Death Gratuity

ICR 201908-1240-001

OMB: 1240-0017

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Supporting Statement A
2020-04-02
Supplementary Document
2020-01-08
Supplementary Document
2019-09-27
Supplementary Document
2019-09-27
Supplementary Document
2019-09-27
Supplementary Document
2019-09-27
ICR Details
1240-0017 201908-1240-001
Active 201603-1240-001
DOL/OWCP
Death Gratuity
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 07/14/2020
Retrieve Notice of Action (NOA) 04/14/2020
  Inventory as of this Action Requested Previously Approved
07/31/2023 36 Months From Approved
4 0 0
1 0 0
1 0 0

The National Defense Authorization Act for Fiscal Year 2008, Public Law 110-181, was enacted on January 28, 2008. Section 1105 of P.L. 110-181 amended the Federal Employees' Compensation Act (FECA) creating a new section, 5 U.S.C. § 8102a effective upon enactment. This section establishes a FECA death gratuity benefit of up to $100,000 for eligible beneficiaries of federal employees and Non-Appropriated Fund Instrumentality (NAFI) employees who die from injuries incurred in connection with service with an Armed Force in a contingency operation. 5 U.S.C.§ 8102a also permits agencies to authorize retroactive payment of the death gratuity for employees who died on or after October 7, 2001 in service with an Armed Force in the theater of operations of Operation Enduring Freedom and Operation Iraqi Freedom. 5 U.S.C. § 8102a also allows federal employees to vary the order of precedence of beneficiaries or to name alternate beneficiaries 20 CFR 10.909, and 10.911 provides that the CA-40, CA-41, and CA-42 are the forms to be used to designate beneficiaries and initiate the payment process for death gratuity benefits. Form CA-40 is an optional form that requests the information necessary from the employee to accomplish this variance and to name alternate beneficiaries only if the employee wishes to do so. Form CA-41 provides the means for those named beneficiaries and possible recipients to file claims for those benefits and requests information from such claimants so that OWCP may determine their eligibility for payment. Further, the statute and regulations require agencies to notify OWCP immediately upon the death of a covered employee. CA-42 provides the means to accomplish this notification and requests information necessary to administer any claim for benefits resulting from such a death.

US Code: 5 USC 8102a Name of Law: Amendment to the FECA, Death Gratuity
   PL: Pub.L. 112 - 81 1121 Name of Law: National Defense Authorization Act for Fiscal Year 2012
   PL: Pub.L. 110 - 181 1105 Name of Law: National Defense Authorization Act for Fiscal Year 2008
   US Code: 5 USC 8145 Name of Law: Federal Employees' Compensation Act
   US Code: 5 USC 8149 Name of Law: Federal Employees' Compensation Act
  
None

Not associated with rulemaking

  84 FR 59652 11/05/2019
85 FR 20305 04/10/2020
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4 0 0 0 -258 262
Annual Time Burden (Hours) 1 0 0 0 -66 67
Annual Cost Burden (Dollars) 1 0 0 0 -2 3
No
No
This reinstatement is being made without a change to bring back into compliance as it has expired. The number of claims received for death gratuity has significantly decreased since the implementation of U.S.C. § 8102a in 2008. It is anticipated these claims will continually remain low since OWCP will pay death gratuity benefits minus the amount of any death gratuity payments that have been paid under any other law of the United States based on that same death. Only 1 agency report of death gratuity claim (CA-42) was received between 2016 and 2018, and there were two designated beneficiaries as noted on the CA-40. Both of these beneficiaries filed a CA-41 with OWCP. As a reminder, the CA-40 is an optional form, used only when an employee wishes to vary the order or preference or designate an alternate beneficiary for payment. Not all employees choose to fill out this form and submit it to their employing agency prior to deployment or may choose to rely on a designation from an earlier deployment. However, the completed CA-40 must be submitted to OWCP when a claim for death gratuity benefits is filed. Therefore, the previous approved number of annual respondents 262 is now 4, which represents a decrease in 258 respondents. The previously approved number for burden hours was 67; the requested number now is 1, which is a decrease of 66.

$97
No
    Yes
    Yes
No
No
No
No
Marcus Sharpless 202 693-0998 sharpless.marcus@dol.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/14/2020


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