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OWCP Workers' Compensation Forms

To help our patients with their Federal Workers' Compensation cases, we have assembled the necessary OWCP forms. These forms can be downloaded and printed for your own OWCP claim.

CA-1

Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation.

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CA-2

Notice of Occupational Disease and Claim for Compensation.

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CA-2a

Notice of Recurrence.

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CA-5

Claim for Compensation by Widow, Widower, and/or Children.

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CA-5b

Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren.

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CA-6

Official Supervisor’s Report of Employee’s Death.

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CA-7

Claim for Compensation – Form CA-7 replaces ALL prior versions of CA-7 & CA-8 (see FECA Bulletin No. 99-18).

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CA-7a

Time Analysis Form, used for claiming compensation, including repurchase of paid leave.

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CA-7b

Leave Buy Back (LBB) Worksheet/Certification and Election.

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CA-10

What a Federal Employee Should Do When Injured at Work.

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CA-12

Claim for Continuance of Compensation Under the Federal Employees’ Compensation Act.

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CA-17

Duty Status Report.

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CA-20

Attending Physician’s Report.

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CA-35

Evidence Required in Support of a Claim for Occupational Disease.

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CA-40

Designation of Recipient of FECA Death Gratuity Payment, under Section 1105 of Public Law 110-181 (Section 8102a).

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CA-41

Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity.

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CA-42

Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity.

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CA-278

Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act.

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CA-721

Notice of Law Enforcement Officer’s Injury Or Occupational Disease.

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CA-722

Notice of Law Enforcement Officer’s Death.

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CA-1031

Letter to Dependents to Verify Claimant Support.

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CA-1074

Letter to Parents in Death Claim Development.

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CA-1108

Statement of Recovery Letter with Long Form.

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CA-1122

Statement of Recovery Letter with Short Form.

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CA-2231

Claim for Reimbursement Assisted Reemployment.

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OWCP-5a

Work Capacity Evaluation Psychiatric/Psychological Conditions.

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OWCP-5b

Work Capacity Evaluation Cardiovascular/Pulmonary Conditions.

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OWCP-5c

Work Capacity Evaluation for Muscular Skeletal Conditions.

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OWCP-16

Rehabilitation Plan And Award.

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OWCP-17

Rehabilitation Maintenance Certificate.

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OWCP-20

Overpayment Recovery Questionnaire.

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OWCP-44

Rehabilitation Action Report.

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OWCP-04

Uniform Billing Form.

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OWCP-915

Claim For Medical Reimbursement Form OWCP-915 replaces CA-915.

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OWCP-957

Medical Travel Refund Request.

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