Get Dgs Government Claims Program

This guide provides clear, step-by-step instructions on how to complete the Dgs Government Claims Program form online. Whether you are filing a claim for damage or injury, this comprehensive resource is designed to assist you in successfully completing the necessary sections of the form.

Follow the steps to complete the Dgs Government Claims Program form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the full name of the person claiming damage or injury. If the claimant is a business or entity, please enter the name of the entity.
3. Provide a daytime telephone number where you can be reached.
4. If desired, you can provide an email address for further correspondence.
5. Please fill in your complete mailing address, ensuring all details are accurate.
6. If you are an inmate or a patient at a state hospital, include your identification number.
7. For claims being filed on behalf of a minor, enter the minor's birthdate.
8. If applicable, provide the name of the insured if you are an insurance company claiming subrogation.
9. If relevant, include any claim number or the name of another claimant related to your claim.
10. If you have legal representation, enter the attorney's or representative's name and contact information.
11. Please describe the relationship of the attorney or representative to the claimant.
12. State the exact date of the incident that caused the damage or injury, providing additional dates if necessary.
13. Indicate the state agency you believe is responsible for the damage or injury, including the names of any involved state employees.
14. Enter the total amount being claimed. If the damages are ongoing, show a ‘+’ after the dollar amount.
15. For claims involving real property, provide the specific location of the incident including street addresses and related details.
16. Describe the damage or injury you believe resulted from the incident.
17. Explain the circumstances that led to the damage or injury with all relevant facts.
18. Explain why you believe the state agency is responsible for the damage or injury.
19. If the claim involves a state vehicle, provide the vehicle license number and other relevant details.
20. Indicate whether you have filed a claim with your insurance carrier and provide their contact information if applicable.
21. Sign the form to confirm the accuracy of the provided information and attach the $25 filing fee.
22. Submit the completed form along with all necessary attachments and payment to the designated address.

Begin your online submission of the Dgs Government Claims Program form today.