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November 5, 2008    DOL Home > Find It! By Form > DOL Form   

DOL Form CA-12

View ESA-OWCP-DFEC's Form 1215-0154 Online htm
Agency: ESA-OWCP-DFEC
Title: DFEC CA-12, Claim For Continuance of Compensation Under the Federal Employees' Compensation Act
Form Description: DFEC CA-12, Claim For Continuance of Compensation Under the Federal Employees' Compensation Act: Beneficiaries of deceased federal employees may complete and submit this form to request continuation of compensation under the Federal Employees' Compensation Act.
OMB Control Number: 1215-0154
OMB Expiration Date: Tuesday, May 31, 2011




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