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Judgment Fund

Forms

As part of the process for asking the Judgment Fund to pay an award, an authorized official must submit the following 3 forms and the fax sheet via mail or fax.

Forms must be completed, signed, and submitted to the Judgment Fund by an authorized official of a federal agency. Forms signed by anyone other than an authorized federal official will be deemed fraudulent. Filing a false or fraudulent claim constitutes a Federal offense that is punishable by fines, imprisonment, or both. Refer to 31 U.S.C. § 3729 and 18 U.S.C § 287.

Electronic Filing

Agencies may submit requests by faxing or mailing completed payment request forms (see below). However, payment requests can also be submitted electronically through the Judgment Fund Internet Claims System.

Request Payment Electronically

Judgment Fund Forms

The Judgment Fund ONLY accepts the 194, 196 and 197 forms below. All older versions are no longer being used.

Important Notes

Form Signature

Only an authorized official may ask that the Judgment Fund pay.

Determining the Taxpayer Identification Number

The Taxpayer Identification Number (TIN) on the form must be that of the plaintiff (the person to whom the government owes the money).

The TIN cannot be of an intermediary, such as an attorney or claims administrator who is getting the money on behalf of the plaintiff.

Even where a claims administrator is getting a lump sum on behalf of many plaintiffs, the Bureau of the Fiscal Service must have the TINs of all the plaintiffs. If the payment is for a class action suit or other situation with many plaintiffs, the agency official must contact the Judgment Fund Section before submitting the request to work out how to provide the TINs.

The only 5 exceptions to the requirement for a TIN, as listed in the Taxpayer Identification Number (TIN) section. For additional information about this, visit the Offsets page.

Additional Information

On the requesting form (Form 196), the agency must list deductions from the payment for any known Judgment Debts the plaintiff owes and any known IRS tax levy to which the plaintiff is subject. These amounts will be paid to the right entities from the total amount of the award.

Last modified 12/18/18