[Code of Federal Regulations]
[Title 44, Volume 1]
[Revised as of October 1, 2007]
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 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.

[[Page 114]]

    (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.