How to Fill Out DOL Form 790 (w/Examples) + FAQs

If a federal worker dies because of a job-related injury or illness, eligible survivors fill out DOL Form CA-5 or CA-5b along with the guidance booklet known as Form CA-790 to claim death benefits under the Federal Employees’ Compensation Act (FECA). The Office of Workers’ Compensation Programs (OWCP) inside the U.S. Department of Labor runs this program under 5 U.S.C. §§ 8101–8193 and 20 C.F.R. Part 10.

Form 790 is the survivor’s roadmap. It explains who can file, what proof OWCP demands, how compensation is figured, and how benefits interact with Social Security, FERS, CSRS, and military retirement pay. According to the DOL FECA Annual Report to Congress, OWCP paid more than 800 million dollars in survivor and disability death-case benefits in the most recent reporting year, yet roughly 1 in 5 initial death claims is delayed because of missing documents on the CA-5 or CA-5b.

This guide walks you through every box, every signature line, and every nuance the OWCP Procedure Manual expects. You will see named examples, scenario tables, common mistakes, and answers drawn from binding ECAB decisions.

Here is what you will learn:

• 📝 How to fill every numbered item on Form CA-5 and CA-5b without triggering a development letter
• 💰 How OWCP calculates the 50%, 45%, 40%, and 15% compensation tiers under 5 U.S.C. § 8133
• 📑 Which death certificates, marriage records, and dependency proofs OWCP must see
• ⚖️ How dual benefits offsets cut your check when SSA, FERS, or VA pay also apply
• 🚨 The top mistakes that cause denial and how the Employees’ Compensation Appeals Board has ruled on each

What Form 790 Actually Is (And What It Is Not)

The phrase “Form 790” causes confusion because the DOL uses it as the information pamphlet number, not as the claim form itself. The official title is Questions and Answers About the Federal Employees’ Compensation Act, publication CA-790. It travels with the actual death-benefit claim forms — Form CA-5 for traumatic injury death and Form CA-5b for occupational disease death.

So when a reader asks “how do I fill out Form 790,” they almost always mean the CA-5 or CA-5b that the CA-790 pamphlet explains. This article treats them as one package because OWCP processes them as one package under 20 C.F.R. § 10.410.

The plain-English purpose is simple. The form gives OWCP the facts it needs to decide three things: whether the death was work-related, who qualifies as a dependent, and how much each dependent gets each month. The consequence of getting it wrong is steep. A defective claim can be denied outright, or worse, sit in “development” for months while the family goes without income.

A real-world example helps. Maria Alvarez, the widow of a USPS letter carrier killed in a delivery-vehicle crash, filed her CA-5 with a photocopied marriage license and no death certificate. OWCP issued a 30-day development letter under 20 C.F.R. § 10.121, and her first payment was delayed nearly four months. A common misconception is that OWCP can pull these records on its own. It cannot. The burden of proof sits on the claimant under Joseph M. Whelan, 20 ECAB 55.

There is also a separate Longshore form, LS-790, used under the Longshore and Harbor Workers’ Compensation Act. That is a different program with different rules. This article focuses on the federal-employee FECA version, which covers nearly 2.6 million civilian federal workers.

Who Can File Form CA-5 or CA-5b

Eligibility flows from 5 U.S.C. § 8133, which lists the dependents entitled to FECA death benefits. The statute names a surviving spouse, unmarried children under 18, unmarried children 18 to 23 enrolled full-time in school, children of any age who are incapable of self-support due to disability, and in some cases dependent parents, brothers, sisters, grandparents, and grandchildren.

Each class has its own proof requirement. A spouse must show a valid marriage at the time of death, even if the couple lived apart, as long as the separation was not the spouse’s fault under 20 C.F.R. § 10.414. The consequence of a faulty marriage proof is total denial of the spousal share.

A common misconception is that common-law spouses cannot recover. They can, if the state where the couple lived recognizes common-law marriage and the proof meets that state’s standard. ECAB confirmed this in B.S. and Department of the Army, Docket No. 09-1364.

Surviving Spouse

The surviving spouse gets 50% of the deceased’s pay if there are no eligible children, or 45% if children also qualify, under 5 U.S.C. § 8133(a)(1)–(2). The spouse must attach a certified marriage certificate and the certified death certificate to the CA-5.

