OMB control number
Death Gratuity
OMB 1215-0206 ยท DOL/ESA.
OMB 1215-0206
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form ca-42 Official Notice of Employees' Death for Purposes of FECA Section 8102a Death Gratuity | Form and Instruction |
| Form ca-41 Claim for Survivor Benefits under FECA Section 8102a Death Gratuity | Form and Instruction |
| Form ca-40 Designation of a Recipient of a FECA Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a) | Form and Instruction |
| DEPARTMENT OF LABOR 1215-AB66 Emergency Submission.doc | Supplementary Document |
| dol-govt-1.doc | Supplementary Document |
 2009 opm salary table (4).pdf | Supplementary Document |
| 2009 databases tables and calculators by subject 8-10-09.pdf | Supplementary Document |
| Death Gratuity Forms Supporting Statement 8-27-2009.doc | Supporting Statement A |
 Death Gratuity Official Notice of Employees' Death |
Form and Instruction |
| Death Gratuity Claim for Survivor Benefits |
Form and Instruction |
| Death Gratuity Beneficiary Designation |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 200908-1215-001 | New collection (Request for a new OMB Control Number) | 2009-08-28 | Approved with change |