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. 315 East Main Street Suite A Ottawa, OH 45875.STANDARD FORM 95 (SF 95), "Claim for Damage, Injury, or Death": You must submit three. (3) completed forms, WITH AN ORIGINAL SIGNATURE, IN INK, ON EACH COPY. The Federal Tort Claims Act prescribes a uniform procedure for handling of claims against the United States, for money damages only. Filing an FTCA claim involves submitting a Standard Form 95 to the appropriate federal agency. When the termination date is known, complete a new Form 95 and check "Termination of Previous Notice" on page 1. POINT OF CONTACT: Last Name. 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 have filled out the form correctly, including a specific amount of money you are asking for, you will receive a letter that acknowledges receipt of your.
