[Code of Federal Regulations]

[Title 45, Volume 1]

[Revised as of October 1, 2006]

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

[CITE: 45CFR35.4]



[Page 112-113]

 

                        TITLE 45--PUBLIC WELFARE

 

                    SUBTITLE A--DEPARTMENT OF HEALTH

                           AND HUMAN SERVICES

 

PART 35_TORT CLAIMS AGAINST THE GOVERNMENT--Table of Contents

 

                          Subpart B_Procedures

 

Sec.  35.4  Administrative claims; 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 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 payments 

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.

    (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 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 the constituent organization. A copy of the report of 

the examining physician shall be made available to the claimant upon the 

claimant's written request provided that claimant 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 

or the operating agency any other physician's reports 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 duration of and 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.

    (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.

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

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

following evidence or information:

    (1) Proof of ownership.



[[Page 113]]



    (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, market 

value of the property as of date of damage, and salvage value, where 

repair is not economical.

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

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

loss of property or the damages claimed.

    (d) Time limit. All evidence required to be submitted by this 

section shall be furnished by the claimant within a reasonable time. 

Failure of a claimant to furnish evidence necessary to a determination 

of his claim within three months after a request therefor has been 

mailed to his last known address may be deemed an abandonment of the 

claim. The claim may be thereupon disallowed.