§ 750.27 Information and supporting documentation.

(a) Proper documentation. Depending on the type of claim, claimants may be required to submit information, as follows: (1) Death. (i) An authenticated death certificate or other competent evidence showing cause of death, date of death, and age of the decedent; (ii) Decedent's employment or occupation at time of death, including monthly or yearly earnings and the duration of last employment; (iii) Full names, addresses, birth dates, relationship, and marital status of the decedent's survivors, including identification of survivors dependent for support upon decedent at the time of death; (iv) Degree of support provided by decedent to each survivor at time of death; (v) Decedent's general physical and mental condition before death; (vi) Itemized bills for medical and burial expenses; (vii) If damages for pain and suffering are claimed, a physician's detailed statement specifying the injuries suffered, duration of pain and suffering, any drugs administered for pain, and the decedent's physical condition during the interval between injury and death; and, (viii) Any other evidence or information which may affect the liability of the United States. (2) Personal injury. (i) A written report by attending physician or dentist on the nature and extent of the injury, nature and extent of treatment, any degree of temporary or permanent disability, the prognosis, period of hospitalization, any diminished earning capacity. In addition, the claimant may be required to submit to a physical or mental examination by a physician employed by any Federal agency. Upon written request, a copy of the report of the examining physician shall be provided; (ii) Itemized bills for medical, dental, and hospital expenses incurred, or itemized receipts of payments of such expenses; (iii) A statement of expected expenses for future treatment; (iv) If a claim is made for lost wages, a written statement from the employer itemizing actual time and wages lost; (v) If a claim is made for lost self-employed income, documentary evidence showing the amount of earnings actually lost; and (vi) Any other evidence or information which may affect the liability of the United States for the personal injury or the damages claimed. (3) Property damage. (i) Proof of ownership; (ii) A detailed statement of the amount claimed for each item of property; (iii) An itemized receipt of payment for necessary repairs or itemized written estimates of the cost of repairs; (iv) A statement listing date of purchase, purchase price, and salvage value where repair is not economical; and (v) Any other evidence or information which may affect the liability of the United States for the property damage claimed. (b) Failure to submit necessary documentation. If claimant fails to provide sufficient supporting documentation, claimant should be notified of the deficiency. If after notice of the deficiency, including reference to 28 CFR 14.4, the information is still not supplied, two follow-up requests should be sent by certified mail, return receipt requested. If after a reasonable period of time the information is still not provided, the appropriate adjudicating authority should deny the claim.