PART 10—CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED
Subpart A—General Provisions
Definitions and Forms
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§ 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–1 | Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/ Compensation |
| (2) CA–2 | Notice of Occupational Disease and Claim for Compensation |
| (3) CA–2a | Notice of Employee's Recurrence of Disability and Claim for Pay/ Compensation |
| (4) CA–5 | Claim for Compensation by Widow, Widower and/or Children |
| (5) CA–5b | Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren |
| (6) CA–6 | Official Superior's Report of Employee's Death |
| (7) CA–7 | Claim for Compensation Due to Traumatic Injury or Occupational Disease |
| (8) CA–7a | Time Analysis Form |
| (9) CA–7b | Leave Buy Back (LBB) Worksheet/Certification and Election |
| (10) CA–16 | Authorization of Examination and/or Treatment |
| (11) CA–17 | Duty Status Report |
| (12) CA–20 | Attending Physician's Report |
(b) Copies of the forms listed in this paragraph are available for public inspection at the Office of Workers' Compensation Programs, Employment Standards Administration, 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 www.dol.gov./dol/esa/owcp.htm.
[63 FR 65306, Nov. 25, 1998; 63 FR 71202, Dec. 23, 1998]
