DISC-010 - Case Questionnaire—For Limited Civil Cases (Under $35,000)

Summary

Case Questionnaire—For Limited Civil Cases (Under $35,000)

Text

Form ID: DISC-010
Title: Case Questionnaire—For Limited Civil Cases (Under $35,000)
Effective Date: 2024-01-01
Mandatory Form: yes
Info Page: https://selfhelp.courts.ca.gov/jcc-form/DISC-010
Primary Download URL: https://www.courts.ca.gov/documents/disc010.pdf
Form Detail Page:
Case Questionnaire—For Limited Civil Cases (Under $35,000)
(DISC-010)
Tell the other side to answer questions if those questions are first answered by a plaintiff or cross-complainant in a limited civil (under $35,000) case and served with a complaint or cross-complaint.
Get form DISC-010
Effective: January 1, 2024
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How-to instructions for Discovery and Subpoenas
PDF Text:
Form Adopted for Mandatory Use  
Judicial Council of California  
DISC-010 [Rev. January 1, 2024]
CASE QUESTIONNAIRE—FOR LIMITED CIVIL CASES  
(Under $35,000)
Code of Civil Procedure, § 93 
www.courts.ca.gov 
DISC-010DO NOT FILE WITH THE COURT
THIS IS NOT AN ANSWER OR RESPONSE TO THE COMPLAINT
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
CASE NUMBER:Plaintiff (name):
Defendant (name):
CASE QUESTIONNAIRE—FOR LIMITED CIVIL CASES 
(Under $35,000)
Requesting Party (name):
Requesting Party (name):
—INSTRUCTIONS—
A. The purpose of the case questionnaire is to help the parties settle their differences without spending a lot 
of money. This is accomplished by exchanging information about the case early in the lawsuit. The  
exchange of case questionnaires may be started only by a plaintiff (or cross-complainant) in a limited civil
case. The case questionnaire is optional, and if plaintiff (or cross-complainant) exercises the option, only  
this form may be used.
B. Instructions for plaintiffs (and cross-complainants)
1.   Under Code of Civil Procedure section 93, a plaintiff (or cross-complainant) may serve a completed
case questionnaire and a blank questionnaire with a complaint (or cross-complaint).
2. This is the only way you can require defendants (or cross-defendants) to serve you with a completed  
case questionnaire.
C. Instructions for defendants (and cross-defendants)
1.   If you have been served with a completed case questionnaire by a plaintiff (or cross-complainant),  
then you must fill in the blank case questionnaire. Your completed case questionnaire must be served   
on that same plaintiff (or cross-complainant) with your answer to the complaint (or cross-complaint).
2.   THIS IS NOT AN ANSWER OR RESPONSE TO THE COMPLAINT.
D. Instructions for all parties
1.   ALL QUESTIONS REFER TO THE INCIDENT OR AGREEMENT IN THIS LAWSUIT ONLY. 
2. Answer each question. If a question is not applicable, answer “NA.”
3. Your answers are not limited to your personal knowledge, but you are required to furnish information  
available to you or to anyone acting on your behalf, whether you are a plaintiff, defendant,  
cross-complainant, or cross-defendant.
4. Type or legibly print your answer below each question. If you cannot completely answer a question in 
the space provided on the case questionnaire, check the “attachment” box and put the number of the 
question and the complete answer on an attached sheet of paper or form MC-025. You should not put 
part of an answer on the case questionnaire and part on the attachment. You may put more than one 
answer on each attached page.
5. When you have completed the case questionnaire, sign the verification and serve the original.
6. You may compel compliance with these requirements under Code of Civil Procedure section 93. 
7.   DO NOT FILE THIS CASE QUESTIONNAIRE WITH THE COURT.
Page 1 of 4

