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he or she was injured, or his or her property was damaged by a federal government employee; the employee was acting within the scope of his or her official duties; the employee was acting negligently or wrongfully; and. the negligent or wrongful act proximately caused the injury or damage of which he or she complains.
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. (Note: you may complete one form, omitting the signature, photocopy it three times (one for your file), then sign three forms.)
You can also call 1-800-624-5060 for more information, claim forms and customer service assistance. The claim form provides detailed instructions for submission of the form and should be mailed to: Service Benefit Plan Retail Pharmacy Program, P.O. Box 52057, Phoenix, AZ 85072-2057.
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, along with the required supporting documentation, to the CBP port of entry, Border Patrol station, CBP pre-clearance location, or other CBP facility nearest the
The completed Standard Form 95 must be presented to the appropriate federal agency within two years after the claim accrues.
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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 allegedly caused by a federal employees negligence or wrongful act or omission occurring within the scope of the employees federal employment.
You may submit your claim and supporting documents one of three ways: Mail your claim and documents to: Associate General Counsel. Office of General Counsel. Email your claim and supporting documents to FTCAClaim@opm.gov. Fax your claim and supporting documents to 202-606-2609.

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