Death Gratuity Claim for Survivor Benefits

Death Gratuity

OMB: 1240-0017

IC ID: 190296

Information Collection (IC) Details

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Death Gratuity Claim for Survivor Benefits
 
No Unchanged
 
Required to Obtain or Retain Benefits
 
20 CFR 10

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction ca-41 Claim for Survivor Benefits under FECA Section 8102a Death Gratuity CA-41-new-pending.pdf http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm Yes No Fillable Printable

Workforce Management Worker Safety

dol/govt-1  67 FR 16826

25 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 25 0 0 0 0 25
Annual IC Time Burden (Hours) 6 0 0 0 0 6
Annual IC Cost Burden (Dollars) 12 0 0 0 0 12

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