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Get Dol Ca-40 2016-2025
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How to fill out the DoL CA-40 online
Filling out the DoL CA-40 form accurately is essential for designating recipients of the Federal Employees' Compensation Act death gratuity payment. This guide provides users with a step-by-step approach to help them complete the form online with ease and confidence.
Follow the steps to fill out the DoL CA-40 online effectively.
- Press the ‘Get Form’ button to acquire the form and access it within your selected editor or browser.
- In section A, provide identifying information about the federal employee. This includes their name (last, first, and middle), date of birth, department or agency details (including bureau, division, and phone number), social security number, and location (city, state, and ZIP code).
- Navigate to section B to designate an alternate order of precedence. If there are no surviving spouse or child, fill in the required boxes with the names, addresses, relationships, and shares (%) for each designee. Ensure that each person designated is alive at the time of payment.
- Proceed to section C to designate additional alternate beneficiaries if desired. Here, you can allocate portions of the gratuity in increments of 10%. Fill in the names and addresses of each designee along with the percentage share for each.
- In section D, complete the statement of the federal employee. Acknowledge that the designation is only valid if it is delivered to an official of the employing establishment before the employee's death. Sign and date the form in the provided boxes.
- Finally, section E requires the signature of the employing establishment official who received the form. This official must sign and indicate the date in the designated areas. Ensure all necessary information, including the printed name, title, address, phone, and fax numbers, is also supplied.
- Once all sections are completed, review the form for accuracy. Users can save their changes, download the form, print it, or share it as necessary.
Complete your DoL CA-40 form online today for a smooth process.
You can obtain your workers' comp claim number by reaching out to your employer or the insurance company handling your claim. Additionally, reviewing any communication from the Office of Workers' Compensation Programs can provide you with this information. Using resources such as the DoL CA-40 can streamline your claim management and help you acquire necessary details promptly.
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