Get Omb No 1240 0013 Form

Filling out the Omb No 1240 0013 Form online can be a straightforward process if you follow the appropriate steps. This guide aims to provide clear and concise instructions tailored to assist users in successfully completing the claim for compensation by widow, widower, and/or children.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the deceased employee in the designated field, ensuring you use their last name first, followed by their first and middle names.
3. Input the date of birth of the deceased employee, using the format of month, day, and year.
4. Record the date of injury that caused the death of the employee.
5. Fill in the date of death using the specified format.
6. Provide the nature of the injury which resulted in the death.
7. Complete the section detailing the name and address of the employing agency, including the ZIP code.
8. If applicable, complete the claim section for the surviving spouse by filling out their name, address, date of birth, and answering questions regarding previous marriages and cohabitation status at the time of death.
9. List all children from both the current and previous marriages who may be entitled to compensation, including their names, relationships, dates of birth, and addresses.
10. If a guardian has been appointed for any child, provide their name and address in the relevant section.
11. Submit any claims made for federal retirement or disability benefits related to the employee's death.
12. Fill out the burial expenses and details of any payments made by other parties towards these expenses.
13. Certify the truthfulness of your statements by signing the document, entering your address and the date.
14. Review all provided information, ensuring accuracy, before finalizing.

Complete your documents online today for a smoother claim process.