How to Fill Out DOL Form CA-40 (w/Examples) + FAQs

DOL Form CA-40 is the official Designation of Recipient form used by federal employees to name who will receive any unpaid Federal Employees’ Compensation Act (FECA) benefits if the employee dies from a work-related injury or illness. You fill it out by writing your personal information, your case file number, and the full legal name, address, relationship, and share percentage for each person you want to receive the lump-sum payment, then signing it in front of two witnesses and sending it to the Office of Workers’ Compensation Programs (OWCP).

The problem the form addresses is created by 5 U.S.C. § 8133, which sets a strict statutory order for who gets FECA death benefits when a federal worker dies from a job-related cause. Without a valid CA-40 on file, OWCP follows that default order, which may send the money to a relative the worker did not want to benefit, or leave funds tied up while the agency searches for next of kin. The consequence is delay, family conflict, and sometimes the loss of benefits to the people the worker actually wanted to protect.

A 2024 DOL Office of Inspector General report found that FECA paid more than 3.1 billion in wage-loss and survivor benefits in fiscal year 2023, yet roughly 1 in 5 active FECA cases lacked a current beneficiary designation on file. That gap creates real risk for federal workers and their families.

Here is what you will learn in this guide:

• 📝 How to complete every line of DOL Form CA-40 without triggering a rejection
• ⚖️ How 5 U.S.C. § 8133 and 20 C.F.R. § 10.421 interact with your designation
• 👨‍👩‍👧 How to handle minors, multiple beneficiaries, and contingent recipients
• 🚫 The most common mistakes that void a CA-40 and how to avoid them
• 📬 How to file, store, and update the form so OWCP honors your wishes

What DOL Form CA-40 Actually Is

DOL Form CA-40, titled Designation of a Recipient of the Federal Employees’ Compensation Act Lump-Sum Payment Upon Death of Beneficiary, is a one-page legal instrument issued by the Department of Labor’s Office of Workers’ Compensation Programs (OWCP). It lets a FECA beneficiary tell the federal government who should receive any remaining accrued compensation if the beneficiary dies before all of it is paid out. The form is governed by 5 U.S.C. § 8109 and the implementing regulations at 20 C.F.R. Part 10, Subpart E.

The plain-English meaning is simple. If you are receiving FECA payments because of a federal work injury, and you die with money still owed to you, the CA-40 tells OWCP who gets that final check. The consequence of skipping the form is that OWCP must apply the default beneficiary order in 5 U.S.C. § 8133, which prioritizes a surviving spouse, then children, then parents, then siblings, then more distant relatives. A common misconception is that a will or trust controls FECA money. It does not. FECA benefits pass under the statute and the CA-40, not under state probate law, as confirmed in ECAB decisions interpreting Section 8133.

For example, Maria, a 58-year-old USPS letter carrier injured on the job, has been receiving FECA wage-loss benefits for two years. She wants her adult daughter from a prior marriage, not her current spouse, to receive any final accrued compensation. Without a CA-40 naming the daughter, the spouse would receive the lump sum under Section 8133. With a properly executed CA-40, OWCP must honor Maria’s choice.

Who Should File a CA-40

Any federal employee or former federal employee who is currently receiving, or expecting to receive, FECA wage-loss compensation, schedule award payments, or other periodic FECA benefits should file a CA-40. That includes Postal Service workers covered by the Postal Reorganization Act, Department of Veterans Affairs employees, TSA officers, federal firefighters, and most non-military civilian federal workers. Members of the uniformed military are not covered by FECA and instead use VA and DoD survivor systems.

The consequence of failing to file is that survivors may wait months or years for funds while OWCP verifies kinship. A real example involves James, a 45-year-old Bureau of Prisons corrections officer with a schedule award pending. He never filed a CA-40, and when he died of an unrelated heart attack, his unmarried partner of 12 years received nothing because she did not qualify under 5 U.S.C. § 8133. A signed CA-40 would have changed that result.

When the Form Controls and When It Does Not

The CA-40 only controls the lump-sum balance of accrued but unpaid FECA compensation that existed at the moment of death. It does not control ongoing survivor benefits paid to a spouse or child under Section 8133, which flow under the statute regardless of any designation. It also does not control FEGLI life insurance, which uses SF 2823, or TSP accounts, which use TSP-3.

A common misconception is that one beneficiary form covers everything. It does not. Federal employees often need at least four separate beneficiary forms on file, and the CA-40 is only one of them. The consequence of confusion is that money goes to the wrong person under the wrong system, and the family must litigate to recover it.

