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SELECT AGENCY
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CLAIM INFORMATION
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CLAIMANT INFORMATION
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SUMMARY & REVIEW

WELCOME

This site is an extension of the Arkansas Claims Commission website and is here to facilitate the online submission of claims against state agencies. If you have questions about the process, use the CONTACT button above.

Please Note
We are happy to answer questions about the claim process, but we cannot give legal advice. Please also note that your claim is essentially a lawsuit filed against a state agency (the Claims Commission is the courthouse for such lawsuits), and the commissioners collectively serve as the judge deciding this lawsuit. While many claimants represent themselves before the Claims Commission (otherwise known as proceeding pro se), as you are, please be aware that Arkansas law holds pro se claimants to the same standard as an attorney.

REVIEW

Please review the information you've provided below, make any needed changes and proceed to the final step. If you have questions about any part, use the CONTACT button above to see the contact options.

PLEASE ENSURE ALL REQUIRED FIELDS HAVE BEEN COMPLETED: COMPLAINT DESCRIPTION & INCIDENT DATE

STEP 1: AGENCY INFORMATION

PROCEED

Choose the agency the claim is against:

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STEP 2: CLAIM INFORMATION

PROCEED
PLEASE PROVIDE A CLAIM DESCRIPTION, INCIDENT DATE AND DAMAGES
Use MM/DD/YYYY format
If damages are unknown, enter 0

Tell us about the type of claim you're making:

PPOPERTY DAMAGE DETAILS - MUST COMPLETE

$

WARRANT/CHECK INFORMATION - MUST COMPLETE

MOTOR VEHICLE DAMAGE DETAILS - MUST COMPLETE

EX. CHEVROLET
EX. CORVETTE
4-DIGITS (YYYY) 4 DIGITS
$

If the accident was investigated by the State Police, supply the officer's name:

If the accident was investigated by a law enforcement officer other than the State Police, supply their name and title:

PROCEED

STEP 3: CLAIMANT INFORMATION

PROCEED

Who is filing this claim?

Claimant Information:

Second Claimant Information:

Third Claimant Information:

NOTE: If you have more than three claimants, please call the office to discuss your claim.

Attorney information

The Claims Commission will use this email address as the method of communicating with you, including time-sensitive information. Please call the Claims Commission if you prefer to receive communication via another method.

Firm information

Company information (this is the claimant’s information)

Agency Financial Details:

Dispersing Officer Details:

PROCEED

Your Promise:

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FINAL STEPS

RESTART

Your claim information has been saved. However, in order for your claim to be accepted and processed, you will need to mail or drop off the following documents to:

Arkansas State Claims Commission
101 East Capitol Avenue, Suite 410
Little Rock, AR 72201
DIRECTIONS

  1. Signature Page | This must be signed and notorized FOR EACH CLAIMANT and the original submitted. Retain a copy for your records.
    VIEW
  2. Signature Page | This must be signed and notorized and the original submitted. Retain a copy for your records.
    VIEW
  3. Personal property insurance declaration. Obtain this from your insurance carrier.
  4. Copy of the claimant’s health insurance card(s).
  5. Any relevant medical bills.
  6. Three estimates for repair of the damaged personal property.
  7. Health insurance declarations. Can be obtained from your insurer or insurance agent.
  8. Automobile insurance declaration. Obtain this from your insurance carrier.
  9. Copies if the three estimates for automobile repair.
  10. Certified copy of the death certificate for the deceased.
  11. Certified copies of birth certificates for the decedent’s spouse and any of decedent’s children seeking educational benefits.
  12. Copy of the unpaid bill or invoice.
  13. Copy of the contract in dispute.
  14. Copy of all supporting documentation to support your expense reimbursement claim.
  15. Copy of the check/warrant to be re-issued.
  16. Notice of lost outdated warrant form.
    VIEW
  17. Agency check pick-up request (if owed DFA-addition).
  18. Certified copy of the claimant's birth certificate
  19. A copy of the incident report, if such report exists
  20. Certification that claimant has been medically retired
  21. Any applicable medical records
  22. Certified copies of birth certificates for the claimant’s spouse and any of claimant’s children seeking educational benefits.