Tort Claims

Legal Processes

Documents and Forms

Document Name Document Type
Form SF 95 Tort Claims Form
SF 95 Claim for Damage, Injury, or Death SF-95.pdf Form
SF 95 Claim for Damage, Injury, or Death SF-95.pdf Form
SF95.pdf Claim for Damage, Injury, or Death IC Document
SF95.pdf Claim for Damage, Injury, or Death IC Document

Information Collection (IC) Details

IC Title:	Tort Claims	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 104.41-104.42

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SF 95	Claim for Damage, Injury, or Death	SF-95.pdf		Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records
Title: Patent Examiner Testimony Files	FR Citation: 78 FR 19462

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6	0	6
Annual IC Time Burden (Hours)	36	0	36
Annual IC Cost Burden (Dollars)	11	2	9

Documents for IC

Title	Document	Date Uploaded
Claim for Damage, Injury, or Death	SF95.pdf	06/28/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.