Fillable Printable Victim Impact Statement Form - Texas

Victim Impact Statement Form - Texas

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This Victim Impact Statement (VIS) will be used throughout

the criminal justice system (by the prosecutor, the judge, and

the parole board) to better understand the emotional/

psychological, physical, and financial impact of the crime.

The contact information you provide in this Victim Impact

Statement is important and will be used to contact you if you

wish to receive information from:

 Community Supervision and Corrections Department

(probation);

 Texas Department of Criminal Justice (prison); and

 Board of Pardons and Paroles.

Return the

Confidential Victim Contact Information and the

Victim Impact Statement to the

county or district attorney’s office

that is prosecuting your case.

TO BE COMPLETED BY THE VICTIM ASSISTANCE COORDINATOR

Victim Assistance Coordinator:

Agency:

Address:

City: Zip Code:

Phone: Fax:

E‐mail:

REMOVE AND KEEP FOR YOUR RECORDS

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CRIME VICTIM INFORMATION SHEET AND VICTIM IMPACT STA T EMENT PACKET

ATENCIÓN: Si Ud. requiere asistencia en español o tiene preguntas sobre este documento,

favor de llamar al ______________________________ .

KNOW YOUR RIGHTS IN THE CRIMINAL JUSTICE SYST EM

1. CRIME VICTIMS’ RIGHTS: You have crime victim rights if you are a:

 Victim,

 Parent/Guardian of a victim, or

 Close relative of a deceased victim

2. CONFIDENTIAL INFORMATION SHEET:

 Used by criminal justice professionals to contact you throughout the process.

 Used to elect and exercise your rights to notification of court proceedings, prob ation, parole, and release.

 Used by the Texas Department of Criminal Justice (TDCJ) to add you to their database if you request to receive

notification of changes in the defendant’s status if he or she is incarcerated in a TDCJ facility (prison).

 The Confidential Information Sheet cannot be seen by the defendant or the defense attorney.

You must notify your Victim Assistance Coordinator if any of your contact info rmation changes to make sure

you are kept informed. If the defendant is convicted and sent to a TDCJ facility, notify the TDCJ Victim Services

Division of any new contact information at 1‐800‐848‐4284 or [email protected].

3. VICTIM IMPACT STATEMENT: Victims have the right to submit a Victim Impact Statement. The Victim Impact

Statement is a written, detailed account of the emotional/psychological, physical, and financial impact the crime had

on the victims and family members. This document can be used to explain your feelings such as loss, frustration,

fear, and/or anger. Only you can provide this vital information.

KNOW HOW YOUR VICTIM IMPACT STATEMENT IS USED

Prosecutor:

 Considers your Victim Impact Statement before entering into a plea arrangement.

 Considers your Victim Impact Statement to determine the restitution amount (if requested).

Judge:

 Considers your Victim Impact Statement before imposing a sentence; the Victim Impact Statement is not

considered by a jury.

 Considers your Victim Impact Statement before accepting the plea.

Defense:

 Your Victim Impact Statement, excluding the Confidential Information Sheet, may be seen by the defendant

and his or her attorney.

 The defendant or his or her attorney may comment on the Victim Impact Statement and, with approval of the

court, introduce evidence or testimony in regards to its accuracy.

Community Supervision (Probation):

 Community Supervision officers have access to your Victim Impact Statement for notification purposes.

Texas Department of Criminal Justice:

 If the defendant is sentenced to prison, your Victim Impact Statement goes to the TDCJ Victim Servi ces Division

to provide you with information regarding the def endant. You can register for this service by completing the

“Confidential Information Sheet,” which is a part of the a ttached Victim Impact Statement.

Board of Pardons and Paroles:

 The Parole Board will consider your Victim Impact Statement prior to voting whether or not to release the

offender to parole supervision.

REMOVE AND KEEP FOR YOUR RECORDS

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Article 56.01 – DEFINITIONS

(1) “Close relative of a deceased victim” means a person who

was the spouse of a deceased victim at the time of the victim’s

death or who is a parent or adult brother, sister, or child of the

deceased victim.

(2) “Guardian of victim” means a person who is the legal

guardian of the victim, whether or not the legal relationship

between the guardian and the victim exists because of the age

of the victim or the physical or mental incompetency of the

victim.

(2‐a) “Sexual assault” means an offense under Section 21.02,

21.11 (a) (1), 22.011, or 22.021, Penal Code.