DISC-010 [Rev. January 1, 2024] CASE QUESTIONNAIRE—FOR LIMITED CIVIL CASES 
(Under $35,000)
DISC-010DO NOT FILE WITH THE COURT
Plaintiff (name):
Defendant (name):
CASE NUMBER:
—QUESTIONS—
a. State your name and street address.
1. FOR ALL CASES
b. State your current business name and street address, the type of business entity, and your title.
c. Describe in detail your claims or defenses and the facts on which they are based, giving relevant dates.
See attachment for answer number 1c.
d. State the name, street address, and telephone number of each person who has knowledge of facts relating to this lawsuit, and 
specify his or her area of knowledge.
See attachment for answer number 1d.
e. Describe each document or photograph that relates to the issues or facts. You are encouraged to attach a copy of each. For 
each that you have described but not attached, state the name, street address, and telephone number of each person who  
has it.
See attachment for answer number 1e.
Page 2 of 4

DISC-010 [Rev. January 1, 2024] CASE QUESTIONNAIRE—FOR LIMITED CIVIL CASES 
(Under $35,000)
DISC-010DO NOT FILE WITH THE COURT
Plaintiff (name):
Defendant (name):
CASE NUMBER:
1. f. Describe each item of physical evidence that relates to the issues and facts; give its location; and state the name, street 
address, and telephone number of each person who has it.
See attachment for answer number 1f.
g. State the name and street address of each insurance company and the number of each policy that may cover you in whole or 
part for the damages claimed.
See attachment for answer number 1g.
2. FOR PERSONAL INJURY OR PROPERTY DAMAGE CASES 
a. Describe each injury or illness that you received and your present complaints about each.
See attachment for answer number 2a.
b. State the name, street address, and telephone number of each physician, dentist, or other health care provider who treated or  
examined you; the type of treatment; the dates of treatment; and the charges by each to date.
See attachment for answer number 2b.
c. Itemize the medical expenses you anticipate in the future.
See attachment for answer number 2c.
d. Itemize your loss of income to date, give the name and street address of each source, and show how the loss is computed.
See attachment for answer number 2d.
Page 3 of 4

DISC-010 [Rev. January 1, 2024] CASE QUESTIONNAIRE—FOR LIMITED CIVIL CASES 
(Under $35,000)
DISC-010DO NOT FILE WITH THE COURT
Plaintiff (name):
Defendant (name):
CASE NUMBER:
2. e. Itemize the loss of income you anticipate in the future, give the name and street address of each source, and show how the loss 
is computed.
See attachment for answer number 2e.
f. Itemize your property damage, and state the amount or attach an itemized bill or estimate.
See attachment for answer number 2f.
g.  Describe each other item of damage or cost that you claim, and state the amount.
See attachment for answer number 2g.
3. FOR CASES BASED ON AGREEMENTS
a. In addition to your answer to 1e, state all the terms and give the date of any part of the agreement that is not in writing.
See attachment for answer number 3a.
b. Describe each item of damage or cost you claim, state the amount, and show how it is computed.
See attachment for answer number 3b.
VERIFICATION
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE)
Page 4 of 4

Retrieval chunks

• #1

  Form ID: DISC-010 Title: Case Questionnaire—For Limited Civil Cases (Under $35,000) Effective Date: 2024-01-01 Mandatory Form: yes Info Page: https://selfhelp.courts.ca.gov/jcc-form/DISC-010 Primary Download URL: https://www.courts.ca.gov/documents/disc010.pdf Form Detail Page: Case Questionnaire—For Limited Ci…

• #2

  1. ALL QUESTIONS REFER TO THE INCIDENT OR AGREEMENT IN THIS LAWSUIT ONLY. 2. Answer each question. If a question is not applicable, answer “NA.” 3. Your answers are not limited to your personal knowledge, but you are required to furnish information available to you or to anyone acting on your behalf, whether you …

• #3

  See attachment for answer number 1f. g. State the name and street address of each insurance company and the number of each policy that may cover you in whole or part for the damages claimed. See attachment for answer number 1g. 2. FOR PERSONAL INJURY OR PROPERTY DAMAGE CASES a. Describe each injury or illness tha…