Apply: Vaccine Impact Assistance Program

On this page

• Check if you’re eligible
• Gather your information and documents
• Apply to the program
• Proof of identity documents

Check if you’re eligible

Before you apply, review the eligibility requirements to see if you qualify.

It will also help to have:

• information about the vaccine you received, including the date you received the vaccine
• details about your injury and medical care
• a health care professional who can complete the required medical form

Eligibility requirements: Vaccine Impact Assistance Program

Gather your information and documents

As part of your application, you must submit a:

• completed claim intake form
• medical form completed by a health care professional
• copy of your record of vaccination
• copy of a valid government-issued ID that confirms your identity (such as a passport, driver's licence, or provincial ID card)

Details on proof of identity documents

These forms provide basic information about your vaccination, medical history and injury.

Medical history form for completion by a health care professional

Download the medical history form for the Vaccine Impact Assistance Program (PDF, 986 KB).

To receive the printed form by mail, contact us by phone. You'll need to provide your mailing address.

Contact us

Apply to the program

You can apply:

• online through the Vaccine Impact Assistance Program Claimant Portal
• by mail using printed application forms sent to the program mailing address

Apply

If someone is helping you apply

You may choose to have an authorized representative help with submitting and managing your application.

Learn more:

• Definitions (including authorized representative): Policy Framework for the Vaccine Impact Assistance Program

Proof of identity documents

Basic requirements

• Claimants must submit 1 piece of identification (ID), from the 'Accepted proof of identity documentation' list.
• If the claimant has a different legal name from what is on the ID, additional documents will need to be provided (consult 'Legal name change').
• The document must be valid and not expired.
• The document must include the claimant's current legal name (consult 'Legal name change').
• The document must include the claimant's date of birth.
• We do not accept non-photo health cards, social insurance numbers, tax documents or bank statements.
• The document must be a photocopy for mailed applications or in digital format for electronic submissions (for example, a picture taken from a smartphone or a scanned image).
• The copy of the original document must be clear and legible.
• If a document has information on more than 1 page, all pages must be provided.
• If a document has information on both the front and back, both sides must be provided.
• Only English or French documents will be accepted, unless accompanied by an acceptable translation (consult 'Language of documents').

Learn more:

• Legal name change: Proof of identity documents
• Language of documents: Proof of identity documents

Accepted proof of identity documentation

• Canadian passport
• Foreign passport issued by a federal, provincial, territorial or state government authority, or the equivalent abroad (consult 'Language of documents')
• Certificate of Canadian Citizenship issued by Immigration, Refugees and Citizenship Canada or Citizenship and Immigration Canada 
• Permanent Resident Card issued by Immigration, Refugees and Citizenship Canada or Citizenship and Immigration Canada
• Secure Certificate of Indian Status issued by Health Canada, Indigenous and Northern Affairs Canada or Indigenous Services Canada
• Provincial or territorial driver's licence
• Provincial or territorial photo card (ID card or photo health card)
• Firearms licence issued by a province or territory, or by the Royal Canadian Mounted Police (RCMP)
• Photo employee identification card issued by the federal government, or a provincial or territorial government  
• Parole ID issued by the Parole Board of Canada, or by Ontario, Alberta or Quebec
• Birth certificate issued by the vital statistics agency in the province or territory of birth 
• Certificate of registration of birth abroad issued by a federal, provincial, territorial or state government authority, or the equivalent (consult 'Language of documents')

Learn more:

• Language of documents: Proof of identity documents

Legal name change

If the claimant has a different legal name from what is on the ID, you need to provide a document with the new legal name.

Acceptable documents for legal name change

• Common-law relationship certificate
• Court order issued in or outside Canada, such as a:
  • separation agreement
  • divorce order or judgment
• Certificate to dissolve a registered common-law relationship
• Resumption of surname certificate
• Legal name-change certificate
• Adoption order
• Court order

Language of documents

All documents submitted must be in English or French. If the document isn't in English or French, it must be translated. You must submit a copy of the:

• original document in the original language and
• translated version of the document

Alongside the translation, you must also provide a copy of:

• an attestation from the person who completed the translation if they're a Canadian certified translator or
• a notarized affidavit from the person who completed the translation, swearing that the translation provided is a true and accurate version of the original text if they're a non-certified translator

Translations performed by the claimant or by the claimant's family members will not be accepted.

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