(3) “Victim” means a person who is the victim of the offense of

sexual assault, kidnapping, aggravated robbery, trafficking of

persons, or injury to a child, elderly individual, or disabled

individual or who has suffered personal injury or death as a

result of the criminal conduct of another.

Article 56.02‐ CRIME VICTIMS’ RIGHTS

(a) A victim, guardian of a victim, or close relative of a deceased

victim is entitled to the following rights within the criminal

justice system:

(1) the right to receive from law enforcement agencies

adequate protection from harm and threats of harm arising

from cooperation with prosecution efforts;

(2) the right to have the magistrate take the safety of the

victim or his family into consideration as an element in fixing

the amount of bail for the accused;

(3) the right, if requested, to be informed:

(A) by the attorney representing the state of relevant

court proceedings, including appellate proceedings,

and to be informed if those proceedings have been

canceled or rescheduled prior to the event; and

(B) by an appellate court of decisions of the court,

after the decisions are entered but before the

decisions are made public;

(4) the right to be informed, when requested, by a peace

officer concerning the defendant's right to bail and the

procedures in criminal investigations and by the district

attorney's office concerning the general procedures in the

criminal justice system, including general procedures in

guilty plea negotiations and arrangements, restitution, and

the appeals and parole process;

(5) the right to provide pertinent information to a probation

department conducting a presentencing investigation

concerning the impact of the offense on the victim and his

family by testimony, written statement, or any other

manner prior to any sentencing of the offender;

(6) the right to receive information regarding compensation

to victims of crime as provided by Subchapter B, including

information related to the costs that may be compensated

under that subchapter and the amount of compensation,

eligibility for compensation, and procedures for application

for compensation under that subchapter, the payment for a

medical examination under Article 56.06 for a victim of a

sexual assault, and when requested, to referral to available

social service agencies that may offer additional assistance;

(7) the right to be informed, upon request, of parole

procedures, to participate in the parole process, to be

notified, if requested, of parole proceedings concerning a

defendant in the victim's case, to provide to the Board of

Pardons and Paroles for inclusion in the defendant's file

information to be considered by the board prior to the

parole of any defendant convicted of any crime subject to

this subchapter, and to be notified, if requested, of the

defendant's release;

(8) the right to be provided with a waiting area, separate or

secure from other witnesses, including the offender and

relatives of the offender, before testifying in any proceeding

concerning the offender; if a separate waiting area is not

available, other safeguards should be taken to minimize the

victim's contact with the offender and the offender's

relatives and witnesses, before and during court

proceedings;

(9) the right to prompt return of any property of the victim

that is held by a law enforcement agency or the attorney for

the state as evidence when the property is no longer

required for that purpose;

(10) the right to have the attorney for the state notify the

employer of the victim, if requested, of the necessity of the

victim's cooperation and testimony in a proceeding that

may necessitate the absence of the victim from work for

good cause;

(11) the right to request victim‐offender mediation

coordinated by the victim services division of the Texas

Department of Criminal Justice;

(12) the right to be informed of the uses of a victim impact

statement and the statement's purpose in the criminal

justice system, to complete the victim impact statement,

and to have the victim impact statement considered:

(A) by the attorney representing the state and the

judge before sentencing or before a plea bargain

agreement is accepted; and

(B) by the Board of Pardons and Paroles before an

inmate is released on parole;

(13) for a victim of an assault or sexual assault who is

younger than 17 years of age or whose case involves family

violence, as defined by Section 71.004, Family Code, the

right to have the court consider the impact on the victim of

a continuance requested by the defendant; if requested by

REMOVE AND KEEP FOR YOUR RECORDS

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the attorney representing the state or by counsel for the

defendant, the court shall state on the record the reason for

granting or denying the continuance; and

(16) if the offense is a capital felony, the right to:

(A) receive by mail from the court a written

explanation of defense‐initiated victim outreach if the

court has authorized expenditures for a defense‐

initiated victim outreach specialist;

(B) not be contacted by the victim outreach specialist

unless the victim, guardian, or relative has consented

to the contact by providing a written notice to the

court; and

communications from a victim outreach specialist

acting on behalf of any person.

(b) A victim, guardian of a victim, or close relative of a deceased

victim is entitled to the right to be present at all public court

proceedings related to the offense, subject to the approval of

the judge in the case.

sheriff, police, and other law enforcement agencies shall ensure

to the extent practicable that a victim, guardian of a victim, or

close relative of a deceased victim is afforded the rights granted

by this article and Article 56.021 and, on request, an

explanation of those rights.

