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Crime Victim Restitution Amount Summary Form

Ohio · Supreme Court of Ohio

This form helps gather information about economic losses after a crime to help calculate restitution. It is not meant to be filed with the court and requires documentation to show the amounts listed.

Open the official PDFfrom Supreme Court of Ohio

Where this fits in a case

General & info

Information / general use — not tied to one step of a case

This form is used by a victim or their representative to gather information to present at a restitution hearing after an offender has been found guilty or found delinquent.

Either party may file.

Common questions

Who should file this form?
The form is intended to assist the victim or the victim’s estate with gathering information for calculating restitution.
Does this form go directly to the court?
No, the form is not intended to be filed with the court. It should be given to the prosecutor assigned to the case or the victim's attorney.
What kind of proof is needed?
You are responsible for providing documentation, such as receipts or medical bills, to verify the amounts listed on the form.

Revision history

No changes recorded since we started tracking this form on October 10, 2026.

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