Death Gratuity Claim for Survivor Benefits

Death Gratuity

OMB: 1240-0017

IC ID: 190296

Documents and Forms

Document Name Document Type
Form ca-41 Death Gratuity Claim for Survivor Benefits Form and Instruction
ca-41 Claim for Survivor Benefits under FECA Section 8102a Death Gratuity CA-41.pdf www.dol.gov/owcp/dfec/regs/compliance/forms.htm Form and Instruction