OMB control number

Filing Claims Under the Federal Tort Claims Act

OMB 0960-0667 · SSA.

OMB 0960-0667

The Federal Tort Claims Act (FTCA) is the mechanism for compensating people who Federal employees injured through negligent or wrongful acts that occurred during the performance of those employees’ official duties. SSA accepts claims filed under the FTCA for damages against the United States; loss of property; personal injury; or death resulting from an SSA employee’s wrongful act or omission. The various types of claims included under this information collection request require claimants to provide information SSA can use to determine whether to make an award, compromise, or settlement under the FTCA. The respondents are individuals or entities making a claim under the FTCA.

The latest form for Filing Claims Under the Federal Tort Claims Act expires 2027-09-30 and is listed under ICR 202403-0960-011.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form SF-95 20 CFR 429.102; 429.103 - Filing a Claim (SF-95, OMB No. 1105-0008)	Form and Instruction
Supporting Statement - 0667 (Final).docx	Supporting Statement A
20 CFR 429.102; 429.103 - Filing a Claim (SF-95, OMB No. 1105-0008)	Form and Instruction
20 CFR 429.106(b) - File a written request with SSA for reconsideration	Information collection
20 CFR 429.104(c) - Death that a negligent or wrongful act or omission an SSA employee caused	Information collection
20 CFR 429.104(b) - Personal injury	Information collection
20 CFR 429.104(a) - Damage to or loss of property	Information collection

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202403-0960-011	Revision of a currently approved collection	2024-07-08	Approved without change
202104-0960-001	Revision of a currently approved collection	2021-06-11	Approved with change
201711-0960-003	Revision of a currently approved collection	2018-02-19	Approved without change
201410-0960-002	Revision of a currently approved collection	2015-01-28	Approved without change
201110-0960-006	Extension without change of a currently approved collection	2012-02-02	Approved without change
200810-0960-014	Extension without change of a currently approved collection	2009-04-14	Approved without change
200602-0960-008	Extension without change of a currently approved collection	2006-02-14	Approved without change
200212-0960-009	New collection (Request for a new OMB Control Number)	2002-12-23	Approved without change

OMB Details

20 CFR 429.102; 429.103 - Filing a Claim (SF-95, OMB No. 1105-0008)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Information collection instruments
Form	Name	Electronic access	Type
Form SF-95	Claim for Damage, Injury, or Death	www.gsa.gov/reference/forms/claim-for-damage-injury-or-death	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.