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ATTACHMENT 4: SAMPLE “ELECTION TO ACCEPT JUDGMENT”
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
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_____________________________________ *
_____________________________________, *
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Petitioner[s],
*
*
v.
*
No. ___ - _____V
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Special Master [name of master]
SECRETARY OF HEALTH AND
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HUMAN SERVICES,
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Respondent.
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*
* * * * * * * * * * * * * * * * * * * * * * * * * *
ELECTION TO ACCEPT JUDGMENT
Petitioner[s], through [his/her/their] counsel of record, hereby elect[s], pursuant to 42
U.S.C. § 300aa-21(a), to accept the Judgment entered on [date] in the above-captioned
case.
[Name of Counsel]
Counsel of Record for Petitioner[s]
[Address]
Date:
[PLEASE NOTE: A certificate of service on opposing counsel is required to be stapled to the
end of all filings; an original plus one copy of the Election is required for filing.]