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View ESA-OWCP-DFEC's Form 1215-0155 Online 
| Agency: |
ESA-OWCP-DFEC |
| Title: |
DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children |
| Form Description: |
DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children: A deceased federal employee's widow, widower, and/or children may use this form to claim work-related death benefits. |
| OMB Control Number: |
1215-0155 |
| OMB Expiration Date: |
Monday, May 31, 2010
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