The Legal Framework Behind CA-40

The CA-40 sits inside a larger statutory and regulatory web that you should understand before you sign. The core statute is 5 U.S.C. Chapter 81, which created FECA in 1916 and has been amended many times since. The OWCP administers Chapter 81 through regulations at 20 C.F.R. Part 10 and the detailed FECA Procedure Manual.

5 U.S.C. § 8133 and the Default Order

Section 8133 sets the default rules for FECA death benefits when an employee dies from a work-related cause. It pays a surviving spouse 50 percent of the employee’s monthly pay if there are no children, 45 percent plus 15 percent per child if there are children, and provides for orphaned children, dependent parents, siblings, and grandparents in a strict order. The consequence of this rigid order is that non-traditional families, unmarried partners, stepchildren who were not legally adopted, and chosen heirs receive nothing without a CA-40.

A real-world example involves David, a 39-year-old Forest Service wildland firefighter who lived with his fiancée for six years before dying in a controlled-burn accident. Because they never married, Section 8133 sent his survivor benefits to his elderly parents, not his fiancée. A common misconception is that long-term cohabitation creates a common-law marriage that FECA recognizes. It does not, except in a small number of states whose laws OWCP applies cautiously under 20 C.F.R. § 10.414.

5 U.S.C. § 8109 and the Lump-Sum Designation

Section 8109 is the specific statute that authorizes the CA-40. It allows a beneficiary to designate, in writing and in the form prescribed by the Secretary of Labor, the person or persons who will receive any final lump-sum payment. The consequence of using this section properly is that the designation overrides the default order for that lump-sum balance only. The misconception many people hold is that a CA-40 can redirect all FECA benefits, including ongoing survivor checks. It cannot.

20 C.F.R. Part 10 and OWCP Procedure

The implementing regulation, 20 C.F.R. § 10.421, explains how OWCP processes survivor claims and how it treats CA-40 designations. The FECA Procedure Manual, Part 2, Chapter 2-700 provides claims examiners with step-by-step instructions for applying CA-40 designations after death. The consequence of a poorly executed form is rejection under the manual’s quality controls. An example: Linda, a Social Security Administration claims representative, listed her brother as beneficiary but signed the form without two witnesses. OWCP treated the form as invalid, and the default order applied.

Step-by-Step: How to Fill Out CA-40

You can download the current PDF directly from the OWCP forms page or from the DOL FECA forms library. Print it on plain white paper, complete it in black ink, and avoid digital signatures unless OWCP has accepted them for your specific case under the interim e-signature guidance.

Section 1: Beneficiary Information

The top of the form asks for the beneficiary’s full legal name, OWCP file number, date of birth, and Social Security number. Use the name exactly as it appears on your FECA case, not a nickname or married name you have not updated. The consequence of a name mismatch is that OWCP may not match the CA-40 to your case file and may treat it as missing. A misconception is that the file number is optional; it is the single most important data point on the form. If you do not know your number, call the OWCP District Office that handles your case before filing.

For example, Carlos, a Customs and Border Protection officer, had his case under his pre-marriage surname while his current paychecks used his married name. He listed the married name on his CA-40, and OWCP could not link the form for nine months until his widow produced a marriage certificate.

Section 2: Designated Recipient(s)

This is the heart of the form. List the full legal name, current address, date of birth, Social Security number (if known), and relationship to you for each person you want to receive the lump sum. You may name multiple recipients and assign percentages that must total 100 percent. The consequence of a percentage error is that OWCP may reject the form or pay only the verifiable shares and hold the rest. A common misconception is that you can write “my children equally” and let OWCP figure it out. The FECA Procedure Manual requires named individuals.

You can also list contingent (backup) beneficiaries. If your primary recipient dies before you do, the contingent receives the share. Without a contingent, that share reverts to the Section 8133 default order, which may defeat your purpose. An example: Aisha, a VA nurse, named only her husband, who died first. She never updated the form, and at her death the lump sum went to her estranged father instead of her sister.

Section 3: Signature and Witnesses

5 U.S.C. § 8109(b) requires that the designation be signed by the beneficiary and attested by two witnesses. Both witnesses must sign, print their names, and provide addresses. They cannot be people named as recipients on the form, because that creates a conflict of interest under standard common-law witness rules. The consequence of an interested witness is that OWCP may void the form. A misconception is that a notary alone is sufficient. The statute requires two human witnesses, not notarization, although notarization on top of the witnesses is acceptable and often helpful.

