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
CA-915 - Claim for Medical Reimbursement - August, 2003
OWCP Forms - Department of Labor Website
AB-1 - Application for Review Form - USDOL - Employees’ Compensation Appeals Board
UB-92 - HCFA-1450 - For Use By Physician
NALC Authorization to Represent and Release Form
HCFA-1500 - Health Insurance Claim Form - Non-Fillable
FECA Authorization Form - PT and OT Authorization Request Form - August 5, 2005
Authorization Request Form - General Medical - January 12, 2005
OWCP-957 - Medical Travel Refund Request
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