Professional Liability Insurance Reimbursement

A claimant from the Department of State can find the SF-1164 on the Forms site on the agency's intranet:

DOMESTIC EMPLOYEES

  • Complete SF-1164.
  • Add the following statement on the form: "This claim is submitted in accordance with P.L. 104-208 as amended in the Appropriations Act, 2000, September 29, 1999."
  • Attach receipt of paid insurance premium to the SF-1164.
  • Submit form to employing Bureau's Executive Director for approval and reimbursement.

ABROAD

  • Complete SF-1164.
  • Add the following statement on the form: "This claim is submitted in accordance with P.L. 104-208 as amended in the Appropriations Act, 2000, September 29, 1999."
  • Attach receipt of paid insurance premium to the SF-1164.
  • Submit form to post's Management Officer for approval and reimbursement.