Death Gratuity

ICR 201301-1240-002

OMB: 1240-0017

Federal Form Document

ICR Details
1240-0017 201301-1240-002
Historical Active 201204-1240-001
DOL/OWCP
Death Gratuity
Revision of a currently approved collection   No
Regular
Approved without change 08/19/2013
Retrieve Notice of Action (NOA) 06/18/2013
  Inventory as of this Action Requested Previously Approved
08/31/2016 36 Months From Approved 08/31/2013
272 0 2,635
70 0 659
5 0 12

The National Defense Authorization Act for Fiscal Year 2008, Public Law 110-181, was enacted on January 28, 2008. Section 1105 of P.L. 110-181 amended the Federal Employees' Compensation Act (FECA) creating a new section, 5 U.S.C. § 8102a effective upon enactment. This section establishes a FECA death gratuity benefit of up to $100,000 for eligible beneficiaries of federal employees and Non-Appropriated Fund Instrumentality (NAFI) employees who die from injuries incurred in connection with service with an Armed Force in a contingency operation. 5 U.S.C.§ 8102a also permits agencies to authorize retroactive payment of the death gratuity for employees who died on or after October 7, 2001 in service with an Armed Force in the theater of operations of Operation Enduring Freedom and Operation Iraqi Freedom. 5 U.S.C. § 8102a also allows federal employees to vary the order of precedence of beneficiaries or to name alternate beneficiaries Form CA-40 is an optional form that requests the information necessary from the employee to accomplish this variance and to name alternate beneficiaries only if the employee wishes to do so. Form CA-41 provides the means for those named beneficiaries and possible recipients to file claims for those benefits and requests information from such claimants so that OWCP may determine their eligibility for payment. Further, the statute and regulations require agencies to notify OWCP immediately upon the death of a covered employee. CA-42 provides the means to accomplish this notification and requests information necessary to administer any claim for benefits resulting from such a death.

US Code: 5 USC 8102a Name of Law: Amendment to the FECA, Death Gratuity
   PL: Pub.L. 110 - 181 1105 Name of Law: National Defense Authorization Act for Fiscal Year 2008
   PL: Pub.L. 112 - 81 1121 Name of Law: National Defense Authorization Act for Fiscal Year 2012
  
None

Not associated with rulemaking

  78 FR 11683 02/19/2013
78 FR 36596 06/18/2013
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 272 2,635 0 0 -2,363 0
Annual Time Burden (Hours) 70 659 0 0 -589 0
Annual Cost Burden (Dollars) 5 12 0 0 -7 0
No
No
The number of claims received for death gratuity varies from year to year. For example, only 2 death gratuity claims were received in 2012. We have noted that the number submitted tends to reflect the intensity level of conflicts involving contingency operations – this has so far been operations related to Iraq and Afghanistan. As these operations wind down, the number of claims may decrease. Furthermore, as the CA-40 is an optional form, used only when an employee wishes to vary the order or preference or designate an alternate beneficiary for payment, not all employees choose to fill out this form prior to deployment or may choose to rely on a designation from an earlier deployment, so the number of people filling out this form varies greatly year to year. Therefore, the previous approved number of annual respondents 2635 is now 272, which represents a decrease in 2363 respondents. The previously approved number for burden hours was 659; the requested number now is 70, a decrease of 589. Likewise, the costs burden for maintenance and reporting costs (postage and envelope) decreased from $12.00 to $5.00, a difference of $7.00. In reference to revisions to the forms themselves, one line was added in the instructions to the CA-40 and CA-41 to clarify the usage of forms CA-40 and CA-41. Also, a minor change in the instructions for the CA-42 was made to correct a reference to a page number. Finally, an accommodation statement was placed after the Public Burden Statements in forms CA-41 and CA-42 to inform claimants who have mental or physical limitations to contact DFEC for if further assistance is needed in the claims process. This statement was previously added to the CA-40 when it was revised last year.

$602
No
No
No
No
No
Uncollected
Marcus Sharpless 202 693-0998 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/18/2013


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