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DOL Home > Find It! By Form > DOL Form |
DOL Form CA-5
Agency: | OWCP-DFEC |
Title: | DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children |
Form Description: | DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children: A deceased federal employee's widow, widower, and/or children may use this form to claim work-related death benefits. |
OMB Control Number: | 1240-0013 |