Information Collection

Tort Claims

IC 180065 under ICR 202509-0651-005 · OMB 0651-0046.

Documents and Forms

Document Name Document Type
Form SF 95 Tort Claims Form
Form SF 95 Claim for Damage, Injury, or Death Tort Claims Form
SF 95 Claim for Damage, Injury, or Death SF-95.pdf Form
SF 95 Claim for Damage, Injury, or Death SF-95.pdf Form
SF95.pdf Claim for Damage, Injury, or Death IC Document
SF95.pdf Claim for Damage, Injury, or Death IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Tort Claims	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 104.41-104.42

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SF 95	Claim for Damage, Injury, or Death	SF-95.pdf		Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records
Title: Patent Examiner Testimony Files	FR Citation: 78 FR 19462

Number of Respondents: 6	Number of Respondents for Small Entity: 1

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6	0	6
Annual IC Time Burden (Hours)	36	0	36
Annual IC Cost Burden (Dollars)	14	3	11

Documents for IC

Title	Document	Date Uploaded
Claim for Damage, Injury, or Death	SF95.pdf	06/28/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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