[Code of Federal Regulations]

[Title 44, Volume 1]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 44CFR11.14]



[Page 113-114]

 

              TITLE 44--EMERGENCY MANAGEMENT AND ASSISTANCE

 

 CHAPTER I--FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND 

                                SECURITY

 

PART 11_CLAIMS--Table of Contents

 

      Subpart B_Administrative Claims Under Federal Tort Claims Act

 

Sec. 11.14  Administrative claim; evidence and information to be 

submitted.



    (a) Death. In support of a claim based on death the claimant may be 

required to submit the following evidence or information:

    (1) An authenticated death certificate or other competent evidence 

showing cause of death, date of death, and age of the decedent.

    (2) Decedent's employment or occupation at time of death, including 

his or her monthly or yearly salary or earnings (if any), and the 

duration of his or her last employment or occupation.

    (3) Full names, addresses, birth dates, kinship, and marital status 

of the decedent's survivors, including identification of those survivors 

who were dependent for support on the decedent at the time of his or her 

death.

    (4) Degree of support afforded by the decedent to each survivor 

dependent on him or her for support at the time of death.

    (5) Decedent's general physical and mental condition before death.

    (6) Itemized bills or medical and burial expenses incurred by reason 

of the incident causing death, or itemized receipts of payment for such 

expenses.

    (7) If damages for pain and suffering before death are claimed, a 

physician's detailed statement specifying the injuries suffered, 

duration of pain and suffering, any drugs administered for pain, and the 

decedent's physical condition in the interval between injury and death.

    (8) Any other evidence or information which may have a bearing on 

either the responsibility of the United States for the death or the 

amount of damages claimed.

    (b) Personal injury. In support of a claim for personal injury, 

including pain and suffering, the claimant may be required to submit the 

following evidence or information:

    (1) A written report by his or her attending physician or dentist 

setting forth the nature and extent of the injury, nature and extent of 

treatment, any degree of temporary or permanent disability, the 

prognosis, period of hospitalization, and any diminished earning 

capacity. In addition, the claimant may be required to submit to a 

physical or mental examination by a physician employed by FEMA or 

another Federal agency. FEMA shall make available to the claimant a copy 

of the report of the examining physician on written request by the 

claimant, if he or she has, on request, furnished the report referred to 

in the first sentence of this subparagraph and has made or agrees to 

make available to FEMA any other physician's reports previously or 

thereafter made of the physical or mental condition which is the subject 

matter of the claim.

    (2) Itemized bills for medical, dental, and hospital expenses 

incurred, or itemized receipts of payment of such expenses.

    (3) If the prognosis reveals the necessity for future treatment, a 

statement of expected expenses for such treatment.

    (4) If a claim is made for loss of time from employment, a written 

statement from the employer showing actual time lost from employment, 

whether he or she is a full- or part-time employee, and wages or salary 

actually lost.

    (5) If a claim is made for loss of income and the claimant is self-

employed, documentary evidence showing the amount of earnings actually 

lost.

    (6) Any other evidence or information which may have a bearing on 

either the responsibility of the United States for



[[Page 114]]



the personal injury or the damages claimed.

    (c) Property damage. In support of a claim for injury to or loss of 

property, real or personal, the claimant may be required to submit the 

following evidence or information:

    (1) Proof of ownership of the property interest which is the subject 

of the claim.

    (2) A detailed statement of the amount claimed with respect to each 

item of property.

    (3) An itemized receipt of payment for necessary repairs or itemized 

written estimates of the cost of such repairs.

    (4) A statement listing date of purchase, purchase price, and 

salvage value, where repair is not economical.

    (5) Any other evidence or information which may have a bearing on 

either the responsibility of the United States for the injury to or loss 

of property or the damages claimed.