Form CA-41 Claim for Survivor Benefits Under the Federal Employees' Compensation Act Section 8102a Death Gratuity

Form CA-41 Claim for Survivor Benefits Under the Federal Employees' Compensation Act Section 8102a Death Gratuity

What Is Form CA-41?

This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on May 1, 2016 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form CA-41?
A: Form CA-41 is a claim form for survivor benefits under the Federal Employees' Compensation Act (FECA) Section 8102a Death Gratuity.

Q: Who is eligible to claim survivor benefits under FECA?
A: Survivors of federal employees who died due to work-related injuries or illnesses may be eligible to claim survivor benefits under FECA.

Q: What is the purpose of Form CA-41?
A: The purpose of Form CA-41 is to apply for the death gratuity benefit available to survivors under FECA.

Q: What information is required on Form CA-41?
A: Form CA-41 requires information about the deceased federal employee, the survivor claiming the benefits, and supporting documentation.

Q: How do I submit Form CA-41?
A: Form CA-41 should be submitted to the OWCP along with any required supporting documentation.

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Form Details:

  • Released on May 1, 2016;
  • The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CA-41 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.

Download Form CA-41 Claim for Survivor Benefits Under the Federal Employees' Compensation Act Section 8102a Death Gratuity

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  • Form CA-41 Claim for Survivor Benefits Under the Federal Employees Compensation Act Section 8102a Death Gratuity, Page 2
  • Form CA-41 Claim for Survivor Benefits Under the Federal Employees Compensation Act Section 8102a Death Gratuity, Page 3
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