The plain-English rule is that the marriage must be legal where it happened. The consequence of a void marriage — for example, a bigamous one — is that the share shifts to the children. A real-world example is James Carter, whose second marriage was never finalized because the first divorce decree was defective; OWCP redirected his share to his stepchildren after a putative spouse analysis.

A common misconception is that remarriage always ends benefits. Under the FECA Amendments of 1974, remarriage after age 55 no longer terminates the spouse’s compensation, and remarriage before 55 triggers a 24-month lump sum payout, not zero.

Surviving Children

Each eligible child receives 15% of pay, with the total family share capped at 75% under 5 U.S.C. § 8133(e). Children must be unmarried and either under 18, between 18 and 23 in full-time school, or disabled before 18.

The plain-English rule is children get paid until they age out, marry, or finish school. The consequence of failing to report a marriage or school dropout is overpayment recovery under 20 C.F.R. § 10.441. A real-world example is Tasha Reynolds, a 20-year-old who left college mid-semester; her mother kept cashing the share for six months, and OWCP issued a 4,800 dollar overpayment notice with 10% interest.

A common misconception is that stepchildren do not qualify. They do, if they were members of the deceased’s household at the time of death, per 20 C.F.R. § 10.5(g).

Dependent Parents, Siblings, Grandparents, Grandchildren

These relatives only collect if they were wholly or partly dependent on the deceased at the time of death. Wholly dependent parents share 25% (combined) when no spouse or child exists; partly dependent parents share a proportional amount under 5 U.S.C. § 8133(a)(4).

The plain-English rule is show the money flow. The consequence of weak dependency proof — no bank records, no rent receipts — is denial. A real-world example is Henry Okafor, a retired father in Nigeria who received monthly remittances from his TSA-officer son; OWCP accepted Western Union receipts and an affidavit and approved partial dependency at 35%.

A common misconception is that any blood relative can file. Only the classes listed in § 8133 may, and only after the spouse and children’s shares are paid.

Step-by-Step: Filling Out Form CA-5 (Traumatic Injury Death)

Form CA-5 is used when a federal employee dies from a single traumatic event during one workday or shift, like a vehicle crash, fall, or violent attack. The form has three parts: claimant information, employee information, and the employing agency’s certification.

The plain-English rule is every blank gets answered, even if the answer is “none.” The consequence of leaving a box empty is a development letter that pauses the claim under 20 C.F.R. § 10.121.

Item-by-Item Walkthrough of CA-5

Item 1 asks for the deceased employee’s full name. Use the legal name on the SF-50, not a nickname. The consequence of using a nickname is mismatch with payroll records, which forces manual verification.

Item 2 asks for the date of birth and Social Security number. Pull these from the death certificate or the SSA-721 notice.

Item 3 asks for the date and time of death. Use the certified death certificate’s exact entry. A misconception is that estimated times are fine; OWCP wants the medical examiner’s listed time.

Items 4 through 7 collect the claimant’s name, relationship, address, and dependency status. Each dependent files a separate CA-5. The consequence of filing one form for the whole family is rejection of the secondary claimants under 20 C.F.R. § 10.410(b).

Item 8 asks whether the claimant has remarried. Answer truthfully — OWCP cross-checks with SSA. The consequence of a false answer is a fraud referral under 18 U.S.C. § 1920, which carries up to five years in prison.

Items 9 through 12 ask about other federal benefits — Social Security survivor benefits, FERS or CSRS survivor annuity, VA dependency and indemnity compensation, and military survivor benefit plan payments. List every one. The consequence of omission is a dual benefits overpayment that OWCP will recover with interest.

Items 13 and 14 cover funeral and burial expenses. FECA pays up to 800 dollars in funeral costs and a 200-dollar administrative allowance for terminating the decedent’s status under 5 U.S.C. § 8134. Attach itemized receipts.

Item 15 is the certification and signature. Sign in ink, date it, and have the signature notarized only if the claimant cannot appear in person. A misconception is that notarization is always required; it is not, under 20 C.F.R. § 10.102.

Agency Side of CA-5

The employing agency completes Items 16 through 35 within 10 working days. The agency provides pay rate, work schedule, date and place of injury, and witness statements. The consequence of agency delay is a direct claimant filing under 20 C.F.R. § 10.111, bypassing the agency.

