§ 1014.4 Administrative claims; evidence and information to be submitted. ( a ) *Death.* In support of a claim based on death, the claimant may be required to submit the following evidence or information: ( 1 ) An authenticated death certificate or other competent evidence showing the cause of death, the date of death, and the age of the decedent.
( 2 ) Decedent's employment or occupation at time of death, including monthly or yearly salary or earnings (if any), and the duration of last employment or occupation.
( 3 ) Full names, addresses, birth dates, kinship, and marital status of the decedent's survivors, including identification of those survivors who were dependent for support upon the decedent at the time of death.
( 4 ) The degree of support afforded by the decedent to each survivor dependent upon decedent for support at the time of death.
( 5 ) Decedent's general physical and mental condition before death.
( 6 ) Itemized bills for medical and burial expenses incurred by reason of the incident causing death, or itemized receipts of payment for such expenses.
( 7 ) If damages for pain and suffering prior to death are claimed, a physican's detailed statement specifying the injuries suffered, the duration of pain and suffering, any drugs administered for pain, and the decedent's physical condition between injury and death.
( 8 ) Any other evidence or information that may have a bearing on either the responsibility of the United States for the death or the amount of damages claimed.
( b ) *Personal injury.* In support of a claim for personal injury, including pain and suffering, the claimant may be required to submit the following evidence or information: ( 1 ) A written report by the attending physician or dentist setting forth the nature and extent of the injury, the nature and extent of treatment, any degree of temporary or permanent disability, the prognosis, the period of hospitalization, and any diminished earning capacity. In addition, the claimant may be required to submit to a physical or mental examination by a physician employed by the DOE or another Federal agency. A copy of the physician's report shall be made available to the claimant upon the claimant's written request, provided that the claimant has, upon request, made or agrees to make available to the DOE any physician's reports previously or thereafter made of the physical or mental condition which is the subject matter of the claim.
( 2 ) Itemized bills for medical, dental, and hospital expenses incurred, or itemized receipts of payment for such expenses.
( 3 ) If the prognosis reveals that future treatment will be needed, a statement of the expected expenses of such treatment.
( 4 ) If a claim is made for loss of time from employment, a written statement from the claimant's employer showing actual time lost from employment, whether the claimant is a full-time or part-time employee, and the wages or salary actually lost.
( 5 ) If a claim is made for loss of income and the claimant is self-employed, documentary evidence showing the amounts of earnings actually lost.
( 6 ) Any other evidence or information that may bear on either the responsibility of the United States for the personal injury or the damages claimed.
( c ) *Property damage.* In support of a claim for injury to or loss of property, real or personal, the claimant may be required to submit the following evidence or information: ( 1 ) Proof of ownership of the property interest that is the subject of the claim.
( 2 ) A detailed statement of the amount claimed with respect to each item of property.
( 3 ) An itemized receipt of payment for necessary repairs or itemized written estimates of the cost of such repairs.
( 4 ) A statement listing date of purchase, purchase price, and salvage value, where repair is not economical.
( 5 ) Any other evidence or information that may bear on either the responsibility of the United States for the injury to or loss of property or the damages claimed.