5 U.S.C. § 8119

Notice of injury or death

An employee injured in the performance of his duty, or someone on his behalf, shall give notice thereof. Notice of a death believed to be related to the employment shall be given by an eligible beneficiary specified in section 8133 of this title , or someone on his behalf. A notice of injury or death shall—

(a)

be given within 30 days after the injury or death;

(b)

be given to the immediate superior of the employee by personal delivery or by depositing it in the mail properly stamped and addressed;

(c)

be in writing;

(d)

state the name and address of the employee;

(e)

state the year, month, day, and hour when and the particular locality where the injury or death occurred;

(f)

state the cause and nature of the injury, or, in the case of death, the employment factors believed to be the cause; and

(g)

be signed by and contain the address of the individual giving the notice.

( Pub. L. 89–554 , Sept. 6, 1966 , 80 Stat. 543 ; Pub. L. 93–416, § 12(a) , Sept. 7, 1974 , 88 Stat. 1146 .)