A real-world example is Linda Park, widow of a Forest Service firefighter; her agency sat on the form for six weeks, so she mailed a copy directly to the OWCP Cleveland District Office and triggered the 10-day rule.

Step-by-Step: Filling Out Form CA-5b (Occupational Disease Death)

Form CA-5b applies when death results from a condition that developed over more than one workday — asbestosis, mesothelioma, hearing loss complications, cardiac disease from chronic stress, or COVID-19 contracted under the FECA presumption for federal employees.

The plain-English rule is prove exposure plus medical causation. The consequence of weak medical evidence is denial under the SECA causation standard.

Key Differences From CA-5

CA-5b adds Items asking for the date the employee first became aware of the disease, the date the employee first realized the disease was work-related, and a full work history. The three-year statute of limitations under 5 U.S.C. § 8122 runs from the awareness date, not the death date, for occupational claims.

A real-world example is Robert Nguyen, a Navy shipyard pipefitter who died of mesothelioma in 2025; his widow’s claim was timely because Robert only learned of the asbestos link in 2023, even though exposure ended in 1998.

Medical Evidence Requirements

OWCP requires a physician’s narrative report addressing diagnosis, exposure history, and a reasoned opinion on causation. The consequence of a conclusory “yes, work caused it” letter is rejection under Lillian M. Jones, 34 ECAB 379.

A common misconception is that the death certificate alone proves causation. It does not. OWCP wants pathology, exposure logs, and a doctor’s bridge to the workplace.

How Compensation Is Calculated

Death benefits are paid as a monthly percentage of the deceased’s “pay rate” as defined in 5 U.S.C. § 8101(4). The pay rate is usually the annual salary at date of death, or at date of last exposure for occupational disease, whichever yields the higher figure.

The plain-English rule is spouse alone gets 50%, spouse plus kids splits 45% to spouse and 15% per child up to 75% total. The consequence of miscalculating pay rate is years of underpayment that may be hard to recover beyond the one-year retroactive limit in 20 C.F.R. § 10.421.

Maximum and Minimum Caps

FECA caps the total monthly compensation at 75% of the GS-15 step 10 rate and sets a floor at 75% of GS-2 step 1, under 5 U.S.C. § 8112. For 2026, the maximum monthly cap sits near 14,800 dollars based on current OPM tables.

Cost-of-Living Adjustments

Survivors receive annual COLAs under 5 U.S.C. § 8146a, tied to the CPI-W. The consequence of forgetting to update direct-deposit information is a missed COLA reflected in the March payment cycle.

Three Common Scenarios

Family Situation	OWCP Outcome
Spouse only, no children, age 60, deceased earned 90,000 dollars	50% of pay, about 3,750 dollars per month, plus annual COLA, paid for life
Spouse age 45 with two kids ages 10 and 14, deceased earned 75,000 dollars	Spouse 45%, each child 15%, total capped at 75% of pay; spouse remarries at 50, gets 24-month lump sum
Dependent mother in home country, no spouse or kids, deceased sent 600 dollars monthly	Wholly dependent parent share 25% of pay if proof of remittances and affidavits accepted

Filing Mistake	OWCP Consequence
Missing certified death certificate	30-day development letter, claim suspended
Listing nickname instead of legal name	Manual verification, 4–8 week delay
Failing to disclose SSA survivor benefits	Dual offset overpayment plus 10% interest
Filing one CA-5 for whole family	Secondary claimants denied until each files separately

Evidence Type	Why It Matters
Certified marriage certificate	Establishes spousal eligibility under § 8133
School enrollment letter for child 18–23	Keeps the 15% child share alive past age 18
Physician narrative on causation	Required for CA-5b occupational disease cases

Three Named Examples in Action

Maria Alvarez is the 52-year-old widow of a USPS letter carrier killed in a delivery crash in Phoenix. She files CA-5, attaches the certified Maricopa County death certificate, her Arizona marriage license, and itemized funeral receipts of 9,400 dollars. OWCP pays the 800-dollar funeral allowance, the 200-dollar termination allowance, and 50% of her husband’s 68,000 dollar GS-7 step 8 salary, about 2,833 dollars per month indexed annually.

Robert Nguyen Jr. files CA-5b on behalf of his late father, a Norfolk Naval Shipyard pipefitter who died of mesothelioma in 2025. He attaches the pathology report, a Navy exposure log, and a Dr. Patel narrative tracing causation to 1970s asbestos work. Because the awareness date was 2023, the claim is timely under § 8122, and Robert Jr., a disabled adult child, draws the surviving-child share for life.

