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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Death Gratuity Beneficiary Designation
Modified
250
63
0
Form and Instruction
ca-40
CA-40 Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a
Death Gratuity Official Notice of Employees' Death
Modified
11
4
0
Form and Instruction
ca-42
Official Notice of Employees' Death for Purposes of FECA Section 8102a Death Gratuity
Death Gratuity Claim for Survivor Benefits
Modified
11
3
5
Form and Instruction
ca-41
Claim for Survivor Benefits under FECA Section 8102a Death Gratuity
Total burden requested under this ICR:
272
70
5
To view an IC, click on IC Title