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Form SF 95: How to Resolve a Claim with a Federal Agency

Form SF 95 Claim for Damage, Injury, or Death.

No one is immune from becoming a victim of someone else’s negligence in the workplace, even when your employer is a federal agency. Regardless of what kind of damage was done to you, you can request compensation from the appropriate agency by completing and filing Form SF 95. Let’s take a closer look at how it’s done.

Who needs a Form SF 95?

Standard Form 95 should be filed with the federal agency whose employee’s negligence was the cause of injury, damage suffered, or the death of the claimant (in this case the form is filled by the consumer’s relatives or any other person having legal grounds for filing a lawsuit).

It is recommended to consult a lawyer before submitting the completed form to the agency. However, anyone can file their claim directly with the agency.

What is Form SF 95 for?

Using this form, a claimant should lay out in detail the known facts and circumstances of the damage, injury, or death, identifying persons and property involved, the place of occurrence, and the cause thereof. Also, the claimant should specify witnesses to the case and the amount of the claim.  

Based on the information provided on the SF 95 form, the agency considers the claim and decides whether or not to pay compensation. The form certifies that the amount of the claim covers only damages and injuries caused by the incident and that a claimant agrees to accept the indicated amount in full satisfaction and final settlement of this form.

Remember that the claim should be filed within two years from the date of the accident. The failure to completely execute this form may render person’s claim invalid.

Is Form SF 95 accompanied by other forms?

If the form is submitted by an authorized representative of the claimant, the Standard Form 95 must be accompanied by evidence of their authority to present a claim on behalf of the injured party. Additional evidence regarding the case may also be required. .

How do I fill out Form SF 95?

The following blocks of the Form 95 are to be completed:

  1. Federal Agency title;
  2. Claimant’s personal information;
  3. Type of employment;
  4. Basis of claim;
  5. Property Damage;
  6. Personal Injury/Wrongful Death;
  7. Witnesses;
  8. Amount of Claim;
  9. Signature of Claimant.

Where do I send Form SF 95?

Once completed and signed, Form SF 95 should be directed to the address of the appropriate agency connected to the claimant’s case.

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