[Code of Federal Regulations]

[Title 20, Volume 1]

[Revised as of April 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 20CFR10.7]



[Page 16]

 

                      TITLE 20--EMPLOYEES' BENEFITS

 

                      CHAPTER I--OFFICE OF WORKERS'

                         COMPENSATION PROGRAMS,

                           DEPARTMENT OF LABOR

 

PART 10_CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION 

ACT, AS AMENDED--Table of Contents

 

                      Subpart A_General Provisions

 

Sec.  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]



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