(a) Who may file a claim. A claim may be filed by the following individuals:
(1) An employee;
(2) An authorized agent or representative of an employee or employee's estate, regardless of whether the claim arose before or concurrent with an employee's death; and
(3) A former employee or his authorized agent or representative if damage or loss occurred prior to the separation from the Department.
(b) Requirements. A claim submitted under this part must be presented in writing to the Claims Officer (See paragraph (c) of this section). Claims may be submitted on a HHS-481 form, Employee Claim for Loss or Damage to Personal Property. All claims must be signed by the claimant or his authorized agent or representative. The HHS-Form can be obtained from the Claims Officer or downloaded from the Program Support Center's webpage at www.psc.gov. All claims must include the following:
(1) Name and address of the claimant;
(2) The office in which the claimant was employed at the time of loss, current office, if different, and telephone number;
(3) Date of loss or damage;
(4) Amount of claim;
(5) Description of the property, including but not limited to type, design, model number, date acquired, value when acquired, value when lost, and estimation of repair or replacement cost;
(6) Description of incident; and
(7) If property was insured when loss or damage occurred, a statement indicating whether a claim was filed with an insurance carrier.
(c) Where to file your claim.
(1) Claimants employed with the Regional Offices should submit claims to the Chief Regional Counsel, Office of the General Counsel, within the claimant's Region.
(2) All other claimants must submit claims to the Office of the General Counsel, General Law Division, Claims and Employment Law Branch, 330 Independence Ave., SW., Room 4760, Cohen Building, Washington, DC 20201.
(d) Evidence required. You must submit the following:
(1) Not less than two itemized signed estimates for the cost of repairs, or an itemized bill of repair for the damaged property;
(2) In the event the property is not economically repairable or is totally lost or destroyed, proof of this fact, its market value before or after loss, purchase price, and date of acquisition of the property;
(3) Proof of ownership or right to recover for the damage such as a receipt;
(4) Police/incident report;
(5) If property is insured, insurance information, such as insurance carrier, type of coverage, deductible, and whether claim has been filed and/or paid;
(6) Travel orders, if applicable;
(7) Any citations or traffic tickets, if applicable; and
(8) Any other evidence required by the claims officer not specified above.
(e) Time limit.
(1) A claim filed under this section must be filed in writing with the Department within two years from the date of the incident.
(2) If the claim accrues in the time of war or in the time of armed conflict in which any armed forces of the United States are engaged or if such a war or armed conflict occurs within two years after the claim accrues, and if good cause is shown, the claim shall be presented no more than two years after that cause ceases to exist, or two years after the war or armed conflict is terminated, whichever is earlier.
(3) All required evidence in support of a claim submitted under this section must be forwarded to the claims officer within sixty days after request. Failure to do so will be deemed as an abandonment of the claim and the claim will be disallowed.