CINXE.COM
PROD Create Account - VCF Claimant Portal
<!DOCTYPE html> <html lang="en"> <head> <meta charset="utf-8"> <meta http-equiv="X-UA-Compatible" content="IE=edge"> <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no"> <title>PROD Create Account - VCF Claimant Portal</title> <!-- Global stylesheets --> <link href="//fonts.googleapis.com/css?family=Roboto:300,400,400italic,500,500italic,700" rel="stylesheet" type="text/css"> <link href="/assets/css/bootstrap.css" rel="stylesheet"/> <link href="/assets/css/core.css" rel="stylesheet"/> <link href="/assets/css/components.css" rel="stylesheet"/> <link href="/assets/css/colors.css" rel="stylesheet"/> <link href="/assets/css/styles.css" rel="stylesheet"/> <link href="/assets/css/tables.css" rel="stylesheet"/> <link href="/assets/css/checkbox-radio.css" rel="stylesheet"/> <link href="/assets/css/pages.css" rel="stylesheet"/> <link href="/assets/js/bluimp/css/jquery.fileupload.css" rel="stylesheet"/> <link href="/assets/js/bluimp/css/jquery.fileupload-ui.css" rel="stylesheet"/> <!-- /global stylesheets --> </head> <body class="navbar-top login-container"> <div class="navbar navbar-fixed-top navbar-default"><div class="navbar-header"><a class="navbar-brand" href="/"><img class="img-responsive" alt="VCF Logo" src="/assets/img/vcf-icon.png"><span class="logo-text">September 11th Victim Compensation Fund</span></a><ul class="nav navbar-nav visible-xs-block"><li><a data-toggle="collapse" data-target="#navbar-mobile"><i class="glyphicon glyphicon-tree"></i></a></li><li><a class="sidebar-mobile-main-toggle"><i class="glyphicon glyphicon-align-justify"></i></a></li></ul></div><div class="navbar-collapse collapse" id="navbar-mobile"><ul class="nav navbar-nav"></ul><ul class="nav navbar-nav navbar-right"><li class="divider-vertical"></li><li><a class="sidebar-control sidebar-detached-hide text-indigo hidden-xs" data-container="body" data-placement="bottom" title="" data-popup="tooltip" data-original-title="Contact VCF Helpline">VCF Helpline: 1-855-885-1555</a></li><li class="divider-vertical"></li><li class="dropdown dropdown-user" style=""><a class="dropdown-toggle" aria-expanded="false" aria-haspopup="true" role="button" data-toggle="dropdown" href="#"><i class="glyphicon glyphicon-user position-left"></i><span>sign in..</span><i class="caret"></i></a><ul class="dropdown-menu dropdown-menu-right"><li><a href="/Account/Register" id="registerLink">Create Account</a></li><li><a href="/Account/Login" id="loginLink">Sign In</a></li></ul></li><li class="divider-vertical"></li><li style="display:none;"><a href="javascript:void(0)" onclick="document.getElementById('logoutForm').submit()"><i class="icon-switch2"></i>Logout</a><form action="/Account/LogOff" id="logoutForm" method="post"><input name="__RequestVerificationToken" type="hidden" value="j8NsLulwGkZraW0fLCYAyn6k9NGZH4a8bfU8unjzor6qAZB849Euxc3tJtJNXtAoJY7cFQ4RNjSaauQn_g4PnWU9guk1"/></form></li></ul></div></div> <!-- Page container --> <div class="page-container"> <div class="page-content"> <div class="content-wrapper"> <div class="content"> <div class="row"> <div class="col-md-8 col-md-offset-2 "> <div class="panel panel-default md-whiteframe-z3"> <div class="panel-heading"> <h6 class="panel-title">Create a New Account</h6> <p class="text-left pb-5" style="margin: 8px 4px 4px 0px"> Per Department of Justice policy, the VCF <strong><i>only</i></strong> supports Google Chrome or Microsoft Edge for use with the online claims management system. <strong><i>You may experience issues with the online claims management system, including loss of data, if you access it using a browser not supported by the Department of Justice, such as Safari or Firefox.</i></strong> Please only access the online claims management system using Google Chrome or Microsoft Edge. </p> </div> <form action="/Account/Register" class="form" method="post" role="form"> <div class="panel-body"> <div class="validation-summary-valid alert alert-danger alert-styled-left" data-valmsg-summary="true"><ul><li style="display:none"></li> </ul></div> <input name="__RequestVerificationToken" type="hidden" value="zM9uXufMHfyJ-tXLF0KY4MjmErHMj2cSsR7s8b3tID1mLkhN-lJ0AZ2PkuJWXrc0APFULWcW4XssqADej7ZwC10a0Vo1" /> <div class="col-md-6"> <fieldset class=""> <legend class="text-semibold">Account Information</legend> <div class="form-group has-feedback"> <label class="control-label field-required" for="UserName">User Name</label> <div class="input-group"> <div class="input-group-addon"><i class="icon-user"></i> </div> <input class="form-control" data-val="true" data-val-regex="Please enter a username that includes only the following:</br> <table> <tr> <td style="padding-left: 8px;"> • a-z </td> <td style="padding-left: 30px;"> • Period (.) </td> </tr> <tr> <td style="padding-left: 8px;"> • A-Z </td> <td style="padding-left: 30px;"> • Underscore (_) </td> </tr> <tr> <td style="padding-left: 8px;"> • 0-9 </td> <td style="padding-left: 30px;"> • At Symbol (@) </td> </tr> <tr> <td style="padding-left: 8px;"> • Hyphen (-) </td> <td style="padding-left: 30px;"> </td> </tr> </table>" data-val-regex-pattern="^([a-zA-Z0-9_\.