SF 95 Damages Worksheet for Your Sum Certain

To work out the sum certain for your Standard Form 95 (SF-95), add every documented loss into three boxes: property damage (12a), personal injury (12b) and wrongful death (12c). The total you write in box 12d is your sum certain, and it caps what a later lawsuit can ask for. The worksheet above does that addition and lists the documents that back each number.

How to Work Out Your SF-95 Sum Certain

Your sum certain is the single dollar total in item 12d of the SF-95, built from the amounts in 12a, 12b and 12c. Item 12 on the General Services Administration (GSA) "Claim for Damage, Injury, or Death" form is titled "Amount of claim (in dollars)," and it has four lines.

1. Add your property losses and write the total in 12a, Property Damage.
2. Add your injury costs and write the total in 12b, Personal Injury.
3. Add any costs tied to a death and write the total in 12c, Wrongful Death.
4. Write the word NONE in any box with no amount. The form's instructions say: "Complete all items - Insert the word NONE where applicable."
5. Add 12a, 12b and 12c, and write the result in 12d, Total. That figure is your sum certain.

If you are claiming both personal injury and property damage, the instructions say the amount for each "must be shown in item number 12 of this form." The form also prints a warning beside 12d: "Failure to specify may cause forfeiture of your rights."

Under 28 Code of Federal Regulations (C.F.R.) § 14.2(a), a claim is presented when the agency receives an executed SF-95 or other written notice with a claim for money damages in a sum certain. Under 28 United States Code (U.S.C.) § 2675(b), a later lawsuit cannot ask for more than that amount, with two exceptions covered below.

The worksheet does not decide which losses belong in your claim. Ask a licensed attorney that question. The Federal Tort Claims Act (FTCA) lawyer guide explains when to hire one and how attorney fees are capped.

How to Use the Worksheet

The worksheet has three groups that match boxes 12a, 12b and 12c, and each group starts with description rows already filled in. Type a dollar amount next to each row that applies. Remove a row that does not fit your claim with its "×" button.

• "Box 12a: Property Damage" starts with "Repair estimate or receipt" and "Value of property lost or destroyed." Click "+ Add a property loss" for another line, such as a towing bill.
• "Box 12b: Personal Injury" starts with "Medical and hospital bills to date," "Future medical care (doctor-supported)," "Lost wages" and "Other injury damages." Click "+ Add an injury cost" for another line.
• "Box 12c: Wrongful Death" starts with "Medical and burial expenses" and "Other wrongful death damages." Click "+ Add a wrongful death cost" for another line.

Each group shows its own subtotal. The result panel, "What to write in box 12 of your SF-95," shows the figure for 12a, 12b and 12c, and it shows the word NONE when a box is zero. Its last line, "12d. Total (your sum certain)," is the number that goes in box 12d.

"Documents that back these numbers" lists the evidence the SF-95 instructions ask for, for each box that has an amount. Three buttons let you keep your work:

• "Print / save as PDF" prints only the worksheet: a name and date line, directions, your line items and the four totals. You can save it as a Portable Document Format (PDF) file instead of printing.
• "Copy totals" copies the totals.
• "Download CSV" saves the worksheet as a comma-separated values (CSV) file.

The worksheet does its math in your browser. The amounts and descriptions you type are not sent to an agency or to anyone else.

How the Worksheet Counts

The only math the worksheet does is addition, rounded to cents. It follows four rules:

• Each group's rows add up to that box's subtotal, and the three subtotals add up to 12d.
• A box that adds up to zero shows NONE, matching the form's instruction to insert NONE where applicable.
• An amount it cannot read as dollars, or a negative amount, is left out of the totals and flagged so you can fix it.
• A zero total triggers the warning "Box 12d cannot be blank," with the 28 C.F.R. § 14.2(a) citation.

The worksheet does not put a value on your claim or judge whether a cost can be recovered.