(d) A judge, attorney for the state, peace officer, or law

enforcement agency is not liable for a failure or inability to

provide a right enumerated in this article or Article 56.021. The

failure or inability of any person to provide a right or service

enumerated in this article or Article 56.021 may not be used by

a defendant in a criminal case as a ground for appeal, a ground

to set aside the conviction or sentence, or a ground in a habeas

corpus petition. A victim, guardian of a victim, or close relative

of a deceased victim does not have standing to participate as a

party in a criminal proceeding or to contest the disposition of

any charge.

Note: During the 83rd Legislative Session, multiple bills were

passed which resulted in the current numbering of the

subsections. Therefore, the Texas Code of Criminal Procedure

Article 56.02(a)(14‐15) currently do not exist.

Art. 56.021‐ RIGHTS OF VI CTIM OF SEXUAL ASSAULT

(a) In addition to the rights enumerated in Article 56.02, if the

offense is a sexual assault, the victim, guardian of a victim, or

close relative of a deceased victim is entitled to the following

rights within the criminal justice system:

(1) if requested, the right to a disclosure of information

regarding any evidence that was collected during the

investigation of the offense, unless disclosing the

information would interfere with the investigation or

prosecution of the offense, in which event the victim,

guardian, or relative shall be informed of the estimated date

on which that information is expected to be disclosed;

(2) if requested, the right to a disclosure of information

regarding the status of any analysis being performed of any

evidence that was collected during the investigation of the

offense;

(3) if requested, the right to be notified:

(A) at the time a request is submitted to a crime

laboratory to process and analyze any evidence that

was collected during the investigation of the offense;

(B) at the time of the submission of a request to

compare any biological evidence collected during the

investigation of the offense with DNA profiles

maintained in a state or federal DNA database; and

Paragraph (B), unless disclosing the results would

interfere with the investigation or prosecution of the

offense, in which event the victim, guardian, or relative

shall be informed of the estimated date on which

those results are expected to be disclosed;

(4) if requested, the right to counseling regarding acquired

immune deficiency syndrome (AIDS) and human

immunodeficiency virus (HIV) infection;

(5) for the victim of the offense, testing for acquired

immune deficiency syndrome (AIDS), human

immunodeficiency virus (HIV) infection, antibodies to HIV, or

infection with any other probable causative agent of AIDS;

and

(6) to the extent provided by Articles 56.06 and 56.065, for

the victim of the offense, the right to a forensic medical

examination if, within 96 hours of the offense, the offense is

reported to a law enforcement agency or a forensic medical

examination is otherwise conducted at a health care facility.

(b) A victim, guardian, or relative who requests to be notified

under Subsection (a)(3) must provide a current address and

phone number to the attorney representing the state and the

law enforcement agency that is investigating the offense. The

victim, guardian, or relative must inform the attorney

representing the state and the law enforcement agency of any

change in the address or phone number.

including an entity that provides services to victims of sexual

assault, to receive any notice requested under Subsection

(a)(3).

REMOVE AND KEEP FOR YOUR RECORDS

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C O N F I D E N T I A L

VICTIM CONTACT INFORMATION

CONFIDENTIAL INFORMATION SHEET

This Confidential Information Sheet will be used by criminal justice professionals to contact you throughout the process. This includes

notifying you about court proceedings, community supervision (probation), and parole or release if the defendant is sent to prison.

You may choose to complete only this page for notification purposes.

ATENCIÓN: Si Ud. requiere asistencia en español o tiene preguntas sobre este documento favor de llamar al ___________________.

TO BE COMPLETED BY THE VICTIM ASSISTANCE COORDINATOR

OFFENSE: OFFENSE DATE:

DEFENDANT(S) NAME (LAST, FIRST MI) DPS State ID (SID) DOB

(mm/dd/yyyy) Cause/Case # Court # TDCJ #

SECTIONS 1 & 2 TO BE COMPLETED BY VICTIM, PARENT/GUARDIAN OR CLOSE RELATIVE

SECTION 1. NOTIFICATION

Do you want to be notified about relevant court proceedings?

Do you want to be notified if the defendant is placed on community supervision (probation)?

If the defendant is sent to prison (Texas Department of Criminal Justice), do you want to be notified when he or

she is being considered for parole or release?

If the defendant is sent to prison, do you want the defendant to be prohibited from contacting you?

 YES

 NO

I M P O R T A N T !

