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  • April 12, 2013

OWCP Forms

OWCP Forms

150 150 Gregory A. Hall

OWCP will handle your claim more efficiently if you and your doctor use the proper OWCP form.  OWCP Attorney Gregory Hall has been handling OWCP cases since 1996 and has the requisite expertise to properly advise you on your federal workers’ compensation claim.  All of the OWCP forms listed below can be downloaded directly from the Department of Labor’s, OWCP website:  


Form Number

OWCP’s Form Title / Description

CA-1* Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
CA-2* Notice of Occupational Disease and Claim for Compensation
CA-2a* Notice of Recurrence
CA-5* Claim for Compensation by Widow, Widower, and/or Children
CA-5b* Claim for Compensation by Parents, Brothers, Sisters, Grand Parents, or Grand Children
CA-6 Official Supervisor’s Report of Employee’s Death
CA-7* Claim for Compensation Form CA-7 replaces ALL prior versions of CA-7 & CA-8 (see FECA Bulletin No. 99-18)
CA-7a* Time Analysis Form, used for claiming compensation, including repurchase of paid leave
CA-7b Leave Buy Back (LBB) Worksheet/Certification and Election
CA-10 What A Federal Employee Should Do When Injured At Work
CA-12* Claim For Continuance of Compensation Under the Federal Employees’ Compensation Act
CA-17* Duty Status Report
CA-20* Attending Physician’s Report
CA-35 Evidence Required in Support of a Claim for Occupational Disease
CA-40* Designation of a Recipient of the Federal Employees’ Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a
CA-41* Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity
CA-42* Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity
CA-278 Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
CA-721* Notice of Law Enforcement Officer’s Injury Or Occupational Disease
CA-722* Notice of Law Enforcement Officer’s Death
CA-1031 Letter to Dependants to Verify Claimant Support
CA-1074 Letter to Parents in Death Claim Development
CA-1108* Statement of Recovery Letter with Long Form
CA-1122* Statement of Recovery Letter with Short Form
CA-2231* Claim for Reimbursement Assisted Reemployment
OWCP-5a* Work Capacity Evaluation Psychiatric/Psychological Conditions
OWCP-5b* Work Capacity Evaluation Cardiovascular/Pulmonary Conditions
OWCP-5c* Work Capacity Evaluation for Musculoskeletal Conditions
OWCP-16* Rehabilitation Plan And Award
OWCP-17* Rehabilitation Maintenance Certificate
OWCP-20* Overpayment Recovery Questionnaire
OWCP-44* Rehabilitation Action Report
OWCP-04 Uniform Billing Form
OWCP-915* Claim For Medical ReimbursementForm OWCP-915 replaces CA-915
OWCP-957* Medical Travel Refund Request
OWCP-1168 Provider Enrollment form
OWCP-1500* Health Insurance Claim Form
HCFA-1500* Health Insurance Claim Form

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