|
View ESA-OWCP-DFEC's Form 1215-0116 Online 
| Agency: |
ESA-OWCP-DFEC |
| Title: |
DFEC CA-722, Notice of Law Enforcement Officer's Death |
| Form Description: |
DFEC CA-722, Notice of Law Enforcement Officer's Death: This form is used to report the death of a law enforcement officer, including an attending physician's report. It may also be used to file a claim on behalf of a widow, widower, or children. |
| OMB Control Number: |
1215-0116 |
| OMB Expiration Date: |
Tuesday, August 31, 2010
|
| |
|
