Death Gratuity Official Notice of Employees' Death

Death Gratuity

OMB: 1240-0017

IC ID: 190297

Information Collection (IC) Details

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Death Gratuity Official Notice of Employees' Death
 
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-42 Official Notice of Employees' Death for Purposes of FECA Section 8102a Death Gratuity CA-42-1240 revision.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

10 0
   
Federal Government
 
   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 10 0 0 0 0 10
Annual IC Time Burden (Hours) 3 0 0 0 0 3
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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