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May 8, 2009   
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DOL Form CA-12

View ESA-OWCP-DFEC's Form CA-12 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

 

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