Death Gratuity

ICR 202304-1240-001

OMB: 1240-0017

Federal Form Document

Forms and Documents

Document Name	Status
Form ca-42 Death Gratuity Official Notice of Employees' Death Form and Instruction	Modified
Form ca-41 Death Gratuity Claim for Survivor Benefits Form and Instruction	Modified
Form ca-40 Death Gratuity Beneficiary Designation Form and Instruction	Modified
1240-0017 Supporting Statement Death Gratuity FINAL.docx Supporting Statement A	2023-05-05
81 Fed. Reg. 47418 (July 21, 2016).pdf Supplementary Document	2023-04-06
Death Gratuity 4.2023.docx Supplementary Document	2023-04-06
20 cfr 10.909 and 10.911 4.2023.docx Supplementary Document	2023-04-06
2022 opm salary table cleveland.pdf Supplementary Document	2023-04-07
BLS Data.pdf Supplementary Document	2023-04-07

IC Document Collections

IC ID	Document Title	Status
190297	Death Gratuity Official Notice of Employees' Death Form and Instruction	Modified
190296	Death Gratuity Claim for Survivor Benefits Form and Instruction	Modified
190277	Death Gratuity Beneficiary Designation Form and Instruction	Modified