This government document is issued by Office for Victims of Crime (OVC) for use in U.S.
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https://www.google.com/url?client=internal-element-cse&cx=015849196504226064512:4mkc8veamow&q=https://ovc.ojp.gov/sites/g/files/xyckuh226/files/pubs/victimswithdisabilities/pdf/ConsentForms_FocusGroups.pdf&sa=U&ved=2ahUKEwj3x73Wp9eMAxWCRvEDHaTLBnc4FBAWegQIBBAB&usg=AOvVaw2yKtr8a-lKVJ0J4nctb8jh