Fillable United States Court of Federal Claims - Cover Sheet (US Courts)

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United States Court of Federal Claims - Cover Sheet (US Courts)

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In The United States Court of Federal Claims
Plaintiff(s) or Petitioner(s)
Cover Sheet
Names:
Location of Plaintiff(s)/Petitioner(s) (city/state):
(If this is a multi-plaintiff case, pursuant to RCFC 20(a), please use a separate sheet to list additional plaintiffs.)
Name of the attorney of record (See RCFC 83.1(c)):
Firm Name:
Contact information for pro se plaintiff/petitioner or attorney of record:
Post Office Box:
Street Address:
City-State-ZIP:
Telephone & Facsimile Numbers:
E-mail Address:
Is the attorney of record admitted to the Court of Federal Claims Bar? □ Yes □ No
Nature of Suit
Code: Agency Identification Code: ___________________
Select only one (three digit) nature-of-suit code from the
attached sheet. Number of Claims Involved:
Amount Claimed: $
Use estimate if specific amount is not pleaded.
Bid Protest Case (required for NOS 138 and 140):
Indicate approximate dollar amount of procurement at issue: $
Is plaintiff a small business? □ Yes □ No
Was this action preceded by the filing of a □ Yes □ No
protest before the GAO?
If yes, was a decision on the merits rendered? □ Yes □ No
Income Tax (Partnership) Case:
Identify partnership or partnership group: _________________________________________
Takings Case:
Specify Location of Property (city/state):
Vaccine Case:
Date of Vaccination:
Related
Case:
Is
this case directly
related to any pending or previously filed
case(s) in the United States Court of Federal Claims? If yes, you are
required to file a separate
notice of directly related case(s). See RCFC 40.
2.
□ Yes □ No
178
Clear Form
Nature-of-Suit Codes for General Jurisdiction Cases
100 Contract - Construction - (CDA)
102 Contract - Fail to Award - (CDA)
104 Contract - Lease - (CDA)
106 Contract - Maintenance - (CDA)
108 Contract - Renovation - (CDA)
110 Contract - Repair - (CDA)
112 Contract - Sale - (CDA)
114 Contract - Service - (CDA)
116 Contract - Supply - (CDA)
118 Contract - Other - (CDA)
120 Contract - Bailment
122 Contract - Bid Preparation Costs
124 Contract - Medicare Act
125 Contract - Affordable Care Act
126 Contract - Realty Sale
128 Contract - Subsidy
130 Contract - Surety
132 Contract - Timber Sale
134 Contract - Other
136 Contract - Other - Wunderlich
138 Contract - Protest (Pre Award)
140 Contract - Protest (Post Award)
200 Tax - Allowance of Interest
202 Tax - Declaratory Judgment - 28:1507
204 Tax - Estate
206 Tax - Excise
208 Tax - Gift
210 Tax - Income, Corporate
212 Tax - Income, Individual
213 Tax - Income, Individual (Partnership)
214 Tax - Informer’s Fees
216 Tax - Preparer’s Penalty
218 Tax - Railroad
Retirement/Unemployment Tax Act
220 Tax - TEFRA Partnership - 28:1508
222 Tax - Windfall Profit
Overpayment - Interest
224 Tax - 100% Penalty - 26:6672 -
Withholding
226 Tax - Other
300 Civilian Pay - Back Pay
302 Civilian Pay - COLA
303 Civilian Pay - Disability Annuity
304 Civilian Pay - FLSA
306 Civilian Pay - Overtime Compensation
308 Civilian Pay - Relocation Expenses
310 Civilian Pay - Suggestion Award
312 Civilian Pay - Other
340 Military Pay - Back Pay
342 Military Pay - CHAMPUS
344 Military Pay - Correct records
346 Military Pay - Correct/Reinstate
348 Military Pay - Reinstatement
350 Military Pay - Relocation Expenses
352 Military Pay - Retirement
354 Military Pay - SBP
356 Military Pay - Other
500 Carrier - transportation
502 Copyright
504 Native American
506 Oil Spill Clean Up
507 Taking - Town Bluff Dam
508 Patent
509 Taking - Addicks & Barker Reservoirs
510 Taking - Personalty
512 Taking - Realty
513 Taking - Rails to Trails
514 Taking - Other
515 Unjust Conviction and Imprisonment
516 Miscellaneous - Damages
518 Miscellaneous - Lease
520 Miscellaneous - Mineral Leasing Act
522 Miscellaneous - Oyster Growers
Damages
524 Miscellaneous - Safety Off. Ben. Act
526 Miscellaneous - Royalty/Penalty Gas
Production
528 Miscellaneous - Other
535 Informer’s Reward
536 Spent Nuclear Fuel
Nature-of-Suit Codes for Vaccine Cases
449 Injury - Hepatitis A
453 Injury - Pneumococcal Conjugate
456 Injury - DPT & Polio
457 Injury - D/T
458 Injury - DTP/DPT
459 Injury - Measles
460 Injury - M/M/R
461 Injury - Measles/Rubella
462 Injury - Mumps
463 Injury - Pertussis
464 Injury - Polio - inactive
465 Injury - Polio - other
466 Injury - Rubella
467 Injury - Tetanus & Diphtheria
468 Injury - Tetanus & Tox.
469 Injury - Other
484 Injury - Hepatitis B
485 Injury - Hemophilus Influenzae
486 Injury - Varicella
490 Injury - Rotavirus
492 Injury - Thimerosal
494 Injury - Trivalent Influenzae
496 Injury - Meningococcal
498 Injury - Human Papillomavirus
452 Death - Hepatitis A
454 Death - Pneumococcal Conjugate
470 Death - DPT & Polio
471 Death - D/T
472 Death - DTP/DPT
473 Death - Measles
474 Death - M/M/R
475 Death - Measles/Rubella
476 Death - Mumps
477 Death - Pertussis
478 Death - Polio - inactive
479 Death - Polio - other
480 Death - Rubella
481 Death - Tetanus & Diphtheria
482 Death - Tetanus & Tox.
483 Death - Other
487 Death - Hepatitus B
488 Death - Hemophilus Influenzae
489 Death - Varicella
491 Death - Rotavirus
493 Death - Thimerosal
495 Death - Trivalent Influenzae
497 Death - Meningococcal
499 Death - Human Papillomavirus
179
AGENCY CODES
AGR Agriculture
AF Air Force
ARM Army
AEC Atomic Energy Commission
COM Department of Commerce
DOD Department of Defense
DOE Department of Energy
ED Department of Education
EPA Environmental Protection Agency
GPO Government Printing Office
GSA General Services Administration
HHS Health and Human Services
HLS Homeland Security
HUD Housing and Urban Development
DOI Department of the Interior
ICC Interstate Commerce Commission
DOJ Department of Justice
LAB Department of Labor
MC Marine Corps
NAS National Aeronautical Space Agency
NAV Navy
NRC Nuclear Regulatory Commission
PS Postal Service
STA State Department
SBA Small Business Administration
TRN Department of Transportation
TRE Department of Treasury
VA Department of Veterans Affairs
VAR Various Agencies
O Other
180
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Completed 29 September 2020

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