skip navigational links United States Department of Labor
May 8, 2009   
DOL Home > Find It! By Form > DOL Form
DOL Home

DOL Form CA-722

View ESA-OWCP-DFEC's Form CA-722 Online htm
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

 

Phone Numbers