State Dept Seeks Input on Havana Syndrome Victim Payment Eligibility Form
Published Date: 1/15/2026
Notice
Summary
The Department of State is asking for your thoughts on a short questionnaire that helps decide who qualifies for HAVANA Act payments. This affects current and former State employees, their families, and doctors, and takes about 30 minutes to complete. You’ve got until February 17, 2026, to share your feedback before the form gets renewed—so don’t miss out on shaping this important process!
Analyzed Economic Effects
2 provisions identified: 1 benefits, 1 costs, 0 mixed.
Eligibility Expanded Back to September 11, 2001
On December 18, 2025, section 5604 of the FY2026 NDAA changed the HAVANA Act definition of qualifying brain injury to include injuries that occurred on or after September 11, 2001, and the DS-4316 form has been amended accordingly. If you are a current or former Department of State employee or a dependent with a qualifying brain injury on or after September 11, 2001, that change is now reflected in the Department's claims form.
You Must Complete DS-4316 to Claim
If you are a current or former Department of State employee, a dependent, or a U.S. board‑certified physician completing claims, you must use form DS-4316 (the Eligibility Questionnaire) to support HAVANA Act payment claims. Completing the form is required to obtain or retain a benefit, is estimated to take about 30 minutes per response, and the Department estimates 30 respondents and a total burden of 32.5 hours.
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