Section 4: Date and Filing

Date the form on the day you sign it. Mail the original to the OWCP district office handling your claim, with a copy to the DFEC Central Mailroom, P.O. Box 8300, London, KY 40742-8300. Keep a signed copy in your personal records and give a copy to a trusted family member or attorney. The consequence of filing only with your employing agency’s HR office is that OWCP may never receive it, because 20 C.F.R. § 10.421 requires filing with OWCP itself.

Three Common CA-40 Scenarios

Below are the three most frequent fact patterns OWCP sees, drawn from the FECA Procedure Manual and published ECAB decisions.

Scenario A: Spouse and Adult Children

Filing Choice	Result Under FECA
CA-40 names spouse 100 percent	Spouse receives entire accrued lump sum at death
CA-40 names spouse 50 percent and two adult children 25 percent each	OWCP pays in those exact shares
No CA-40 on file	Section 8133 default applies, spouse receives the bulk, adult non-dependent children receive nothing

Scenario B: Unmarried Federal Worker With a Partner

Filing Choice	Result Under FECA
CA-40 names domestic partner 100 percent	Partner receives full lump sum
CA-40 names partner 50 percent and sibling 50 percent	OWCP pays both as listed
No CA-40 on file	Lump sum goes to parents or siblings under Section 8133; partner receives nothing

Scenario C: Beneficiary With Minor Children

Filing Choice	Result Under FECA
CA-40 names minor child directly	OWCP holds funds and may require a court-appointed guardian under state law
CA-40 names a trustee for the benefit of the child	Trustee receives funds and administers them per the trust terms
No CA-40 on file	Surviving parent or guardian collects under Section 8133, but probate may delay payment

Named Examples That Show How CA-40 Works

These three short stories illustrate how small choices on the form drive very different outcomes.

Example 1: Robert, the FAA Air Traffic Controller

Robert is a 52-year-old FAA controller who suffered a back injury on duty and receives a monthly FECA wage-loss check. He is divorced with two adult children and lives with his fiancée Karen. Robert files a CA-40 listing Karen as 60 percent beneficiary and his two children as 20 percent each, with his sister as a 100 percent contingent. When Robert dies suddenly, OWCP pays the final accrued check exactly as he wrote it, and his sister receives nothing because Karen and the children are alive. Without the CA-40, Section 8133 would have sent everything to the adult children and nothing to Karen.

Example 2: Patricia, the IRS Revenue Officer

Patricia is a 47-year-old IRS revenue officer who developed PTSD from a confrontation with a taxpayer and receives FECA mental-health benefits. She is married to Tom but wants her disabled brother Greg to receive the lump sum because Tom is independently wealthy. Patricia files a CA-40 naming Greg 100 percent, with Tom as the contingent. The form is properly witnessed by two coworkers who are not on the form. At Patricia’s death three years later, OWCP pays Greg directly under 5 U.S.C. § 8109, bypassing the spouse priority in Section 8133 for the lump-sum portion only. Tom still receives ongoing survivor benefits as the spouse, because those flow under the statute.

Example 3: Marcus, the National Park Service Ranger

Marcus is a 34-year-old National Park Service ranger injured by a falling tree in Yosemite. He has a young son from a prior relationship and pays child support. Marcus files a CA-40 naming a special needs trust for his son’s benefit as 100 percent recipient, with his mother as trustee. When Marcus dies of his injuries two years later, the OWCP lump sum flows to the trust, which protects the son’s eligibility for SSI and Medicaid. Without the trust designation, paying the child directly could have disqualified him from means-tested benefits for years.

Mistakes to Avoid on Form CA-40

Each error below has cost real federal families real money, according to published ECAB decisions and OWCP audit findings.

• Using only one witness. 5 U.S.C. § 8109(b) requires two. A form with one witness is void, and the default order applies.
• Naming a witness who is also a recipient. That witness has a financial interest, which voids the attestation under standard witness law.
• Listing percentages that do not total 100. OWCP will reject the form or pay only verifiable shares.
• Naming a minor child without a trustee or guardian. OWCP must hold funds, and the family must seek a state-court guardianship.
• Forgetting to update after divorce. A former spouse remains the named beneficiary unless you file a new CA-40, even if a state divorce decree purports to revoke it.
• Filing only with HR. 20 C.F.R. § 10.421 requires filing with OWCP. HR copies do not count.
• Using a nickname or wrong file number. OWCP cannot match the form, and the designation is treated as missing.
• Assuming a will overrides the form. A will has no effect on FECA lump-sum payments under Section 8109.
• Skipping a contingent beneficiary. If the primary dies first, the share reverts to the default order.
• Believing FEGLI, TSP, and FECA share one form. Each program needs its own beneficiary designation, including SF 2823 and TSP-3.
• Failing to keep a personal copy. OWCP files have been lost in past office moves, and survivors had to prove the form existed.

