[Code of Federal Regulations]

[Title 24, Volume 1]

[Revised as of April 1, 2006]

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

[CITE: 24CFR17.4]



[Page 205-206]

 

                 TITLE 24--HOUSING AND URBAN DEVELOPMENT

 

PART 17_ADMINISTRATIVE CLAIMS--Table of Contents

 

    Subpart A_Claims Against Government Under Federal Tort Claims Act

 

Sec.  17.4  Administrative claim; evidence and information to be 

submitted.



    (a) 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 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 or designated by 

the Department or another Federal agency. A copy of the report of the 

examining physician shall be made available to the claimant upon the 

claimant's written request provided that he has, upon request, furnished 

the report referred to in the first sentence of this subparagraph and 

has made or agrees to make available to the Department any other 

physician's report previously or thereafter made of the physical or 

mental condition which is the subject matter of his claim;

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

incurred, or itemized receipts of payment for 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 his employer showing actual time lost from employment, 

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

actually lost;



[[Page 206]]



    (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 the personal injury 

or the damages claimed.

    (b) 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 monthly or yearly salary or earnings (if any), and the duration of 

his 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 upon the decedent at the time of his 

death;

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

dependent upon him for support at the time of his death;

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

    (6) Itemized bills for 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 prior to 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 

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;

    (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.