Henry Okafor is the dependent father of a TSA officer who died of a workplace heart attack in Newark. Henry lives in Lagos and depended on monthly 600-dollar remittances. He files CA-5 with Western Union receipts spanning four years, an affidavit notarized at the U.S. Consulate, and bank statements. OWCP grants a 25% wholly dependent parent share because no spouse or child claim exists.

Mistakes to Avoid

• Skipping the certified death certificate; the consequence is automatic suspension under 20 C.F.R. § 10.121 until OWCP receives an original.
• Filing a single CA-5 for an entire family; each dependent must file separately, and bundling causes denial of secondary claimants under 20 C.F.R. § 10.410(b).
• Hiding remarriage; OWCP cross-checks Social Security marriage records and may pursue fraud charges under 18 U.S.C. § 1920.
• Forgetting the annual CA-1032 earnings report; failure to return it within 30 days suspends benefits under 20 C.F.R. § 10.528.
• Omitting other federal benefits; the dual benefits offset creates retroactive overpayments that grow with interest.
• Using a conclusory medical letter on CA-5b; ECAB demands a reasoned opinion on causation, not a one-line statement.
• Missing the three-year statute of limitations under 5 U.S.C. § 8122; even one day late, the claim dies unless an exception applies.
• Sending the form to the wrong OWCP district office; routing errors add weeks. Match the office to the duty station, not the claimant’s home.
• Failing to keep school enrollment letters current for children ages 18–23; benefits drop the month school stops.
• Cashing checks after a child marries; the marriage terminates the share immediately under 5 U.S.C. § 8133(c).

Do’s and Don’ts

• Do request multiple certified death certificates from the vital records office; you will need them for OWCP, SSA, FERS, and VA.
• Do keep a copy of every page mailed; OWCP occasionally loses pieces, and you bear the burden of proof.
• Do file within 30 days even if records are incomplete; an early filing preserves the statutory clock under § 8122.
• Do ask the agency for a Form CA-11 booklet; it explains survivor rights in plain language.

• Do consult a FECA attorney for occupational disease cases; medical proof is technical.

• Don’t rely on the agency to file for you; the claimant is responsible.

• Don’t sign blank pages; OWCP treats blank-then-filled forms as suspect.
• Don’t ignore development letters; 30 days means 30 days.
• Don’t assume electronic submission via ECOMP replaces certified originals; OWCP still wants the originals for vital records.
• Don’t spend the funeral allowance before filing CA-5; reimbursement requires itemized receipts.

Pros and Cons of FECA Death Benefits Versus Alternatives

• Pro: FECA benefits are tax-free under 26 U.S.C. § 104(a)(1).
• Pro: Benefits include automatic COLAs that other federal survivor programs lack.
• Pro: No cap on duration for spouses who do not remarry before 55.
• Pro: Funeral and termination allowances are paid regardless of fault.

• Pro: OWCP pays medical bills connected to the fatal condition before death.

• Con: Election rules force survivors to choose between FECA and FERS basic employee death benefit under 5 U.S.C. § 8116(a).

• Con: Dual benefits offsets reduce the apparent value when SSA, VA, or military pay also apply.
• Con: The proof burden is heavier than in private survivor benefit claims.
• Con: Processing time often exceeds 90 days for occupational disease cases.
• Con: Appeals through ECAB can take 12 to 18 months.

Annual Reporting With Form CA-1032

Every year, OWCP sends each survivor a Form CA-1032 requiring disclosure of marital status, dependents, earnings, and other federal benefits. The plain-English rule is return it within 30 days, signed and complete. The consequence of late return is benefit suspension under 20 C.F.R. § 10.528.

A real-world example is Linda Park, who missed her CA-1032 deadline by 45 days; OWCP withheld three months of payments until the form was processed. A common misconception is that CA-1032 is optional once benefits are stable. It is not, and refusal can lead to permanent termination.

Key Court and ECAB Rulings

Joseph M. Whelan, 20 ECAB 55 confirmed that the burden of proof rests on the claimant for every element of a FECA death claim. The plain-English takeaway is no proof, no benefits, even when the facts seem obvious.

