[Code of Federal Regulations]
[Title 28, Volume 2]
[Revised as of July 1, 2003]
From the U.S. Government Printing Office via GPO Access
[CITE: 28CFR104.21]

[Page 430-431]
 
                    TITLE 28--JUDICIAL ADMINISTRATION
 
              CHAPTER I--DEPARTMENT OF JUSTICE (Continued)
 
PART 104--SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001--Table of Contents
 
  Subpart B--Filing for Compensation; Application for Advance Benefits
 
Sec. 104.21  Filing for compensation.


    (a) Compensation form; ``filing.'' Except for applications for 
Advance Benefits pursuant to Sec. 104.22, no claim may be considered 
until the claimant has submitted both an ``Eligibility Form'' and either 
a ``Personal Injury Compensation Form'' or a ``Death Compensation 
Form.'' A claim shall be deemed ``filed'' for purposes of section 
405(b)(3) of the Act (providing that the Special Master shall issue a 
determination not later than 120 days after the date on which a claim is 
filed), and for any time periods in this part, when a Claims Evaluator 
determines that both the Eligibility Form and either a Personal Injury 
Compensation Form or a Death Compensation Form are substantially 
complete. Provided, however, that if a claimant files an Eligibility 
Form requesting Advance Benefits pursuant to Sec. 104.22 of this part 
without filing either a ``Personal Injury Compensation Form'' or a 
``Death Compensation Form,'' the claim shall be deemed ``filed'' when 
the Claims Evaluator determines that the Eligibility Form is 
substantially complete, but the time period for determination and any 
time periods in this part shall be stayed or tolled as described in 
Sec. 104.22(g) of this part.
    (b) Eligibility Form. The Special Master shall develop an 
Eligibility Form that will require the claimant to provide information 
necessary for determining the claimant's eligibility to recover from the 
Fund.
    (1) The Eligibility Form may require that the claimant certify that 
he or she has dismissed any pending lawsuit seeking damages as a result 
of the terrorist-related airplane crashes of September 11, 2001 (except 
for actions seeking collateral source benefits) within 90 days of the 
effective date of this part pursuant to section 405(c)(3)(B)(ii) of the 
Act and that there is no pending lawsuit brought by a dependent, spouse, 
or beneficiary of the victim.
    (2) The Special Master may require as part of the notice requirement 
pursuant to Sec. 104.4(b) that the claimant provide copies of a 
designated portion of the Eligibility Form to the immediate family of 
the decedent (including, but not limited to, the spouse, former spouses, 
children, other dependents, and parents), to the executor, 
administrator, and beneficiaries of the decedent's will, and to any 
other persons who may reasonably be expected to assert an interest in an 
award or to have a cause of action to recover damages relating to the 
wrongful death of the decedent.
    (3) The Eligibility Form may require claimants to provide the 
following proof:
    (i) Proof of death: Death certificate or similar official 
documentation;
    (ii) Proof of presence at site: Documentation sufficient to 
establish presence at one of the crash sites, which may include, without 
limitation, a death certificate, records of employment, contemporaneous 
medical records, contemporaneous records of federal, state, city or 
local government, an affidavit or declaration of the decedent's or 
injured claimant's employer, or other sworn statement (or unsworn 
statement complying with 28 U.S.C. 1746) regarding the presence of the 
victim;
    (iii) Proof of death on board aircraft: Death certificate or records 
of American or United Airlines or other sufficient official 
documentation;
    (iv) Proof of physical harm: Contemporaneous medical records of 
hospitals, clinics, physicians, licensed medical personnel, or 
registries maintained by federal, state, or local government, and 
records of all continuing medical treatment;
    (v) Personal Representative: Copies of relevant legal documentation, 
including court orders; letters testamentary or similar documentation; 
proof of the purported Personal Representative's relationship to the 
decedent; copies of wills, trusts, or other testamentary documents; and 
information regarding other possible beneficiaries as requested by the 
Eligibility Form;
    (vi) Any other information that the Special Master deems necessary 
to determine the claimant's eligibility.
    (4) The Special Master may also require waivers, consents, or 
authorizations from claimants to obtain directly

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from third parties tax returns, medical information, employment 
information, or other information that the Special Master deems relevant 
in determining the claimant's eligibility or award, and may request an 
opportunity to review originals of documents submitted in connection 
with the Fund.
    (5) Application for Advance Benefits: The Eligibility Form shall 
include a section allowing claimants to indicate that they wish to apply 
for Advance Benefits. Claimants who apply for such Advance Benefits must 
certify on that Form that they have not yet received $450,000 in 
collateral source compensation if they are bringing a claim on behalf of 
a deceased victim with a spouse or dependent, $250,000 in collateral 
source compensation if they are bringing a claim on behalf of a deceased 
victim who was single with no dependents, or an amount in excess of 
their lost wages plus out-of-pocket medical expenses if they are an 
injured claimant. All such claimants also must state on the Form facts 
establishing financial hardship that would justify a determination that 
they are in need of Advance Benefits.
    (6) The Special Master may publish a list of individuals who have 
filed Eligibility Forms and the names of the victims for whom 
compensation is sought, but shall not publish the content of any such 
form.
    (c) Personal Injury Compensation Form and Death Compensation Form. 
The Special Master shall develop a Personal Injury Compensation Form 
that each injured claimant must submit. The Special Master shall also 
develop a Death Compensation Form that each Personal Representative must 
submit. These forms shall require the claimant to provide certain 
information that the Special Master deems necessary to determining the 
amount of any award, including information concerning income, collateral 
sources, benefits, and other financial information, and shall require 
the claimant to state the factual basis for the amount of compensation 
sought. It shall also allow the claimant to submit certain other 
information that may be relevant, but not necessary, to the 
determination of the amount of any award.
    (1) Claimants shall, at a minimum, submit all tax returns that were 
filed for the years 1998, 1999, and 2000. The Special Master may, at his 
discretion, require that claimants submit copies of tax returns or other 
records for any other period of years he deems appropriate for 
determination of an award. The Special Master may also require waivers, 
consents, or authorizations from claimants to obtain directly from third 
parties medical information, employment information, or other 
information that the Special Master deems relevant to determining the 
amount of any award.
    (2) Claimants may attach to the ``Personal Injury Compensation 
Form'' or ``Death Compensation Form'' any additional statements, 
documents or analyses by physicians, experts, advisors, or any other 
person or entity that the claimant believes may be relevant to a 
determination of compensation.
    (d) Submission of a claim. Section 405(c)(3)(B) of the Act provides 
that upon the submission of a claim under the Fund, the claimant waives 
the right to file a civil action (or to be a party to an action) in any 
Federal or State court for damages sustained as a result of the 
terrorist-related aircraft crashes of September 11, 2001, except for 
civil actions to recover collateral source obligations and civil actions 
against any person who is a knowing participant in any conspiracy to 
hijack any aircraft or commit any terrorist act. A claim shall be deemed 
submitted for purposes of section 405(c)(3)(B) of the Act when the claim 
is deemed filed pursuant to Sec. 104.21, regardless of whether any time 
limits are stayed or tolled.
    (e) Provisions of information by third parties. Any third party 
having an interest in a claim brought by a Personal Representative may 
provide written statements or information regarding the Personal 
Representative's claim. The Claims Evaluator or the Special Master or 
his designee may, at his or her discretion, include the written 
statements or information as part of the claim.

[66 FR 66282, Dec. 21, 2001, as amended at 67 FR 11245, Mar. 13, 2002]

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