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. Block 1, First-Class Mail.Use Standard Form 95 (PDF)(2 pp, 539 K) to file claims for loss of employment, loss of income, loss or damage to property, or other claims. 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. In order to have a claim against the federal government, notice must be sent in the form of a Standard Form 95 (SF-95). This claim must include a description of the injury and a specific dollar amount in damages. Under PPA C.S.A. Title 42 § 8522, the Commonwealth waives sovereign immunity in certain cases, allowing third-party claims for damages. The filing process involves completing a Standard Form 95, detailing the incident, damages, and the federal agency involved.
