Administrative claims; evidence and information to be submitted.

CFR · 2024-01-01 · US · Title 10

(a) (1) An authenticated death certificate or other competent evidence showing the cause of death, the date of death, and the age of the decedent. (2) Decedent's employment or occupation at time of death, including monthly or yearly salary or earnings (if any), and the duration of 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 upon the decedent at the time of death. (4) The degree of support afforded by the decedent to each survivor dependent upon decedent for support at the time of death. (5) Decedent's general physical and mental condition before death. (6) Itemized bills for 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 prior to death are claimed, a physican's detailed statement specifying the injuries suffered, the duration of pain and suffering, any drugs administered for pain, and the decedent's physical condition between injury and death. (8) Any other evidence or information that may have a bearing on either the responsibility of the United States for the death or the amount of damages claimed. (b) (1) A written report by the attending physician or dentist setting forth the nature and extent of the injury, the nature and extent of treatment, any degree of temporary or permanent disability, the pr

official document · source cfr-2024 · id 10:§ 1014.4