If you are unable to retrieve this form, you may obtain a printed copy by writing to:

Federal Tort Claims Act Staff
Civil Division
U.S. Department of Justice
P.O. Box 888 Benjamin Franklin Station
Washington, DC 20044

Standard Form 95 is 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.