12th Annual Federal Workers' Compensation Conference S i #39 ...
12th Annual Federal Workers' Compensation Conference S i #39 ...
12th Annual Federal Workers' Compensation Conference S i #39 ...
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Standard Form 3104A<br />
• Survivor • Complete this form<br />
Supplement<br />
if deceased was<br />
retired at the time<br />
of death.<br />
• To be completed<br />
by surviving<br />
spouse if he/she is<br />
under age 60 and<br />
the deceased had<br />
at least 5 years of<br />
creditable civilian<br />
service.<br />
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