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DOL Form CA-40

View OWCP's Form CA-40 Online 

Agency:	OWCP
Title:	Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a)
Form Description:	Form CA-40 is used to designate a recipient of the Federal Employees' Compensation Act Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a).
OMB Control Number:	1240-0017

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