Standard Form 95 is used to present claims against the United States under the Federal Tort Claims Act (FTCA) for property damage, personal injury, or death. In order to complete your claim, you must complete all blocks of the attached Standard Form.(SF) 95, Claim For Damage, Injury, or Death. In other words, fill out an inmate request to staff member ("copout" form) and then follow the official grievance procedure beginning with a BP-9. Claimants who wish to file an administrative tort claim against CBP should complete a Standard Form 95, Claim for Damage, Injury, or Death and submit it. If you need to file a tort claim, please click here, for the Standard Form 95 (Claim for Damage, You have to file an administrative notice of claim, known as Standard Form 95, against the negligent military hospital or medical provider. The claim consists of: 1. A Standard Form 95;. 2. These terms and conditions are set forth in the DOJ399 form, which can be obtained from the Constitutional Torts Staff.