Statutes, codes, and regulations
Code of Federal Regulations
Title 20 - EMPLOYEES' BENEFITSChapter I - OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABORSubchapter B - FEDERAL EMPLOYEES' COMPENSATION ACTPart 10 - CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDEDSubpart A - GENERAL PROVISIONS
DEFINITIONS AND FORMS
Section 10.7 - What forms are needed to process claims under the FECA?

20 C.F.R. § 10.7

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Current through September 30, 2024
Section 10.7 - What forms are needed to process claims under the FECA?
(a) Notice of injury, claims and certain specified reports shall be made on forms prescribed by OWCP. Employers shall not modify these forms or use substitute forms. Employers are expected to maintain an adequate supply of the basic forms needed for the proper recording and reporting of injuries.

Form No.Title
(1) CA-1Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation.
(2) CA-2Notice of Occupational Disease and Claim for Compensation.
(3) CA-2aNotice of Employee's Recurrence of Disability and Claim for Pay/Compensation.
(4) CA-3Report of Work Status.
(5) CA-5Claim for Compensation by Widow, Widower and/or Children.
(6) CA-5bClaim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren.
(7) CA-6Official Superior's Report of Employee's Death.
(8) CA-7Claim for Compensation Due to Traumatic Injury or Occupational Disease.
(9) CA-7aTime Analysis Form.
(10) CA-7bLeave Buy Back (LBB) Worksheet/Certification and Election.
(11) CA-16Authorization of Examination and/or Treatment.
(12) CA-17Duty Status Report.
(13) CA-20Attending Physician's Report.
(14) CA-20aAttending Physician's Supplemental Report.
(15) CA-40Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a).
(16) CA-41Claim for Survivor Benefits Under the Federal Employees' Compensation Act Section 8102a Death Gratuity.
(17) CA-42Official Notice of Employees' Death for Purposes of FECA Section 8102a Death Gratuity.
(18) CA-1108Statement of Recovery Letter with Long Form.
(19) CA-1122Statement of Recovery Letter with Short Form.

(b) Copies of the forms listed in this paragraph are available for public inspection at the Office of Workers' Compensation Programs, U.S. Department of Labor, Washington, DC 20210. They may also be obtained from district offices, employers ( i.e., safety and health offices, supervisors), and the Internet, at http://www.dol.gov.

20 C.F.R. § 10.7