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  
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