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CLASS ACTION SETTLEMENT CLAIM FORM

Segar v. Bondi, Case No. 77-cv-0081-EGS

INSTRUCTIONS

If you are a class member and you submit a claim form postmarked or submitted online on or before June 23, 2025, you are entitled to receive at least $5,000 from the settlement fund.  To submit a timely claim form, complete the following steps:     

  1. Please fill in all blanks on the claim form.
  2. Type or print all information on the claim form.
  3. You must date and sign the claim form.
  4. If any information on the claim form is incorrect, cross out the incorrect information.  Clearly type or print the correct information above the crossed-out incorrect information.  If the boxes identifying your race, application history, or experience are incorrectly marked, cross out the incorrect mark, and place an “X” in the correct box.
  5. By signing your form, you are declaring under penalty of perjury that the information provided is true and correct.  Please understand that you could be subject to criminal penalties for submitting any false information on your form.
  6. If you have any questions about these instructions or about how to complete the form, call the claims administrator at (844) 783-5505. There is no fee for any service or assistance provided by SSI, the claims administrator. DO NOT CONTACT THE COURT OR THE CLERK OF THE COURT.
  7. Mail your claim form to: Segar v. Bondi Claims Administrator, c/o Settlement Services, an Epiq Company, PO Box 2715, Portland, OR 97208-2715 or submit your claim form online here. YOUR CLAIM FORM MUST BE POSTMARKED OR SUBMITTED ONLINE ON OR BEFORE June 23, 2025. LATE CLAIM FORMS WILL NOT BE CONSIDERED.
  8. If your address changes at any time before you have received a monetary payment, mail your new address to the Claims Administrator at the address above.  Any change of address must be submitted in writing and include your signature.
  9. You do not need to have your own attorney help you submit a claim form or otherwise participate in this settlement.  However, if you do wish to consult your own attorney, you may do so at your own expense.
  10. Please keep a copy of the form when it is completed for your records.
  11. You also have the option of submitting a completed questionnaire.  The questionnaire may be submitted by mail to: Segar v Bondi Claims Administrator, c/o Settlement Services, an Epiq Company, PO Box 2715, Portland, OR 97208-2715, or it may be submitted online at: here.  Submitting a questionnaire is OPTIONAL.  All claimants must submit a claim form, but all claimants are not required to submit a completed questionnaire to receive a monetary award. The questionnaire will be considered in determining monetary awards.
  12. YOUR QUESTIONNAIRE MUST BE POSTMARKED OR SUBMITTED ELECTRONICALLY ON OR BEFORE June 23, 2025. LATE QUESTIONNAIRES WILL NOT BE CONSIDERED.

In addition to the option of completing the questionnaire, you also have the option of sitting for an interview with the person who will be deciding each claimant’s monetary award (Michael Lewis).  Having an interview with Mr. Lewis is OPTIONAL.  All claimants must submit a claim form, but all claimants are not required to be interviewed to receive a monetary award.  The interview will be considered in determining monetary awards.

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Street Address*
Race (check one)*
Are you a current or former DEA Special Agent who applied for one or more GS-14 or GS-15 level positions at DEA at any time between January 21, 1993, and May 2, 2022?*
Did you make the Best Qualified List for at least one such position?*
Were you selected for every GS-14 or GS-15 level position to which you applied and made the Best Qualified List for between January 21, 1993, and May 2, 2022?*
Consent*
MM slash DD slash YYYY

THIS CLAIM FORM MUST BE POSTMARKED OR SUBMITTED ONLINE ON OR BEFORE JUNE 23, 2025 LATE CLAIM FORMS WILL NOT BE CONSIDERED

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