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: ______________________________________ Is the attorney of record admitted to the Court of Federal Claims Bar? 9 Yes 9 No Does the attorney of record have a Court of Federal Claims ECF account? 9 Yes 9 No If not admitted to the court or enrolled in the court’s ECF system, please call (202) 357-6406 for admission papers and/or enrollment instructions. Nature of Suit Code: 999 Select only one (three digit) nature-of-suit code from the attached sheet. If 213, identify partnership or partnership group. If numbers 118, 134, 226, 312, 356, or 528 are used, please explain. Agency Identification Code: 999 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? 9 Yes 9 No If yes, please note that two copies are necessary. 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.USCourtForms.com