\-\@])+$" data-val-required="The User Name field is required." id="UserName" maxlength="50" name="UserName" placeholder="Enter a user name" type="text" value="" /> </div> <span class="field-validation-valid help-block" data-valmsg-for="UserName" data-valmsg-replace="true"></span> </div> <div class="form-group has-feedback"> <label class="control-label field-required" for="Email">Email</label> <div class="input-group"> <div class="input-group-addon"><i class="icon-envelope"></i> </div> <input class="form-control " data-val="true" data-val-email="The Email field is not a valid e-mail address." data-val-regex="Please Enter Correct Email Address" data-val-regex-pattern="^([a-zA-Z0-9_\.\-])+\@(([a-zA-Z0-9\-])+\.)+([a-zA-Z0-9]{2,4})+$" data-val-required="The Email field is required." id="Email" name="Email" placeholder="email@example.com" title="email" type="text" value="" /> </div> <span class="field-validation-valid help-block" data-valmsg-for="Email" data-valmsg-replace="true"></span> </div> <div class="form-group has-feedback"> <label class="control-label" for="ConfirmEmail">Confirm email</label> <div class="input-group"> <div class="input-group-addon"><i class="icon-envelope"></i> </div> <input class="form-control " data-val="true" data-val-equalto="The email and confirmation email do not match." data-val-equalto-other="*.Email" id="ConfirmEmail" name="ConfirmEmail" placeholder="email@example.com" title="email" type="text" value="" /> </div> <span class="field-validation-valid help-block" data-valmsg-for="ConfirmEmail" data-valmsg-replace="true"></span> </div> <div class="form-group has-feedback"> <label class="control-label field-required" for="FirstName">First Name</label> <div class="input-group"> <div class="input-group-addon"><i class="icon-user"></i> </div> <input class="form-control" data-val="true" data-val-regex="Invalid special characters (:, /, \) in First Name" data-val-regex-pattern="^([^\:\\\/])+$" data-val-required="The First Name field is required." id="FirstName" maxlength="50" name="FirstName" placeholder="First name" type="text" value="" /> </div> <span class="field-validation-valid help-block" data-valmsg-for="FirstName" data-valmsg-replace="true"></span> </div> <div class="form-group has-feedback"> <label class="control-label field-required" for="LastName">Last Name</label> <div class="input-group"> <div class="input-group-addon"><i class="icon-user"></i> </div> <input class="form-control" data-val="true" data-val-regex="Invalid special characters (:, /, \) in Last Name" data-val-regex-pattern="^([^\:\\\/])+$" data-val-required="The Last Name field is required." id="LastName" maxlength="50" name="LastName" placeholder="Last name" type="text" value="" /> </div> <span class="field-validation-valid help-block" data-valmsg-for="LastName" data-valmsg-replace="true"></span> </div> <div class="form-group has-feedback"> <label class="control-label field-required" for="Password">Password</label> <div class="input-group"> <div class="input-group-addon"><i class="icon-key"></i> </div> <input autocomplete="off" class="form-control" data-val="true" data-val-length="The Password must be at least 12 characters long." data-val-length-max="100" data-val-length-min="12" data-val-required="The Password field is required." id="Password" name="Password" type="password" value="" /> </div> <span class="field-validation-valid help-block" data-valmsg-for="Password" data-valmsg-replace="true"></span> </div> <div class="row"> <div class="col-sm-6"> <span id="8char" class="glyphicon glyphicon-remove" style="color: #FF0004;"></span> 12 Characters Long<br> <span id="ucase" class="glyphicon glyphicon-remove" style="color: #FF0004;"></span> One Uppercase Letter<br> <span id="lcase" class="glyphicon glyphicon-remove" style="color: #FF0004;"></span> One Lowercase Letter </div> <div class="col-sm-6"> <span id="spec" class="glyphicon glyphicon-remove" style="color: #FF0004;"></span> One Special Character<br> <span id="num" class="glyphicon glyphicon-remove" style="color: #FF0004;"></span> One Number </div> </div> <div class="form-group has-feedback"> <label class="control-label" for="ConfirmPassword">Confirm password</label> <div class="input-group"> <div class="input-group-addon"><i class="icon-key"></i> </div> <input autocomplete="off" class="form-control" data-val="true" data-val-equalto="The password and confirmation password do not match." data-val-equalto-other="*.Password" id="ConfirmPassword" name="ConfirmPassword" type="password" value="" /> </div> <span class="field-validation-valid help-block" data-valmsg-for="ConfirmPassword" data-valmsg-replace="true"></span> </div> <div class="row"> <div class="col-sm-12"> <span id="pwmatch" class="glyphicon glyphicon-remove" style="color: #FF0004;"></span> Passwords Match </div> </div> </fieldset> </div> <div class="col-md-6"> <fieldset> <legend class="text-semibold">Security Questions</legend> <div class="form-group"> <label class="control-label field-required" for="Secret1.QuestionId">Security Question 1</label> <select class="form-control select2" data-val="true" data-val-number="The field QuestionId must be a number." data-val-required="A question must be selected for Security Question 1" id="Secret1_QuestionId" name="Secret1.QuestionId"><option value="">...</option> <option value="1">What is your oldest sibling’s birthday month and year? (e.g., January 1900) </option> <option value="19">What street did you live on in third grade?</option> <option value="20">In what city did you meet your spouse/significant other?</option> <option value="24">What is the name of your favorite childhood friend? </option> <option value="25">What was your childhood nickname? </option> </select> </div> <div class="form-group"> <label class="control-label field-required" for="Secret1_Answer">Answer</label> <input class="form-control" data-val="true" data-val-regex="Invalid special characters (:, /, \) in Security Question Answer" data-val-regex-pattern="^([^\:\\\/])+$" data-val-required="An answer for Security Question 1 is required." id="Secret1_Answer" name="Secret1.Answer" type="text" value="" /> <span class="field-validation-valid help-block field-validation-error" data-valmsg-for="Secret1.Answer" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label field-required" for="Secret2.QuestionId">Security Question 2</label> <select class="form-control select2" data-val="true" data-val-number="The field QuestionId must be a number." data-val-required="A question must be selected for Security Question 2" id="Secret2_QuestionId" name="Secret2.QuestionId"><option value="">...</option> <option value="4">What school did you attend for sixth grade?</option> <option value="7">What is your oldest sibling's middle name?</option> <option value="8">What was your childhood phone number including area code? (e.g., 000-000-0000)</option> <option value="11">What is the middle name of your youngest child?</option> <option value="18">What is your oldest cousin's first and last name?</option> </select> </div> <div class="form-group"> <label class="control-label field-required" for="Secret2_Answer">Answer</label> <input class="form-control" data-val="true" data-val-regex="Invalid special characters (:, /, \) in Security Question Answer" data-val-regex-pattern="^([^\:\\\/])+$" data-val-required="An answer for Security Question 2 is required." id="Secret2_Answer" name="Secret2.Answer" type="text" value="" /> <span class="field-validation-valid help-block field-validation-error" data-valmsg-for="Secret2.Answer" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label field-required" for="Secret3.QuestionId">Security Question 3</label> <select class="form-control select2" data-val="true" data-val-number="The field QuestionId must be a number." data-val-required="A question must be selected for Security Question 3" id="Secret3_QuestionId" name="Secret3.QuestionId"><option value="">...</option> <option value="2">In what city or town did your mother and father meet? </option> <option value="6">What was the name of your first stuffed animal?</option> <option value="10">What is your youngest brother’s birthday month and year? (e.g., January 1900)</option> <option value="14">In what city does your nearest sibling live? </option> <option value="17">What is your maternal grandmother's maiden name?