            (f) Social Security Administration burial
        
benefits,
            (g) Veterans administration burial benefits,
            (h) life, health, accident or liability insurance,
            (i) the Criminal Victims' Escrow Account Act,
            (j) the Sexual Assault Survivors Emergency
        
Treatment Act,
            (k) restitution, or
            (l) any other source;
        (8) releases authorizing the surrender to the Court
    
of Claims or Attorney General of reports, documents and other information relating to the matters specified under this Act and rules promulgated in accordance with the Act;
        (9) such other information as the Court of Claims or
    
the Attorney General reasonably requires.
    (b) The Attorney General may require that materials substantiating the facts stated in the application be submitted with that application.
    (c) An applicant, on his own motion, may file an amended application or additional substantiating materials to correct inadvertent errors or omissions at any time before the original application has been disposed of by the Court of Claims. In either case, the filing of additional information or of an amended application shall be considered for the purpose of this Act to have been filed at the same time as the original application.
(Source: P.A. 97-817, eff. 1-1-13; 98-463, eff. 8-16-13.)