Form 2 Cover Sheet {2}

FORM 2 COVER SHEET In The United States Court of Federal Claims Cover Sheet Plaintiff(s) or Petitioner(s) _______________________________________________________________________________________ _______________________________________________________________________________________ If this is a multi-plaintiff case, pursuant to RCFC 20(a), please attach an alphabetized, numbered list of all plaintiffs. Name of the attorney of record (See RCFC 83.1(c)): ______________________________________ Firm Name: Post Office Box: Street Address: City-State-Zip: Telephone & Facsimile Numbers: E-mail Address: ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ 9 Yes 9 Yes 9 No 9 No Is the attorney of record admitted to the Court of Federal Claims Bar? Does the attorney of record have a Court of Federal Claims ECF account? If not admitted to the court or enrolled in the court's ECF system, please call (202) 357-6402 for admission papers and/or enrollment instructions. Nature of Suit Code: 999 999 $____________________________________ Select only one (three digit) nature-of-suit code from the attached sheet. If number 213 is used, please identify partnership or partnership group. If numbers 118, 134, 226, 312, 356, or 528 are used, please explain. __________________________________________________________________________________ Agency Identification Code: See attached sheet for three-digit codes. Amount Claimed: Use estimate if specific amount is not pleaded. Disclosure Statement: Is a RCFC 7.1 Disclosure Statement required? If yes, please note that two copies are necessary. 9 Yes 9 No Bid Protest: Indicate approximate dollar amount of procurement at issue: $_____________________________ Is plaintiff a small business? 9 Yes 9 No Vaccine Case: Date of Vaccination: _______________________ Related Cases: Is this case directly related to any pending or previous case? 9 Yes 9 No If yes, you are required to file a separate notice of directly related case(s). See RCFC 40.2. American LegalNet, Inc. www.FormsWorkFlow.com Nature-of-Suit Codes for General Jurisdiction Cases 100 102 104 106 108 110 112 114 116 118 120 122 124 126 128 130 132 134 Contract - Construction - (CDA) Contract - Fail to Award - (CDA) Contract - Lease - (CDA) Contract - Maintenance - (CDA) Contract - Renovation - (CDA) Contract - Repair - (CDA) Contract - Sale - (CDA) Contract - Service - (CDA) Contract - Supply - (CDA) Contract - Other - (CDA) Contract - Bailment Contract - Bid Preparation Costs Contract - Medicare Act Contract - Realty Sale Contract - Subsidy Contract - Surety Contract - Timber Sale Contract - Other 210 212 213 214 216 218 220 222 224 226 300 302 303 304 306 308 310 312 340 342 344 346 348 350 Tax - Income, Corporate Tax - Income, Individual Tax - Income, Individual (Partnership) Tax - Informer's Fees Tax - Preparer's Penalty Tax - Railroad Retirement/Unemployment Tax Act Tax - TEFRA Partnership - 28:1508 Tax - Windfall Profit Overpayment - Interest Tax - 100% Penalty - 26:6672 Withholding Tax - Other 352 Military Pay - Retirement 354 Military Pay - SBP 356 Military Pay - Other Carrier - transportation Copyright Native American Oil Spill Clean Up Patent Taking - Personalty Taking - FIRREA Taking - Realty Taking - Rails to Trails Taking - Other Unjust Conviction and Imprisonment Miscellaneous - Damages Miscellaneous - Lease Miscellaneous - Mineral Leasing Act Miscellaneous - Oyster Growers Damages Miscellaneous - Safety Off. Ben. Act Miscellaneous - Royalty/Penalty Gas Production Miscellaneous - Other TRIS CLA Review - Japanese Internment Indian Claims Commission Informer's Reward Spent Nuclear Fuel 136 Contract - Other - Wunderlich 138 Contract - Injunctions (Pre Award) 140 Contract - Injunction (Post Award) 200 202 204 206 208 Tax - Allowance of Interest Tax - Declaratory Judgment - 28:1507 Tax - Estate Tax - Excise Tax - Gift 500 502 504 506 508 510 511 512 513 514 515 Civilian Pay - Back Pay 516 Civilian Pay - COLA 518 Civilian Pay - Disability Annuity 520 Civilian Pay - FLSA Civilian Pay - Overtime Compensation 522 Civilian Pay - Relocation Expenses 524 Civilian Pay - Suggestion Award 526 Civilian Pay - Other Military Pay - Back Pay Military Pay - CHAMPUS Military Pay - Correct records Military Pay - Correct/Reinstate Military Pay - Reinstatement Military Pay - Relocation Expenses 528 529 532 534 535 536 Nature-of-Suit Codes for Vaccine Cases 449 453 456 457 458 459 460 461 462 463 464 465 466 467 468 469 484 Injury - Hepatitis A Injury - Pneumococcal Conjugate Injury - DPT & Polio Injury - D/T Injury - DTP/DPT Injury - Measles Injury - M/M/R Injury - Measles/Rubella Injury - Mumps Injury - Pertussis Injury - Polio - inactive Injury - Polio - other Injury - Rubella Injury - Tetanus & Diphtheria Injury - Tetanus & Tox. Injury - Other Injury - Hepatitis B 485 486 490 492 494 496 498 452 454 470 471 472 473 474 475 476 Injury - Hemophilus Influenzae Type B Injury - Varicella Injury - Rotavirus Injury - Thimerosal Injury - Seasonal Influenza Injury - Meningococcal Injury - Human Papillomavirus Death - Hepatitis A Death - Pneumococcal Conjugate Death - DPT & Polio Death - D/T Death - DTP/DPT Death - Measles Death - M/M/R Death - Measles/Rubella Death - Mumps 477 478 479 480 481 482 483 487 488 489 491 493 495 497 499 Death - Pertussis Death - Polio - inactive Death - Polio - other Death - Rubella Death - Tetanus & Diphtheria Death - Tetanus & Tox. Death - Other Death - Hepatitus B Death - Hemophilus Influenzae Type B Death - Varicella Death - Rotavirus Death - Thimerosal Death - Seasonal Influenza Death - Meningococcal Death - Human Papillomavirus American LegalNet, Inc. www.FormsWorkFlow.com AGENCY CODES AGR AF Agriculture Air Force SBA TRN TRE VA VAR O Small Business Administration Department of Transportation Department of Treasury Department of Veterans Affairs Various Agencies Other ARM Army AEC Atomic Energy Commission COM Department of Commerce DOD DOE ED EPA GPO GSA HHS HLS HUD DOI ICC DOJ LAB MC NAS NAV NRC PS STA Department of Defense Department of Energy Department of Education Environmental Protection Agency Government Printing Office General Services Administration Health and Human Services Homeland Security Housing and Urban Development Department of the Interior Interstate Commerce Commission Department of Justice Dep