ja_mageia

Good Morning America

ABC's Good Morning America interviews the Poling family and their attorney Cliff Shoemaker regarding the government's recent concession in the National Vaccine Injury Compensation Program.

Click here to watch the video.

  • Narrow screen resolution
  • Wide screen resolution
  • Decrease font size
  • Default font size
  • Increase font size
Home News Filing a Pro Se Short Form Autism Petition
Filing a Pro Se Short Form Autism Petition PDF Print E-mail

If you have a child with autism and you feel that the autism was caused by vaccinations that the child received, you may be able to file a Short Form Petition with the National Vaccine Injury Compensation Program.  (Click here to see Opinion of the Chief Special Master concerning this procedure.)

While we recommend that you find an attorney to represent you, if you cannot find an attorney, you can file the Petition yourself by following these instructions. 

There are three forms to download.  They are as follows:

  1. Cover letter for sending pleadings to the Court and copy to HHS;
  2. Cover sheet;
  3. Short form autism petition

The cover letter is a sample cover letter (feel free to adapt your own) that can be used to send the original and two copies of the pleadings to the Clerk's office, and a copy should be sent to HHS by certified mail, return receipt requested.  Be sure to enclose a check for $250 made payable to Clerk, U.S. Court of Federal Claims.

The cover sheet should be filled out as follows: 

On the first two lines, where it asks to the Petitioner(s), simply put,

"Child's Name, by Parents' Name(s), as parent(s) and natural guardians,"

Where it asks for the name of the attorney, put your name, followed by the words "Pro Se".  Then put in your address and other contact information.

For the "nature of suit code", if you are alleging injury from thimerosal, the code is 492.  For injury from MMR, the code is 460.  For other codes, click here.

The short form autism petition needs to be filled out as well.  The fields are pretty much self-explanatory.

Since you want a copy sent back to you, prepare the cover letter to go in an envelope to the Clerk.  Put one cover sheet in the envelope.  Put the original and 3 copies of the short form autism petition in the envelope.  Put a stamped self-addressed envelope in so that they will send you a time stamped copy.  Be sure to enclose a check for the filing fee.

Send a copy of the cover letter, a copy of the cover sheet, and a copy of the short form autism petition to the address at the bottom of the cover letter.  Send this service copy by certified mail, return receipt requested, so that you will get a signed green card back showing that it was received.