Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity

Form ID:

OWCP CA-41

Control ID:

OMB No. 1240-0017

Expiration date:

Tue, 30 Jun 2026 - 23:59

Forms

OWCP CA-41: Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity