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Get Form Ca 5b
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How to fill out the Form Ca 5b online
Filling out Form Ca 5b is an essential step for eligible dependents seeking compensation due to the death of a federal employee. This guide will provide clear, step-by-step instructions to help you complete this form online, ensuring that you provide all necessary information accurately and completely.
Follow the steps to successfully complete the form online.
- Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Provide the name of the deceased employee (last, first, middle) in the first field.
- Enter the date of birth of the deceased employee in the specified format (month, day, year).
- Input the date of death of the deceased employee in the required format (month, day, year).
- Include the social security number of the deceased employee.
- State the nature of the injury that caused the death in the appropriate section.
- Provide the name and address of the employing agency, including the ZIP code.
- Enter the dependent’s name (last, first, middle) in the designated field.
- Fill in the dependent’s date of birth (month, day, year).
- Input the dependent’s address, ensuring you include the ZIP code.
- Include the dependent’s social security number.
- State the dependent's occupation in the corresponding field.
- Specify the date of injury related to the employee’s death (month, day, year).
- Indicate the extent of dependency on the deceased employee.
- If the employee lived with the dependent during the 12 months before death, select 'Yes' and complete the additional fields regarding financial support.
- Provide total amounts that the employee contributed to the dependent’s support during the 12 months before their death.
- List all property owned by the dependent and their partner, excluding personal items.
- If applicable, supply details regarding any claims made for benefits due to the employee’s death.
- Complete the attending physician's report section, ensuring accuracy and thoroughness.
- Review all entered information for accuracy, make any necessary corrections, and finalize the form.
- Save changes to the form, then choose to download, print, or share the completed Form Ca 5b.
Begin filling out Form Ca 5b online today to ensure timely compensation for eligible dependents.
The CA-1 form is used to report traumatic injuries, while the CA-2 form serves for occupational diseases. Both forms contribute to establishing a claim for compensation, based on the type of injury reported. You can find both forms on uslegalforms, along with the Form Ca 5b, to aid in your claims process.
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