Document Name Document Type
Form 1 Benefits Package and Supporting Documentation Form and Instruction
1 Certification of Status for Death Benefit - Alternative Certification of Status for Death Benefit - Alternative Calculation (Attachment 2).docx Form and Instruction
2 Certification of Status for Death Benefit - Standard Cal Certification of Status for Death Benefit - Standard Calculation (Attachment 1).docx Form and Instruction
3 Compensation Attachment 1 for Estate Compensation Attachment 1 for Estate.docx Form and Instruction
4 Compensation Attachment 1 for Reps Compensation Attachment 1 for Reps.docx Form and Instruction
5 Compensation Attachment 1 Compensation Attachment 1.pdf Form and Instruction
6 Death Benefit Certification of Relationship (Survivor At Death Benefit Certification of Relationship (Survivor Attach 3).docx Form and Instruction
7 Lost Employment Income Certification - Estate (attatchme Lost Employment Income Certification - Estate (attatchment 3).docx Form and Instruction
8 Lost Employment Income Certification (Attach 3) Lost Employment Income Certification (Attach 3).docx Form and Instruction
9 Unreimbursed Medical Expenses Certification - Estate (At Unreimbursed Medical Expenses Certification - Estate (Attachment 2).docx Form and Instruction
10 Unreimbursed Medical Expenses Certification (Attach 2) Unreimbursed Medical Expenses Certification (Attach 2).docx Form and Instruction

            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.