A Worked Example for a Car Hit by a Federal Vehicle

In this example, a federal vehicle hits your car, and you have bills for the car, your medical care and your missed work. The repair estimate is $4,800, and you add a $350 towing bill with "+ Add a property loss." Your doctor's report supports $1,200 of future physical therapy.

The arithmetic is $4,800 + $350 = $5,150, then $3,250 + $1,200 + $1,900 = $6,350, then $5,150 + $6,350 = $11,500. That $11,500.00 total is the most a later lawsuit could ask for, unless newly discovered evidence or intervening facts apply under § 2675(b).

Evidence That Backs Each Box 12 Amount

The SF-95 instructions ask for specific documents behind each amount, and the worksheet lists the ones that match the boxes you filled in.

In the worked example, the instructions ask for at least two itemized signed estimates behind the $4,800 repair line, or itemized signed receipts if the repair has been paid. The $1,200 physical therapy line rests on the doctor's report that supports it.

If an agent or legal representative signs the claim, the signature must show the signer's title or legal capacity. The claim must also include evidence of authority to act for the claimant, such as an executor, administrator, parent or guardian.

Why the Box 12d Total Is Hard to Change Later

The 12d total sets the ceiling on any later lawsuit. Under 28 U.S.C. § 2675(b), a suit cannot ask for more than the amount presented to the agency. The only exceptions are an increase based on newly discovered evidence that was not reasonably discoverable when you presented the claim, or on intervening facts relating to the amount.

The form adds a second commitment above your signature. You certify that the amount of claim covers only damages and injuries caused by the incident, and you "agree to accept said amount in full satisfaction and final settlement of this claim."

Under 28 U.S.C. § 2401(b), you must present the claim within two years after it accrues. The form says a claim "is deemed presented when it is received by the appropriate agency, not when it is mailed."

When This Worksheet Is Not Enough

The worksheet adds the numbers you give it, so it cannot tell you which costs to include or how to price a cost that has not happened yet. Talk to a licensed attorney before you sign if any of these apply, because the total cannot easily be raised later:

• You are still in treatment and your future medical costs are uncertain.
• The claim is for a wrongful death, where the person signing must have authority to act for the estate.
• Some of your losses are hard to put a dollar figure on.
• You are close to the two-year deadline.

The FTCA lawyer guide covers when to bring in a lawyer, and find a lawyer is where to start looking for one. For the wider claim process, read how to sue the federal government and suing a federal agency, or start at the how to sue the government hub.

What to Do Next

Save your worksheet with "Print / save as PDF" so the line items and totals stay with your bills, estimates and reports.

If you came here from the eligibility check built for the Anti-Weaponization Fund, that fund's order was rescinded in August 2026. The worksheet's totals apply to an SF-95 claim.

Enter your incident date in the federal claim deadline calculator now, then complete the rest of your SF 95 with the box-by-box SF-95 guide and copy your four totals into item 12.

Frequently Asked Questions

What is an SF 95 form?

Standard Form 95, "Claim for Damage, Injury, or Death," is a form published by the GSA. Item 12 is where you write the dollar amounts of your claim.

What is a sum certain on an SF-95?

The sum certain is the exact dollar total in box 12d. Under 28 C.F.R. § 14.2(a), a claim is presented only when it includes a claim for money damages in a sum certain.

What happens if I leave box 12d blank?

The form's instructions say: "Failure to specify a sum certain will render your claim invalid and may result in forfeiture of your rights." The worksheet shows "Box 12d cannot be blank" whenever your total is zero.

Can I raise my claim amount after I file?

A later lawsuit cannot ask for more than the amount you presented, under 28 U.S.C. § 2675(b). The exceptions are newly discovered evidence that was not reasonably discoverable when you filed, or intervening facts relating to the amount.

What documents should I attach to an SF-95?

The instructions ask for an attending physician's report and itemized bills for an injury or death. For property, they ask for two itemized signed estimates or signed receipts, or statements of original cost and value for property that cannot be repaired. The evidence table above lists each requirement by box.