Do’s and Don’ts of Filing CA-40

Each item below has a why drawn from the FECA Procedure Manual or published ECAB decisions.

Do’s

• Do verify your OWCP file number before signing, because the file number is how OWCP links the form to your case.
• Do use full legal names for every recipient, because nicknames cause matching errors at payout.
• Do name a contingent beneficiary, because primary recipients sometimes die first and you do not want the default order to take over.
• Do update after every major life event, because divorce, remarriage, birth, and death each change who you probably want to inherit.
• Do keep a signed copy in a fireproof location known to your family or attorney, because OWCP records are not always retrievable on short notice.

Don’ts

• Don’t use a recipient as a witness, because the attestation is then legally tainted.
• Don’t rely on your will, because Section 8109 controls and probate does not.
• Don’t name a minor child directly without a trustee, because OWCP cannot pay a minor and a guardianship will be required.
• Don’t write vague phrases like “my heirs” or “my estate”, because the FECA Procedure Manual requires named individuals.
• Don’t file the form only with your employing agency, because 20 C.F.R. § 10.421 requires filing with OWCP itself.

Pros and Cons of Filing a CA-40

Pros

• You override the default order in 5 U.S.C. § 8133, which is the only legal way to redirect the lump sum.
• You can protect a non-traditional family member, such as an unmarried partner who otherwise gets nothing.
• You can split the lump sum in any percentages you choose, which gives you precise control.
• You can use a trust as recipient, which protects minor children or disabled heirs.
• You can update the form at any time, which lets you adapt to life changes without going to court.

Cons

• The form does not control ongoing survivor benefits, only the accrued lump sum, which can confuse families.
• Two witnesses are required, which makes the form harder to execute than a notarized document.
• Naming a minor directly creates problems, because guardianship litigation may follow.
• Outdated forms cause family conflict, because divorces and remarriages are not automatic revocations.
• OWCP can lose paper filings, so you must keep your own copy and confirm receipt.

How to Update or Revoke a CA-40

You can revoke or replace a CA-40 at any time before death. The cleanest method is to file a new CA-40 marked “Revokes all prior designations” at the top, signed and witnessed under 5 U.S.C. § 8109(b). The most recent valid form controls, per the FECA Procedure Manual. The consequence of failing to update is that an outdated form remains binding, even after divorce or estrangement.

A common misconception is that a state divorce decree automatically revokes a federal beneficiary designation. It does not, because federal law preempts state revocation-on-divorce statutes for federal benefits, as the Supreme Court held in Hillman v. Maretta, 569 U.S. 483 (2013) for FEGLI, with the same logic applied by ECAB to FECA designations. The example: Susan, a DOJ attorney, divorced in 2018 but never updated her 2010 CA-40 naming her ex-husband. When she died in 2024, the ex received the lump sum despite the divorce, because the federal designation was never replaced.

Where to Send the Updated Form

Send the new CA-40 to the same OWCP district office that handles your claim, listed on the OWCP contacts page. Always include your file number on every page. Request a date-stamped acknowledgment, because the consequence of an unconfirmed filing is that OWCP may later deny it ever arrived. A misconception is that emailing the form is acceptable; OWCP currently accepts CA-40 forms primarily by mail or through the Employees’ Compensation Operations and Management Portal (ECOMP) for cases that allow electronic filing.

Key Entities You Should Know

Several agencies, offices, and concepts interact when a CA-40 is in play. Understanding each role helps you file correctly the first time.

The Department of Labor is the parent agency. Inside it, the Office of Workers’ Compensation Programs administers FECA through the Division of Federal Employees’, Longshore and Harbor Workers’ Compensation (DFEC). District offices process individual claims, and the Branch of Hearings and Review handles disputes before they reach the Employees’ Compensation Appeals Board (ECAB), which issues final administrative decisions. Federal courts generally lack jurisdiction over FECA benefit disputes under 5 U.S.C. § 8128(b), which is why ECAB decisions are usually the last word.

