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Standard Form 95
- used to
present claims against the United States under the Federal Tort
Claims Act for property damage, personal injury, or death
allegedly caused by a federal employee's negligence or wrongful
act or omission occurring within the scope of the employee's
Federal employment. These claims must be presented to the
federal agency whose employee's conduct gave rise to the injury.
The Form 95 need not be used to present a claim, but is a
convenient format for supplying the necessary information. The
Form 95 must be completed and state a claim for money damages in
a sum certain amount claimed
for injury to or loss of property, personal injury, or death. If a sum certain
is not specified in block 12d on the Form 95 or in accompanying information,
a submission cannot be considered to be a valid claim. The completed Form 95
must be presented to the appropriate federal agency within
two years
after the claim accrues.
Judgment Fund Payment Forms
FMS 194
FMS 196
FMS 197
The online Judgment Fund payment forms (FMS 194, FMS 196, and FMS 197) can be edited and saved as new documents by using the Adobe 6.0 Advanced Editing TouchUp Text Tool. The online forms replace all prior versions of the forms. Prior versions will not be accepted by the Judgment Fund Staff after October 1, 2004.
