OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Claim for Damage Injury or Death

OMB 1105-0008 ยท DOJ/LA.

OMB 1105-0008

This form is utilized by those persons making a claim against the United States Government under the Federal Tort Claims Act.

The latest form for Claim for Damage Injury or Death expires 2021-09-30 and is listed under ICR 201807-1105-001.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form SF 95 Claim for Damage, Injury, or DeathForm and Instruction
28_USC_2672.pdfSupplementary Document
1105-0008_SF_95_Supporting_Statement A.docxSupporting Statement A
Claim for Damage Injury or Death Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202601-1105-001 Reinstatement without change of a previously approved collection 2026-01-16
202109-1105-001 Extension without change of a currently approved collection 2021-09-21 Approved without change
201807-1105-001 Extension without change of a currently approved collection 2018-07-17 Approved without change
201505-1105-001 Extension without change of a currently approved collection 2015-05-28 Approved without change
201201-1105-004 Extension without change of a currently approved collection 2012-03-12 Approved without change
200810-1105-001 Extension without change of a currently approved collection 2009-01-26 Approved without change
200801-1105-001 No material or nonsubstantive change to a currently approved collection 2008-01-16 Approved with change
200612-1105-002 No material or nonsubstantive change to a currently approved collection 2006-12-27 Approved with change
200507-1105-002 Extension without change of a currently approved collection 2005-07-21 Approved with change
200203-1105-002 Extension without change of a currently approved collection 2002-03-08 Approved without change
200105-1105-001 Extension without change of a currently approved collection 2001-05-30 Approved without change
199804-1105-001 Revision of a currently approved collection 1998-04-08 Approved without change
199603-1105-002 No material or nonsubstantive change to a currently approved collection 1996-03-29 Approved without change
199408-1105-001 Reinstatement with change of a previously approved collection 1994-08-31 Approved without change
199103-1105-002 Extension without change of a currently approved collection 1991-03-27 Approved without change
198802-1105-002 Extension without change of a currently approved collection 1988-02-23 Approved without change
198503-1105-001 Extension without change of a currently approved collection 1985-03-07 Approved without change
198203-1105-003 Revision of a currently approved collection 1982-03-09 Approved without change
197906-1105-001 Reinstatement with change of a previously approved collection 1979-06-12 Approved without change
197903-1105-001 Extension without change of a currently approved collection 1979-03-16 Withdrawn
197804-1105-001 New collection (Request for a new OMB Control Number) 1978-04-14 Approved without change