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This version of the form is not currently in use and is provided for reference only. Download this version of
Form CA-5
for the current year.
Form CA-5 Claim for Compensation by Surviving Spouse and / or Children
What Is Form CA-5?
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-5?
A: Form CA-5 is a claim for compensation by surviving spouse and/or children.
Q: Who can file Form CA-5?
A: The surviving spouse and/or children of a deceased employee can file Form CA-5.
Q: What is the purpose of Form CA-5?
A: Form CA-5 is used to claim compensation benefits as a surviving spouse and/or children.
Q: How do I fill out Form CA-5?
A: You need to provide personal information, details of the deceased employee, and any other relevant information regarding the claim.
Q: Is there a deadline for filing Form CA-5?
A: Yes, there is a deadline for filing Form CA-5. It is important to file the claim within the specified time frame.
Q: What documents do I need to attach to Form CA-5?
A: You may need to attach documents such as proof of relationship, death certificate of the employee, and any other supporting documents.
Q: How long does it take to process a Form CA-5 claim?
A: The processing time for Form CA-5 claims can vary, but it typically takes several weeks to months.
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-5 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-5 Claim for Compensation by Surviving Spouse and / or Children
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