Vaccine E-Notification Consent Form

• Legal Form Number: 15B
• Court: U.S. Claims Court
• Section: Court of Federal Claims

FORM 15B

VACCINE E-NOTIFICATION CONSENT FORM

237

In the United States Court of Federal Claims

OFFICE OF SPECIAL MASTERS

_______________________________,

Petitioner,

v.

SECRETARY OF HEALTH AND

HUMAN SERVICES,

Respondent.

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No. __________________

E-NOTIFICATION CONSENT FORM

The undersigned pro se petitioner in the above-identified case:

Consents to receiving notice by e-mail via the court’s electronic filing system of all

electronic filings in the above-identified case.

Consents to service by e-mail, pursuant to Rule 5(b) of the Rules of the United States

Court of Federal Claims.

Waives service and notice by first class mail of all electronic filings in the above-

identified case, including orders and judgments.

Is responsible for immediately notifying the court in writing of any change of e-mail

address.

The Clerk of Court is authorized to add petitioner’s e-mail address identified below to the court’s

electronic filing system. Petitioner will

submit all case filings via e-mail to

ProSe_case_filings@cfc.uscourts.gov, through the U.S. Mail, or by deposit in the court’s night box located

at the garage entrance on H Street NW, between 15th Street and Madison Place.

________________________________________

(Signature of Petitioner)

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(E-mail Address)

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(Date)