</option> </select> </div> <div class="form-group"> <label class="control-label field-required" for="Secret3_Answer">Answer</label> <input class="form-control" data-val="true" data-val-regex="Invalid special characters (:, /, \) in Security Question Answer" data-val-regex-pattern="^([^\:\\\/])+$" data-val-required="An answer for Security Question 3 is required." id="Secret3_Answer" name="Secret3.Answer" type="text" value="" /> <span class="field-validation-valid help-block field-validation-error" data-valmsg-for="Secret3.Answer" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label field-required" for="Secret4.QuestionId">Security Question 4</label> <select class="form-control select2" data-val="true" data-val-number="The field QuestionId must be a number." data-val-required="A question must be selected for Security Question 4" id="Secret4_QuestionId" name="Secret4.QuestionId"><option value="">...</option> <option value="3">What is the name of your favorite childhood teacher?</option> <option value="9">In what city or town was your first job?</option> <option value="16">What is the name of a college you applied to but didn't attend?</option> <option value="22">What was the name of your elementary / primary school?</option> <option value="23">What is the name of the place your wedding reception was held?</option> </select> </div> <div class="form-group"> <label class="control-label field-required" for="Secret4_Answer">Answer</label> <input class="form-control" data-val="true" data-val-regex="Invalid special characters (:, /, \) in Security Question Answer" data-val-regex-pattern="^([^\:\\\/])+$" data-val-required="An answer for Security Question 4 is required." id="Secret4_Answer" name="Secret4.Answer" type="text" value="" /> <span class="field-validation-valid help-block field-validation-error" data-valmsg-for="Secret4.Answer" data-valmsg-replace="true"></span> </div> <div class="form-group"> <label class="control-label field-required" for="Secret5.QuestionId">Security Question 5</label> <select class="form-control select2" data-val="true" data-val-number="The field QuestionId must be a number." data-val-required="A question must be selected for Security Question 5" id="Secret5_QuestionId" name="Secret5.QuestionId"><option value="">...</option> <option value="5">What was your dream job as a child? </option> <option value="12">What is the name, breed, and color of current pet?</option> <option value="13">What was the first concert you attended?</option> <option value="15">Who was your childhood hero? </option> <option value="21">What month and day is your anniversary? (e.g., January 2)</option> </select> </div> <div class="form-group"> <label class="control-label field-required" for="Secret5_Answer">Answer</label> <input class="form-control" data-val="true" data-val-regex="Invalid special characters (:, /, \) in Security Question Answer" data-val-regex-pattern="^([^\:\\\/])+$" data-val-required="An answer for Security Question 5 is required." id="Secret5_Answer" name="Secret5.Answer" type="text" value="" /> <span class="field-validation-valid help-block field-validation-error" data-valmsg-for="Secret5.Answer" data-valmsg-replace="true"></span> </div> </fieldset> </div> </div> <div class="panel-footer"> <div class="heading-elements"> <div class="pull-right"> <button type="submit" class="btn btn-primary btn-raised btn-block legitRipple">Create Account</button> </div> </div> </div> </form> </div> </div> </div> </div> </div> </div> </div><!-- /page content --> <footer class="main-footer"><div class="navbar navbar-inverse navbar-xs"><ul class="nav navbar-nav no-border visible-xs-block"><li><a class="text-center collapsed" data-toggle="collapse" data-target="#navbar-second"><i class="icon-circle-up2"></i></a></li></ul><div class="navbar-collapse collapse" id="navbar-second"><div class="navbar-text">© 2016.<a href="#"></a><a href="" target="_blank"></a></div><div class="navbar-right"><ul class="nav navbar-nav"><li><a href="https://www.vcf.gov/" target="_blank">September 11th Victim Compensation Fund</a></li><li><a href="https://www.justice.gov" target="_blank">DOJ Home</a></li><li><a href="https://www.justice.gov/legalpolicies.htm" target="_blank">Legal Policies</a></li><li><a href="https://www.justice.gov/doj/privacy-policy" target="_blank">Privacy</a></li><li><a href="https://www.justice.gov/oip/" target="_blank">FOIA</a></li><li><a data-toggle="modal" data-target="#footer-paperworkreductionact">Paperwork Reduction Act</a></li></ul></div></div></div></footer><div class="modal fade" id="footer-paperworkreductionact" tabindex="-1" role="dialog" aria-labelledby=""><div class="modal-dialog modal-sm" role="document"><div class="modal-content"><div class="modal-header bg-primary-600"><h6>Paperwork Reduction Act Notice</h6><button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">×</span></button></div><div class="modal-body">An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of information unless it contains a currently valid OMB approval number. We try to create forms and instructions that are accurate, can be easily understood, and which impose the least possible burden on you. The estimated average time to complete and file this application is 20 minutes. