I. Plaintiff, Defendant, and Attorney

ADD FIRST PLAINTIFF AND PLAINTIFF ATTORNEY

Plaintiff(s)	Defendant(s)
Plaintiff Attorney(s)	Defendant Attorney(s) (if known)

II. Case Information

County Where Claim for Relief Arose:
Check here if you are filing a motion to proceed in forma pauperis.
Does this case challenge the constitutionality of a federal or state statute and neither the U. S., the state, nor their agencies, officers, or employees are parties? (See Fed. R. Civ. P. 5.1)              Yes No NOTE: Do not include cases that only allege that the U. S., this state, or any of their agencies have acted unconstitutionally or petitions or complaints filed by persons confined in federal, state, county or municipal penal institutions, jail or mental institutions.

Basis of Jurisdiction: 1. U.S. Government Plaintiff 2. U.S. Government Defendant 3. Federal Question (U.S. not a party) 4. Diversity of Citizenship

Origin: 1. Original Proceeding 2. Removed From State Court 3. Remanded From Appellate Court 4. Reinstated or Reopened 5. Transferred from another district 6. Multidistrict Litigation County:  Case Number: District: Alabama Middle Alabama Northern Alabama Southern Alaska Arizona Arkansas Eastern Arkansas Western California Central California Eastern California Northern California Southern Colorado Connecticut Delaware District of Columbia Florida Middle Florida Northern Florida Southern Georgia Middle Georgia Northern Georgia Southern Guam Hawaii Idaho Illinois Central Illinois Northern Illinois Southern Indiana Northern Indiana Southern Iowa Northern Iowa Southern Kansas Kentucky Eastern Kentucky Western Louisiana Eastern Louisiana Middle Louisiana Western Maine Maryland Massachusetts Michigan Eastern Michigan Western Minnesota Mississippi Northern Mississippi Southern Missouri Eastern Missouri Western Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York Eastern New York Northern New York Southern New York Western North Carolina Eastern North Carolina Middle North Carolina Western North Dakota Northern Mariana Islands Ohio Northern Ohio Southern Oklahoma Eastern Oklahoma Northern Oklahoma Western Oregon Pennsylvania Eastern Pennsylvania Middle Pennsylvania Western Puerto Rico Rhode Island South Carolina South Dakota Tennessee Eastern Tennessee Middle Tennessee Western Texas Eastern Texas Northern Texas Southern Texas Western Utah Vermont Virgin Islands Virginia Eastern Virginia Western Washington Eastern Washington Western West Virginia Northern West Virginia Southern Wisconsin Eastern Wisconsin Western Wyoming  Case Number:

Class Action:

If an original proceeding, is the case being filed as a Class Action Under FRCP23? If removed from state court, was the case filed as a Class Action under State statute or rule? Not filed as a Class Action

Monetary Demand (in Thousands):
Jury Demand (requested in Complaint):  Yes No

Cause of Action:	(Cite the U.S. Statute under which you are filing and write a brief statement of cause. Do not cite jurisdictional statutes unless diversity.)
Related Cases:	is not a refiling of a previously dismissed action. is related to case number , currently pending before Judge . is a refiling of case number , previously dismissed by Judge .

III. Nature of Suit

Administrative Agency 899 Administrative Procedures Act/Review or Appeal of Agency Decision Agricultural - Title 7 U.S.C. 891 Agricultural Actions (e.g., PACA) 899 Administrative Procedures Act/Review or Appeal of Agency Decision Arbitration - Title 9 U.S.C. 896 Confirm or Modify Arbitration Award Banking and Consumer Credit 140 Negotiable Instruments 371 Truth in Lending Act 430 Banks and Banking 480 Fair Credit Reporting Act or Fair Debt Collection Practices Act Bankruptcy 422 Appeal to District Court 423 Withdrawal of Reference Business and Commercial 160 Shareholder Derivative Actions 410 Antitrust 450 Interstate Commerce (e.g., Carmack Amendment) 850 Securities, Commodities, Exchanges Civil Rights - Non Prisoner 441 Voting Rights 442 Employment 443 Housing and Accommodations 445 Americans With Disabilities Act - Employment 446 Americans with Disabilities Act - All Other 448 Education (e.g., IDEA) 440 All Other Civil Rights

Contracts 110 Insurance Contracts 120 Marine Contracts 130 Miller Act 195 Warranties 196 Franchise Agreements 190 All Other Contract Actions Environmental 893 Environmental Matters 899 Administrative Procedures Act/Review or Appeal of Agency Decision Forfeiture and Penalty 625 Drug-Related Seizure of Property (21 U.S.C. 881) 690 All Other Forfeiture and Penalty Actions Fraud and False Claims 370 Fraud Actions 375 False Claims Act (31 U.S.C. 3729) Freedom of Information Act 895 Freedom of Information Act Immigration 462 Naturalization Applications 463 Habeas Corpus - Alien Detainee 465 Other Immigration Actions Intellectual Property 820 Copyright 830 Patent 840 Trademark Labor 710 Fair Labor Standards Act 720 Labor-Management Relations/Reporting 740 Railway Labor 751 Family and Medical Leave Act 791 ERISA 790 Other Labor Actions

Prisoner Petitions 510 Motion to Vacate Sentence 530 Habeas Corpus 535 Habeas Corpus - Death Penalty 540 Prisoner Petition for Writ of Mandamus 550 Prisoner Civil Rights 555 Prison Conditions 560 Civil Detainee - Conditions of Confinement Real Property 210 Land Condemnation 220 Foreclosure 230 Rent, Lease, and Ejectment 240 Torts to Land/Real Property Damage 245 Real Property Damage Product Liability 290 Other Real Property Actions Recovery of Overpayment and Enforcement of Judgments 150 Other Recovery Actions/Enforcement of Judgements 151 Overpayment of Medicare Benefits 152 Defaulted Student Loans 153 Overpayment of Veterans' Benefits RICO 470 Civil RICO Actions Social Security Appeals 861 Medicare - HIA (1395ff) 862 Black Lung 863 DWIC/DIWW (405(g)) 864 SSID Title XVI 865 RSI (405(g)) FOR SOCIAL SECURITY APPEALS ONLY If this case seeks review of an application that was previously awarded by this court, please enter the case number:

Tax Suits 870 Tax Suits (U.S. a party) 871 Third Party Tax Suits Torts Personal Injury 310 Airplane Personal Injury 320 Assault, Libel, Slander 330 FELA (45 U.S.C. 51) 340 Jones Act/Marine Personal Injury 350 Motor Vehicle Personal Injury 362 Medical Malpractice 360 Other Personal Injury Actions Personal Injury Product Liability 245 Real Property Damage Product Liability 315 Airplane Product Liability 345 Marine Product Liability 355 Motor Vehicle Product Liability 367 Health Care/Pharmaceutical Product Liability 368 Asbestos Product Liability 365 Other Personal Injury Product Liability Property Damage 240 Torts to Land/Real Property Damage 245 Real Property Damage Product Liability 380 Personal Property Damage 385 Personal Property Damage Product Liability Other Statutes 400 State Reapportionment 490 Illegally Accessing Satellite/Cable TV Signals 950 Constitutionality of State Statutes 890 Other Statutory Actions

IV. Signature

Signature of Attorney of Record:         Date:  

NOTE: After completing the information above, click the "Generate Civil Cover Sheet (JS-44)" button. The generated civil cover sheet will appear in a new window. Please save (or print) the completed form in PDF format and use it to submit your civil cover sheet.

V. Local Court Modifications

This tab is intended to provide a location for courts to modify the standard form to add information not currently collected on the civil cover sheet. If no such modifications are necessary this tab can be deleted from the form.