Death Gratuity Beneficiary Designation

Death Gratuity

OMB: 1215-0206

IC ID: 190277

Information Collection (IC) Details

View Information Collection (IC)

Death Gratuity Beneficiary Designation
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction ca-40 Designation of a Recipient of a FECA Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a) CA 40 Death Gratuity Beneficiary Designation -8-25-2009 SDL[1].doc http://www.dol.gov/esa/regs/compliance/owcp/forms.htm Yes No Fillable Printable

Workforce Management Worker Safety

DOL/Govt -1  67 FR 16826

2,600 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,600 2,600 0 0 0 0
Annual IC Time Burden (Hours) 650 650 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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