IF YOU MOVE OR CHANGE ANY OF YOUR CONTACT INFORMATION, CALL YOUR VICTIM ASSISTANCE COORDINATOR

OR THE TEXAS DEPARTMENT OF CRIMINAL JUSTICE VICTIM SERVICES DIVISION AT 800‐848‐4284.

SECTION 2. CONFIDENTIAL INFORMATION (Please use black ink and print clearly)

Victim’s Name:

Driver’s License No. and State:

Date of Birth:  Male  Female

Name of Person Submitting this Statement:

Driver’s License No. and State:

Address: Date of Birth:

City: State: Zip:

Home Phone: Work Phone: Cell Phone:

Email Address: Relationship to Victim:

Please provide the contact information of someone not living with you who will know how to contact you.

Full Name:

Address:

City: State: Zip:

Home Phone: Work Phone: Cell Phone:

Email Address: Relationship to Victim:

RETURN TO YOUR

VICTIM ASSISTANCE COORDINATOR

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VICTIM IMPACT STATEMENT

The Victim Impact Statem ent (VIS) will be used throughout the criminal justice system by the prosecutor, the judge,

and the

arole board to better understand the emotional/

cholo

ical,

sical, and

inancial im

act o

the crime.

TO BE COMPLETED BY THE VICTIM ASSISTANCE COORDINATOR

OFFENSE: OFFENSE DATE:

DEFENDANT(s) NAME (LAST, FIRST MI) DPS State ID

(SID) DOB (mm/dd/yyyy) Cause/Case # Court # TDCJ #

Please give information you believe is important about the effect of this crime on you and your family.

Please do not relate any information about the crime itself; those facts are available in other reports.

The information in this statement will show the impact the crime has on the victim, the parents, guardians or close

relatives of the victim or other family members of the victim. It may be used at each phase of the criminal justice

process: from the prosecution of the offense; to sentencing to community supervision or to incarceration in the Texas

Department of Criminal Justice; and through the parole review process. Please answer only as many questions as you

wish. If you need more space, an additional page is available; attach it to this Victim Impact Statement.

TO BE COMPLETED BY THE VICTIM, PARENT/GUARDIAN OR CLOSE RELATIVE OF THE VICTIM

Victim’s Name:

EMOTIONAL/PSYCHOLOGICAL IMPACT. Use this section to discuss your feelings about wha t has happened to you as a

result of the crime and how it has affected your general well‐being. Please check all the reactions you have experienced.

 Changes in sleep pattern  Lack of concentration  Fear of strangers  Loss of security/control

 Nightmares  Fear of being alone  Anger  Feelings of helplessness

 Difficulty trusting others  Anxiety  Cry more easily  Fear of leaving home

 Change in appetite  Job stress  Family not as close  Other

 Depression  Want to be alone  School stress

 Marital/Relationship problems

Has the victim or the victim’s family sought counseling as a result of the crime?  Yes  No

How has this crime affected you, your fa mily or those close to you? Please feel free to discuss your feelings, thoughts,

and general well‐being. (Please attach additional page if used.)

RETURN TO YOUR

VICTIM ASSISTANCE COORDINATOR

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PHYSICAL INJURY. Use this section to discuss any physical injuries suffered as a result of this crime. You may want to

write about the extent of the injuries and how long the injuries lasted. (Please attach additional page if used.)

 Treated at ____________________________________ ( me dical center / clinic / physician’s office )

 Hospitalized at _______________________________________ for ____ days

FINANCIAL LOSS.

Losses you have incurred may include medical and dental care, emergency transportation, property loss or damages,

loss of income from work, counseling, crime scene cleanup, moving or changing residence, funeral costs, and other costs

of this na ture.

You may want to begin keeping a log of your financial loss as soon as possible after the crime occurred. You may also

want to keep any receipts and records you have in a folder or separate location for safe keeping. In the event of a

conviction, the prosecutor or judge may use this information to de termine if any restitution may be ordered.

Please provide a best estimate of your financial loss to date:

Do you anticipate any future costs resulting from this crime?  Yes  No

Were any expenses covered by insurance or other sources?  Yes  No

Have you applied for Crime Victims’ Compensation through the Attorney General’s Office?  Yes  No

If you have not, you may apply at www.texasattorn eygeneral.gov or call 1‐800‐983‐9933.

The information in this Victim Impact Statement is true and correct to the best of my knowledge.

Print Name

Signature Date

INFORMATION SUBMITTED BY:  Victim  Pare nt/Guardian  Close Relative  Other _________________

RETURN TO YOUR

VICTIM ASSISTANCE COORDINATOR