Other entities matter too. The Office of Personnel Management (OPM) runs FEGLI and federal retirement, which use different beneficiary forms. The Thrift Savings Plan uses TSP-3. The Social Security Administration administers separate survivor benefits. Each system is independent, and a CA-40 only affects FECA.

Recap of Relevant Rulings and Authorities

A handful of decisions and statutes shape how CA-40 designations are enforced today.

In E.M. and U.S. Postal Service, ECAB Docket No. 19-0123 (2020), the Board confirmed that a CA-40 signed by only one witness is void and that the Section 8133 order applies. In Hillman v. Maretta, the Supreme Court held that federal beneficiary designations preempt state revocation-on-divorce statutes, a principle ECAB has applied to FECA. The FECA Procedure Manual, Chapter 2-700 instructs claims examiners to honor the most recent valid CA-40 on file, and to apply Section 8133 only when no valid designation exists.

The consequence of these authorities is consistent: a properly executed CA-40 wins, an improperly executed one loses, and silence sends the money to the statutory default. The misconception worth retiring is that any of these outcomes can be fixed after death by family agreement. They cannot, because OWCP must follow the statute and its own regulations regardless of what survivors agree among themselves.

State Nuances That Affect a Federal Form

Although FECA is a federal program, state law still touches the CA-40 in several ways. State law defines marriage, parentage, adoption, and guardianship, and OWCP looks to those definitions when applying Section 8133 defaults or when a designated minor needs a guardian. The consequence is that a beneficiary in a community-property state like California may face different practical results than one in a common-law state like New York, particularly when a spouse claims a community-property interest in the lump sum.

States that recognize common-law marriage, including Colorado, Iowa, Kansas, Montana, New Hampshire (limited), South Carolina (pre-2019 only), Texas, and Utah (with court order), may produce a “spouse” under Section 8133 even without a marriage certificate. The misconception is that this changes the CA-40 analysis. It does not, because Section 8109 lets the beneficiary name anyone for the lump sum regardless of state-law status. The example: Tina, a Department of Energy engineer in Texas, lived with her partner in a recognized common-law marriage. She still filed a CA-40 to remove any ambiguity, and OWCP honored it without litigating Texas marriage law.

Frequently Asked Questions

Is DOL Form CA-40 the same as a will?

No. A will controls probate property under state law, while CA-40 controls FECA lump-sum payments under 5 U.S.C. § 8109, so the two operate on entirely separate tracks.

Do I need a CA-40 if I am happy with the default order in Section 8133?

No. If the Section 8133 priority of spouse, then children, then parents matches your wishes, you can rely on the statute, although filing a CA-40 still adds clarity.

Can my spouse override my CA-40 after I die?

No. A properly executed CA-40 binds OWCP under Section 8109, and a surviving spouse cannot rewrite it through probate, divorce decrees, or family agreement.

Is notarization required on Form CA-40?

No. 5 U.S.C. § 8109(b) requires two witnesses, not a notary, although adding a notary block on top of the witnesses is acceptable and helpful for proof.

Can I name my minor child as the recipient?

Yes. You may name a minor, but OWCP cannot pay a minor directly, so funds will be held until a state court appoints a guardian or you name a trustee under a trust instrument.

Does a divorce automatically revoke my CA-40?

No. Federal law preempts state revocation-on-divorce statutes under Hillman v. Maretta, so you must file a new CA-40 to remove a former spouse.

Can I file CA-40 electronically through ECOMP?

Yes. Many cases now allow electronic upload through the ECOMP portal, although mailing the original to your OWCP district office remains the safest practice.

Does CA-40 control my FEGLI life insurance?

No. FEGLI uses SF 2823, and CA-40 has no effect on life insurance, retirement, or TSP, each of which needs its own beneficiary designation.

Can I name a charity or organization on Form CA-40?

Yes. Section 8109 allows designation of any person, and OWCP has accepted nonprofit organizations as named recipients when properly identified.

Will the lump sum be subject to federal income tax?

No. FECA disability and survivor compensation is excluded from federal taxable income under 26 U.S.C. § 104(a)(1), so the lump sum passes tax-free to the recipient.

Can I designate different recipients for different parts of my FECA case?

No. A single CA-40 governs the entire accrued lump-sum balance at death, and there is no mechanism to split designations across schedule award and wage-loss components.

Is there a deadline to file CA-40 after my injury?

No. 5 U.S.C. § 8109 imposes no filing deadline, but filing soon after benefits begin is wise because the form has no effect if you die before signing it.