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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.
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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