; (B) in accordance with section 275C, any other requirements needing to be met to be eligible for compensation under this part; and (C) hear and decide appeals brought pursuant to section 275C(b)(3)(A). 275C. Determination of eligibility for compensation (a) Filing of Claim (1) In general A claimant may file a claim for compensation under this part with the Special Master. The claim shall be on the form developed under paragraph (2) and shall state the factual basis for eligibility for compensation and the amount of compensation sought. (2) Claim form (A) In general The Special Master shall develop a claim form that claimants shall use when submitting claims under paragraph (1). The Special Master shall ensure that such form can be filed electronically, if determined to be practicable. (B) Contents The form developed under subparagraph (A) shall request— (i) information from the claimant concerning the serious injury that the claimant suffered, or in the case of a claim filed with respect to a decedent information confirming the decedent's death, as a result of having COVID–19; (ii) in the case of a claim concerning such serious injury, information concerning any economic and noneconomic losses that the claimant suffered as a result of the serious injury; and (iii) information regarding collateral sources of compensation the claimant has received or is entitled to receive as a result of such injury or death. (3) Limitation No claim may be filed under paragraph (1) after calendar year 2029. (b) Review and determination (1) Review The Special Master shall review a claim submitted under subsection (a) and, with respect to a claimant determined to be an eligible individual, determine— (A) in the case of a claim concerning serious injury, the extent of the economic and noneconomic losses that the claimant suffered as a result of the injury