CA-1 - Federal Employee’s Notice of Traumatic Injuiry & Claim for COP/Compensation - April, 1999

CA-2 - Notice of Occupational Disease & Claim for Compensation - January, 1997

CA-2a - Notice of Recurrence - September, 1996

 

CA-5 - Claim for Compensation by Widow, Widower, and/or Children - January, 1997

CA-5b - Claim for Compensation by Parents, Brothers, Sisters, Grandparents or Grandchildren - January, 1997

CA-6 - Official Superior’s Report of Employee’s Death - January, 1997

CA-7 - Claim for Compensation - June, 2005

CA-7a - Time Analysis Form - June, 1997

CA-7b - Leave Buy Back (LBB) Worksheet/Certification and Election - June, 1996

CA-10 - What a Federal Employee Should Do When Injured at Work - August, 1987

CA-12 - Claim for Continuation of Compensation Under the Federal Employee’s Compensation Act

CA-17 - Duty Status Report - January, 1997

CA-20 - Attending Physician Report - November, 1999

CA-35 - Evidence Required in Support of a Claim for Occupational Disease - August, 1988

CA-278 - Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act - January, 2004

CA-721 - Notice of Law Enforcement Officer’s Injury or Occupational Disease - Oct.,  2001

CA-722 - Notice of Law Enforcement Officer’s Death - October, 2001

CA-1031 - Additional Information Needed to Help DOL OWCP Reach a Decision Regarding a Claim for Compensation

CA-1074 - Additional Information Needed in Support of a Claim for Dependency Compensation

CA-1108 - Third Party Claim - Notice to Attorney of Injured Employee

CA-1122 - Third Party Claim - Notice to Injured Employee Without an Attorney

CA-2231 - Claim for Reimbursement Assisted Reemployment - June, 2004

CA-3 - Report of Termination of Disability and/or Payment - June, 1988

Fillable CA Forms:

CA-915 - Claim for Medical Reimbursement - August, 2003

Non-Fillable CA Forms:

OWCP Forms - Department of Labor Website

ca-12.pdf
ca-722.pdf
CA-915 OWCP.pdf
CA-3 Termination of Disability or Payment.pdf
CA Forms - 
(OWCP Forms)
Office of Workers’ Compensation Program
 Other OWCP Forms:

AB-1 - Application for Review Form - USDOL - Employees’ Compensation Appeals Board

OWCP - AB1.pdf

UB-92 - HCFA-1450 - For Use By Physician

OWCP - UB-92.pdf

NALC Authorization to Represent and Release Form

OWCP Release - NALC Rep.pdf

HCFA-1500 - Health Insurance Claim Form - Non-Fillable

OWCP - HCFA-1500.pdf

FECA Authorization Form - PT and OT Authorization Request Form - August 5, 2005

1-FECA_Auth_Form.pdf

Authorization Request Form - General Medical - January 12, 2005

General_Medical_form_111205.pdf

OWCP-957 - Medical Travel Refund Request

OWCP-957 Mileage Reimbursement.pdf

CA-16 - Authorization for Examination and/or Treatment - October, 1988  [This Form Has Been Removed Per a Request From OWCP.]

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HCFA-1500 - Health Insurance Claim Form - Fillable

OWCP-1500 Fillable.pdf