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CA-40 Death Gratuity Designation Form – Fillable PDF

  1. Language English
  2. Country USA
  3. Department Department of Labor
  4. Agency Office of Workers' Compensation Programs
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CA-40 Death Gratuity Designation Form – Fillable PDF

The CA-40 is the official Federal Employees' Compensation Act (FECA) death gratuity designation form. Federal employees use it to name beneficiaries who will receive the death gratuity payment if the employee passes away while in service.

Formize offers a secure, fillable PDF version of the CA-40 that loads instantly in your browser. No extra software is required – simply click the button, fill in the fields, sign electronically, and download the completed document.

Key benefits of using the Formize fillable CA-40 PDF:

  • Fast online loading – start filling in seconds.
  • Automatic field validation to reduce errors.
  • eSignature capability meets federal requirements.
  • Save a copy to your device or cloud storage for future reference.

Below you’ll find step‑by‑step instructions, tips to avoid common pitfalls, and answers to the most frequently asked questions.

FAQ
  • What is the purpose of the CA-40 form?

    The CA-40 allows federal employees to designate who will receive the FECA death gratuity payment if the employee dies while on active duty.

  • Who must complete a CA-40?

    All federal employees covered by the Federal Employees' Compensation Act who wish to name or change beneficiaries for the death gratuity.

  • Can I submit the CA-40 electronically?

    Yes. Most agencies accept the electronically signed PDF generated by Formize. Check your agency’s specific submission guidelines.

  • How often should I update the CA-40?

    Update the form whenever your personal circumstances change—marriage, divorce, birth of a child, or change in beneficiary preferences.

  • What happens if I don’t submit a CA-40?

    If no designation is on file, the death gratuity defaults to the employee’s spouse or, if none, to the estate according to federal regulations.

  • Is the Formize fillable PDF secure?

    Absolutely. Formize uses SSL encryption and stores no personal data on its servers. Your information stays on your device unless you choose to share it.

HOW TO

How to fill out CA-40 form for free, online in 7 easy steps:

  1. 1
    Click the Fill‑out Button
    On this page, click the bright “Fill out this form” button. The Formize PDF Filler app will open in a new tab.
  2. 2
    Wait for the Form to Load
    The fillable CA-40 PDF loads within seconds. You’ll see clearly labelled fields ready for input.
  3. 3
    Enter Employee Information
    Type your name, Social Security Number, agency, and employment dates exactly as they appear on official records.
  4. 4
    Designate Beneficiaries
    Add each beneficiary’s name, relationship, and the percentage of the gratuity they should receive. Use the “Add Another Beneficiary” button for multiple entries.
  5. 5
    Provide Electronic Signatures
    Both the employee and the authorized official must sign. Use the built‑in eSignature tool – it complies with federal e‑sign rules.
  6. 6
    Review and Save
    Double‑check every field for accuracy, then click “Save & Download”. The completed PDF is saved to your computer or cloud storage.
  7. 7
    Submit the Form
    Follow your agency’s instructions to submit the PDF – usually via email or internal HR portal.
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ABOUT

Department of Labor (DOL) Forms

CA-40 form is one of the official forms that are used by the United States Department of Labor and its various agencies to collect information, administer programs, and enforce labor-related laws and regulations. The Department of Labor is a federal executive department responsible for promoting and protecting the welfare of workers, ensuring fair employment practices, and overseeing various aspects of labor and employment in the United States.

Here are some examples of Department of Labor forms:

Employment Eligibility Verification (Form I-9): While administered by the U.S. Citizenship and Immigration Services (USCIS), Form I-9 is often associated with the Department of Labor. It is used by employers to verify the identity and employment eligibility of individuals hired for employment in the United States.

Family and Medical Leave Act (FMLA) Forms: The DOL's Wage and Hour Division administers the FMLA, and various forms are used to implement and comply with the provisions of this federal law, including the Certification of Health Care Provider form and the FMLA Notice of Eligibility and Rights & Responsibilities form.

Occupational Safety and Health Administration (OSHA) Forms: OSHA, a division of the DOL, requires certain employers to maintain records of workplace injuries and illnesses using forms such as OSHA Form 300, OSHA Form 300A, and OSHA Form 301.

Unemployment Insurance Forms: The DOL's Employment and Training Administration oversees the Unemployment Insurance (UI) program, and various forms are used by state workforce agencies to administer and process UI benefits claims.

Wage and Hour Compliance Forms: The DOL's Wage and Hour Division enforces various labor laws, including the Fair Labor Standards Act (FLSA) and the Family and Medical Leave Act (FMLA). Employers may be required to use specific forms to maintain compliance with these laws, such as records of hours worked, wage rates, and other related information.

These examples represent some common categories of Department of Labor forms, but there are many other forms used by the DOL and its various agencies to carry out their responsibilities related to labor and employment. The specific forms required may vary depending on the program, regulation, or enforcement action involved. It's advisable to visit the official website of the U.S. Department of Labor (www.dol.gov) or consult with the relevant DOL agencies or legal professionals to obtain accurate and up-to-date information regarding the specific DOL forms relevant to your labor-related needs or compliance requirements.

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