I'm getting the crash so many others are on my Windows 7 x64 machine (HP dv8-1000 laptop w/ GTX 230M GPU, 8GB RAM, etc). I have all the latest drivers installed, and I tried most of the things people here have suggested. No luck - I can't even start a New game. Using ADPlus, I captured some crash information, below. I obviously don't have any debugging symbols for FalloutNV.exe, but Obsidian does - if they want to contact me, I have the dump files. I can also supply the list of loaded DLLs from the crash WER file if that's helpful.

(334.c94): Access violation - code c0000005 (first chance)
FirstChance_av_AccessViolation

Current time:
Debug session time: Tue Oct 19 10:37:08.333 2010 (UTC - 6:00)
System Uptime: 1 days 3:11:36.551
Process Uptime: 0 days 0:01:41.415
Kernel time: 0 days 0:00:09.204
User time: 0 days 0:00:57.860


Call stack below ---
*** ERROR: Module load completed but symbols could not be loaded for c:\program files (x86)\steam\steamapps\common\fallout new vegas\FalloutNV.exe
# ChildEBP RetAddr Args to Child
WARNING: Stack unwind information not available. Following frames may be wrong.
00 0b8bfd2c 00611d48 1a96dbf4 0b8bfd84 d08a0c07 FalloutNV+0x74f0b9
01 0b8bfe88 00605414 0b8bfed0 0b8bfecc 18d122c4 FalloutNV+0x211d48
02 0b8bfeac 0043edbb 0b8bfed0 0b8bfecc d08a0c6f FalloutNV+0x205414
03 0b8bfee0 00c36e34 29000ac8 0b8bff80 00c38327 FalloutNV+0x3edbb
04 0b8bfeec 00c38327 160b85e8 d08a0d0f 150006e8 FalloutNV+0x836e34
05 0b8bff80 00c39e4f 0b8bff94 75c93677 150006e8 FalloutNV+0x838327
*** ERROR: Symbol file could not be found. Defaulted to export symbols for KERNEL32.dll -
06 0b8bff88 75c93677 150006e8 0b8bffd4 77849d42 FalloutNV+0x839e4f
*** ERROR: Symbol file could not be found. Defaulted to export symbols for ntdll.dll -
07 0b8bff94 77849d42 150006e8 79cee33e 00000000 KERNEL32!BaseThreadInitThunk+0x12
08 0b8bffd4 77849d15 00c39e30 150006e8 00000000 ntdll_77810000!RtlInitializeExceptionChain+0x63
09 0b8bffec 00000000 00c39e30 150006e8 00000000 ntdll_77810000!RtlInitializeExceptionChain+0x36

Creating D:\CrashReport\20101019_103645_Crash_Mode\MINIDUMP_FirstChance_av_AccessViolation_FalloutNV.exe__1a08_2010-10-19_10-37-08-369_0334.dmp - mini user dump
GenReadTlsDirectory.Index(0x2e79617272417463, C:\Windows\System32\DShowRdpFilter.dll) failed, 0x800703e6
Dump successfully written
(334.c94): Access violation - code c0000005 (!!! second chance !!!)
SecondChance_av_AccessViolation

Current time:
Debug session time: Tue Oct 19 10:37:10.830 2010 (UTC - 6:00)
System Uptime: 1 days 3:11:39.048
Process Uptime: 0 days 0:01:43.912
Kernel time: 0 days 0:00:09.204
User time: 0 days 0:00:57.860


Call stack below ---
# ChildEBP RetAddr Args to Child
WARNING: Stack unwind information not available. Following frames may be wrong.
00 0b8bfd2c 00611d48 1a96dbf4 0b8bfd84 d08a0c07 FalloutNV+0x74f0b9
01 0b8bfe88 00605414 0b8bfed0 0b8bfecc 18d122c4 FalloutNV+0x211d48
02 0b8bfeac 0043edbb 0b8bfed0 0b8bfecc d08a0c6f FalloutNV+0x205414
03 0b8bfee0 00c36e34 29000ac8 0b8bff80 00c38327 FalloutNV+0x3edbb
04 0b8bfeec 00c38327 160b85e8 d08a0d0f 150006e8 FalloutNV+0x836e34
05 0b8bff80 00c39e4f 0b8bff94 75c93677 150006e8 FalloutNV+0x838327
06 0b8bff88 75c93677 150006e8 0b8bffd4 77849d42 FalloutNV+0x839e4f
07 0b8bff94 77849d42 150006e8 79cee33e 00000000 KERNEL32!BaseThreadInitThunk+0x12
08 0b8bffd4 77849d15 00c39e30 150006e8 00000000 ntdll_77810000!RtlInitializeExceptionChain+0x63
09 0b8bffec 00000000 00c39e30 150006e8 00000000 ntdll_77810000!RtlInitializeExceptionChain+0x36

Creating D:\CrashReport\20101019_103645_Crash_Mode\FULLDUMP_SecondChance_av_AccessViolation_FalloutNV.exe__1a08_2010-10-19_10-37-10-846_0334.dmp - mini user dump
GenReadTlsDirectory.Index(0x2e79617272417463, C:\Windows\System32\DShowRdpFilter.dll) failed, 0x800703e6
Dump successfully written
FirstChance_epr_Process_Shut_Down

Current time:
Debug session time: Tue Oct 19 10:37:18.804 2010 (UTC - 6:00)
System Uptime: 1 days 3:11:47.021
Process Uptime: 0 days 0:01:51.886
Kernel time: 0 days 0:00:09.204
User time: 0 days 0:00:57.891

Something you might want to try in the interim...

Go to My Documents/MyGames/FalloutNV -- look for the FalloutPrefs.ini file. If the file is less than 20kb, it might be corrupted. Try deleting the file, and reloading the launcher.

We'll have more updates soon.