OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Claim for Damage Injury or Death

OMB 1105-0008 · DOJ/LA.

OMB 1105-0008

This form is utilized by those persons making a claim against the United States Government under the Federal Tort Claims Act.

The latest form for Claim for Damage Injury or Death expires 2021-09-30 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form and Instruction
Supplementary Document
Supporting Statement A
All Historical Document Collections
 Reinstatement without change of a previously approved collection 2026-01-16
Approved without change
 Extension without change of a currently approved collection 2021-09-21
Approved without change
 Extension without change of a currently approved collection 2018-07-17
Approved without change
 Extension without change of a currently approved collection 2015-05-28
Approved without change
 Extension without change of a currently approved collection 2012-03-12
Approved without change
 Extension without change of a currently approved collection 2009-01-26
Approved with change
 No material or nonsubstantive change to a currently approved collection 2008-01-16
Approved with change
 No material or nonsubstantive change to a currently approved collection 2006-12-27
Approved with change
 Extension without change of a currently approved collection 2005-07-21
Approved without change
 Extension without change of a currently approved collection 2002-03-08
Approved without change
 Extension without change of a currently approved collection 2001-05-30
Approved without change
 Revision of a currently approved collection 1998-04-08
Approved without change
 No material or nonsubstantive change to a currently approved collection 1996-03-29
Approved without change
 Reinstatement with change of a previously approved collection 1994-08-31
Approved without change
 Extension without change of a currently approved collection 1991-03-27
Approved without change
 Extension without change of a currently approved collection 1988-02-23
Approved without change
 Extension without change of a currently approved collection 1985-03-07
Approved without change
 Revision of a currently approved collection 1982-03-09
Approved without change
 Reinstatement with change of a previously approved collection 1979-06-12
Withdrawn
 Extension without change of a currently approved collection 1979-03-16
Approved without change
 New collection (Request for a new OMB Control Number) 1978-04-14