Death Gratuity Beneficiary Designation

Death Gratuity

OMB: 1240-0017

IC ID: 190277

Information Collection (IC) Details

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Death Gratuity Beneficiary Designation
 
No Modified
 
Voluntary
 
20 CFR 10

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction ca-40 CA-40 Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a CA 40 mjs (2) jv 3-12-12 feewc edits.docx http://www.dol.gov/owcp/dfec/regs/compliance/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 0 0 0 0 2,600
Annual IC Time Burden (Hours) 650 0 0 0 0 650
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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