Case 1:22-cv-00252-MSG Document 60-5 Filed 03/02/23 Page 1 of 4 PagelD #: 1277
`Case 1:22-cv-00252-MSG Document 60-5 Filed 03/02/23 Page 1 of 4 PageID #: 1277
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`INTERVENORS’ EXHIBIT 3
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`USDISTRICT COURT
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`DISTRICT OF DELAWARE
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`Case 1:22-cv-00252-MSG Document 60-5 Filed 03/02/23 Page 2 of 4 PagelD #: 1278
`Case 1:22-cv-00252-MSG Document 60-5 Filed 03/02/23 Page 2 of 4 PageID #: 1278
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`Facai / DEP.
`geREALTY4
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`NT OF HEALTH
`
`SERVICES
`
`r
`SEP 22 ona
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`,
`
`Office of the General Counsel
`General Law Division
`Claims Office
`330 C Street, SW,
`Switzer Building, Suite 2100
`Washington, D.C. 20201
`Ph: (202) 691-2369
`Heather.Hill@bhs.gov
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`REQUESTED
`RECEIPT
`RETURN
`-
`CERTIFIED
`Certified Receipt Number: 7014 [20 066\ $335 T4e\
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`Emanuel McCray ~
`400 West McLoughlin Boulevard, Apartment 5
`Vancouver, WA 98660
`
`Re:
`
`Administrative Tort Claim of Emanuel McCray,
`Claim No. 2020-1415.
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`Dear Mr. McCray:
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`This will acknowledgethe receipt ofthe administrative tort claim youfiled forpersonal injury and/or,
`loss ofproperty or other damage(s) occurring on or about January 27, 2020. Your administrative tort
`claim was received in the.Claims Office-on September 8, 2020 for consideration andreply.
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`In order to evaluateyouradministrative tort claim, please forward thefollowingsubstantiating evidence
`within thirty (30) days ofréceiptofthis letter:
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`1)
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`2)
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`3)
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`For each claim ofpersonal injury alleged in the administrative claim, provide
`medical records, including reports by medical providers concerning the nature
`and extent ofthe injury, nature and extent of medical treatment, any degree of
`temporary or permanent physical or mental disability, the prognosis, any period
`of hospitalization, and any diminished earning capacity resulting from your
`injuries.
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`For.any claim of personal injury alleged in the administrative claim, provide all
`X-rays, ultrasonography, computed tomography (“CT”), and magnetic resonance
`imaging (“MRI”), preferably on CDs or thumb drives and shipped by
`FEDEX, DHL OR UPS.
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`itemized bills pertaining to any medical expenses you claim to have incurred in
`relation.to any claim of personalinjury;
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`4)
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`-
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`5)
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`Ifaclaimismadeforlostwages, a signed statement from your current or former
`‘employershowing actual time and wages lost;
`Ifa claim is made for loss of income and the claimant is self-employed,
`documentary evidence showing the amountof earnings actually lost.
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`
`
`
`
`“-—rratenimatnaacunteteietttiraoeeanENDRRNCRGOSH
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`

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`Case 1:22-cv-00252-MSG Document 60-5 Filed 03/02/23 Page 3 of 4 PagelD #: 1279
`Case 1:22-cv-00252-MSG Document 60-5 Filed 03/02/23 Page 3 of 4 PageID #: 1279
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`6)
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`ifyour claim is for damageto or loss of property, real or personal, please submit
`the following evidence:
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`(i) Proof of ownership.
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`(ii) A detailed statement ofthe amount claimed with respect to each item of
`property.
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`(iii) Evidencerelating to the date ofpurchase, purchase price, and market value of
`the property as of the date ofloss;
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`(iv) Any other evidence orinformation that may have a bearing either on the
`responsibility ofthe United States for the injury to or loss of property or the
`damages claimed.
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`7)
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`8)
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`Any other documents, evidence or information that you believe has
`bearingon the responsibility of the federal governmentfor the injuries and/or the
`damages claimed.
`.
`if any ofthe documents requestedabove have already been provided to
`the OGC’s Claims Office in support of your administrative tort claim, please
`disregard those requests.
`
`AS ALL MAIL DELIVERED TO FEDERAL GOVERNMENT BUILDINGIS
`X-RAYED/RADIATED, AND MAYBE DAMAGED DURING THE PROCESS, PLEASE
`FORWARD ALL EVIDENCE TO THIS OFFICE USING FEDEX, DHL OR UPS. PLEASE DO
`NOT FAX MEDICAL EVIDENCE OR SEND CDs or X-RAYS BY U.S. MAIL.
`
`Please be advisedthat all evidence must be furnished by the claimant within a reasonable period oftime.
`By operation of45 C.F.R. § 35.4(d), a claimant’s failure to furnish evidence necessary to make a
`determination of his/her administrative tort claim within three monthsafter a request for such evidence
`has been made, may be deemed an abandonmentof the administrative tort claim. Further, a claimant's
`failure to provide requested evidence duringthe administrative tort claim process may result ina finding
`that his/her administrative remedies have not been exhausted,even if suit is filed more than six months
`after filing-an administrative tort claim. See Swift v. United States, 614 F.2d 812 (ist Cir. 1980).
`
`Yourstruly,
`
`Heather E. Hill
`Paralegal Specialist
`Claims and Employment Law Branch
`
`

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`Case 1:22-cv-00252-MSG Document 60-5 Filed 03/02/23 Page 4 of 4 PagelD #: 1280
`Case 1:22-cv-00252-MSG Document 60-5 Filed 03/02/23 Page 4 of 4 PageID #: 1280
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`DEPARTMENT OF
`HEALTH & HUMAN SERVICES
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