226.

FMS Form 194 -- Judgment Fund Payment Request

FMS Form 194 Department of the Treasury . AUTHORIZED FOR LOCAL REPRODUCTION FMS Judgment Fund Payment Request (Litigative Award) . FOR FMS USE ONLY: Z- General Instruction: Use this form to transmit to FMS a request to certify a litigative award against the United States for payment from the Judgment Fund, under 31 U.S.C. § 1304. Date: ______________________ Judgment Fund Section Financial Management Service Department of the Treasury Room 6F03 3700 East-West Highway Hyattsville, Maryland 20782 (Telephone: (202) 874-6664) Matter of: _____________________________________________ Dear Sir or Madam: I am the authorized representative of the United States in the captioned matter. As described in the enclosed documentation, I certify all of the pertinent criteria required by law for the approval of the claim(s) has been satisfied. I believe the award made in the enclosed judgment or settlement is payable by the United States. The United States will seek no further judicial review of this award, and I have obtained all approvals necessary for its referral for payment. I believe that this award qualifies for payment pursuant to 31 U.S.C. § 1304. Accordingly, I request that you certify this award for payment from the Judgment Fund established by that law. Enclosed are completed copies of FMS Form 196: Judgment Fund Award Data Sheet; FMS Form 197 or FMS Form 197A: Voucher for Payment; the judgment or settlement agreement; and any other enclosures required by FMS regulations. Unless payment by electronic funds transfer is indicated on FMS Form 196, please have the check sent to the agency contact shown in item 5(c) of FMS Form 196. . __________________________ Signature . __________________________ Name (printed or typed) . __________________________ Title and Agency Enclosures: FMS Form 196, FMS Form 197 or 197A, and FMS Form 198. Incomplete submissions will be returned to the submitter without action. FMS Form 194 7-97 (PREVIOUS EDITIONS ARE OBSOLETE) DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE [updated May 1999]