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Crime Victim Restitution Amount Summary Form (Spanish)

Ohio · Supreme Court of Ohio

This form is a summary tool to help gather information about financial losses after a crime. It is designed to collect details about damages, medical bills, and other costs that might be used to request restitution from the court.

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 the victim or their representative to gather information to present at a restitution hearing after a criminal defendant has been found guilty or entered a plea agreement.

Either party may file.

Common questions

Who should fill out this form?
The victim, the victim's representative, or the victim's lawyer should use this form to gather information about losses. You are responsible for providing the proof for the amounts listed. Great care must be taken to keep copies of all supporting documents.
Is this form for filing in court?
No, this form is not meant to be filed with the court. It is a tool to help gather information for a restitution hearing.
What kind of losses can be included?
The form helps track economic losses, such as the cost to repair or replace stolen/damaged items, medical expenses, and lost wages. Its purpose is to help determine the amount of restitution.

Revision history

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

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