Notice of Law Enforcement Officer's Injury or Occupational Disease and Notice of Law Enforcement Officer's Death

OMB 1240-0022

OMB 1240-0022

The CA-721 and CA-722 are used for filing claims for compensation for injury and death to non-Federal law enforcement officers under the provisions of 5 USC 8191 et seq. The forms provide the basic information needed to process the claims made for injury or death. The program requests clearance by the expiration date of March 31, 2020.

The latest form for Notice of Law Enforcement Officer's Injury or Occupational Disease and Notice of Law Enforcement Officer's Death expires 2023-10-31 and can be found here.


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