Lillian M. Jones, 34 ECAB 379 held that conclusory medical opinions cannot establish causation in occupational disease deaths. The consequence is that survivors must invest in a thorough physician narrative.

B.S. and Department of the Army, Docket No. 09-1364 recognized common-law marriage when the state of residence does. The takeaway is check your state’s marriage law before filing.

Federal Express Corp. v. Holowecki, 552 U.S. 389 is often cited by analogy for the liberal-construction approach federal agencies must apply to claimant filings, including FECA forms.

Where to File and How

Mail the completed CA-5 or CA-5b plus exhibits to the OWCP district office covering the deceased’s last duty station. Twelve district offices serve the country, from Boston to Seattle. Survivors may also file electronically through ECOMP, the Employees’ Compensation Operations and Management Portal, but originals of vital records still travel by mail.

The plain-English rule is one packet, one office, one tracking number. The consequence of mailing duplicates to multiple offices is system confusion and delay. Always request certified-mail return receipts.

A real-world example is James Carter, who mailed his CA-5 to both Dallas and Jacksonville offices; the duplicate flag froze processing for six weeks until he called the Branch of Hearings and Review to consolidate.

State Nuances

FECA is a federal program and preempts state workers’ compensation under 5 U.S.C. § 8116(c), so federal employees and their survivors cannot file parallel state claims. The consequence is that survivors should never sign state release forms before consulting a FECA attorney.

State law still matters for marriage validity, common-law recognition, paternity, and probate of the funeral allowance. For example, Texas, Colorado, Iowa, Kansas, Montana, New Hampshire (post-death only), Oklahoma, Rhode Island, South Carolina, and the District of Columbia recognize common-law marriage to varying degrees.

Probate rules also affect who collects the 200-dollar termination allowance; without a will, state intestacy law decides. The plain-English takeaway is federal benefits, state family law.

FAQs

Is Form 790 the same as Form CA-5?

No. CA-790 is the DOL information pamphlet that explains FECA survivor rights. The actual claim forms are CA-5 for traumatic-injury deaths and CA-5b for occupational-disease deaths.

Can I file CA-5 online?

Yes. Survivors may file through ECOMP, the DOL’s electronic portal, but certified vital records must still be mailed to the assigned OWCP district office.

Do FECA death benefits stop if I remarry?

No. Under the 1974 FECA amendments, remarriage after age 55 does not end your benefits, and remarriage before 55 triggers a 24-month lump-sum payout instead of termination.

Are FECA survivor benefits taxable?

No. Federal workers’ compensation death benefits are excluded from gross income under 26 U.S.C. § 104(a)(1), so they are tax-free at the federal level and in nearly every state.

Can I receive both FECA and Social Security survivor benefits?

Yes. You may collect both, but FECA reduces its payment by the portion of SSA benefits attributable to the deceased federal worker’s earnings under 5 U.S.C. § 8116(d).

Is there a deadline to file CA-5 or CA-5b?

Yes. 5 U.S.C. § 8122 sets a three-year window from the date of death, or from the date the survivor became aware the death was work-related for occupational diseases.

Do stepchildren qualify for child benefits?

Yes. Stepchildren who lived in the deceased’s household at the time of death qualify under 20 C.F.R. § 10.5(g) and receive the same 15% share as biological children.

Can dependent parents in another country collect?

Yes. Foreign dependent parents may collect FECA benefits if they prove wholly or partly dependent status under 5 U.S.C. § 8133(a)(4), usually with remittance records and notarized affidavits.

Will FECA pay funeral costs?

Yes. FECA pays up to 800 dollars in funeral expenses and a 200-dollar termination allowance under 5 U.S.C. § 8134, on top of monthly survivor compensation.

Can I appeal a denied CA-5 claim?

Yes. Survivors may request reconsideration, an oral hearing before the Branch of Hearings and Review, or file an appeal with the Employees’ Compensation Appeals Board within 180 days of the final decision.

Do I need a lawyer to file CA-5?

No. Filing does not require an attorney, but FECA attorneys help in occupational-disease cases, dual-benefits offsets, and ECAB appeals where medical and legal proof must be tightly assembled.

Can a divorced spouse collect FECA death benefits?

No. Divorce ends spousal eligibility under 5 U.S.C. § 8133, even if the deceased paid alimony, because FECA only recognizes a current legal spouse at the time of death.