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the Office of the Special Master, U.S. Department of Justice, 950 Pennsylvania Ave, NW, Washington, DC 20530; OMB control number 1123-0012. (Do not mail your completed application to this address.)</div><div class="modal-footer"></div></div></div></div> <script src="/assets/js/jquery.min.js?v=10"></script> <script src="/assets/js/bootstrap.min.js?v=10"></script> <script src="/assets/js/jquery.nicescroll.min.js?v=10"></script> <script src="/assets/js/jquery.blockUI.js?v=10"></script> <script src="/assets/js/toastr.js?v=10"></script> <script src="/assets/js/autosize.js?v=10"></script> <script src="/assets/js/bootstrap-session-timeout.js?v=10"></script> <script src="/assets/js/vcf/common/vcf.app.js?v=10"></script> <script src="/assets/js/vcf/common/vcf.utils.js?v=10"></script> <script src="/assets/js/vcf/common/vcf.alert.js?v=10"></script> <script src="/assets/js/vcf/common/vcf.show-hide.js?v=10"></script> <script src="/assets/js/vcf/common/vcf.ajax-tabs.js?v=10"></script> <script src="/assets/js/vcf/common/vcf.blockui.js?v=10"></script> <script src="/assets/js/ripple.min.js?v=10"></script> <script src="/Scripts/jquery.unobtrusive-ajax.js"></script> <script src="/Scripts/jquery.validate.js"></script> <script src="/Scripts/jquery.validate.unobtrusive.js"></script> <script src="/Client%20Scripts/mvcfoolproof.unobtrusive.js"></script> <script src="/assets/js/knockout/knockout.js"></script> <script src="/assets/js/knockout/knockout.validation.js"></script> <script src="/assets/js/knockout/knockout-mapping.js"></script> <script src="/assets/js/validation-defaults.js"></script> <script src="/assets/js/vendor/jquery.scrolling-tabs.js"></script> <script src="/assets/js/bootstrap-maxlength.js"></script> <script src="/assets/js/jquery.mask.js"></script> <script src="/assets/js/jQuery.print.js"></script> <script src="/assets/js/jquery.mark.js"></script> <script src="/assets/js/select2.min.js"></script> <script src="/assets/js/vcf/common/vcf.knockout.js"></script> <script src="/assets/js/vcf/common/vcf.forms.js"></script> <script src="/assets/js/vcf/common/vcf.validation.js"></script> <script type="text/javascript"> $("input[type=password]").keyup(function () { var ucase = new RegExp("[A-Z]+"); var lcase = new RegExp("[a-z]+"); var num = new RegExp("[0-9]+"); var spec = new RegExp("[^A-Za-z0-9_]+"); if ($("#Password").val().length >= 12) { $("#8char").removeClass("glyphicon-remove"); $("#8char").addClass("glyphicon-ok"); $("#8char").css("color", "#00A41E"); } else { $("#8char").removeClass("glyphicon-ok"); $("#8char").addClass("glyphicon-remove"); $("#8char").css("color", "#FF0004"); } if (ucase.test($("#Password").val())) { $("#ucase").removeClass("glyphicon-remove"); $("#ucase").addClass("glyphicon-ok"); $("#ucase").css("color", "#00A41E"); } else { $("#ucase").removeClass("glyphicon-ok"); $("#ucase").addClass("glyphicon-remove"); $("#ucase").css("color", "#FF0004"); } if (lcase.test($("#Password").val())) { $("#lcase").removeClass("glyphicon-remove"); $("#lcase").addClass("glyphicon-ok"); $("#lcase").css("color", "#00A41E"); } else { $("#lcase").removeClass("glyphicon-ok"); $("#lcase").addClass("glyphicon-remove"); $("#lcase").css("color", "#FF0004"); } if (num.test($("#Password").val())) { $("#num").removeClass("glyphicon-remove"); $("#num").addClass("glyphicon-ok"); $("#num").css("color", "#00A41E"); } else { $("#num").removeClass("glyphicon-ok"); $("#num").addClass("glyphicon-remove"); $("#num").css("color", "#FF0004"); } if (spec.test($("#Password").val())) { $("#spec").removeClass("glyphicon-remove"); $("#spec").addClass("glyphicon-ok"); $("#spec").css("color", "#00A41E"); } else { $("#spec").removeClass("glyphicon-ok"); $("#spec").addClass("glyphicon-remove"); $("#spec").css("color", "#FF0004"); } if ($("#Password").val() == $("#ConfirmPassword").val()) { $("#pwmatch").removeClass("glyphicon-remove"); $("#pwmatch").addClass("glyphicon-ok"); $("#pwmatch").css("color", "#00A41E"); } else { $("#pwmatch").removeClass("glyphicon-ok"); $("#pwmatch").addClass("glyphicon-remove"); $("#pwmatch").css("color", "#FF0004"); } }); </script> </body> </html>